can you keep a secret…

Monday, January 31, 2011

After days of worry, the parents of the Iowa thirteen can rest knowing that all of them have been released from the hospital hopefully no worse for wear. The treatment for rhabdomyolysis is aimed at protecting the kidneys from becoming clogged by the proteins released from muscle cells when they are damaged. Buried in the stories about their care was a release that suggested the athletes’ medical records may have been inappropriately accessed. This is a polite way of saying that people were snooping where they didn’t belong.

The electronic medical record has many advantages. It is legible (which is a bonus when considering physician handwriting skills), easily shared among multiple care providers, and can help promote medical safety issues. The difficulty is that an electronic record is too accessible. A person with a password may be able to get into a medical record where they aren’t supposed to be and while security monitoring exists, the access damage has usually already occurred.

With a written medical record, the ability to touch the information was much more difficult. If a patient was in the hospital, the chart was stored at the nursing station and it was hard to take an anonymous peek. Once the patient was discharged, the chart was stored in a central medical records department where the doctor had to request the chart and had to fill our paperwork that would make a bank safe deposit vault proud.

The penalty for accessing an electronic chart inappropriately is severe and usually begins with being fired. Unfortunately, it is hard to know who looks where unless a complaint is filed. Celebrity and VIP patients can have access restricted to their medical files but improper star gazing still occurs and leaks of information are not an uncommon event. What happens though, to John Q. Public? Because of the number of people who have to look at the chart when a person is in the hospital, one inappropriate look may go unnoticed and undetected. Aside from the doctors and nurses who care for the patient, others need to look from dieticians and therapists to coders, billers and insurance people. Add the people who do quality assurance, others who may be doing research and a patient’s medical record may be opened and reviewed by a legion of people.

Privacy is an important part of medical care. People would be unwilling to share their most personal secrets and thoughts if the felt there was a risk their medical records would be displayed for all to see. Unlike the internet privacy policies that people tend to ignore, medical release forms should be read and understood before routinely being signed. The ability to control personal information is a partnership of trust between the hospital and the patient and both need to be responsible and vigilant. It may be frustrating for a parent to need to ask permission to talk about their teenager’s medical care but the benefit of trust outweighs that inconvenience.

Celebrity is fleeting and the names of the Iowa thirteen don’t matter for lessons to be learned about over training and pushing athletes beyond what is safe. It is only right that each person be allowed to maintain their anonymity unless individually, they may choose to reveal their identity. The public’s right to know should stop at the hospital door.

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