Opening Act: Patients Given Broad Access to Their EHRs

Starting April 5, physicians must be ready to electronically share with patients more of the information generated during office visits. This change comes thanks to "information blocking" rules that are part of the 21st Century Cures Act, passed by Congress in 2016 and put into regulation in 2020 by the U.S. Department of Health and Human Services' Office of the National Coordinator (ONC).

Understanding the response of mammography facilities to breast density notification

BACKGROUND

State-specific breast density notification legislation requires that women undergoing mammography be informed about breast density, with variation among states. Because mammography facilities are among the main points of contact for women undergoing mammography, research is needed to understand how facilities communicate information on breast density, cancer risk, and supplemental screening to women.

METHODS

A cross-sectional, 50-item, mailed survey of 156 American College of Radiology-certified mammography facilities in North Carolina was conducted in 2017 via the Tailored Design Method. Breast density notification practices, supplemental screening services, and patient educational materials were compared by supplemental screening availability via t tests and chi-square tests.

RESULTS

All responding facilities (n = 94; 60.3% response rate) notified women of their breast density in the mammography results letter. Breast cancer risk assessments were performed by 36.2% of the facilities, with risk information communicated in the final radiology report for the referring provider to discuss with the woman (79.4%) or in the results letter (58.8%). Supplemental breast cancer screening was offered by 63.8% of the facilities, with use based on multiple factors, including recommendations from the referring physician (63.3%) or reading radiologist (63.3%), breast density (48.3%), other risk factors (48.3%), and patient request (40.0%). Although 75.0% of the facilities offered breast density educational materials, only 36.6% offered educational materials on supplemental screening.

CONCLUSIONS

In a state with a breast density notification law, mammography facilities communicate breast density, cancer risk, and supplemental screening information to women through various approaches. When supplemental screening is offered, facilities use multiple decision-making criteria rather than breast density alone.

[The New General Data Protection Regulation and Its Implications Regarding Clinical Information Requests to Healthcare Professionals]

N/a.

The Perils of Parity: Should Citizen Science and Traditional Research Follow the Same Ethical and Privacy Principles?

The individual right of access to one's own data is a crucial privacy protection long recognized in U.S. federal privacy laws. Mobile health devices and research software used in citizen science often fall outside the HIPAA Privacy Rule, leaving participants without HIPAA's right of access to one's own data. Absent state laws requiring access, the law of contract, as reflected in end-user agreements and terms of service, governs individuals' ability to find out how much data is being stored and how it might be shared with third parties. Efforts to address this problem by establishing norms of individual access to data from mobile health research unfortunately can run afoul of the FDA's investigational device exemption requirements.

Return of Results in Participant-Driven Research: Learning from Transformative Research Models

Participant-driven research (PDR) is a burgeoning domain of research innovation, often facilitated by mobile technologies (mHealth). Return of results and data are common hallmarks, grounded in transparency and data democracy. PDR has much to teach traditional research about these practices and successful engagement. Recommendations calling for new state laws governing research with mHealth modalities common in PDR and federal creation of review mechanisms, threaten to stifle valuable participant-driven innovation, including in return of results.

Assessment of US Hospital Compliance With Regulations for Patients' Requests for Medical Records

IMPORTANCE

Although federal law has long promoted patients' access to their protected health information, this access remains limited. Previous studies have demonstrated some issues in requesting release of medical records, but, to date, there has been no comprehensive review of the challenges that exist in all aspects of the request process.

OBJECTIVE

To evaluate the current state of medical records request processes of US hospitals in terms of compliance with federal and state regulations and ease of patient access.

DESIGN, SETTING, AND PARTICIPANTS

A cross-sectional study of medical records request processes was conducted between August 1 and December 7, 2017, in 83 top-ranked US hospitals with independent medical records request processes and medical records departments reachable by telephone. Hospitals were ranked as the top 20 hospitals for each of the 16 adult specialties in the 2016-2017 US News & World Report Best Hospitals National Rankings.

EXPOSURES

Scripted interview with medical records departments in a single-blind, simulated patient experience.

MAIN OUTCOMES AND MEASURES

Requestable information (entire medical record, laboratory test results, medical history and results of physical examination, discharge summaries, consultation reports, physician orders, and other), formats of release (pick up in person, mail, fax, email, CD, and online patient portal), costs, and request processing times, identified on medical records release authorization forms and through telephone calls with medical records departments.

