Current federal law mandates that patients have access to their medical records. Parents can, by proxy, have access to their child’s electronic medical records.
There have been concerns about the balance between transparency and privacy, particularly with regards to the medical records for adolescents, especially when reproductive care and mental health are discussed during medical visits.
This week, Pediatrics is early releasing a Case Report that raises another instance where we should be alert to the possibility of accidental information disclosure and how it can have unanticipated consequences. The Case Report is entitled “Perils of Auto-population of Newborn EHR with Maternal Intimate Partner Violence History,” authored by Drs. Casey Lamar, Deepak Jain, and Kristine Schmitz from Rutgers Robert Wood Johnson Medical School (10.1542/peds.2022-060189).
If you care for newborns, you will likely use a template that automatically transfers information from the birth parent’s chart into the newborn’s record. This information may include lab results, problem list, and medications, and is pertinent to care of the newborn.
In this Case Report, one of the problems listed in the mother’s chart was intimate partner violence, with details about the violence, and safety plan. The alleged perpetrator of the violence was the infant’s father. The template used for the infant’s birth note included this information that had been auto-populated from the mother’s chart. The chart was then signed. While the father of the infant did not have access to the mother’s chart, as a parent of the infant, he had legal access to the infant’s chart. At the time when the chart was signed, he could have accessed that note in the patient portal.
Fortunately, someone noticed that this information was in the infant’s chart, and it was manually removed in an addendum to the note. Any potential harm was averted.
Reading this Case Report will remind you to read notes carefully, including the information that is auto-populated, before you sign it, and to think about who has access to each note. Most institutions have tools that allow clinicians to block access to confidential information that they believe could cause harm if released (for instance, when an adolescent discloses that they are gay and have not disclosed this to their parents). Certainly, one must be judicious in using these tools, as “information blocking” can result in a hefty 1 million dollar fine, but using these tools to prevent the release of the information that could cause harm to an individual is allowable. Thus, these tools can and should be used when needed.
