Skeletons in the Family Medical Closet: Access of Personal Representatives to Interoperable Medical Records

Abstract

The growing use of interoperable electronic medical records poses difficult questions about access by personal representatives to medical records. HIPAA defers to state law about access by personal representatives. Although some states have mechanisms for patients to specify what parts of their medical records their personal representatives should be able to see, most do not. Moreover, interoperable records may not be designed to allow for more granular management of different types of information such as reproductive histories or mental health information. The result may be that representatives have access to information that patients would not want them to see -- and that is not relevant to decisions about their current health conditions. This article addresses allowing patients more control over their representatives' access to their medical records, an issue that has been largely forgotten in the enthusiasm about interoperable medical records.

Keywords: advance directives, privacy, confidentiality, personal representative, HIPAA, medical record