By Alex M Siegel

1. SUPERVISION, MOBILITY AND
TELEPSYCH: THE NEXT FRONTIER TO
PSYCHOLOGICAL PRACTICE
ALEX M. SIEGEL, J.D.,PH.D.
ASSOCIATION OF STATE AND PROVINCIAL
PSYCHOLOGY BOARDS
NOVEMBER 18, 2011

2. Disclaimer and
Acknowledgement
 It is PAST October 17, 2011 yet.
 DPA for ASPPB
 APA/ASPPB/APAIT JOINT TF
 I am a reluctant digital immigrant
 APAIT TRUST Presentation with Eric
Harris and Jeff Younggren, Risk
Management in the Electronic Age

3. WHAT IS ASPPB
 Association of State and Provincial Psychology
Boards
 64 State/provincial/territorial psychology
regulatory boards/colleges US and Canada
 Services to licensing boards, applicants for
licensure/registration, licensed psychologists
 Goal is to be the international source of
information and offer model programs on
regulation of psychologists

4. PURPOSE OF PRESENTATION
 Identify benefits and problems with an internet practice of
psychology
 Compare electronic practice with portability and mobility
of your license
 What you will need to do as a practitioner for telepsych
and or mobility
 Discuss the changes in supervision requirements in PA

5. Psychology
A Regulated Profession
 Canada - by province/territory
 10 Provinces
 Northwest Territories
 United States - by state/territory
 50 States
 Virgin Islands, Puerto Rico, Guam
 District of Columbia

6. Registration/Licensure
Overview of Requirements
 Graduate degree in psychology
 Supervised professional experience (SPE)
 1500 to 6000 hours of SPE
 Examinations
 Examination for Professional Practice in
Psychology (EPPP)
 Jurisprudence and/or Ethics Exam
 Oral Examination

7. Sequence of Training
Leading to
Licensure
Academic Program
Practicum
Dissertation/Thesis…
Internship
Graduation
Postdoctoral Experience
Testing
Licensure

8. Entry to Independent
Practice:
United States
 Most (49) states require a doctoral degree for
licensure as a Psychologist
 One (1) state (West Virginia) requires a
masters degree for licensure as a Psychologist
 Two (2) jurisdictions also license at masters
level for independent practice, different title:
 Oregon: Psychological Associate
 Vermont: Psychologist - Master

9. Entry to Independent
Practice
Academic Degree: Canada
 Five jurisdictions (BC, MB, ON, NB, QC)
 Psychologist: doctoral degree
 Psychological Associate: masters degree
 Six jurisdictions (AB, SK, NS, PE, NL, NWT)
 Psychologist: doctoral or masters degree

10. Psychologist
Graduate Degree
 Must be a recognized psychology
program (accredited/designatated
 Specific courses may be required
 CPA/APA accredited doctoral
program may meet all degree
requirements

11. Pennsylvania Requirements
 41.31(5)
 First time applicants who were enrolled in
doctoral program prior to March 23,
1991will have their educational credentials
evaluated under regulations in effect at that
time.
 If apply under 41.42(b)[reapplication] will
have credentials evaluated under
regulations in effect at time of reapplication

12.  Old 41.31(b) prior to June 30, 2008
 REQUIREMENTS
 Education
 1) Program Director completes the
Verification of Doctoral Program Approval
Status reflecting APA or CPA Accreditation or
 2) ASPPB/NR Designation or
 Within 1 year from the award of Doctoral
Degree

13. IF NOT APA OR ASPPB
 Must demonstrate applicant’s satisfactory
completion of core, specialty, practicum
and internship:
 1)Recognized Sequence within the overall
program or department
 2) Comprises Integrated, Organized
Sequence of Study
 Ethics
 Research Design and Methodology

14.  Competence 4 Substantive Content Areas:
 Biological Bases of Behavior
 Cognitive-Affective Bases of Behavior
 Social Bases of Behavior
 Individual Differences
 Specialty Courses, Practicum, Internship
 At least 60 graduate hours of above

15. RESIDENCY
 Each degree candidate complete a minimum
of two consecutive academic semesters as a
matriculated student physically present at
the institution grating the degree

