So You Want to Share Your EMR?

Some medical groups are allowing patients online access to electronic medical record (EMR) notes taken by their doctors. Many hope access to doctors' notes will improve patient compliance and outcomes. However, the practice raises a number of issues.

Some medical groups are allowing patients online access to electronic medical record (EMR) notes taken by their doctors. The hypothesis is that by allowing patients to do so, they become more engaged and compliant and their outcomes will improve. A few studies so far indicate it might be true.

However, there are some issues confronting patients and their doctors preventing widespread adoption of doctor-patient data sharing:

1. Who should have which decision rights when it comes to online access?

2. Should patients have the right to edit their data and how would that be done?

3. Patients are increasingly interested in accessing and sharing their data with relatives or Facebook friends. How do we reconcile "protect but share"?

4. The sick-care business model places a premium on protected data with little incentive to share. Lack of EMR interoperability does not help.

5. Doctors have liability and workflow concerns.

6. Doctors and their staff don't get paid to do online chats.

7. It is questionable whether most patients are willing and able to assume responsibility for and accept the consequences of their care decisions, particularly when they use do-it-yourself medicine to avoid costs. Will this actually increase, rather than decrease per capita costs of care?

8. There is still a digital divide. Nineteen million Americans still lack access to broadband. Arguably, these are patients who need it the most.

9. The medical education establishment has not responded to the need to provide digital health knowledge, skills and abilities to medical students and residents.

10. Security, privacy, and confidentiality could become more compromised than it already is. Doctors could "fudge" the record either out of fear or patient demands to eliminate potentially damaging or stigmatizing information, like substance abuse, mental, or behavioral health notes.

We'll have to share the data on data sharing to see if it helps achieve better outcomes. In the meantime, it just might be something that seemed like a good idea at the time.