RESULTS

Among the 83 top-ranked US hospitals representing 29 states, there was discordance between information provided on authorization forms and that obtained from the simulated patient telephone calls in terms of requestable information, formats of release, and costs. On the forms, as few as 9 hospitals (11%) provided the option of selecting 1 of the categories of information and only 44 hospitals (53%) provided patients the option to acquire the entire medical record. On telephone calls, all 83 hospitals stated that they were able to release entire medical records to patients. There were discrepancies in information given in telephone calls vs on the forms between the formats hospitals stated that they could use to release information (69 [83%] vs 40 [48%] for pick up in person, 20 [24%] vs 14 [17%] for fax, 39 [47%] vs 27 [33%] for email, 55 [66%] vs 35 [42%] for CD, and 21 [25%] vs 33 [40%] for online patient portals), additionally demonstrating noncompliance with federal regulations in refusing to provide records in the format requested by the patient. There were 48 hospitals that had costs of release (as much as $541.50 for a 200-page record) above the federal recommendation of $6.50 for electronically maintained records. At least 6 of the hospitals (7%) were noncompliant with state requirements for processing times.

CONCLUSIONS AND RELEVANCE

The study revealed that there are discrepancies in the information provided to patients regarding the medical records release processes and noncompliance with federal and state regulations and recommendations. Policies focused on improving patient access may require stricter enforcement to ensure more transparent and less burdensome medical records request processes for patients.

[Is psychiatry ready to let patients review their own files? Inventory of initial experiences]

BACKGROUND

Dutch patients will be granted the right to digitally access their own medical records, an option already available to the patients at the University Medical Center Utrecht since 2015.

AIM

To start a conversation about the development of readily accessible online patient records. METHODS Describe the experiences of a University department of psychiatry with an online patient portal, obtained through discussions and questionnaires.

RESULTS

During the next few years three legal developments will enable patients to acquire direct, remote, digital access to their medical files. Immediate online review of medical records improves accessibility and empowers the patient. Some therapists experienced a change in patient interaction. Furthermore, during documentation psychiatrists took into account that patients could review the contents at a later point.

CONCLUSION

Patients' accessibility of online records will influence the patient-therapist dynamic. More research on the patient perspective and a discussion among professionals are necessary to further streamline broad implementation of online patient portals.

Honoring Dental Patients' Privacy Rule Right of Access in the Context of Electronic Health Records

A person's right to access his or her protected health information is a core feature of the U.S. Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. If the information is stored electronically, covered entities must be able to provide patients with some type of machine-readable, electronic copy of their data. The aim of this study was to understand how academic dental institutions execute the Privacy Rule's right of access in the context of electronic health records (EHRs). A validated electronic survey was distributed to the clinical deans of 62 U.S. dental schools during a two-month period in 2014. The response rate to the survey was 53.2% (N=33). However, three surveys were partially completed, and of the 30 completed surveys, the 24 respondents who reported using axiUm as the EHR at their dental school clinic were the ones on which the results were based (38.7% of total schools at the time). Of the responses analyzed, 86% agreed that clinical modules should be considered part of a patient's dental record, and all agreed that student teaching-related modules should not. Great variability existed among these clinical deans as to whether administrative and financial modules should be considered part of a patient record. When patients request their records, close to 50% of responding schools provide the information exclusively on paper. This study found variation among dental schools in their implementation of the Privacy Rule right of access, and although all the respondents had adopted EHRs, a large number return records in paper format.

[Some current threats to confidentiality in medicine]

Social, technical and legal conditions of the current practice of medicine make it necessary to insist on certain actions and circumstances that may jeopardize the confidentiality of information, offered by patients to their health providers. Therefore, some effects of the current Chilean law are analyzed in this respect, regarding access to data from the clinical record of a patient. Also, the risks of putting certain data on social networking sites are analyzed, as well as some of its effects on clinical practice. The reasons because of mandatory reporting of diseases, meaning danger to public health, is allowed, are mentioned. We also discuss the difficulties involved in managing the results of preventative health screenings and its knowledge by third parties, as well as some possible violations of personal privacy, regarding dissemination of some people health information and its further mention or figuration in mass media. We conclude that it is a must for both physicians and other health team members, to safeguard confidentiality of data to which they have had access, as well as the need to know the relevant law, in order to respect human dignity of patients, each one as a person. We address the attention to the possibility that, practicing in a different way, it could endanger the reliability of clinical records, also impairing the quality of people's health care.

Patient Access to Personal Health Information: Regulation vs. Reality

Patient-centered healthcare initiatives are underway to enable patients to take more responsibility for their healthcare. To do so, patients must be able to access, utilize, and share their health information. Access to health information through patient portals and other electronic means is increasing with the adoption of electronic health records (EHRs), but not all providers have EHRs or patient portals and not all information may be available electronically. Patients are expected to continue to request paper and electronic copies of their medical records. This research project was initiated to obtain up-to-date data regarding health information management (HIM) practices related to patients' access to their health information.

