Give Patients Full Access to their Health Records
Doctors and hospitals are becoming increasingly transparent about the way they care for patients. But most stop short of allowing patients to have full access to their health records. An editorial just published in the Canadian Medical Association Journal (CMAJ) says that needs to change. I'll tell you why I agree emphatically....
Doctors and hospitals are becoming increasingly transparent about the way they care for patients. But most stop short of allowing patients to have full access to their health records. An editorial just published in the Canadian Medical Association Journal (CMAJ) says that needs to change. I'll tell you why I agree emphatically.
The editorial in CMAJ says patients should have full and transparent access to everything their doctor writes or compiles about them in the doctor's chart. It calls for making the process by which patients can obtain their records as quick, as easy and as inexpensive as possible. Right now, in some parts of Canada, the doctor has sixty days produce the chart; in other parts of the country, it's ninety days. The editorial says all Canadians should have the same access no matter where they live.
There are several reasons why has the CMAJ come out in favour of full access. If the health record is filled with factual errors, the patient is at risk of receiving less than optimal care. The editorial says doctors have a duty to ensure that the health records they compile are accurate and complete. Who better than patients to examine the record to make sure the information is correct?
In the past, it was considered acceptable for doctors to write comments about the patient knowing the patient would never read them. But now that's regarded as an outdated concept. It's not appropriate for doctors to effectively conceal their notes and observations.
The biggest reason for allowing patients full access to their records is that patients really like it. There have been successful pilot programs in specialist practices and in primary care or family medicine. A study of three family medicine practices across three US states over a full year found that nearly one hundred percent of the patients wanted open notes to continue. No doctor opted out, even though they were permitted to do so. Patients say open health records make them feel as if they have more control of their care. They are more likely to take their prescription medications as directed. The burden on doctors was minimal, and no patients were harmed.
Open access has its share of critics. They say the biggest downside is that doctors' notes may anger patients. Some patients have found reading their notes confusing and even offensive. The editorial says doctors need to write their notes as if the patient is going to read them. I don't see that as a deal breaker; several hundred mental health patients at a hospital in Boston are part of an experiment in which they are able to read notes their therapists write about them. So far, the results have been surprisingly positive.
Some doctors worry that patients with schizophrenia who read that they are doing well will stop taking their medication and then relapse. Others say doctors who know that patients read their notes will be more guarded in what they write.
The security of open access health records must be addressed. To pass muster, such records would have to be encrypted and password protected in exactly the same way as banking, insurance and pension records. Stringent provincial privacy legislation places a higher standard to protect privacy, and the rules must be followed. Where there's added cost for doctors, I think the provinces should foot the bill.
I think we're moving in the direction of full access to health records, but the pace has been ridiculously slow. The easiest way to provide open access to doctors' notes is through electronic health records. Right now, seventy percent of family doctors use electronic records, which should be a lot easier to make available to patients than paper charts that have to be photocopied.
A fabulous example of open notes at its best- one that demonstrates what can be achieved in the here and now - can be found at Sunnybrook Health Sciences Centre's My Chart.
It's time to speed up the process.