Patient Access to Electronic Health Records Yields Unexpected Results

Patients are generally enthusiastic about open access to their doctors’ visit notes.

In an old Seinfeld episode, Elaine goes to see a dermatologist about a rash and is left sitting on the table in the exam room, alone with her medical chart. She opens the folder and almost immediately makes a sour face. “‘Difficult’?” she says, reading aloud.¹

Now that most of us have transitioned from scribbling illegible notes in our patients’ ever-expanding paper charts to posting neatly typed missives that are compiled and collated somewhere on the cloud, it may be time to consider what lies ahead in the brave new world of healthcare reform.

The passage of the Affordable Care Act (ACA) has already promulgated some significant changes in the practice of medicine in the U.S. It has created a pathway for previously uninsured individuals to gain access to healthcare, a highly laudable goal. It has established rules to rein in some of the rampant costs that threaten the solvency of Medicare and other government programs. Perhaps the ACA’s greatest impact on physicians has been its development of guidelines that attempt to standardize the practice of medicine by encouraging physicians and healthcare facilities to adopt the electronic health record (EHR) (also see “Electronic Health Record Challenges,”).

Digitized records provide a clearer documentation of patients’ illnesses, which can now be linked to other critical elements of their dossiers, including imaging, lab results and medications. The enhanced portability of the EHR enables access from a variety of devices, both inside and outside the office. This simplifies the exchange of information for patients who are being cared for by a host of providers across several healthcare systems and it also makes it easier for patients to access and read their own records.

Wait a minute! Say again. Aren’t medical records protected documents that should be kept from the subjects they are describing? How could patients read their charts and truly understand what their doctors are saying? This is heresy! After all, notes are bursting with medical jargon and countless indecipherable abbreviations, not to mention littered with typographical errors. Wouldn’t patients be insulted if they read personal characterizations that describe them as being obese, looking older than their stated age or moving sluggishly? Would they be offended to learn that their doctor considered their illness to be of psychosomatic origin? Or would they simply be bored reading repeated iterations of their story, neatly cut and pasted into their chart, the EHR version of the movie, Groundhog Day?