In our June 16, 2015 blog “Medical Record Access: Are Patients and Physicians at Odds?” we discussed the controversy regarding the use of sharing patient health records. We presented evidence that there is at least some resistance by physicians to share some or all of the medical record with patients. We presume this latest round of controversy is really targeted around the use of patient portals as the means to share those records. In addition we concluded that this resistance might be related to poor technology solutions that don’t offer providers the granularity they need with regard to selective sharing of certain clinical findings via the portal.
I’ve reached the conclusion that some physicians really don’t want to be bothered with the perceived additional “overhead or headaches” related to sharing health records with patients via a portal. In their defense they were trained to create health records without having to consider the easy access that patients may now enjoy via patient portals.
In a care plan for an overweight uncontrolled diabetic patient they may be used to stating;
“I keep telling the patient that they are too heavy and they will never get their sugars under control if they don’t lose weight”
We all know that the provider can easily accomplish the same type of documentation by stating;
“We discussed the patient’s elevated BMI and the ways that impacts their blood sugar and the impact of their BMI on their overall health”.
Except for certain mental health issues where the patient’s emotional state is very fragile and a few other exceptions the overwhelming majority of office-based chart notes should be able to reflect the honest and forthright communication that ought to occur during the encounter.
In our last blog we offered that there are certain special situations when data on a patient portal should be hidden, like in the sensitive case of a sexually active teen that shares portal access with their parent.
In the Journal of Adolescent Health (2014) very specific recommendations were made about this privacy issue;
“The American Academy of Pediatrics has recently described the lack of current EHR standards to protect adolescent health information in their position statement (endorsed by the Society for Adolescent Health and Medicine) . The Society for Adolescent Health and Medicine has previously affirmed that “confidentiality protection is an essential component of adolescent health care”. Privacy is good care and a right for all patients. Adolescents may forgo health care if they do not perceive that health care providers will keep their private in-formation private, especially for reproductive health, mental health, and substance abuse concerns. The desire for increased transparency and electronic access to health information should be counterbalanced by privacy protections to ensure access to appropriate confidential care for all patients, especially vulnerable adolescents.”
They further commented about what EHRs should do:
“Recommendations for vendors/electronic health record system requirements: EHR systems have largely been designed to facilitate sharing of information within a clinical system and not usually to restrict the flow of that information. ….EHRs should have the functionality to designate problems, medications, visit notes, laboratory and radiology results, genetic testing, and social and family history as confidential, so that these can be easily suppressed”
The MediTouch patient portal and EHR offers certain privacy features that help physicians meet the ethical challenge of preserving the privacy of young adults. Our portal privacy features help to facilitate these American Academy of Pediatrics recommendations and differentiate our software.
Lets take the case of a young female adolescent patient that has traditionally shared portal access with their parent at the insistence of the parent. That adolescent female has just become sexually active and she wants counseling regarding avoiding STDs and in addition she has determined that she wants to use the birth control pill.
In this case the provider may want to hide the encounter note from the portal and in addition hide the birth control pill from the portal version of the medication list. With the MediTouch system the provider can accomplish both goals. Reassuring that adolescent female patient that the encounter and medication will not be shared via the portal helps build trust between patient and provider.
Here’s how it works
An encounter can be marked Private or Portal Private. Private Encounters can only be opened by the rendering (signing) provider. Marking an encounter Portal Private signals the system to hide the encounter on the patient portal.
The birth control pill is marked private (the P is red) and therefore it won’t be displayed on the patient portal. The amoxicillin is not marked private (the P is gray) and it will be displayed on the patient portal.
Patient engagement is happening. Meaningful Use has mandated patient engagement features and even if those requirements are relaxed by CMS in the short term, in the long-term patient engagement features on patient portals will become the norm. We must empower physicians to make more granular decisions about how patient medial records are shared; it is key to making adoption of portals grow. The MediTouch Portal Privacy features solves a major stumbling block with regard to engaging with patients and offers a glimpse into the future of electronic communication between physician and patient.