Patient can't always access complete medical records, doctors say

Technology makes it possible for patients to access medical records online, but a thicket of legal issues may still keep people from always seeing everything in their chart, some doctors say.

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.

"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.