About secured records

Your access to patient records depends on permissions granted by the system administrator. Different levels of system security are in place for Horizon Patient Folder. These include:

Limited access

Limited access (override) security governs the patient and encounter records that you can access during patient selection. Master Patient Index (MPI) access can be limited by the system administrator (using SQL fragments) based on such criteria as service, patient type, patient last name, or discharge date. Physician of Record security, when enabled by the enterprise, also limits access to patient data for physicians not designated as physicians of record. A physician of record will always see his/her patients at the patient and encounter levels, unless limited by another form of security (such as MPI search limitations).

Note: If you are the physician of record for any encounter for an MRN, you can access all encounters for the MRN.

These security features apply to records on the Search Results grid following a patient or encounter search. The override levels described below are the same for MPI search access limitations and physician of record security.

Three types of overrides exist in Horizon Patient Folder for MPI record access limitations and physician of record security. The overrides are described in the following table:

Override Setting

Module Action

Allow override by user (MPI search) or Allow Physician of Record Override

The search results display the patient name; for the non-physician of record, however, any limited access encounters have a 'safe' icon indicating the limited access record.

By entering or selecting a reason when the system prompts you, you can access the documents for the limited access encounter. See To use override security.

Note: These actions are logged in the Horizon Patient Folder audit trail.

Prompt for override requests (MPI search) or Prompt Physician of Record Override

The search results display the patient name; for the non-physician of record, however, any limited access encounters have a 'safe' icon indicating the limited access record.

With this setting, the system prompts the user to enter the reason for viewing the secured record. When the user enters the reason:

The system sends the request through a workflow queue to an analyst, who must approve the request.
If the request is approved, the system creates a workflow assignment for the transaction.

When appropriate, a personal assignment is created manually. This allows the user to access the patient record.

Do not allow override (MPI search) or Do not Allow Physician of Record Override

MPI search

If the MRN has limited access, the module displays None found for criteria entered.

If the encounter has limited access, the module displays None found for criteria entered.

Physician of Record

The search results display the patient name, but if the name is selected by the non-physician of record, the list of encounters and documents is not visible. The module displays None found for criteria entered. Access is denied.

For both types of security, limited access encounters are not displayed on the document tree.

Override Setting	Module Action
Allow override by user (MPI search) or Allow Physician of Record Override	The search results display the patient name; for the non-physician of record, however, any limited access encounters have a 'safe' icon indicating the limited access record. By entering or selecting a reason when the system prompts you, you can access the documents for the limited access encounter. See To use override security. Note: These actions are logged in the Horizon Patient Folder audit trail.
Prompt for override requests (MPI search) or Prompt Physician of Record Override	The search results display the patient name; for the non-physician of record, however, any limited access encounters have a 'safe' icon indicating the limited access record. With this setting, the system prompts the user to enter the reason for viewing the secured record. When the user enters the reason: The system sends the request through a workflow queue to an analyst, who must approve the request. If the request is approved, the system creates a workflow assignment for the transaction. When appropriate, a personal assignment is created manually. This allows the user to access the patient record.
Do not allow override (MPI search) or Do not Allow Physician of Record Override	MPI search If the MRN has limited access, the module displays None found for criteria entered. If the encounter has limited access, the module displays None found for criteria entered. Physician of Record The search results display the patient name, but if the name is selected by the non-physician of record, the list of encounters and documents is not visible. The module displays None found for criteria entered. Access is denied. For both types of security, limited access encounters are not displayed on the document tree.

Locked records

Records can be locked at the patient level or encounter level. Based on your security permissions, you can either access all locked or no locked records.

Locked Level

Module Action

MRN (patient level)

The module displays None found for criteria entered.

The patient record is not displayed.

Encounter

If all encounters for the MRN are locked, the module displays None found for criteria entered.

If the MRN has only one encounter and it is locked, the module displays None found for criteria entered.

Encounters not locked are available. You can access documents from these encounters.

Locked Level	Module Action
MRN (patient level)	The module displays None found for criteria entered. The patient record is not displayed.
Encounter	If all encounters for the MRN are locked, the module displays None found for criteria entered. If the MRN has only one encounter and it is locked, the module displays None found for criteria entered. Encounters not locked are available. You can access documents from these encounters.

If you do not have rights to access locked records, the records are not displayed on the Search Results grid. The same principle applies to the document tree in the secondary viewer when using chart completion functions. (The secondary viewer is enabled when you click Medical Record Viewer or Encounter Viewer.)