What are you hiding from patients in their medical records?

Many a physician is understandably apprehensive about entering the brave, new world of "meaningful use" of EMRs. After all, it's not easy to change the way you've done things for years. What they may be most apprehensive about is not the expense, the workflow modifications or the computer skills they have to learn, but rather the requirement that they be able to give patients copies of their medical records on demand. (Actually, patients have had a right to see their records since HIPAA came along, but meaningful use adds a new dimension.)

As you may have read in FierceHealthcare this week, providing patients access to their records--paper or electronic--could open up a "Pandora's box." Imagine reading that your doctor wrote "SOB" in your chart, for example. No, it's not a commentary on your personality, but medical-speak for "shortness of breath." Same goes for "BS," which means "bowel sounds."

What happens when a doctor dances around a topic such as obesity during an office visit, but then writes the word "obese" in the record? Some are worried that it turns the doctor-patient relationship on its head.

Those are but some of the findings from planning for the Robert Wood Johnson Foundation-funded "OpenNotes" demonstration project, which will study the dynamics of providing physician notes to about 25,000 patients at Beth Israel Deaconess Medical Center in Boston, Geisinger Health System in Pennsylvania, and Harborview Medical Center. Researchers studying OpenNotes plans reported their findings this week in the Annals of Internal Medicine.

Turn the relationship on its head, I say, though one of my colleagues beat me to the punch. In Tuesday's FiercePracticeManagement, Deb Beaulieu, who edits that publication, gave doctors an alternative to sharing notes with their patients: sharing notes with former patients. "If your patient is new, expanding your communication by sharing the file may help your relationship get off on solid ground. For established patients, it might just hold a key to retightening that bond that so many physicians say has suffered as of late," Beaulieu writes.

"My advice: Better to let patients in on what you're thinking now, rather than to have them find out later, when they request their records to leave for another provider," she adds.

I couldn't agree more. If you are reluctant to let patients in on what you've put in their records, why should they trust you? The law says records belong to patients, not physicians. If you want to be a meaningful user of EMR technology--and stay in compliance with HIPAA--you're going to have to open up. Got nothing to hide? Good. - Neil