How much access should patients have to their medical record?

As more patient records go electronic, there is debate as to how much of it a patient should see.

This is a particularly sensitive topic, which I touched upon a few months ago, and brings out some contention between patients and their doctors.

Primary care physician Rob Lamberts’ practice is introducing a patient portal, and in this blog entry, he tries to delineate what patients should see, and what they need to request. In effect, he plans to give them easy access to 99 percent of their record.

There are some patient advocates who would like to complete, unrestricted access to their chart. But there is sensitive information, such as psychiatric issues, suspected abuse, or private conversations, along with the thought process behind a doctor’s medical decisions, that perhaps need to remain private.

That right balance is like finding, in Dr. Rob’s words, the proverbial “sweet spot.” But there’s no doubt that the move towards more transparent records is inevitable, and in the future, the medical chart will be shared and collaborated with both patients and other providers.

Boston’s BI-Deaconess Hospital recently announced they are test-piloting a project where patients will have easy access to the assessment and plan section the medical chart. It’s going to be interesting to see what happens, as many doctors may be wary about the increased workload that the inevitable patient questions will bring.

And, with primary care doctors already pressed for time, is this possible consequence something the current health system can support?

Furthermore, physician Jay Parkinson also feels that the trend towards unrestricted chart access may ultimately lead to two sets of notes, one for the consumer, and another to satisfy billing requirements: “Unfortunately, most medical records exist to maximize reimbursement and are loaded with false information about a patient’s condition. And therein lies the dilemma. Do we give patients access to billing information? Or do we ask doctors to document twice? One aimed at the insurance companies and one aimed at consumers.”