Recommendations, Best Practices

Once real-time information sharing is recognized as fundamentally good with limited exceptions, further efforts should maximize patient benefits.

First, information for patients about how to find their records must be developed and disseminated. Additionally, a disclaimer notice should be tied to uncounseled results being released. These practices seek to support patients’ autonomy to access the information while informing them of potential harms of doing so.

Both instructions on access and anticipatory guidance can be provided via multiple avenues, such as inclusion in discharge instructions, notification via email, provider discussion with patients prior to discharge, and notifications or alerts on the patient portal itself.

For patients who are elderly, disabled, or economically disadvantaged, who may have more difficulty accessing real-time information, it is important to identify a process by which they may register to receive such information if desired. These practices will reduce inequities in the current landscape of EHI sharing.

Training opportunities for documentation best practices should be employed. Recognizing that patients will read the record immediately should promote tactful wording by the physician in the medical note. Specifically, jargon and abbreviations should be avoided, especially ones that can be misinterpreted (e.g., SOB), and alternative value-neutral descriptors should be used (e.g., “substance use disorder”

rather than “drug addict”).

Finally, in accordance with the paucity of empiric data demonstrating harms and the ethical considerations outlined, exceptions to real-time EHI sharing should be exceedingly rare. However, there should be a formalized process within the current documentation workflow for physicians to opt out of real-time release, which could be as simple as a toggle at the top of the notes/orders section. Defaulting to the automatic release of EHI should be maintained and exceptions should adhere to regulatory criteria.

Dr. Bookman is professor and vice chair of operations, department of emergency medicine at the University of Colorado School of Medicine and senior director of informatics for UCHealth, in Aurora, Colo.

Dr. Bissmeyer is a senior resident at Orange Park Hospital in Jacksonville, Fla.

Dr. Denley is a first-year attending at Ochsner Health in New Orleans, where he completed a year as chief resident, and current EMRA President.

Dr. Sauder is an emergency physician working in Kettering, Ohio.

Dr. Traill is a clinical assistant professor at Michigan State University, in Ann Arbor, Mich.

Dr. Kluesner is the associate program director of the Iowa Methodist EM Residency Program working in a community-based nonprofit in Des Moines, Iowa.