Citation

Shum M, Asnes AG, Jubanyik K, Tiyyagura G. Ann. Emerg. Med. 2022; 79(5): 503-504.

Copyright

(Copyright © 2022, American College of Emergency Physicians, Publisher Elsevier Publishing)

DOI

10.1016/j.annemergmed.2022.01.015

PMID

35461585

Abstract

A patient presented to the emergency department (ED) with severe injuries in various stages of healing, necessitating transfer to another facility. The patient disclosed intimate partner violence but shared that her abuser had access to her electronic health record. With the patient's safety in mind, the physician documented the injuries without naming intimate partner violence and "unshared" the note using the "prevent substantive harm to patient" clause to restrict the abuser's access to the note. The patient also called the physician accepting the transfer to convey her concerns and suggest a visitor restriction. Documenting concern for intimate partner violence in her note could have endangered the patient's life; yet, omitting it from her note meant relying on tenuous verbal communications across institutions and failure to document a life-threatening social risk.

Intimate partner violence affects 1 in 4 American women, with children present during 50% to 75% of the episodes of intimate partner violence. One form of control exercised by abusers is by accessing the electronic health records of their victims and children, either legally or duplicitously, which may lead to worsening violence and interference with health care.

On April 5, 2021, the federal government implemented the 21st Century Cures Act, which specifies that health care providers should give patients access to electronic clinical notes without a charge or delay.3
The ruling significantly increased patient and guardian access to medical records...

Language: en