16. 41.31(4)
First time applicants who enrolled in a
graduate degree program in psychology or
field related to psychology on or after July
1, 2008 will be evaluated under theses
regulations.
 MUST BE FROM APA or CPA
ACCREDITED OR
 ASPPB/NR DESIGNATED PROGRAM

17. Psychologist: Supervised
Professional Experience
 Two years (3,000 hours) of supervised
experience typically required, usually one
of these must be postdoctoral

18.  Some states include APPIC most don’t
 Some include APA/CPA most don’t
 Advantage of APPIC/APA is program has
been peer reviewed and meets minimal
standards
 Have some recourse if problems occur

19. Hours Number of Jurisdictions
•2000 11
•1900 2
•1800 6
•1750 5
•1600 1
•1500 14

20. Pennsylvania Requirements
 Practicum hours NOT Counted
 (OLD) Predoc Internship
 Supervised training for at least 450 hours
 Learning activities for an average of 2 hours a
week
 Interact formally and informally with students
 For 1 year and 1500 hours with 25%(375) in
direct patient contact and no more than 25% in
research
 Part time for 2 year half time

21.  New Regs do not define internship
requirements since it is part of the doctoral
program requirements

22. POST DOC
1500 hours is defined as a year (37.5 weeks)
At least one half of experience in direct
services
Must be supervised by psychologist hold
current license
Supervisor meets individually for an average
of 2 hours a week
May delegate 1 hour

23. Not Acceptable Experience
 Independent Private practice as a Qualified
member of another recognized profession
 Independent practice as a certified school
psychologist

24. New 41.31
 Shall complete 1 year of acceptable post doc
supervised experience
 First time applicants who commence post doc
as of December 6, 2010
 1 year is calculated as at least 12 months consisting
of 1750 hours
 No more than 45 hours and no less than 15 hours
may be counted each week
 At least 50% direct services

25. EXPERIENCE AT MORE
THAN 1 PLACE
 Experience is obtained for each entity for a
minimum of 6 consecutive months
 Experience occurs for a minimum of 15
hours per week at each setting
 Total experience for all settings does not
exceed 45 hours

26.  Acceptable Experience
 1) practice at entity consistent with
psychologist’s education and training
 2) No experience may be obtained if
psychology resident acts independently

27.  All experience must be obtained under
supervision of a primary supervision
 Primary – if obtained from more than 1
supervisor, hall have a primary supervisor
at each entity.
 Delegated- may delegate supervision for
up to 1 hour per week

28. TELEPSYCH

29. Scope of Issue
 10% growth in telehealth annually
 $500 million spent in US annually
 Federal health care law provides $1billion a
year to study telehealth
 Insurance plans starting to market to large
employers

30.  “The technology has improved to the point
where the experience of both the doctor and
patient are close to the same as in-person
visits, and in some cases better,” Dr. Kaveh
Safari, head of global health care for Cisco
Systems, NY Times, 05/28/10

31.  Overwhelming research indicates that face
to face therapy is no better(or worse) than
telepsych as measured by satisfaction of
consumers
 983 articles since 1993, 2/3 of them since
2008
 A Comprehensive Review and a Meta-Analyisis of the Effectiveness of
Internet-Based Psychotherapeutic Interventions in J of Technology in Human
Services Vol 26, pages 109-160, 2008

32. China American Analytic Association
organized a 2 year program with seminars,
supervision and psychoanalysis through
Skype.

33. Numbers of users
 73% American adults are internet users (Madden
2006)
 5% broadband internet at home (Horrigan, 2008)
 85% college students report own computer and
72% check email at least once a day( Jones 2002)
 82% of college student use social networks
(Caruso & Salaway 2007)

34.  69% of psychologist admit to providing services by
phone(Vandenbos & Williams 2000)
 75% have offered services to residents of another
jurisdiction where they are not licensed or registered
 Office of Advancement of Telemedicine(HHS) identified
licensure as a major barrier of telemedicine
 Both nursing(compact) and medicine have plan to deal
with interstate practice issues on a national scope

35. WHY NOW
Psychologist are being hit hard by lowering
reimbursement rates and increasing restrictions
Electronic Communications are already a part of
professional practice of psychology (HIPAA and
HITECH). For example in 2012 all billing will
have to be electronic. IN 2014 all records will be
electronic.
Since 75% are providing service, it is the wild west.
No guidelines or regulations.

