Patients and their medical records: It is time to embrace transparency

Dr. Patrick is to be applauded for her enlightening editorial regarding patients and their medical records. The author suggests in her title that "It is time to embrace transparency". In a time when more than 70% of Canadian primary care practices are using electronic medical records (EMR's), the author wonders "Is sharing the entirety of the electronic medical record with a patient not the obvious next step in the laudable movement toward shared decision-making and patient-physician collaboration, an ideology that is well established in Canadian health care?".

I could not agree more with this view. As is Dr. Patrick, I too am a newcomer to Canada. In Israel (where I came from) EMR's have been used for over 15 years with enormous success and compliance from all parties. Direct, view only, web access to their own EMR is now an integral part of a patient's rights and is available at the click of a button. Lab results are shared and accessible to patients within minutes of being reported on the net. As pointed out in her article, with judicious application of appropriate security measures such as those employed to protect banking, pension, tax and insurance information, there should be more advantages than disadvantages to the open access of medical information.

I would like to expand on Dr. Patrick's editorial and suggest that transparency and sharing also extend to the clinic visit summary letter. I am a consultant pediatrician and in my practice in Israel I used the EMR to print two copies of my visit summary notes/letter. These were given to the parent or guardian to take with them, one copy to keep for their records and one for their family physician or pediatrician. I have recently started following this practice in Canada. Although initially this raised some eyebrows, particularly from colleagues who were not accustomed to this degree of transparency, my patients love it. They feel so much more empowered and involved in the clinical decision making process. They leave the appointment armed with a summary of the visit and are able to review the information immediately or later at their convenience when they can fully digest it. These patients are now questioning why other health care providers do not offer the same open access to their medical records. The benefits for me are that I have no more dictations to complete after clinic, I do not have to wait for a transcriptionist to type my letters, and there is no editing required. The consult letter is delivered directly to the referring physician via the returning patient. As a precaution, I do currently send a copy by mail to the family doctor/pediatrician. However, I suspect that as time goes by, this will become unnecessary.

At first this new degree of transparency was surprising to many of my patients but now they are accustomed to it and like it very much. I believe that they will increasingly demand such transparency from other clinical encounters as well.

It is indeed time to embrace transparency!

Conflict of Interest:

None declared

In the editorial article "Patients and their medical records: It is time to embrace transparency" the author states that "the majority of patients would like to have the right to 'approve' or 'amend' their records."

Patients should be given the choice of producing their own records and attach consultation reports and take their own notes on the follow-up appointments (or pay a fee should they prefer to receive a report for each appointment). In this context, I am the consultant and they have the right to search for a provider whose management makes sense to them.

Medical charts should not contain judgmental but objective notes for clinical reasoning purposes. Comments and alterations of medical notes by the patient will affect clinical decisions and be detrimental to their own care.

Lia Rech, MD

Conflict of Interest:

None declared