Response to Open Peer Commentaries on “Compelled Authorizations for Disclosure of Health Records: Magnitude and Implications”

Abstract

Lee Black and Emilie E. Anderson (2007) make a key point about the important role of physicians in protecting the confidentiality of health records. Regardless of the design features of a health record system, the first requirement of health privacy and confidentiality is trust by patients in their health care providers. If patients lack trust in their physicians’ commitment to protect their sensitive health information, they will not disclose matters essential to their health and they may even forego medical care altogether. We agree that the ethical duty of physicians to protect the confidentiality of patient health records does not change with the advent of electronic health records. The American Medical Association’s (AMA’s) Code of Ethics, section 5.07, which Black and Anderson quote, provides, in part, that “[r]elease of confidential medical information from the data base should be confined to the specific purpose for which the information is requested and limited to the specific time frame requested . . . ” (AMA 2006). Contextual access criteria, which, in our main article, we urge policy makers to research, develop and incorporate into the Nationwide Health Information Network (NHIN), would substantially assist physicians and other custodians of health records by facilitating more targeted disclosures of health information in response to an authorization. The AMA’s statement that disclosures “should be confined” to relevant matters is of little practical value if there is no way for a physician to respond easily and accurately to a request for disclosure of a certain class of health information. Physicians simply do not have the time to scour health records to assess what entries in a voluminous record meet the criteria for disclosure. Black and Anderson suggest that physicians are in a “unique position to help patients understand what the disclosure means and how to limit such disclosures to the