Traditionally, a patient’s medical information has been segmented into charts that exist in various places – the offices of the doctors involved, hospitals, etc. Each doctor’s chart is a medico-legal record of the advice given to the patient by the doctor, resides in the doctor’s office, and is “owned” by the doctor. Medical records retention policy applies here, such that a doctor is obligated to maintain the record for some specified minimum period of time, which varies depending on the circumstances. Coming from this framework, a physician may wish to destroy “old” records, believing that such old records might increase a physician’s liability were they to be available. Many malpractice carriers, and even some medical societies, however, have seen chart documentation as the best way to protect physicians from malpractice allegations and encourage long-term retention – even indefinite retention – as desirable.
The move towards shifting medical record-keeping to electronic formats has changed this paradigm. Especially as hosted EHRs emerge that can allow chart sharing, such that there is a single “one-patient one-chart” record for a given patient across all loci of care, the question of who “owns” the patient’s chart becomes more complicated. The traditional concept of data ownership is unraveling as patient data migrates away from paper charts and takes up residence in the EHR cloud. Overlay onto this the consumer-driven desire for a portable Personal Health Record (PHR) – even though currently, most PHRs are disconnected, empty shells that rely on patients to maintain their own data, the future is for PHRs to be dynamically filled and connected to their physician’s EHR – there is the position that it is the patient who “owns” his/her health data.
With the push toward greater interoperability among EHRs, hospitals, laboratories, PHRs and other sources of patient data, we can now see the emergence of a patient-centered unified health record that is shared by all practitioners involved in a given patient’s care, and used for medical decision-making and advice-giving. So, questions relevant to the old, paper-based and physician-centered paradigm of “can I destroy old records that are past the statute of limitations for legal action?” becomes more complicated in the new interconnected era. With a unified patient-centered chart, can a physician delete or at least block from access his/her old chart notes? What impact on malpractice liability exists with unified patient-centered charts? These are the questions that are emerging, and for which we need clear consensus. The emerging technology puts us on a different footing, and raises issues not previously seen.
Robert Rowley, MD
Chief Medical Officer
Practice Fusion, Inc.