Where patients have access to their medical records online, it is important for physicians to filter what information is posted and when, says Sharona Hoffman, JD, LLM, co-director of the Law-Medicine Center at Case Western Reserve University School of Law in Cleveland, OH.
"You don’t want a patient to find a cancer diagnosis by logging on by themselves at midnight and seeing that up there," she says. "If it requires an explanation or is potentially upsetting, it requires a call, as in the old days."
Doctors at Cleveland Clinic post routine information on the MyChart patient portal (manufactured by Verona, WI-based Epic), but physicians still call with important test results or instructions. (For more information, see resource at end of this article.
Relying exclusively on MyChart would be dangerous, says Hoffman, "because patients may simply not check MyChart or may not understand the material that is posted. Therefore, they wouldn’t receive information that they really need to have."
Think through the risks
Hoffman says physicians "have to think through the malpractice risks." If physicians don’t communicate directly with the patient, they can’t be sure he or she has the information, understands it, and knows what next steps to take.
"If treatment is adversely affected by insufficient communication, you could potentially face malpractice claims," Hoffman warns.
The question is how providers can reduce risks by improving communication with each other while actively involving the patient, says Daniel O’Connell, PhD, principle of the Communication Training Group, a Seattle-based firm that provides training to physicians.
"For decades, we have relied on copies of consult notes and progress notes being mailed, faxed, or forwarded to other treating clinicians, when we are aware of their existence," he says.
The patient is now being included in the information loop. As electronic health records (EHRs) become even more widely used, and the concept of meaningful use extends to greater involvement of the patient, more patients will have access to their entire medical record, says O’Connell.
O’Connell says physicians should consider these approaches to decrease liability risks:
• Provide patients with readable glossaries of terms, recommended websites, and vetted sources of healthcare information.
"We would then expect that patients will become more active and sophisticated, both in managing their healthcare situations and in communicating efficiently and effectively with the multiple providers," he says.
Avoid information overload
• Recognize that information overload presents liability risks.
Physicians must use discretion in deciding the scope and timeliness of information sharing to prevent waste and potential patient harm, says O’Connell.
• Find ways to transmit information in ways that are "easily digestible" by patients, as well as busy clinicians and support staff.
"Information must flow across EHRs so as to be readily available for in-person, phone, and electronic interactions with the patient about their conditions," O’Connell says.
- Epic’s MyChart gives patients controlled access to the same medical records their doctors use, via browser or mobile app (for iOS and Android), including test results and upcoming appointments. For more information, contact: Epic in Verona, WI. Phone: (608) 271-9000. Fax: (608) 271-7237. Email: [email protected]. Web: https://www.epic.com/software-phr.php.
