P2B037: Protecting Confidentiality in the Age of the 21st Century Cures Act: A Survey of Pediatric and Emergency Medicine Clinicians

Background: Federal legislation requires that patients have full access to all health information in their electronic medical records with limited exceptions. While this has been shown to improve many patient-centered outcomes, there are concerns regarding the impact on patient safety and privacy. The goal of this study was to understand how the implementation of open access medical notes has affected how clinicians protect confidential patient information in their practice.

Methods: We surveyed faculty physicians, resident physicians, and advanced practice providers (APPs) in the Departments of Emergency Medicine (EM) and Pediatrics at a tertiary academic care center with an integrated children’s hospital. The survey evaluated clinician attitudes, documentation behaviors, and knowledge about protecting confidential information. All survey questions were optional, and missing data points were excluded from final analysis. Responses were stratified by training background, years of training, and department affiliation. Differences between groups were characterized using contingency table analysis. Significance levels were determined by Chi-Square statistic and Fisher’s exact test.

Results: Survey results were returned from 97 participants, representing 61 faculty physicians, 16 resident physicians, and 11 APPs. Participants identified their primary department (Pediatrics, 75.0%; EM, 23.9%; Declined, 1 respondent), and 26 respondents cited an adjunct appointment in Pediatrics or EM.

Since the implementation of open access medical notes, Pediatricians were more likely than EM clinicians to have changed how they document a diagnosis (p = 0.0028). Resident physicians were the group most likely to discuss with a patient when they were unsure what information should be considered confidential (p = 0.0480).

Pediatricians were more likely (69.7%) than EM clinicians (57.1%) to report that they know how to use their electronic health record (EHR) to protect confidential information, although this association was not significant (p = 0.2878). Almost half of all participants have used features of the EHR to protect confidential information, with 35.2% utilizing a note type that is exempt from access regulation. While over 25% of participants were unaware that some kinds of medical notes are not available for patients to access, 35.2% have utilized a note that is exempt from open access regulation.

Pediatricians were more likely (30.3%) than EM clinicians (14.3%) to report knowledge of a situation where patient care was compromised by a patient reading a medical note, but this association was not significant (p = 0.1471). Fewer respondents (7.5%) were able to identify a situation where increased access to medical notes contributed to a breach of patient confidential information.

Conclusion: The results of this study affirm that EM and Pediatrics professionals encounter the challenge of protecting confidential information in their medical documentation. Pediatricians were more likely than EM clinicians to identify confidential information and utilize features of their EHR to protect patient privacy.