Medical records, which include physician notes, lab results, and billing details, are no longer isolated to a single facility. Different hospitals can generally view your information due to a push for digital data sharing across the healthcare system. This ability is not limitless, however, as strict federal regulations govern when and how protected health information (PHI) is shared between medical facilities. The primary goal of enabling this exchange is to ensure continuity of care, improve patient safety, and streamline administrative processes.
The Legal Framework Governing Data Sharing
The foundation for medical data sharing in the United States is rooted in regulations designed to strike a balance between patient privacy and the necessity of coordinated medical treatment. The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule establishes the conditions under which a hospital or other covered entity can use or disclose a patient’s PHI. In most scenarios, sharing PHI requires a patient’s written authorization, but there are significant exceptions built into the law.
The most common exceptions permitting sharing without explicit patient consent fall under what is known as Treatment, Payment, and Healthcare Operations (TPO). Treatment refers to the direct provision, coordination, or management of healthcare, such as a primary care doctor sending records to a specialist for consultation. Payment includes activities related to receiving reimbursement for services, like a hospital submitting a claim to an insurance company. Healthcare Operations covers administrative functions necessary to run the facility, such as quality assurance, auditing, or business planning.
TPO disclosures are permitted because requiring authorization for every instance of sharing would significantly slow down and complicate the delivery of care. For example, a hospital’s emergency department needs immediate access to a patient’s medication list and allergies to provide safe treatment, a process that cannot wait for signed paperwork. While the law permits these disclosures, it also imposes the “minimum necessary” standard, requiring that the amount of information shared be limited to what is needed for the specific purpose.
Mechanisms for Health Information Exchange
The transfer of medical records between different hospital systems is primarily facilitated by technology, through Electronic Health Records (EHRs) and Health Information Exchanges (HIEs). EHRs serve as the digital repository for a patient’s records within a specific health system, standardizing the data for electronic transmission. HIEs are regional, state, or national networks that connect these disparate EHR systems, creating a secure, centralized or federated conduit for data.
HIEs allow providers to access necessary information from outside their own organization, which is particularly useful when a patient receives care from multiple facilities. This sharing happens through two main technological modalities: “push” and “pull” exchange. The “push” method, known as Directed Exchange, is an intentional, point-to-point transmission of a specific record, such as a discharge summary sent from a hospital to a patient’s primary care physician following an inpatient stay.
The “pull” method, or Query-Based Exchange, allows a provider to search the HIE network for a patient’s medical history from multiple connected organizations simultaneously. When a hospital admits a new patient, a clinician can query the HIE using the patient’s demographic information to “pull” records like past lab results, diagnoses, and allergies from other participating providers. This access ensures all relevant information is available at the point of care, especially in emergency situations where a patient may be unable to communicate their history.
Patient Control Over Record Access
Patients retain significant rights regarding their medical records, providing them with agency over who sees their information and how it is used. Under federal law, patients have the right to request and obtain a copy of their PHI. They also have the right to request amendments or corrections to their records if they believe the information is inaccurate.
Patients can generally request that a provider restrict the use or disclosure of their PHI for TPO purposes, though the provider is usually not required to agree to this limitation. There is, however, one mandatory exception where the healthcare provider must honor the restriction request. If a patient pays for a healthcare service entirely out-of-pocket and requests that the information related to that service not be disclosed to their health plan for payment or operations purposes, the provider must comply.
Health Information Exchanges often operate on an “opt-out” consent model, meaning a patient’s data is automatically included in the HIE unless the patient actively submits a form to withdraw participation. Opting out prevents participating providers from querying and retrieving a patient’s records through the HIE, but it does not stop all sharing. Records may still be shared in an emergency when a clinician needs the information to prevent harm, or via the directed “push” exchange between providers for treatment purposes.