First Take: Medical records belong to patients. Period.

Patients own their medical record!

Patients share that ownership with their care providers. We should and will move away from a paternalistic model of command and control by physicians and hospitals over patients. The Open Records movement is a start. Donald Berwick, MD, of the Institute for Healthcare Improvement has been calling for doctors and hospitals to give the records to patients for years.

Patient ownership of medical records will require a shift in how physicians report information. The writing must be respectful at all times. There should be no surprises for the patient. How to report information such as alcohol and drug use, sexual matters, and patient feelings toward others may be discussed during the visit. In rare circumstances, the patient and physician may agree not to put something in the record. That is a delicate matter that has both medical and legal implications.

The transition from paper to electronic health records (EHRs) has increased the transparency of the medical record. Many records look awkward and sterile, lacking the prose of patient and physician expression. We have a long way to go to improve patient medical records in the digital age.

When patients have a unified digital medical record, confusion and redundancy will diminish. I envision that patient medical records will be much like the financial records people have with banks: secure and easily transferable.

Getting to that point is both a cultural and logistical transition. In California, by law, patients may request any of their medical records. No more is it strictly doctor-to-doctor or a hospital transferring medical records out of sight of the patient. At Eisenhower Medical Center, where I practice, we have a link on our website where a patient may log in securely and see any of their medical records, both from the clinic and from the hospital. With these innovations, patients taking ownership of their complete medical records follows naturally when the technology is ready.

In the future, equipped with their own records, patients will be able to assemble their medical homes. The patient’s primary care physician and team will partner with him or her for better health. Specialists will join the medical home as needed. The era of the patient at the center of care is beginning and is very exciting.

Patient-centeredness is one of the six core aims for healthcare in the 21st century as spelled out in the Institute of Medicine 2001 report, “Crossing the Quality Chasm.” The patient-centered medical home movement has been supported by all the primary care organizations since 2007.

This is not just lip service or a “motherhood and apple pie” declaration. It is a fundamental culture change for medicine that has its problems but is long overdue.

Joseph E. Scherger, MD, MPH, is a family physician in La Quinta, California, and a member of the Medical Economics editorial advisory board. Who owns medical records? Tell us at medec@advanstar.com.