36.  Psychologist are uniquely positioned to
become the leading profession in this area.
 Consensus on the need to solve the
interjurisdictional issue
 Opportunity to offer services to individuals
or communities that are under served
 Expand practice
 Digital natives think differently than us

37. Telehealth, Telemedicine,
Telemental Health or Telepsych
 WHAT TO CALL IT.
 APA ETHICS, PA STATE BOARD OF
PSYCHOLOGY( LAWS AND REGS)
 WHAT DO YOU NEED TO KNOW OR
BE COMPETENT TO PROVIDE
INTERNET SERVICES
 RISK MANAGEMENT
 APA/ASPPB/APAIT JOINT TF

38. TELEPSYCH
 Wikipedia: The delivery of health-related services
and information via telecommunication
technologies.
 THE U: The remote provision of health care
services and health education, mediated by
technology.
 Includes:
 Internet text based
 Telephone
 Videoconferencing- education and treatment

39. APA ETHICS
 Ethics Committee Opinion on Remote Therapy
• The APA has not chosen to address teletherapy directly in
its ethics code and by this intentional omission has
created no rules prohibiting such services. The APA
Ethics Committee has consistently stated a willingness to
address complaints regarding such services on a case-by-
case basis, while directing clinicians to apply the same
standards used in ‘‘emerging areas in which generally
recognized standards for preparatory training do not yet
exist,’’ by taking ‘‘reasonable steps to ensure the
competence of their work and to protect patients, clients,
students, research participants, and others from harm’’
(American Psychological Association, 2002, 2.01e). ..

40. APA ETHICS CODE 2010
 Beneficence (Principle A)
 Nonmaleficence (Principle A)
 Autonomy (Principle E)
 Justice (Principle D)
 Fidelity (Principle B)
 Integrity (Principle C)

41. 2.01 Boundaries of Competence
(a) psychologists provide services only within the
boundaries of their competence
(c) Psychologists planning to provide services…involving
techniques and technologies new to them undertake relevant
education, training, supervised experience, consultation or
study.
(e) In those emerging areas in which generally recognized
standards for preparatory training do not yet exist,
psychologists nevertheless take reasonable steps to ensure
the competence of their work and to protect clients/patients,
students, supervisees, research participants, organizational
clients, and others from harm.

42. 3.10(a) Informed Consent
 When psychologists conduct research or provide
assessment, therapy, counseling, or consulting
services in person or via electronic transmission or
other forms of communication, they obtain the
informed consent of the individual or individuals
using language that is reasonably understandable
to that person or persons except when conducting
such activities without consent is mandated by law
or governmental regulation or as otherwise
provided in this Ethics Code.

43. 4.0 Privacy and Confidentiality
 4.01 Psychologists have a primary obligation
and take reasonable precautions to protect
confidential information obtained through or
stored in any medium…
 4.02 Psychologists discuss with persons…(1)
the relevant limitations to confidentiality

44. OTHER KEY APA SECTIONS
 1.02 Resolving Ethical Conflicts
 2.02 Providing Services in Emergencies
 3.05 Multiple Relationships
 3.12 Interruption of Psychological Services
 5.01 Avoidance of False or Deceptive ST’T
 6.01 Documentation of Records
 9.01 Assessment
 10.01 Informed consent to therapy

45. PA State Board of Psychology
 LAW
 Rules and Regulations
 Within the Commonwealth

46. Is Remote Therapy Equivalent
• Intuitively, to most practitioners, in-person
treatment is superior because of the importance
of non verbal cues and other non quantifiable
relationship superiorities.
• Some research shows that the closer a
communication is to in-person, the more
efficacious it is, but there is evidence that
supports efficacy of voice and text only.
• There is considerable research that establishes
equivalency in terms of outcomes and
consumer satisfaction

