Increasingly, physicians are working in arrangements where they share access to a medical record that is maintained by a group practice, a clinic, or an office management service provider. Sometimes the physician works under contract to the group practice or clinic. Sometimes the clinic is operated by a non-physician. What happens when the physician decides to leave the practice/clinic or if the physician’s relationship with the practice/clinic is terminated for other reasons (e.g., the clinic closes)?
The departure or termination of a physician from a practice can be a complicated process if all aspects of severing the professional relationship are not understood by the parties involved. Basic matters including the length of the notice period may or may not be addressed in a contracting arrangement. Failure to deal with administrative issues such as ongoing rights to payments, billings, and collections; access to emails and contact lists; and the right to staff assistance during the notice period may create real challenges to a smooth departure.
Issues surrounding ownership of patient medical records may make matters even more complex—specifically, the intersection of a physician’s professional and legal obligations with the contractual rights of a non-physician owner of a clinic. A physician may require a copy of the patient’s medical records in order to provide continuity of care, but there may be technical, staffing, or timing issues for the clinic.
Physicians should be mindful of the various record-related issues that could arise upon termination of their relationship with that practice or clinic, and consider these issues at the outset of entering into a working agreement. Issues to consider include:
- Can the physician, in the first place, take any patients of the clinic with him or her?
- Who owns the patient record in that case, the physician or the clinic?
- Can the clinic charge the physician a fee to provide the records?
- Can the clinic withhold records altogether?
- Is the clinic obligated to provide the records in a particular format (e.g., transfer the EMR itself if technically compatible or simply provide a PDF) and at what cost, if any?
- What if the clinic closes? How can the physician ensure that he/she or the patient can get access to the records at the clinic?
Physicians who fail to document their expectations in advance may find that terminating an arrangement has unexpected costs and real potential for medico-legal risk. Clarifying expectations in a policy and documenting them in a contract can reduce risk and assist physicians in complying with professional duties (and, as stated above, failure to do so may be considered professional misconduct by the College).
Appendix E contains a sample Termination Policy and Appendix F contains sample contractual terms relating to the parties’ rights and obligations pertaining to medical records upon termination of the parties’ relationship.