COMMENTARY

Topol: Why Are Doctors and Hospitals the Owners of Patient Records?

Disclosures

November 18, 2014

Dear Medscape Readers,

Over 40 years ago, Shenkin and Warner wrote an article in the New England Journal of Medicine titled "Sounding Board. Giving the Patient His Medical Record: A Proposal to Improve the System."[1] That certainly hasn't happened.

Recently, New York Times journalist and physician Elisabeth Rosenthal added to her article series "Paying Till It Hurts" with "Medical Records: Top Secret." In the article, I. Glenn Cohen, a Harvard Law professor, is quoted as saying, "The medical record is held hostage." And David Blumenthal, president of the Commonwealth Fund, tells Dr Rosenthal that HIPAA compliance should not be used as an excuse to refuse patients' requests for copies of their medical records.

Just a couple of months ago, we performed a unique survey of both clinicians (via Medscape) and patients (via WebMD), about health-related digital technology, asking both groups the same set of questions. More than 1100 patients and 1400 health professionals responded, and when it came to the question of who owns medical records, providers and patients had very different opinions (Figure).

Figure. Data from WebMD/Medscape Digital Technology Survey.

More than half of patients believe they own their records, and nearly 40% of physicians think they own their patients' records. Well, these doctors (and hospitals) are right—they legally own the records. But should they?

With all of the remarkable issues surrounding a patient's access to her own records, including multiple providers, cost, and inconvenience, isn't it high time for rightful ownership to belong to the consumer? After all, the patient paid for the visit, procedure, lab test, scan, or hospitalization. It's his or her body. For centuries, the medical community believed that patients could not handle seeing their own information for fear that it would induce major anxiety. They also believed that the information wouldn't be understood; medical jargon is much too complicated for a layperson.

That certainly did not appear to be the case in the Open Notes project,[2] which proved that patients' access to their records actually increased their understanding, satisfaction, and confidence. While the concept of patients owning their own medical records may not play well with physicians and hospitals, shouldn't the current setup be flipped? The patient is the one who should be granting access to doctors and hospitals.

If you are interested in delving further into this topic, as well as the concept of the democratization of medicine, you can read about it in my new book, The Patient Will See You Now.

As always, I'll be very interested in your thoughts on this important topic.
Eric J. Topol, MD
Editor-in-Chief, Medscape
@EricTopol

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