47. Is Remote Therapy Equivalent ?
Traditional therapy has a great deal of variation.
• Remote therapy has advantages of increased flexibility,
access, and administrative convenience.
• There are some treatment situations where remote
treatment has clear advantages
 Providing there is good informed consent,
there is no reason to prohibit or differently
regulate remote treatment if both the
adequately trained licensed psychologist and
his/her client agree and all parties are within
the Commonwealth.
 Not violating other laws, ie insurance

48. RISK MANAGEMENT
 Have a good working knowledge of ethics
code and legal standards governing practice
 Conduct a conservative evaluation of your
competence to perform
 Intellectual competence
 Technical competence
 Emotional competence
 Keep your knowledge base up to date
 Avoid professional isolation

49. Three keys to Success
 Provide Comprehensive Informed Consent
 Seek Appropriate Consultation
 Develop good record-keeping practices and
strategies
 DOCUMENT DOCUMENT DOCUMENT
 Eric Harris

50. APA/ASPPB/APAIT TF
 1 COMPETENCE
 2 MULTIPLE RELATIONSHIPS
 3 INFORMED CONSENT
 4 CONFIDENTIALITY AND PRIVACY
 5 RECORD KEEPING/ BILLING
 6 EDUCATION, SUPERVISION AND CE
 7 ASSESSMENT AND TESTING
 8 ACCESS TO CARE
 9 STANDARDS OF CARE

51.  10 LEGAL ISSUES
 11 INTERJURISDICTIONAL
 12 INFORMATION COLLECTION,
COMMUNICATION AND STORAGE
 13 CONSULTATION AND I/0
 14 ADVERTISING

52. WHAT ARE OTHERS DOING
 ACPRO IN CANADA
 AUSTRALIA
 ASPPB
 EU -EUROPSYC
 Other states

53. INFORMED CONSENT
 Just as you all use an informed consent with all
your face to face patients, need one for telepsych:
 Limitations of confidentiality, privacy
 Interjurisdictional and other state laws
 Duty to report Tarisoff, Emeric or nothing
 Child Abuse Standards -no immunity
 Record keeping- what is part of the record, emails
 How will Emergencies be handled
 How available will you be to the patient
 Billing --90806 ? Payment-- paypal, insurance

54. COMPETENCE
 Before engaging in the remote delivery of
mental health services via electronic means,
practitioners should carefully access their
competence to offer the particular services
and consider the limitations of efficacy and
effectiveness that may be a function of
remote delivery.
 On Calif. Board’s website(Koocher)

55. Practical Competency
 Have you done internet therapy -confidentiality
 Why in this case- benefits vs. risk
 Type of Patient-diagnosis,age,condition,resources
 Patient wants to do it vs you want to do it
 Is there a difference with a patient who goes away
for a month vs. a new patient vs. patient from
website
 Is patient who they say they are, does it matter
 Emergencies how do you handle them-- ND
position vs KY position vs. head in sand

56.  Entertaining? Is it like TV. boring? Avatars
 How much do you get from nonverbal cues
 Conditions which might change the medium
 Narcissism of psychologist
 Intervention you are competent to do
 Therapy vs assessment vs psychoeducational vs
forensic

57. WEB THERAPY

58. Technological Competence
 Do you know how to use the internet, do you
know what you don’t know
 Broad Band Width, asynchronis vs synchronis
 Confidentiality is anything confidential?
 Skype is not HIPAA compliant, sell info?
 When technical difficulties happen
 Skype vs. texting vs emailing vs
videoconferencing
 How to secure records --encryption, back ups
 CLOUD in PC vs MAC?

59. Inter Jurisdictional
 10th amendment-- state rights
 Different states adopt different regulations
 Licensing Boards are conservative by
nature
 Need to protect the citizens of the
jurisdiction, not concerned with citizens of
other states since Board does not have
jurisdiction(authority) in other state.

60. ISSUES
 Where does the electronic interstate
transaction take place?
a) where the consumer resides--distant
b) where the psychologist is providing the
services in the home office of the licensed
jurisdiction-- home
c) in cyberspace

61. Where the Practitioner Resides?
 Is physically located in a state where he/she is
licensed. Reside or domicile?
 Psychologist has not set foot in the consumer’s
state
 Psychologist has not attempted to do business
there(traditional manner or internet).
 Psychologist can be regulated by the state where
they are licensed or on interstate basis.

