Confidentiality in the Age of Open Notes

Authored by: Elizabeth Miller, MD, PhD and Jake Sese, MPH

The shifts toward telemedicine and newly expanded patient access to medical records, driven in part by the 21st Century Cures Act (Cures Act), have brought significant changes to how health information is documented and shared. The Cures Act was put into place to address “information blocking” which can obstruct communication that could be used to improve patient care. Withholding data from electronic health records (EHRs) or failing to provide access to medical records can impact care coordination and can harm a patient. However, as more patients, including survivors of intimate partner violence (IPV), human trafficking (HT), and exploitation (E), gain access to their EHRs, the potential for breaches of confidentiality and harm increases. Specific attention is needed to protect confidentiality and privacy for survivors. This brief explores confidentiality policies and practices, safety considerations for survivors, methods for disclosing limits of confidentiality to patients, EHR adaptations, tracking IPV/HT/E measures in the Uniform Data System (UDS), and client-centered approaches to care.

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