Some of them were not legitimate attempts, and she later admitted they were for attention. But there also have been times when she truly wanted to die. Her psychiatrist and I meet with her frequently to try to keep her as emotionally stable as possible. Rachel will periodically ask to see her medical records. She has a legal right to these records, but there also is concern about how she may respond to seeing doctors' written opinions about her, particularly concerning her personality disorder.
The question of who owns medical information is a big issue. Should the physician or health system own it? Records represent our medical opinions on what is presented, and therefore are not necessarily property of the patient. But why shouldn't the individual own the records? It is completely about them and for them. The issue goes beyond medical notes. Lab work is a literal part of the patient; why should someone else own that? Different states have different laws regarding ownership.
Only one state, New Hampshire, explicitly gives ownership to patients, whereas most states have no law delineating custody of records. Many systems provide limited access to information through Web portals such as MyChart. This grants a list of a patient's conditions that are listed in patient-friendly terms, medications, lab and imaging study results, and recommended preventive health measures. Basically, everything but reading their doctor's notes.
OpenNotes , an organization that encourages full patient access to their doctor's notes, has started a revolution in this area. More than 5 million patients from at least 20 institutions around the country have full and immediate access to their medical records.
They log into a Web portal that allows them to see all of their health information, including what their doctor has written about them. The operative word here is their health information.
Many physicians have been nervous about this for various reasons. What will patients think? Will they be able to understand what is written? What about patients like Rachel? Could it truly be harmful for her to read the notes from her psychiatrist and me? Vendors that offer EHR systems stored remotely and offered as a cloud-based services. And wither within the same vendor or as a partner, there are analysts who review the EHRs for a variety of metrics and data points related to population health, diseases, payments, certain tests, etc.
This analysis may or may not be known to the doctors or the healthcare entity. This analysis is legal and, in some ways, even encouraged to better inform the medical field in general. For example, the U. Centers for Disease Control and Prevention has an interest in reactions to vaccines and may track vaccines across the nation by control number, age of patient, reaction, etc.
However, EHRs also comprise those records with affiliated services, such as radiology, pharmacy, medical device manufacturers, and care coordinators. In some cases, the records with the affiliated services may be the only detailed record in existence. This can add complications for both the providers and the patients. Denying Access In reviewing some of the publicly available information from EHR vendors, there were some common themes, mainly around limitation of liability and access rights.
Nowhere in the agreements is it addressed how the doctors can access records if needed. Another concerning issue is limiting liability. It may be typical to see a software vendor disclaim any liability even if the vendor is the one who caused the harm, but this has far-reaching consequences for the practitioner, and perhaps the patient. For example, if patient records are mixed through a programming error, the vendor would be held blameless.
This may not count in states where gross negligence cannot be contracted away, though even then legal action would have to be taken in order for the issue to be addressed.
Practically speaking, that patient essentially loses access to those records. So, who owns them? Most contracts would state that the doctors own them or that the vendor does. Generally, the vendor owns the right to grant or deny access. This makes ownership a moot point, because if the doctor cannot access them to provide care, transfer the information to another provider, or to give the record to the patient a patient right under HIPAA then the records are essentially being held hostage, which is not permitted.
Even HIPAA provides that a doctor cannot withhold medical records pending payment for care—but these vendors can, and do. There are some common scenarios which complicate this even further; eg, doctors may pass away, or retire or leave the practice of medicine without notice.
In each of these scenarios, there would be a problem immediately accessing EHRs without some kind of arrangement already in place. If the only way to validate an authorized user is through the doctor, and that doctor is unavailable, then there will be issues getting patients the care they need in a timely fashion.
And remember, the vendor has essentially no liability, per contract. In most cases, the vendors also state that they have no responsibility accommodate patient rights directly, and it is common practice for a business associate as defined under HIPAA to defer patient access requests back to the provider. Addressing these serious concerns will take either reasonable minds to work out common practice standards for EHRs or a tragic event where medical records are inaccessible, resulting in dire consequences.
As a primary care doctor, I also find difficulty getting copies of records from other clinicians. Sometimes, despite the widespread use of EHRs, it can take days to receive vital reports from outside services. How can a doctor give the patient the best care when others fail to share information that is needed to treat patients? Everyone, doctors and patients alike, need to learn the rules and make them standard. But far above that, we all need to practice empathy and try to understand each other better.
And in a similar fashion, patients need to understand that doctors are being squeezed by many pressures and demanding immediate copies only adds to that burden. If we all worked together, access to these charts should be the norm and done in a timely fashion for all parties. Linda, A concise overview of medical records for patients, doctors and hospitals alike. Well done!
It always intrigues me when patients seem blissfully ignorant about their ailments and treatment modalities and more specifically the medications they take. I have no idea why I take these pills. There are other options? Become informed! Thanks for sharing! Skip to content.
0コメント