62. • Federal Government Policy: Health Licensing
Board Report to Congress, HRSA, HHS,
2011 (HSRA)
 Federal government has recognized the importance
of use of electronic technology and provision of
telehealth services.
 Federal Agencies Efforts to promote telehealth
 Fed benefits for remote services Medicaid, Medicare
 Interstate practice is essential for full benefits
 Best way to accomplish this is by voluntary compact between
state licensing boards

63. Health Licensing Board Report
to Congress HRSA, HHS 2011
 “ if collaboration between states is unable to
develop effective licensure policies to
reduce barriers to electronic practice across
state lines within the next 18 months, then
Congress should intervene to ensure
Medicare and Medicaid beneficiaries are
not denied the benefits of e-care.”

64. HRSA 2011
 “ In the absence of specific agreements…
states may not discipline healthcare
providers not licensed in their state if
patient harm occurs as the result of the
provision of health care services by an out
of state practitioner.”

65.  State licensing authority cannot interfere
with the regulatory authority of the
federal government such as interstate
commerce or an effective military.
 Military or VA Psychologists
 Health Care is interstate commerce
Anti Trust Cases
Erisa v. state mandates
Current dispute over health care

66. State Licensing Boards
 States have taken the position that the transaction takes
place in forum state no matter where the patient resides.
 California
 Massachusetts
 Wisconsin
 Kentucky
 North Dakota
 Minnesota
 Florida
 Pennsylvania- temp 14 days

67. Minimal Contact Rule
 The state where the patient resides (the forum
state) can assert jurisdiction over an out-of-state
provider, only when that provider has made a
purposeful attempt to promote or provide services
in the forum state or has otherwise availed
him/herself of the laws of the forum state to
his/her advantage.
Wright vs. Yackley (1972), 459 F. 2nd (United States Court of Appeals, Ninth Circuit, 1971) .

68. Prince v. Urban
 Three principles of decision
 Was the doctor-patient relationship created because
of a continuing effort of the doctors to provide
services in California or was the location of the
client incidental to the services?
 Were the doctors services “grounded” in any
relationship [they had] in California”?
 Even if the above tests are met, the court needed to
balance the state’s interest in securing good medical
care for its citizens against the potential and severity
of the anticipated harm.
 Prince v. Urban (1996) 49 Cal.App.4th 1056 [57 Cal.Rptr.2d 181]

69.  The essence of the relationship was that the California
patient sought out the Illinois doctors in Illinois. [The
plaintiff’s] residence was irrelevant and incidental to the
services rendered by her physicians. If anything [the
plaintiff’s] residence hampered the doctor-patient
relationship which existed despite the half continent of
separation between the parties.
 A state’s dominant interest on behalf of its citizens in
such a case as this is not that they should be free from
injury by out-of-state doctors, but rather that they
should be able to secure adequate medical services to
meet their needs wherever they may go. In the case of
personal services, focus must be on the place where the
services are rendered, since this is the place of the
patient’s need. They are directed to no place but to the
needy person herself.

70. Tentative Conclusions by APAIT
 Unless a psychologist actively promotes services
in an interstate manner, forum ( pt resides) state
licensing boards will be unable to gain
jurisdiction.
 What level of marketing is required to give a
forum state jurisdiction is not yet clear.
 Websites are unlikely to be seen as promotional.
 Psychologists who actively market themselves on
an interstate basis are taking risk.
 Extradition is very unlikely.

71. Other View
 Licensing Board could issue a cease and
desist order and due to laws of comity have
it enforced in another jurisdiction
 How lucky do you feel?
 Do you want to be the test case?

