HHS Extends Deadline for Patient Access to Your Clinical Notes

Nick Mulcahy

October 29, 2020

The US Department of Health and Human Services (HHS) today extended the deadline for healthcare groups to provide patients with immediate electronic access to their doctor's clinical notes as well as test results and reports from pathology and imaging.

The mandate, called "open notes" by many, is part of the 21st Century Cures Act, and will now go into effect April 5.

The announcement comes just 4 days before the previously established November 2 deadline and gives the pandemic as the reason for the delay.

"We are hearing that while there is strong support for advancing patient access…stakeholders also must manage the needs being experienced during the current pandemic," Don Rucker, MD, national coordinator for health information technology at HHS, said in a press statement.

"To be clear, the Office of the National Coordinator is not removing the requirements advancing patient access to their health information," he added.

"What You Make of It"

Scott MacDonald, MD, electronic health record medical director at UC Davis Health in Sacramento, California, said his organization is proceeding anyway. "UC Davis is going to start releasing notes and test results on November 12," he tells Medscape Medical News.

Other organizations and practices now have more time, he said, but the law stays the same. "There's no change to the what or why — only to the when," MacDonald points out.

Vanderbilt University Medical Center in Nashville, Tennessee will take advantage of the extra time, said Trent Rosenbloom, MD, MPH, director of patient portals, in an email shared with Medscape Medical News.

"Given the super-short time frame we had to work under as this emerged out from dealing with COVID, we feel that we have not addressed all the potential legal-edge cases such as dealing with adolescent medicine and child abuse," he said.

Last week, Medscape Medical News reported on the then-imminent start of the new law, which irked many readers. They cited, among other things, the likelihood of patient confusion with fast patient access to all clinical notes.

"To me, the biggest issue is that we speak a foreign language that most outside of medicine don't speak. Our job is to explain it to the patient at a level they can understand. What will 100% happen now is that a patient will not be able to reconcile what is in the note to what they've been told…" wrote Andrew White, MD, in a reader comment on the Medscape story.

But benefits of open notes outweigh the risks, say proponents, who claim that doctor–patient communication and trust actually improve with information access and that research indicates other benefits such as improved medication adherence.

Open notes are "what you make of it," said Marlene Millen, MD, an internist at UC San Diego Health in California, which has had a pilot open notes program for 3 years.

"I actually end all of my appointments with, 'Don't forget to read your note later,' " she told Medscape Medical News last week.

Millen feared open notes initially but within the first 3 months of usage, about 15 patients gave her direct feedback on how much they appreciated her notes. "It seemed to really reassure them that they were getting good care," she said.

MacDonald and Millen have disclosed no relevant financial relationships.

Nick Mulcahy is an award-winning senior journalist for Medscape. He previously freelanced for HealthDay, MedPageToday and has had bylines on WashingtonPost.com, MSNBC, and Yahoo. Email: nmulcahy@medscape.net and on Twitter: @MulcahyNick

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