Electronic records and patient entitlement

One of the major mis-interpretations of the HIPAA law  is that the patient has legal ownership of the medical record in a doctor’s office. In actuality, the patients merely have a right to access their record. But what does record mean? In an electronic system, how much of the system is a part of the record? Can the patient demand access to  internal system variables used to construct the record?

Before electronic records systems were available, medical charts were kept on paper. The charts were literally in the doctors’ hands. When HIPAA came along, you could demand a copy of the chart , but the doctor still owned the original pieces of paper and manila folder. [consumer’s guide, rule summary(pdf)] The chart stopped and started with the pieces of paper.

Now that many electronic medical systems are in place, the notion of ‘record’ has become more ethereal and  elusive. Like all software, EMR products will have lots of internal technical variables to keep track of how to construct charts, display values and the like.  These variables are the electronic equivalent to the file cabinet, manila folder and sticker on the outside of a physical chart.

These internal variables, while not directly shown on the patient chart, ARE used to determine what is shown there. Things like global drug reaction tables or information about published regimens are just a few examples of these types of data. Does the patient really have a right to know what the internal primary key of the electronic approval for their saline treatment is? Do they have the right to know your database schema? Your template prototypes? your XMB or YLA? or any number of other made-up tech terms?

If they do, do these internal variables become a part of the record? Under HIPAA law, must things like timestamps  and internal ids be transmitted to other providers? Exposing these internals may leak trade secrets or, worse,  expose software security holes.  I am being a bit pendantic here, but There needs to be a clear definition of where the patient record stops and where the EMR software internals begin.

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