The authors cited the following areas of concern expressed to them by their medical peers:

Disagreement over content: Physicians worry that their own notes and other entries may be difficult to understand by patients. They fear that patients will actually find errors in the entries, which could prove embarrassing at best and could expose them to legal action at worst. Further, as patients gather their own medical data via mobile devices and enter that information into their files, doctors are concerned about how that will be done and what its legal status will be. Currently, HIPAA considers patient records to be “owned” primarily by the medical provider. But as patients become more engaged in their records maintenance and review, questions will inevitably arise about who the true keeper of the data is.

Litigation: In an already litigious society, doctors are reluctant to invite even more legal action by allowing patients untethered access to their records. The authors suggest just the opposite could happen. “Transparent access may build trust, allay fears, and help identify important errors before adverse consequences ensure, reducing clinicians’ malpractice liability overall.”

Access to minors’ medical records: This one is a complex issue that raises basic questions of who has a right to see someone else’s records. The authors suggest a gradual access strategy in which vendors create EHRs that adolescents can partially access to help educate them about their own medical care.

Mental illness and clinicians’ notes: Another sensitive area, one in which practitioners have enjoyed great leeway till now. State laws vary on access to such records; the authors call for greater transparency under the guidance of consistent policies. “Clinicians and patients need to advocate for a more uniform landscape, such as a general principle of open access unless the clinician believes it would harm an individual patient.” Which, of course, still positions the provider as records gatekeeper.

Suspected abuse and electronic records: Physicians are mandatory reporters of abuse. But how far should they go in allowing patients who review how they have recorded this information? If a child has been abused by a parent, or a spouse by their partner, the specter of the victim’s family member accessing the information is raised in the physician’s mind.

All of these concerns are real and they illustrate that physicians’ concerns about the legal ramifications of complete patient access are hardly unfounded. Yet, the authors argue, transparency and access are already upon us. The question is, how will it be managed to the benefit of patient health?