Whose Medical Record Is It Anyway?

From a federal advisory committee meeting in Washington, D.C.:

Photo courtesy Flickr Creative Commons user Fabian.Nikon

Courtesy Flickr Creative Commons user Fabian.Nikon

You’d think that a meeting of the federal Health Information Technology Standards Committee would be pretty dull, but actually, the discussions can get interesting. Such was the case on Oct. 14, when the panel discussed how much online access patients should have to their health records.

No one had a problem with patients having access to their diagnoses, lab results, and medication lists; those were no-brainers. A few panelists, such as Jamie Ferguson of Kaiser Permanente, also praised their organizations’ ability to allow patients to refill prescriptions online or have email exchanges with their physicians.

The interesting part of the discussion came when committee chair Jonathan Perlin, of the Hospital Corporation of America, asked whether panelists thought patients should have access to physician notes.

Panel vice-chair Dr. John Halamka of Harvard Medical School said that his organization’s definition of an online personal health record includes a problem list, medication list, allergies, lab results and other test results, but not the physician’s notes. He pointed out that HIPAA regulations permit patients to physically go to the facility’s medical records department and get their complete medical record. However, when his hospital launched its personal health record system,  “we tried to tell our physicians…. ‘We’re going to share every observation you made about the patient with the patient themselves,’ and there was some resistance,” he said. “If I said [in my notes], ‘I have just met with a slightly depressed obese man’ and the patient is now going to see that — that’s controversial.”

Linda Fischetti of the Department of Veterans Affairs (VA) said her agency releases health information electronically “in a way that repects the clinician’s role” in caring for the patient. For example, if a patient has a lab result that is abnormal, the VA will alert the physician — thus creating a delay — before releasing the record.

Judy Murphy of Aurora Health Care in Milwaukee, Wisc., said, “In terms of personal health records, we’ve been real selective in what we’ve been doing — we only [release] lab results and even then it’s at the specific discretion of the physician to release them.” But she added that releasing more information to patients “is where we need to be going if we’re really going to be patient-centric…. This is all about the patient, and we absolutely have to make sure we’re partnering with the patient and not seeing this as our data, but seeing it as data we’re working on together as a team.”

Physicians, how comfortable are you with sharing the electronic medical record? Where would you prefer to draw the line? Take our poll and let us know.

–Joyce Frieden (Twitter @joycefr)
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Filed under health reform, Practice Trends, Uncategorized

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