The Physician’s Role
While it is understandable that some patients might have concerns about other healthcare entities’ access to their PHI, including office staff, the amount of information requested in this scenario about the scope of access appears to fall outside of a “reasonable accommodation.” However, this case does point out the importance of the physician’s keen oversight of those staff members who participate in the recording of a patient’s PHI, especially the background, capabilities, and trustworthiness of a scribe. The veracity of the information input by a scribe is not only important to the patient’s clinical care, but also to the legal integrity of the documents. The patient is entitled to know how much responsibility is given to a scribe as well as the level and extent of the physician’s oversight of the information the scribe inputs into the EHR. Failure to identify
inaccurate information in the medical record can be harmful to the patient and may jeopardize the physician. Therefore, the patient poses a valid concern. The physician need not discuss personal or private information about the scribe, or any staff, in order to reassure the patient of her/his integrity. A general description of the education and training of the scribe, however, would be worthwhile to explain to the patient.
The patient has an ethical and legal right to learn of any breaches to his secure PHI in a timely manner, and with guidance on any potential risk. The American Medical Association Council on Ethical and Judicial Affairs has outlined the appropriate procedures of disclosure to the patient if such a breach has occurred.1 Just as with breaches of financial information, the patient, and potentially his family, could be at great risk if sensitive PHI were obtained and misused. If no breaches have occurred, the patient can be reassured and given an explanation of the security barriers in place to prevent breaching of the EHR or other sources of PHI. If the patient cannot be dissuaded from requesting the withdrawal of PHI from the EHR, then some accommodation or compromise must be pursued through further discussion.