Over the last 10 years or so I have witnessed a significant upward trend in requests for the provision of complete copies of medical files from a third-party i.e. a party outside the primary doctor:patient relationship.
I have previously written (Justice and Harm Minimisation – Is that possible?) about situations where there is a legal requirement to release files, but “voluntary” requests are more common in my experience.
Increasingly insurers, particularly insurers that hold income protection, life or TPD insurance, and sometimes motor accident scheme insurers (but rarely, if ever, Tasmanian Workers Compensation Insurers), request copies of entire medical files. It has become less common for insurers to seek a formal report or ask for specific information, such as details of a specific medical condition or information about capacity to work.
Requests for file copies are usually accompanied by a relatively non-specific consent to provide medical information in event of a claim.
I have no firm basis for an opinion about the extent of this change, or the reasons, but my observations suggest.
- Medical Practice software in almost universal use, means consultation records, referral letters and investigation results are type-written and stored in the practice software database. This facilitates the provision of full electronic file copies, and forwarding to another party “at the touch of a button”.
- Some doctors, or at least the entities that own the medical practice, see the sale of medical of medical information as a valid income generating activity, particularly in an environment of corporate medical practice where the focus is on efficient scheduling of a doctor’s consultation time to maximise income, leaving little administrative time for doctor’s to undertake non-clinical activity, such as the preparation of formal reports.
- Doctors can be reluctant to write reports, whether due to disinterest, a perception that the activity doesn’t contribute to health outcomes, concerns about wasting time or insufficient remuneration. This can contribute to third party motivation to request file copies, rather than seeking a formal “purpose-specific” report.
I suspect however that the above factors are probably less important than the recognition by the insurance industry and other third parties with a business interest in medical information, about potential advantages from an insurer perspective, as follows:
- Seeking a file copy is a faster option to obtain information, actioned as an administrative task, rather than having to rely on a doctor’s response
- The administrative task of producing a copy of the file, is likely to be less costly that seeking a formal report requiring professional time
- The third party has the opportunity to look through all the detailed information to determine what information is relevant to their needs, rather than relying on the doctor’s interpretation
- Complete file release overcomes any potential for adverse medical information to be hidden from the third party or any selectivity by the treating doctor about the information presented in a formal report
Third parties, I suspect, often lose sight that the primary purpose of medical records is to assist the treating doctor manage treatment as an “aide-memoire” and as a communication tool between practitioners involved in treatment. The main purpose of records is not to provide an account of treatment for the benefit of authorities or third party business interests, although legal decisions tend to reinforce the importance of these secondary purposes.
Routine provision of medical file copies to non-medical organisations , however raises a number of concerns:
- The doctor who compiled the records and is aware of clinical background which might not be recorded on the file, can potentially provide information of greater relevance to the matter being investigated
- The records are not intended for interpretation by non-medical entities, leaving scope for misinterpretation, particularly of consultation notes
- Medical files accessed and copied to third parties, might be held beyond the period necessary creating an unnecessary risk of inappropriate access or disclosure
- There are concerns about security and access restriction on records, particularly when they are not under the control of a doctor who has primary ethical and legal responsibility for patient confidentiality
- The records might be utilised for activities outside the scope of their original provision
The most significant issue, in my view, is that the practice of providing entire file copies, undermines the whole concept of a confidential medical file and the “doctor-patient” relationship. With widespread accessing of files there is potential for patients to lose trust and might not divulge important information to their doctor, for fear of adverse consequences and doctors themselves might adopt less that satisfactory record keeping and fail to record important information in the file if concerned about loss of confidentiality.
Like most things it should be a matter of balance. Very few would argue that the Law Enforcement Officers should not be able to examine a detailed medical file if the information has reasonable prospects of solving a case of serious criminal activity or where the safety of the wider community is at risk. The widespread “trading” of medical files to assist insurers defend claims seems inappropriate to me, when there are alternative ethically sound and less intrusive means of obtaining necessary information.
Requests for copies of entire files by income protection insurers has become widespread. I have developed a practice policy that reinforces the privacy of medical records and states the preference for provision of a purpose-specific report provided there is an informed purpose-specific written consent provided by the person. The circumstances where a full copy might be released are spelled out in the policy.
Recently there has been an increase in the number of commercial entities that offer services to insurers to obtain medical information (including release of complete file copies) from medical practices, increasing the commercial interests from the release of medical file information. The businesses that have offered such services over many years have recently been joined by larger corporate providers of independent medical advice offering enhanced processes to retrieve medical records from medical practices. I believe that is an adverse trend.
What is the appropriate response to these trends?
- Medical practices need to develop policies to communicate their stance in relation to file access and requirements for consent
- Doctors responsible for patient care need to be involved in assessment of any risks involved in the release of medical records
- Where insurers (or brokering entities) make reasonable requests for reports with an appropriate consent, these requests be met by the practice within a reasonable timeframe at realistic cost
- Publicity about the negative aspects of complete file release
I would like to raise awareness of the trend for medical records to as a tradable commodity and the downside of that trend
I am interested to hear the perspectives of others on this matter.