Docs: Laws are hindering patient access to records

The increased use of electronic health records and other technology provides patients with more access to their medical information, but several legal issues are creating obstacles that should be re-examined, according to a viewpoint published in the Annals of Internal Medicine.

The article, written by several physicians, points out that patients can theoretically view data via online portals, add patient-generated information to their records and read physicians' clinical notes. However, various laws, some written before the advent of EHRs, restrict or prohibit patients from seeing all of their records.

For instance, allowing patients to view their records increases the chances the patient will catch an error, enabling the record to be made more accurate. While the Health Insurance Portability and Accountability Act (HIPAA) requires patients to have access to their information and to request amendments made to the record, HIPAA reserves most decision-making authority to providers on the theory that they own the record. However, as more patient-generated information is added to the record, it is less clear as to who the owner is, according to the authors.

Moreover, while HIPAA allows parents to view the records of their minor children, "mature minor" and other state laws can override that access. The ensuing complexity of how to comply has caused many providers to simply deny all access to minors' records, which is "unfortunate" since adolescents, comfortable with technology, in particular may benefit from electronic access to their records, according to the viewpoint.  

In addition, they note that HIPAA flat out denies patient access to psychotherapy notes, but more open access to such notes may be preferable, especially as mental health providers are exploring the use of cogenerated online notes.

"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," the authors state.

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