Potential Risks, Benefits of Patient Access to EHR Clinical Notes

Patient access to EHR clinical notes has the potential to improve malpractice liability risks, according to a JAMA Network Open op-ed written by Charlotte Blease, PhD of Beth Israel Deaconess Medical Center.

ONC’s information blocking provisions mandate patient access to eight kinds of EHR notes: those relating to consultation, discharge, history and physical examination, imaging, laboratory tests, pathology, procedures, and progress.

Enhanced patient access to clinical notes could reduce malpractice claims by reducing diagnostic delays, mitigating medical errors, and improving patient-clinician relationships, Blease noted.

Misdiagnosis and delayed diagnosis are leading causes of malpractice claims. Access to EHR data may boost caregiver and patient engagement in the diagnosis and treatment processes, which could potentially help reduce the risk of delays and missed diagnoses.

“Under the law, a finding of malpractice liability requires a finding of patient injury,” Blease said. “Patients who report errors in their health information could therefore prevent physicians from relying on erroneous data that may lead to poor diagnostic or treatment decisions and legal liability.”

Additionally, EHR clinical note access could make it easier for patients to obtain legal advice about potential malpractice cases.

“Attorneys have an important role in advising potential clients about whether they have a valid or frivolous case,” Blease explained. “Access to patients’ clinical notes could potentially enable them to perform that function more accurately.”

However, offering patients full access to their health information could invite new legal concerns for clinicians as well.

In particular, Blease said litigation risks could increase if physicians make changes to their clinical notes that reduce documentation quality.

“Knowing that patients are reading what clinicians write in medical records may cause physicians to alter the contents of clinical documentation,” Blease pointed out. “Medical records that are tailored to satisfy patients could mislead other treating clinicians and diminish the quality of care.”

Records that are inaccurate or incomplete due to physicians’ concerns about sharing EHR notes could also hinder plaintiffs and defendants in malpractice litigation, she added.

On the other hand, failure to adjust the tone or content of EHR documentation in light of sharing notes could strain patient-provider relationships and impact decisions to pursue claims. For example, physicians who include notes about overeating, risky sexual behaviors, or poor health habits could offend patients, Blease suggested.  

“Patients who feel they do not have a good relationship with their physicians are more likely to sue if they are dissatisfied with treatment outcomes,” she said.

In addition, Blease said that sharing clinical notes could contribute to clinician burnout due to increased patient queries related to EHR notes.

She suggested that health systems hire additional support personnel to answer patient queries related to EHR notes.

“Technology should be used to facilitate error correction and ensure that approved corrections are incorporated throughout the electronic record,” Blease wrote. “These measures might also help reduce clinician burnout and strengthen teamwork with patients.”

She also suggested that healthcare organizations provide clinicians with resources to help ensure efficient documentation while maintaining accuracy, clarity, and sensitivity to patients’ needs.

“Some clinicians may feel uncomfortable with the notion of having all their notes visible to patients, and training could provide much needed support, including on how to manage disagreements constructively,” she said.

Additionally, Blease said that healthcare organizations should provide patients with training on how to use their patient portals and report documentation errors to clinicians.

“It is uncertain whether enhanced patient access to their health information will generate more benefits than litigation risks and contribute to a culture of greater transparency and trust in medicine,” Blease concluded. “Verifying the potential effects of sharing clinical notes on malpractice liability risks will require thorough study and monitoring.”