Shared Access to Medical Records

Electronic medical records make it easier for doctors to allow allied health professionals – e.g. Physiotherapists, Audiologists, Podiatrists, Social Workers, Psychologists, Speech Pathologists and Occupational Therapists – to access and contribute to patient files.

Benefits

Multidisciplinary access to medical records can improve continuity of care and patient safety, and reduce the time spent communicating. The Speech Pathologist who is treating a five-year-old can see a delay in developmental milestones which may be related to current speech patterns. A doctor may see that a Physiotherapist has recorded deterioration of a patient’s range of motion over several consultations. This may prompt the doctor to review the patient and consider imaging and/or referral to a specialist.

As Surgeon Atul Gawande put it:

The public’s experience is that we have amazing clinicians and technologies but little consistent sense that they come together to provide an actual system of care, from start to finish for people. We train, hire and pay doctors to be cowboys. But it’s pit crews that people need.¹

Managing the risks

Informing patients

Disclosing patient information to an allied health professional may be interpreted as a “secondary” purpose under Australian privacy law. This disclosure is acceptable if:

• the patient consented to the secondary use or disclosure, or
• the patient would reasonably expect the secondary use or disclosure, and that is directly related to the primary purpose of collection.

The practice’s privacy policy should include details about access by allied health professionals.

Access controls

Consider whether the patient would reasonably expect that their records would be available in totality to allied health professionals. For example, are they happy that the Podiatrist who is fitting orthotics can see their sexual health history? Can the software restrict access to only the relevant parts of the record?

Informing allied health professionals

Allied health professionals have the same obligations as doctors regarding privacy and confidentiality. Having them sign a confidentiality agreement may protect you in the event that they breach confidentiality using information from your notes. Allied health professionals could be included in staff training about privacy requirements.

Communication

Have clear guidelines for when specific communication other than writing in the notes should be made. Do not assume that urgent or important matters will be picked up in the notes.

Abbreviations that can’t be understood across professions may cause problems and should be clarified. For example, a Physiotherapist may add “cervical spine mobilisations” before recording the symbols for types of spinal mobilisations that are unique to their profession.

Data security

Privacy law also requires protecting the security of personal information. Reasonable steps may include:

• robust IT systems – firewalls, virus protection, frequent password updates, backups, maintenance of hardware and software
• procedures – appropriate staff access levels, safe and proper use of internet and email, signed confidentiality agreements from staff
• building security and alarms.

Karen Stephens
Risk Adviser, MDA National

Reference

1. Gawande A. Cowboys and Pit Crews. The New Yorker. May 26 2011.