72. Hypotheticals
 Psychologist in PA, patient in PA
 Psych in NJ, patient in PA
 Psych in PA, patient in New Orleans, LA.
 Psych’s PA pt. on trip in Texas, call emergency
 Psych’s PA pt. now attending college at Michigan
 Psych’s PA pt. in winter in Florida
 Psych’s pt. on sabbatical in New Zealand
 Psych’s pt. in PA, psych in Florida or Psych’s pt is
in Florida and psych is at meeting in Florida.
 Psych’s pt. at Michigan goes to Calif during

73.  Even though the distant( pt resides)
jurisdiction might not have jurisdiction,
home jurisdiction(where psych is licensed)
could always bring action against your
license

74. My Fantasy
 Registry for all who want to practice telepsych
inter jurisdictionally.
 Benefit:
 One license
 Like military and VA
 Lets states know who is practicing in the state
 Protects the citizens of the distant state
 Moving toward a similar standard across jurisdictions
 Psych to provide services where they are needed

75.  Problems
1) need to know distant laws, PA v.TX
2) need to abide by stricter standards,
records
3) emergencies
4) conflicts of law, child abuse

76. Confidentiality: Communications
Voicemail
 Websites
 Email
 Text Messaging
 Social Networking
 Facebook
 MySpace
 Blogging
 Virtual worlds- 2nd Life
 Synchronous v Asynchronous

78. Clinical Communication
 Direct Care
 Telepsych
 Coaching
 Assessment
 I/O Consultation
 Forensic

79. Administrative
 Billing; Insurance, credit or otherwise
 Scheduling
 Record Keeping and other documentation
 Information Storage and Transmission

80. Points to Consider
 Resolution and Picture Quality
 Real time Audio
 Reliability of technology
 Ease of Use
 Cost
 Differences from In Person Communication
 Privacy

81. SKYPE
 It is not HIPAA Compliant
 Sells information to others- confidentiality
 Public part of profile can be seen by others
 May respond to subpoenas
 NETSIS (web video conferencing) better
than Skype but $$

82.  Public parts of your Skype profile can be seen by
everyone else on Skype. Do not put details in your
profile that you do not want to be publicly
available.
 Except as provided below, Skype shall not sell,
rent, trade or otherwise transfer any personal
and/or traffic data or communications content to
any third party without your explicit permission,
unless it is obliged to do so under applicable laws
or by order of the competent authorities.

83.  Skype may disclose personal information to
respond to legal requirements, to protect Skype’s
interests, to enforce our policies or to protect
anyone's rights, property, or safety.
 In order to provide you with Skype products you
have requested, Skype may sometimes, if
necessary, share your personal and traffic data
with Skype’s group companies.

84. Voice Mail, Email, Texting
 Convenience and efficiency
 Duty to Care
 Alternative Backups
 WHAT ARE YOU RESPONSIBLE FOR?

85. Holmes v. Petrovich
 Gina Holmes sued her employer
based on allegations of pregnancy
disability discriminations.
 Holmes forwarded e-mails from her
employer to her lawyer, and sent
documents through the company’s
fax machine.

86.  The Court reasoned that the e-mails sent
through her company computer were
“akin to consulting her lawyer in her
employer's conference room, in a loud
voice, with the door open, yet
unreasonably expecting that the
conversation . . . would be privileged

87.  The Court emphasized that an email
communication does not lose its privileged
character solely because it is communicated by
electronic means, or because persons involved in
the delivery, facilitation, or storage of the
electronic communication may have access to its
content.
 While Holmes decision was largely impacted by
the employer’s policies and employee’s awareness
of those policies, a practitioner should assume that
any communication through such devises may find
itself in litigation.

88. Informed Consent with Patient
 Do not SMS or use social network site
 No Wall postings, @replies or other on line
 Not secure,may have to be part of the record
 You, patient and server, ie AOL and State of Virginia
 All texting in Library of Congress
 If need to contact me between sessions, call
 DO NOT PUT ANYTHING IN AN
EMAIL/TEXT/TWEET THAT YOU WOULD NOT
PUT ON A POST CARD
 Hush mail is may be a better choice

89. FACEBOOK
 Is constantly changing, hard to keep up with
all the changes.
 Business page now can be post on a page.
 mashable.com/2011/09/28/newfacebook/

90.  Is friending a patient a multiple relationship?
 If you friend someone are friending all of their
friends as well
 Avoid social networks with patients. No friending
 Relationship with patient and internet- pregnancy
group therapy
 Limit emails to administrative,ie appointments
 Exchange clinical info only in secure manner.
 Encryption or landline phone not VOI

