Medical records, whether stored digitally in an Electronic Health Record (EHR) system or kept in physical charts, represent a comprehensive history of a patient’s health and care. The simple answer is that sharing occurs routinely, but it is strictly governed by laws that balance a patient’s right to confidentiality with the necessity of coordinated, safe medical treatment.
The framework that permits this sharing establishes clear boundaries and patient rights over how and when their sensitive health data is accessed by unaffiliated hospital systems. Sharing is essential for seamless healthcare, helping to prevent medical errors and ensure every doctor has a complete picture of the patient’s condition.
Standardized Sharing for Care Coordination
The primary mechanism allowing hospitals to share records without explicit patient authorization is the federal law that permits disclosure for Treatment, Payment, and Operations (TPO). Treatment refers to coordinating or managing healthcare between providers, such as a primary care doctor sharing notes with a specialist during a referral. This is permitted without requiring the patient to sign a new consent form for every interaction.
Payment activities involve the necessary exchange of information to receive reimbursement for services, including submitting claims to an insurance company or verifying coverage. Healthcare Operations cover a variety of administrative and business functions, such as conducting quality assessment activities, training staff, and managing legal or accounting services. The law requires hospitals and providers to limit the shared information to the minimum necessary amount to accomplish the intended purpose.
This information exchange across different, unaffiliated health systems is often facilitated by a structure called a Health Information Exchange (HIE). An HIE is a secure, electronic network that allows providers to access vital patient data, like lab results, discharge summaries, and prescriptions, at the point of care. This ensures that a hospital emergency room physician can quickly retrieve a patient’s medical history from their primary care office across town. Query-based exchange allows providers to find and request a patient’s information from other participants in the network.
Patient Authority and Control Over Record Exchange
Despite the permitted sharing for TPO, federal law grants patients significant rights to control and access their own protected health information. Patients have the right to request and receive a copy of their medical records, often including electronic copies, and can request that a provider amend any information they believe to be incomplete or incorrect.
Patients also have the right to request restrictions on the use and disclosure of their information, particularly for treatment, payment, or healthcare operations. While a hospital is generally not required to agree to all such requests, they must comply with a patient’s request to restrict the disclosure of information to a health plan if the patient has paid for the healthcare item or service entirely out of pocket.
Furthermore, patients often have the ability to formally “opt out” of participation in a Health Information Exchange (HIE). Opting out means that providers using the HIE will not be able to search for the patient’s records through that network. However, the hospital may still share information in other ways, such as for public health reporting or through direct provider-to-provider communication.
Information Requiring Enhanced Protection
Certain categories of health information are legally granted enhanced protection. Psychotherapy notes, for instance, are treated differently under federal law because they contain a therapist’s analysis of a conversation during a session and are required to be kept separate from the rest of the patient’s medical record. These notes cannot typically be shared for payment or operations purposes, even to an insurer, without the patient’s specific consent.
Records concerning substance use disorder (SUD) treatment are also subject to stringent federal confidentiality regulations, historically known as 42 CFR Part 2. While recent modifications have aligned some sharing practices with standard health information practices, these records still generally require a specific patient consent for disclosure.
In addition to federal rules, many states have laws that impose stricter protections on specific types of sensitive health data, such as HIV status information. These state laws may require specific written authorization before a provider can share HIV-related information, often superseding the standard federal permission for sharing for treatment purposes.