Tuesday, April 26, 2011

who's chart is it?

is it mine?  i paid for the paper (now the computer) on which the data is stored, i wrote it and compiled it, i am required by law to keep it safe and maintain it years beyond any actual contact with the patient.

is it the patient's?  it is after all a record of their personal medical history, a repository of data that they may need access to in the future. does the patient have any real control over content? does a patient have a right to ask me to omit something from  his or her chart?

is it the insurance company's?  both the patient and i signed contracts giving the insurance company unlimited access to the chart, whether it is to be sure i am charting and billing correctly, or to be sure the patient has left no diagnosis, no matter how trivial, undeclared. (my least favorite task is filling out pre-existing condition forms for insurance companies, forms that basically hunt for some reason to deny a claim.  i feel like i am doing their dirty work, and possibly causing grief for my patient to boot, but i am obligated to fill them out.  they often have ridiculous questions like 'will this patient need surgery in the next five years?' i'm not making this up.)

is it the government's?  they increasingly want and demand access to cumulative chart data that has for so long been fragmented and inaccessible, data that now, with electronic health records, seems tantalizingly close to their fingertips.

is it the free market's?  electronic health records are already being mined by companies for marketing data, much as pharmacy records have been exploited for years.

i think the answer is e)  all of the above.


  1. As patients with chronic diseases we are told over and over to keep copies of all our medical records. Unless you have unlimited funds it is near impossible to do. Almost all of my doctors will give me copies of my records if I ask. But to receive a copy of records from a hospital, I have to pay the third party record retention company exorbitantly to obtain a copy. The records from one 26 hour hospitalization was $250. I understand your viewpoint that you compiled and paid for the creation of those records. But I paid you and the insurance company. And those records have information in them that can be vital to me. I have had things put into my medical record that were flat out wrong, such as a code for prostrate cancer. I'm a woman. That error probably wouldn't cause any problem, but if there is something that could be deleterious, other than to my pride, shouldn't I have the right to ask that it be removed? It's a sticky subject, and I feel it is unfortunate that we have to sully our relationships with each other by asking them.