91. Privacy
 “This Ethics Code applies only to psychologists'
activities that are part of their scientific,
educational, or professional roles as
psychologists .... These activities shall be
distinguished from the purely private conduct of
psychologists, which is not within the purview of
the Ethics Code.”
 Ie, San Fran politics or student applying to grad
school

92.  In the age of Google, the concept of privacy has
changed.
 We all practice in small communities and need to
figure out a strategy the maximizes protection of
appropriate boundaries.
 A psychologist has a right to make his/her feelings
about invasions of privacy known to his/her
clients and this is an appropriate part of the
professional conversation.

93. GOOGLED OR YELPED?
 How many of you think you patients have googled
you?
 Patients will review sites and other means of
electronic criticism, up to cyber attacks
 Do you respond?

94.  How many of you have googled a patient?
 Informed consent
 Do you have to let them know
 Difference in forensic cases
 BUT slippery slope … duty to warn

95. Security,Record Keeping and
Storage
 Same applicability trigger: electronic transmission
in covered transaction
 Applies only to electronically transmitted and
stored PHI
 Provides a number of steps that each psychologist
must take.
 Scalability for smaller practices
 More complicated for practitioners with
employees

96.  Conduct a documented risk analysis which must
be kept with other HIPAA compliance records.
 Modify your policies and procedures in order to
achieve appropriate compliance.
 If scaled, document how it has complied with the
requirements of the Security Rule.
 Periodically review risk analysis, policies and
procedures and modify as necessary.
 Appoint someone who is responsible for security
(Usually you).

97.  Develop specific policies for data access to all
electronic devices that store data. (Scalable Issues)
 Includes not only computers, but PDAs, cell phones
and any other wireless device that stores data.
 Require passwords that are unique & robust.
 Fire walls and virus protection: up to date
 Procedure for assigning/changing passwords for those
entering practice and changing them when they leave.
 Data separation capacity so individuals only have
access to the information that is necessary for their
responsibilities.

98.  Train all employees in the Security Rule.
 Have policies for dealing with security
breaches including specific sanctions in
personnel policies for employee/IC
breaches.
 Written plan for dealing with emergencies

99.  Have appropriate facility access controls
 Only staff should be able to reach place where
EPHI is stored.
 Specific rules about removing EPHI from the
premises and be conservative.
 Proof of Client Identity

100. 2007 APA Recording Keeping
Guidelines
 Electronic records, like paper records,
should be created and maintained in a way
that is designed to protect their security,
integrity, confidentiality, and appropriate
access, as well as their compliance with
applicable legal and ethical requirements

101. PA PSYCH REGULATIONS
Section 41.57(c)
 A psychologist shall store and dispose of
written, electronic and other records in a
manner which insures their confidentiality.
 41.57(e)
 A psychologist shall provide for the
confidential disposition of records in the event
of the psychologist’s withdrawal from practice,
incapacity or death.

102. Onsite Back Up
 External Hard Drive
 Flash Drives
 Back up Drives
 Tape
 Flash Memory
 Paper

103. Off Site Storage
 http://www.carbonite.com/
 http://www.mozy.com/
 http://www.backblaze.com/
 http://www.crashplan.com/
 http://go.iomega.com/en-us/?partner=4760
 http://www.ironmountain.com/

104. ENCRYPTION
 Stanford Hospital $20M Class Action Law for
data breach involving 20,000 patients(San Jose
Mercury News)
 4.9M Tricare Patients Data Breach: name,
Diagnosis, SS#, Address, treatment Info, ect.(San
Antonio Express)
 14,000 Patient Data Breach: Unencrypted Names,
Diagnosis, DOB, Addresses, SS# ect (Minneapolis
Pioneer Press)
 These just in last three weeks

105. What is Encryption
 Definition: Encryption is the conversion of
data into a form, called a hypertext that cannot
be easily understood by unauthorized people.
 A cipher, often incorrectly called a code, can
be employed to keep others from obtaining the
contents of transmissions.
 In order to easily recover the contents of an
encrypted signal, the correct decryption key
required.

