Attorney tells doctors: Share your notes

David Harlow, principal at The Harlow Group, LLC, a healthcare attorney and consultant and author of the Healthcare Blawg says doctors should have no concerns with showing their notes to patients.

“The patient has a right to access their record,” Harlow says. “There are certain types of notes not releasable to patients, but those are few and for between. You should assume that something you are putting in a record is something that can be read by a patient.”
Harlow says the sharing of patient records is something that has long been the case and is not being reinforced. It’s much easier in now that records can be offered in an electronic format.
In the most recent update to the HIPAA rules, patients can ask for their entire record in the format of their choosing. “Patients are slowly being more recognized,” Harlow says of current laws.
Programs like OpenNotes, an initiative to improve health outcomes by helping clinicians and patients get on the same page, are helping to get patients more involved in their own care, Harlow says.
“OpenNotes is a more involved and a better approach than shipping a copy of the record to the patient. OpenNotes is going broader, it really creates more of an ongoing dialog,” he adds.
Harlow says he can understand that some doctors may feel a sense of discomfort in sharing notes, but in essence, patients have always had the right to access their notes.
Some clinicians think the record belongs to them. “There is this tension that exists, but it doesn’t necessarily have to be seen as a negative,” he says. “I think the shift to electronic records is part of what creates this discomfort on the part of doctors, because now it’s so much easier to share the record.”
The use of patient portals, required for meaningful use incentives, has also contributed to patient access to records. In Stage 1, providers were required to have portals, but they didn’t necessarily have to get patients to use them. Stage 2 has bumped that up to requiring 10 percent of patients to use the portal. This broader access through a portal is a patient’s right, Harlow says. Access through a portal, can be conducive to better care and care management, as payment system changes to encourage fewer office visits, as long as it doesn’t affect care negatively, he says.
As far as sharing notes, beyond the strictly legal aspect of it, “at some level, folks can understand it’s the right thing to do,” Harlow says. More communication between patients and their doctors can lead to better clinical outcomes.