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. 2022 Feb 17;24(2):e34085.
doi: 10.2196/34085.

The 21st Century Cures Act and Multiuser Electronic Health Record Access: Potential Pitfalls of Information Release

Simone Arvisais-Anhalt  1   2 , May Lau  3 , Christoph U Lehmann  4   5 , A Jay Holmgren  6 , Richard J Medford  7 , Charina M Ramirez  8 , Clifford N Chen  9
Affiliations

The 21st Century Cures Act and Multiuser Electronic Health Record Access: Potential Pitfalls of Information Release

Simone Arvisais-Anhalt et al. J Med Internet Res. .

Abstract

Although the Office of The National Coordinator for Health Information Technology's (ONC) Information Blocking Provision in the Cures Act Final Rule is an important step forward in providing patients free and unfettered access to their electronic health information (EHI), in the contexts of multiuser electronic health record (EHR) access and proxy access, concerns on the potential for harm in adolescent care contexts exist. We describe how the provision could erode patients' (both adolescent and older patients alike) trust and willingness to seek care. The rule's preventing harm exception does not apply to situations where the patient is a minor and the health care provider wishes to restrict a parent's or guardian's access to the minor's EHI to avoid violating the minor's confidentiality and potentially harming patient-clinician trust. This may violate previously developed government principles in the design and implementation of EHRs for pediatric care. Creating legally acceptable workarounds by means such as duplicate "shadow charting" will be burdensome (and prohibitive) for health care providers. Under the privacy exception, patients have the opportunity to request information to not be shared; however, depending on institutional practices, providers and patients may have limited awareness of this exception. Notably, the privacy exception states that providers cannot "improperly encourage or induce a patient's request to block information." Fearing being found in violation of the information blocking provisions, providers may feel that they are unable to guide patients navigating the release of their EHI in the multiuser or proxy access setting. ONC should provide more detailed guidance on their website and targeted outreach to providers and their specialty organizations that care for adolescents and other individuals affected by the Cures Act, and researchers should carefully monitor charting habits in these multiuser or proxy access situations.

Keywords: 21st Century Cures Act; Information Blocking; Open Notes; adolescent Health; cures act; electronic health information; electronic health record; health IT Policy; health information; information technology; multiuser EHR access; patient care; proxy EHR access.

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Conflict of interest statement

Conflicts of Interest: ML has been compensated for presentations for the Texas Pediatric Society, for consulting on modules to educate providers for Texas Health Steps, for time working with the Texas Essential Knowledge and Skills Proclamation 2022 Review Adoption Review Panel, and as a consultant for the Texas Child Psychiatry Access Network. She was also awarded support funds through the Technology and Adolescent Mental Well Being (TAM) youth Advisory Board (funding to start in January 2022), received a grant from Texas Pediatric Society Foundation, and is a Nexplanon trainer for Organon. CUL owns shares in Celanese and Markel. The remaining authors have no conflicts to declare.

Figures

Figure 1
Figure 1
Elements of the United States Core Data for Interoperability [11].
See this image and copyright information in PMC

References

    1. P.L. 114–255, Approved December 13, 2016 (130 Stat. 1033) Social Security. 2016. [2022-02-09]. https://www.ssa.gov/OP_Home/comp2/F114-255.html#:~:text=An%20Act%20to%20... .
    1. 21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Final Rule: Summary of Information Blocking and Eight Exceptions. CHiME Public Policy. [2022-02-09]. https://chimecentral.org/wp-content/uploads/2020/06/061420_CHIME-Informa... .
    1. About ONC. The Office of the National Coordinator for Health Information Technology (ONC) [2021-03-20]. https://www.healthit.gov/topic/about-onc .
    1. About ONC's Cures Act Final Rule. The Office of the National Coordinator for Health Information Technology (ONC) [2021-03-20]. https://www.healthit.gov/curesrule/overview/about-oncs-cures-act-final-rule .
    1. What ONC's Cures Act Final Rule Means for Patients. The Office of the National Coordinator for Health Information Technology. [2021-03-20]. https://www.healthit.gov/curesrule/what-it-means-for-me/patients .

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