Providers: Ethically obligated to give easier access to records?
Providers: Ethically obligated to give easier access to records?
Both autonomy and the law favor allowing patients access to their medical records, and there are clearly associated benefits, says Gregory R. Moore, MD, MPH, senior director at Stamps Health Services at Georgia Institute of Technology in Atlanta.
Recent health services research indicates a benefit to open records in which patients have access to their medical records via secure portals, says Stephen T. Miller, MD, MACP, Pearce Professor of Medicine at University of Tennessee and medical director of medical education and research at Methodist LeBonheur Healthcare, both in Memphis.
Of 5391 patients of 105 primary care providers at three sites who opened at least one note and completed a follow-up survey, 77%-87% reported that access to their visit records helped them feel more in control of their care. For example, 60%-78% of those taking medications reported increased medication adherence.1
"If open records are a benefit to patients, is the medical care facility obligated to provide that access as an acknowledgement of patient autonomy?" asks Miller. "My thought is that all facilities should proceed with the view of open records."
The Meaningful Use portion of the Centers for Medicare & Medicaid Services' Electronic Health Record (EHR) Incentive Program requires some patient portal functionality, notes Peter Winkelstein, MD, MBA, professor of clinical pediatrics and executive director of the Institute for Healthcare Informatics at the University of Buffalo (NY).
"Certainly, health care professionals have an obligation to provide the best care they can. Whether patient portals and open medical records become standard of care remains to be seen," he says.
Here are ethical concerns involving open medical records:
• Patients might be harmed by finding unexpected information.
For example, most physicians would want to tell a patient that he or she had a positive HIV test rather than having the patient find the result through a portal. "Patient portals typically allow for the physician to look at data before it is released for exactly this reason, which helps alleviate this concern," says Winkelstein.
A counter argument to having physicians always screen information before it reaches the patient is that it is really up to the patient to decide how he or she wants to receive information, adds Winkelstein.
• The patient and the physician have interests in the record that aren't always aligned.
A patient might not want an HIV test result to be in the record, whereas the physician wants a record that the test was performed and appropriate action taken, says Winkelstein.
• Systems might not be secure, and unauthorized stakeholders could gain access to the information.
The health information management professional is responsible for the protection of privacy and confidential information and has always had to respond to the ethical implications of technological applications — copying, faxing, EHRs, and now portals and health information exchanges, says Laurinda B. Harman, PhD, RHIA, FAHIMA, associate professor emeritus in the Department of Health Information Management at Temple University in Philadelphia.
EHRs have increased a patient's ability to gain access to their health information, and have also given access to family members, as authorized by the patient, notes Harman.
The facility is obligated to assure that the information will only be released if authorized by the patient or as required by law, accreditation bodies, or public health agencies, says Harman.
"Some facilities may give open access to the information with some caveats," she says. For example, someone, such as a patient advocate or health care professional, might need to assist the patient in the interpretation of the information.
• Patients might misinterpret information, causing worry or confusion.
"Medical records contain vast amounts of information, much of it insignificant or even meaningless," says Moore.
While the patient's physician may have correctly evaluated and dismissed a technically abnormal laboratory finding, the patient may demand further explanations and additional testing, thereby stressing the system and increasing costs, Moore says.
• Knowing that patients may be reading their medical records could result in physicians self-censoring records.
"This results in medical notes that are less useful and conceivably harmful to the patient," says Moore.
References
- Delbanco T, Walker J, Bell SK, et al. Inviting patients to read their doctors' notes: A quasi-experimental study and a look ahead. Ann Intern Med 2012;157(7):461-470.
- Harman LB (editor). Ethical Challenges in the Management of Health Information, 2nd ed. Sudbury, MA: Jones and Bartlett; 2006.
- Rinehart-Thompson L, Harman, LB. Privacy and Confidentiality in Ethical Challenges in the Management of Health Information, 2nd ed. Sudbury, MA: Jones and Bartlett; 2006.
Sources
- Laurinda B. Harman, PhD, RHIA, FAHIMA, Associate Professor Emeritus, Department of Health Information Management, Temple University, Philadelphia, PA. E-mail: [email protected].
- Stephen T. Miller, MD, MACP, Medical Director, Medical Education and Research, Methodist LeBonheur Healthcare, Memphis, TN. Phone: (901) 448-5770. E-mail: [email protected].
- Gregory R. Moore, MD, MPH, Senior Director, Stamps Health Services, Georgia Institute of Technology, Atlanta. E-mail: [email protected].
- Peter Winkelstein, MD, MBA, Professor of Clinical Pediatrics/Executive Director, Institute for Healthcare Informatics, University of Buffalo (NY). Phone: (716) 881-7546. E-mail: [email protected].
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