Implementation of the Directive on the Application on Patient's Rights in Cross-border Healthcare (2011/24/EU) in Finland

Implementation of the Directive on the Application on Patient's Rights in Cross-border Healthcare (2011/24/EU) has proved to be quite challenging in Finland.

Implementation of the Cross-border Care Directive in EU Member States: Luxembourg

The Cross-border Care Directive sets up basic patient rights in case of cross-border healthcare. These rights concern both the country of affiliation and the country of treatment of the patient. The article briefly describes the state of the transposition in Luxembourg, with a focus on the draft act on patients' rights and obligations. This new act on patient rights and obligations will apply without distinction to domestic and cross-border patients, thus transposing most of Luxembourg's obligations as a country of treatment of a cross-border patient.

The implementation of the Directive on the Application of Patients' Rights in Cross-border Healthcare in the Netherlands

This article discusses the significance of the Directive 2011/24/EU on the application of patients' rights in cross-border healthcare for the protection of individual patients' rights in the Netherlands by describing how its provisions are implemented in Dutch health law. The responsible Dutch authorities take the view that most of the Directive's provisions and requirements are covered in existing Dutch law. Implementation of the Directive would only require adaptations to national legislation with regard to the establishment of a national contact point for cross-border healthcare and the recognition of medical prescriptions issued in another Member State. This article looks into the question of how far the Dutch law meets the requirements of the Directive in relation to the individual patients' rights addressed in this special issue of the European Journal of Health Law.

Implementation of the Directive 2011/24/EU in the Czech Republic

The article describes implementation of the Directive 2011/24/EU in the Czech Republic, its consequences with individual patient's rights and financing of healthcare for citizens of the European Union.

Cross-border healthcare: Directive 2011/24 and the Greek law

The Greek legal framework on healthcare is characterized by the complexity of an immense number of laws and regulatory acts, particularly regarding the national health system. In the face front of that problem, the Directive stands as an effort (and an opportunity) to achieve a regulatory rationalization. The Law 3918/2011 established the National Organisation for Healthcare (EOPYY). EOPYY is the unique national contact point in the country for the purposes of the Directive, having a responsibility to ensure that the services provided by its affiliated healthcare providers meet certain quality and safety standards. Furthermore, the Greek legal system encompasses an integrated body of legislation on informed consent, privacy, and data protection, as well as an explicit reference to the 'quality, safety and efficiency' of medical services, and provisions related to reimbursement issues that need further regulatory specification.

Cross-border healthcare in Spain and the implementation of the Directive 2011/24/EU on the Application of Patient's Rights in Cross-border Healthcare

This work describes and assesses the implementation of the Cross-border Healthcare Directive in Spain. Although implementation has not yet taken place, the Government has already adopted a draft implementing regulation, on which this article is based. In addition, this article deals with a number of other rules that have been adopted in Spain, which are not strictly aimed at the implementation of the Directive but which are expected to facilitate its implementation and to help cement its effectiveness.

[The Patient Rights Act (PatRG)--part 2: informed consent, duty to inform, documentation of treatment, access to the patient file]

The article deals with the new regulations in the German Civil Code (BGB) which came into effect in Germany on 26 Feb 2013 as the Patient Rights Act (PatRG). In the second part, the consent of the patient (Section 630d Civil Code), the physician's duties to inform the patient (Section 630e Civil Code), the documentation of treatment (Section 630f Civil Code), and the right of access to the patient file (Section 630g Civil Code) are discussed and critically analysed.

Can I access my personal genome? The current legal position in the UK

This paper discusses the nature of genomic information, and the moral arguments in support of an individual's right to access it. It analyses the legal avenues an individual might take to access their sequence information. The authors describe the policy implications in this area and conclude that, for now, the law appears to strike an appropriate balance, but new policy will need to be developed to address this issue.

When to allow or deny adult access to children's health records

The Data Protection Act 1998, section 7, has long granted patients the right of access to their health records. The right is exercised by a subject access request and a person with parental responsibility may exercise this right on behalf of a child. However, once the child is considered Gillick competent then a subject access request to a child's records must only be granted with the consent of the child. In this article the author sets out the requirements for a subject access request and why community nurses and specialist practitioners must proceed with caution when a request is received in respect of a child from the age of 12 years.

In search of donor relations and identity: the missing voices of Israel's children

The voices of donor offspring and their families are missing from the debate regarding gamete donor anonymity v. openness in Israel, their unique predicament unheeded. Despite a context of worldwide change, various fears and myths impede the outlawing of donor anonymity, with Israel's medical establishment and legal representatives invested in maintaining a status quo characterized by regulations that discriminate between families whose members know their biological parents/siblings and those who do not. The most prominent of these is that abolishing anonymity leads to long-term shortage of donors, despite well-documented evidence to the contrary. A review of key research findings regarding the particular needs and experiences of offspring, recipients and donors clearly supports the need for a well thought-out re-evaluation of persistent fears and myths via the prism of grassroots reality. This evidence-based approach can lead to the formulation of recommendations that should facilitate, reflect and constitute such policy change.

