Abstract
BackgroundInternationally, patient access to notes is increasing. This has been driven by respect for patient autonomy, often recognised as a primary tenet of medical ethics: patients should be able to access their records to be fully engaged with their care. While research has been conducted on the impact of patient access to outpatient and primary care records and to patient portals, there is no such review looking at access to hospital medical records in real time, nor an ethical analysis of the issues involved in such a change in process.MethodsThis study employed a systematic review framework in two stems, to integrate literature identified from two searches: Medline, CINAHL and Scopus databases were conducted, (for (1) hospitalised patients, patient access to records and its effects on communication and trust within the doctor-patient relationship; and (2) patient access to medical records and the ethical implications identified). The qualitative and quantitative results of both searches were integrated and critically analysed.Results3954 empirical and 4929 ethical studies were identified; 18 papers representing 16 studies were identified for review (12 empirical and 6 ethical). The review reveals a consensus that our current approach to giving information to patients – almost exclusively verbally – is insufficient; that patient access to notes is a welcome next step for patient-centred care, but that simply allowing full access, without explanation or summary, is also insufficient. Several ethical implications need to be considered: increased information could improve patient trust and knowledge but might transfer an (unwelcome) sense of responsibility to patients; doctors and patients have conflicting views on how much information should be shared and when; sharing written information might increase the already significant disparity in access to health care, and have unforeseen opportunity costs. The impact on medical practice of sharing notes in real time will also need to be evaluated.ConclusionsThe review presents encouraging data to support patient access to medical notes. However, sharing information is a critical part of clinical practice; changing how it is done could have significant empirical and ethical impacts; any changes should be carefully evaluated.
Highlights
This mandate was built on respect for patient autonomy as a primary tenet of medical ethics: patients should be able to access their records to be fully engaged with their care
It was noted that clinician contact for portal users increased, and, perhaps related to this, disparity of uptake among different ethnic and socioeconomic groups was noted. While these reviews demonstrate significant bodies of research on the impact of patient access to outpatient and primary care records and to patient portals, there is no such review looking at access to hospital medical records in real time, nor an ethical analysis of the issues involved in such a change in process
Our aim was to review empirical papers relating to patient access and contribution to medical records, and consider the ethical issues raised by this proposed change in practice to fully appreciate the consequences of access to notes in real time
Summary
This has been driven by respect for patient autonomy, often recognised as a primary tenet of medical ethics: patients should be able to access their records to be fully engaged with their care. The U.K. government mandated that patients should be able to readily access their electronic medical record by 2018, a promise which has not been fulfilled, mostly due to logistical difficulties [2]. This mandate was built on respect for patient autonomy as a primary tenet of medical ethics: patients should be able to access their records to be fully engaged with their care. A 2003 (Ross and Lin) [10] and 2007 (Ferreira et al) [11] review of the literature in these fields found that patient access was unlikely to cause harm and can improve doctor-patient communication and relations; the latter review identified the potential for patients to spot and correct mistakes in their records
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
