Considerations for Medical Professionals Navigating Open Medical Records

Novel patient access to electronic medical records, granted by the 21st Century Cures Act, allows individuals greater insight into their own health documents—but also brings new complexity to record management.

In the past, many patients had access to portals that allowed individuals to book appointments or view lab results, but complete notes from physicians were not visible. As of April 5, 2021, federal law granted patients full access to this information.

This change has some clear benefits: The access to information helps patients become more informed about and engaged in their own healthcare. Patients feel empowered by the new knowledge and can have more meaningful discussions with their doctors. On the other hand, physicians have raised concerns:

• What happens when patients receive bad news from a computer screen, rather than a professional with whom they have a personal relationship?
• How can privacy be maintained—particularly when dealing with adolescents?
• What happens when patients identify errors in their charts?

At MLMIC, we’ve been following the latest developments related to this topic and have identified a few considerations that may help physicians and healthcare providers navigate this new frontier.

One common criticism of the new federal law is that patients may experience increased distress after receiving bad news through a portal, rather than a personal conversation with their physician. However, MedPage Today‘s Cheryl Clark explains there’s a simple workaround: “Doctors can simply ask their patients in advance if they want the results withheld until the doctor can deliver the results directly, with delayed posting electronically. If the patient agrees, the doctor is not in danger of violating the Information Blocking rule.”

 Another concern associated with open medical records is the gray area surrounding patient portal accounts for teenagers. “On the one hand, the teenager is technically still a child with a parent or legal guardian acting as that child’s healthcare proxy,” writes Patient Engagement HIT’s Sara Heath. “But teens are also quickly approaching adulthood, developing their own personal autonomy and responsibility while beginning to encounter more personal health matters. Having their parents or guardians review their patient portals could be a breach of that autonomy.” As a solution, hospitals and healthcare systems have created proxy patient portal accounts—but guardians sometimes bypass these, jeopardizing both privacy and compliance.

As patients become more engaged in their own medical records, another concern arises when individuals detect errors in their charts. As Clark explains in a Medpage Today article, patients can request changes, but these are time consuming and can also be rejected by the healthcare provider. “Then there’s the question of who is responsible for actually making the fix and whether there even is a process,” she writes.

To account for these issues, hospitals and healthcare facilities should carefully examine policies and procedures related to open medical records and develop strategies, such as patient education programs, to maximize benefits while minimizing risks. MLMIC will continue to monitor emerging trends and challenges related to open medical records.

We also recommend that our insureds revisit our Risk Management Tip on minimizing errors associated with electronic health records.