Accessing donor conception information in Australia: a call for retrospective access

Donor conception practices in Australia have left thousands of donor-conceived people, their families and gamete donors bereft of information. The lack of a nationally timeline-consistent approach to information access has driven these people to seek support and information from self-help groups, online communities and even their own DNA. This article examines the historical perspective of information access and how progress is being made through lobbying and public awareness. To determine the current status of information availability, fertility clinics around Australia were surveyed. It is argued that current practices continue to fail donor-conceived people, their families and gamete donors, and that until all donor offspring are afforded the right to know their genetic family history, they will continue to suffer discrimination, and potentially risk psychological and physical trauma.

Keeping mum about dad: "contracts" to protect gamete donor anonymity

This article considers the legal status of so-called contracts for anonymity between fertility clinics and donors of gametes that were made in the period before legislation authorising disclosure. It notes that while clinics frequently cite the existence of these "contracts" to argue against retrospective legislation authorising disclosure of the donor's identity, they may be nothing more than one-sided statements of informed consent. However, the article notes that even if an agreement between a donor and a clinic is not contractual, it does not follow that a person conceived through assisted reproductive technology has any right of access to the identity of the donor. The writer has not been able to locate examples of written promises by the clinics promising anonymity. There are written promises by the donors not to seek the identity of the recipients. These promises do not bind the resulting offspring nor do they appear to be supported by consideration. The article suggests that the basis for any individual donor to restrain a clinic from revealing their identity may be found in promissory estoppel. Nevertheless, there is no real issue in Australia concerning clinics revealing these details absent legislative authority. The issue is whether parliaments will legislate to authorise the disclosure. The article notes that it would be rare for parliaments to legislate to overturn existing legal contracts but suggests that the contract argument may not be as strong as has been thought.

Donor conception legislation in Victoria, Australia: the "Time to Tell" campaign, donor-linking and implications for clinical practice

The State of Victoria in Australia was one of the first jurisdictions in the world to introduce legislation regulating donor conception. Under the Infertility (Medical Procedures) Act 1984 (Vic), donor-conceived people, aged 18 years and over, parents of children under 18 years, and donors gained the right to apply for the release of identifying information about each other recorded in a Central Register. As a result, of this and subsequent legislation, services providing donor treatment were obliged to change clinical practice relating to recruitment of donors, counselling of donors and recipients and recordkeeping. Since this legislation was introduced in 1988, over 5,000 donor-conceived children have been born and in 2006 the first 100 of these children reached the age of 18. The Victorian Infertility Treatment Authority (ITA) conducted a public education campaign to provide information and support to people affected by the legislation. This article describes clinical practice changes prompted by legislation, the 'Time to Tell" campaign and the service model developed for linking parties on the donor registers. The Victorian experience demonstrates that laws allowing the parties involved in donor conception access to information about each other must be accompanied by changes to clinical practice, public education about the implications of the laws, and services to meet the needs of those seeking information relating to donor conception and those contacted as a result.

Information rights and donor conception: lessons from adoption?

This article reviews the Australian experience in providing information rights for people separated through adoption, and considers its relevance in adjusting the competing interests of those involved in donor conception. The Australian laws, which differ from State to State, create information rights for adults who have been adopted, and also--with more qualifications--for other family members, such as birth parents and siblings. Some laws also seek to protect privacy, notably by use of the "contact veto". The author argues that the review of the Australian laws provides strong support for the rights of donor offspring, when adult, to information about their genetic origins. It also raises important questions about the rights and interests of other family members involved in donor conception, and how they might be accommodated.

Donor-conceived individuals and access to information about their genetic origins: the relevance and role of rights

The discourse of rights has increasingly been used to frame debates about access to information for donor-conceived individuals. This article seeks to clarify the moral and legal basis upon which human rights are relevant to this issue. It outlines the elements of a substantive rights-based approach which is then used to resolve the competing rights of a donor and a donor-conceived individual. Three arguments are offered. First, donor anonymity must be prohibited prospectively and donor-conceived individuals must be entitled to information about their genetic parents. Secondly, a context-sensitive application of a human rights-based approach allows retrospective access to non-identifying information but precludes retrospective access to identifying information where a donor wishes to remain anonymous in circumstances where anonymity was guaranteed at the time of donation. Finally, despite this finding, a rights-based approach requires states to actively encourage such donors to consent to the release of identifying information and to take reasonable steps to support donor-conceived individuals in circumstances where donors refuse to provide their consent.