106. Do You Need Encryption?
 If you don’t encrypt and there is a breach, you must
inform your clients.
 Unencrypted data breach is more likely to damage
relationship with your clients
 Clients may then want identity theft protection and
may want you to pay for it.
 If clients are harmed, they can probably sue or file
licensing boards complaints.
 If your computer has more than 500 files, you have to
inform the media.

107.  TrueCrypt (http://www.truecrypt.org/)
 BestCrypt Enterprise (
http://www.jetico.com/data-protection-encryption
)
 PGP Whole Disk Encryption (
http://www.symantec.com/index.jsp)

108. MOBILITY AND
PORTIBILITY

109. PASS RATE ON EPPP
 Doctoral degree first-time takers: 83%
 APA/CPA accredited graduates: 78%
 NON APA/CPA graduates: 53%
 APA/CPA/APPIC internship: 80%
 No APA/CPA accredited/APPIC: 54%
 My impression for the last 12 years in PA are
similar to the national numbers

110.  For those already licensed/registered with no
disciplinary sanctions
 Mechanisms to facilitate mobility:
 Certificate of Professional Qualification
 Reciprocity Agreement
 Mutual Recognition Agreement
 Interview and jurisprudence exam may be
required

111.  Most new practitioners will relocate at least once in
their career
 Slight variations in registration and licensure
requirements can become huge obstacles later
 Documenting supervised experience, course content,
etc. becomes more difficult over time
 Licensing/registration boards can not accept
personal copies of documents because of possible
fraud
 Training programs, internship sites close,
supervisors and their records disappear

112. Certificate of professional
Qualification (CPQ)
 Program of ASPPB
 Individual must meet requirements
for CPQ
 Includes credentials bank feature
 Low cost to obtain & maintain

113.  Accepted by 44 jurisdictions in Canada &
United States
 3 more jurisdictions in the process of
accepting the CPQ for licensure
 8 more jurisdictions recognize the CPQ for
licensure

114. Accepting CPQ
 Jurisdictions in Canada:
all 10 provinces
 Jurisdictions in the United States:
AZ, AR, CA, CO, CT, DE, DC, GA, HI,
ID, KY, LA, ME, MI, MS, MO, ND, NV,
NE, NH, NM, NC, OH, OK, OR, PA, RI,
SC, UT, VT, VA, WV, WI, WY

115.  These jurisdictions have “voted” to accept CPQ,
and are in process of making legislative or
administrative changes for implementation.
 US
 AK, MN, SD,
 Canada

116. Recognize CPQ
 These jurisdictions may waive at least one
requirement for applications who hold a
CPQ.
 US
 IA, MD, MA, MT, NJ, TN, WA

117. Not Accepting CPQ
 US
 NY, FL, AL, IN, IL, KS, PR, VI, GU

118. ASPPB Agreement of
Reciprocity
 11 jurisdictions (2 provinces, 9 states)
 Jurisdiction must meet requirements of
Agreement to participate
 Psychologist licensed with no disciplinary
sanctions in one participating jurisdiction
may seek registration/licensure in
another participating jurisdiction

119.  Jurisdictions in Canada
MB, ON
 Jurisdictions in the United States
AR, KY, MO, MS, NV, NH, OK, TX,
WI

120. Interjurisdictional Practice
Certificate (IPC)
 Accept IPC
 Idaho
 Georgia
 South Carolina
 Kentucky
 Ohio

121. National Register
 The National Register credential is approved
or in process of approval in 46 jurisdictions in
the US and Canada. The National Register
has helped more than 1,300 of our
credentialed psychologists easily and quickly
apply for licensure in another jurisdiction.
 BUT must look at each jurisdiction to see
what is waived

122. ABPP

123. THANK YOU.
ASIEGEL@ASPPB.ORG
 610 668 4240 in Narberth, PA
 Pa Licensing Board
 ST-PSYCHOLOGY@PA.GOV
 717 783 7155(P)
 717 787 7769(F)
 STATE BOARD OF PSYCHOLOGY
 PO BOX 2649
 HARRISBURG, PA 17105-2649