Ethically Managing Your Patients’ Digital Health Information

inaccurate information in the medical record can be harmful to the patient and may jeopardize the physician. Therefore, the patient poses a valid concern. The physician need not discuss personal or private information about the scribe, or any staff, in order to reassure the patient of her/his integrity. A general description of the education and training of the scribe, however, would be worthwhile to explain to the patient.

The patient has an ethical and legal right to learn of any breaches to his secure PHI in a timely manner, and with guidance on any potential risk. The American Medical Association Council on Ethical and Judicial Affairs has outlined the appropriate procedures of disclosure to the patient if such a breach has occurred.¹ Just as with breaches of financial information, the patient, and potentially his family, could be at great risk if sensitive PHI were obtained and misused. If no breaches have occurred, the patient can be reassured and given an explanation of the security barriers in place to prevent breaching of the EHR or other sources of PHI. If the patient cannot be dissuaded from requesting the withdrawal of PHI from the EHR, then some accommodation or compromise must be pursued through further discussion.

Listen to Your Patient

With respect to this particular scenario, the physician would be well advised to invite the patient in for an informal discussion of his requests and to take the time to listen to the patient’s concerns before addressing them. Just why, after all the years of care by his physician, did the patient feel the need to make these requests? Perhaps something occurred recently in his life to bring about this anxiety or paranoia, and consultation from the appropriate healthcare provider might be appropriate. The patient can be reassured that the physician takes the protection of his PHI very seriously and appreciates his concern. Such a discussion will likely lead to a better understanding by the patient of the processes in place in the physician’s office to protect and defend his PHI, as well as the physician’s willingness to work with the patient toward a “reasonable accommodation.”

While it might be possible to alleviate the patient’s concerns and respond satisfactorily to his requests through a professional discussion, this may not be effective, and the physician will then need to follow the federal rules and regulations that govern protected health information. It is usually best to utilize the confidential patient-physician relationship to solve conflicts, and often an acceptable ethical solution can be found. Our responsibility is to find a way to preserve patient autonomy while still maintaining our professional integrity and following applicable legal guidelines.