Five years after the U.S. Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology (ONC) developed the 21st Century Cures Act al-lowing patients expanded access to their electronic health records, the sweeping law is, for all practical purposes, in full effect. And although the increased transparency that the law represents is empowering to patients, it does require adjustments for physicians.

“There’s always been this veil of mystery around physicians’ notes,” said Áine Yore, MD, an emergency physician affiliated with Providence Regional Medical Center in Everett, Washington. “Before [the Cures Act], if the patient wanted to see their whole chart, they would have to request it from a medical records department, pay a fee and maybe wait weeks for it to be released.” Today, patients log in to their record to easily view appointment information, medication lists, lab results and, now, physicians’ clinical notes.

Given this latest development, emergency physicians weigh in on the law’s unique impact in the emergency department.

Sparking a Conversation

Any patient who can connect to an online patient portal can gain access to their information, and this becomes a jumping off point for doctor patient discussion about their health status. “Patients accessing their information in real-time fuels more questions about their results, leading to meaningful conversations with physicians,” explained Indira Gowda, MD, an emergency physician at University of California Los Angeles Medical Center. “As a result, patients end up better informed.” The easy availability Dr. Indira Gowda of information also enables patients to share it with family members or friends who may help them better interpret their results. “Research has shown this is especially true for non-English-speaking patients,” added Dr. Gowda.

To translate those real-time results into informative discussions, Dr. Yore is always prepared to give impromptu anatomy lessons in the patient room. “I’ll walk in and say, ’You’ve got a kidney stone,’ and they’ll say, ’Yeah, doctor, we know—we saw that an hour ago.’ And I’ll say, ’Okay, well, very good, let’s talk a little more about this,’” she explained. “And that gives me an opportunity to provide more education.”

Another potential benefit can be seen in cases of incidental findings. “You do a chest Xray to look for pneumonia, and it shows a spot on one of the lungs. Although this is a double edged sword because now the patient sees this and the radiologist is saying, ’Well, you have to rule out cancer,’ it also keeps us honest,” Dr. Yore said. “Maybe in the past some of us haven’t been too diligent about disclosing incidental findings and saying to patients, ’This is probably nothing, but you do need to follow it up and get that CT in six months,’ or whatever the recommendation is. So the patient is now independently aware, and I think this increases our compliance to that communication with patients.”