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 The Health Insurance Portability and Accountability Act (HIPAA)
gives U.S. patients the right to access their medical records and
control who else has access to the information, physicians note in
an essay in the Annals of Internal Medicine.
But in reality, the contents of electronic records may be limited by
doctors’ concerns about disputes with patients about what the
records say, fear of malpractice litigation, and questions about how
much information to give certain individuals like minors and people
with mental illness, these physicians argue.
“I think the default should be for patients to have complete access
to their electronic medical records, and the benefits would likely
greatly outweigh any harm,” said lead author Dr. Bryan Lee of Altos
Eye Physicians in Los Altos, California, and the University of
Washington in Seattle.
As patients increasingly read their medical records, they will
disagree with content, find errors and request changes, Lee and
colleagues point out. While doctors may have the final say over what
they add to records, patients may want to add information of their
own, and the legal status of patient-created content is unclear.
In another point of legal murkiness, parents generally have control
over minors’ medical records and can prevent children from accessing
online notes. Providers can deny parents access if they suspect
abuse or think parental involvement isn’t in a child’s best interest
– but this, too, is an area where laws vary and liability concerns
may color doctors’ decisions, the authors argue.
With mental illness, HIPAA prevents patients from accessing
psychotherapy notes in some circumstances, but some state laws allow
broader access to these records, the authors note.
While patients can benefit from access to records in most cases,
there are some exceptions, and psychotherapy notes may be one of
them, said Ann Kutney-Lee, a health policy researcher at the
University of Pennsylvania School of Nursing in Philadelphia, in
email to Reuters Health.
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“There are certain clinical situations where providing access may
cause more harm to the patient than good – e.g. psychotherapy notes
for a patient that is suicidal,” said Kutney-Lee, who wasn’t
involved in the essay.
For many patients, though, reviewing records may make them more
proactive about their health, said Daniel Walker, a family medicine
researcher at Ohio State University in Columbus who wasn’t involved
in the study.
“It can make them feel more a part of the healthcare experience, and
empower them to engage in shared decision making,” Walker said by
email.
Preventing errors is another big advantage of electronic records,
said Dr. Dean Sittig, a researcher at the University of Texas Health
Science Center in Houston who wasn’t involved in the essay.
“Without an electronic health record, it is very difficult if not
impossible to check whether the right medications were given at the
right time, to the right patients,” Sittig said by email.
SOURCE: http://bit.ly/1i46lF7 Annals of Internal Medicine, online
May 23, 2016.
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