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Ideas and Opinions |2 August 2016

Transparent Electronic Health Records and Lagging Laws

Bryan S. Lee, MD, JD; Jan Walker, RN, MBA; Tom Delbanco, MD; Joann G. Elmore, MD, MPH

Article, Author, and Disclosure Information
Author, Article, and Disclosure Information
This article was published at www.annals.org on 24 May 2016.
  • From the University of Washington School of Medicine, Seattle, Washington; Altos Eye Physicians, Los Altos, California; and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.

    Acknowledgment: James Ralston, MD, MPH, and Benjamin W. Moulton, JD, MPH, reviewed an early version of the manuscript.

    Grant Support: By the Robert Wood Johnson Foundation, National Cancer Institute K05 CA 104699, and a department of ophthalmology grant from Research to Prevent Blindness.

    Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-2827.

    Requests for Single Reprints: Bryan S. Lee, MD, JD, Altos Eye Physicians, 762 Altos Oaks Drive #1, Los Altos, CA 94024; e-mail, bryan@bryanlee.pro.

    Current Author Addresses: Dr. Lee: Altos Eye Physicians, 762 Altos Oaks Drive #1, Los Altos, CA 94024.

    Ms. Walker and Dr. Delbanco: Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215.

    Dr. Elmore: Department of Internal Medicine, University of Washington, Harborview Medical Center, Box 359780, 325 Ninth Avenue, Seattle, WA 98104.

    Author Contributions: Conception and design: B.S. Lee, J. Walker, T. Delbanco, J.G. Elmore.

    Analysis and interpretation of the data: B.S. Lee, J. Walker, T. Delbanco.

    Drafting of the article: B.S. Lee, T. Delbanco.

    Critical revision of the article for important intellectual content: B.S. Lee, J. Walker, T. Delbanco, J.G. Elmore.

    Final approval of the article: B.S. Lee, J. Walker, T. Delbanco, J.G. Elmore.

    Obtaining of funding: J. Walker, T. Delbanco.

    Administrative, technical, or logistic support: T. Delbanco.

    Collection and assembly of data: B.S. Lee, T. Delbanco.

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FULL TEXT
Millions of patients are accessing their medical records online via secure electronic patient portals. They are also increasingly uploading data directly into their records, and many clinicians now offer patients ready and ongoing access to the notes that document encounters. In response, patients report improved understanding of their care, better recall, enhanced adherence to care plans, and an increased sense of control over their health (1).
Although these changes hold promise for improving the value and safety of health care, some opportunities are hindered by legal constraints dating back to when patients rarely saw their physical charts. To reflect new technical and cultural realities, this legal framework will require ongoing consideration and revision, ideally reflecting strong clinician and patient input and leadership. To highlight potential legal issues and suggest strategies for active clinician involvement, we describe areas that often engender discussion and debate.
As patients increasingly read their medical records, they will disagree with content, find errors, and request changes. Online access makes poor-quality documentation more apparent, particularly when notes are copied forward, templates predominate, and the patient's story is obscured or disappears. The Health Insurance Portability and Accountability Act (HIPAA) guarantees patients the right to access and control distribution of their protected health information (2). Although it permits patients to request amendments, HIPAA reserves most decision-making authority for providers, and the general legal principle is that the provider owns the record. However, “ownership” will become less clear as records increasingly include information uploaded or contributed...
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Lee BS, Walker J, Delbanco T, Elmore JG. Transparent Electronic Health Records and Lagging Laws. Ann Intern Med. [Epub ahead of print 24 May 2016]165:219–220. doi: 10.7326/M15-2827

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Published: Ann Intern Med. 2016;165(3):219-220.

DOI: 10.7326/M15-2827

Published at www.annals.org on 24 May 2016

©
2016 American College of Physicians
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