EPtalk by Dr. Jayne 5/15/25

I was at a neighborhood gathering the other night. One of my neighbors was talking about her health experiences, and in particular, with wearable devices. Just from what I could see, she had an Oura ring, an Apple watch, and a continuous glucose monitor sensor. Someone asked her if they were recommended by her physician, and her response was essentially that she was following various wellness influencers for recommendations.

One of my older and more curmudgeonly neighbors (who is of course my favorite) made a comment about “not wanting all those people spying on me,” which made me smile. He’s the kind of guy who can type up a binding contract in minutes and can explain the appropriate use of a comma at the drop of a hat, so I enjoyed hearing his thoughts on End User Licensing Agreements and how “the young people are just giving their rights away.” The comments shocked the neighbor with the wearables since she had no idea that her health data isn’t covered by HIPAA when using consumer devices.

I did a quick web search later that evening and discovered that only roughly 9% of users actually read the licensing agreement or terms and conditions that come with new devices, services, or subscriptions. That number actually seemed high to me considering the number of agreements we all run into on a given day. I know I haven’t read one in a very long time, and when I do look at them, I tend to only look at specific portions. I avoid wellness apps and services that touch my health data, so that’s one level of privacy defense right there.

Another search brought me a decade-old Atlantic article that said that if people read the agreements they encountered in a year, it would take 76 work days. Still, knowing the risks of having data shared makes you want to think twice before signing up for anything, and three times for anything involving sensitive information.

From Forest Fan: “Re: visit notes summary. What should the patient do when the documentation is not accurate? One of my doctors was doing a lot of copy-paste, not reviewing, etc. He had the meds all wrong. Medicare uses that documentation to decide whether to authorize his recommended treatments, so I started to think that I need to pay attention. An RN who did the Epic implementation for this organization recommended speaking up, but UGHH. How to do this? It doesn’t seem right to correct my physician.”

From the physician perspective, I’ve seen so many inaccurate notes over the years that nothing shocks me. Early in my career, many of them were errors in dictation and transcription. Most of them were when physicians didn’t read their notes after they returned from the transcription service, but instead simply signed them and sent them out the door. Generally they had an accurate physical exam, diagnosis, and plan content, so I could overlook the semantic issues.

As EHRs came onto the scene, we started to see templated physical exams that were entirely fanciful. My favorite was the one from an orthopedic surgeon who claimed to have performed an eye exam that included visualizing the fundus. I’ve never been in an orthopedic office where an ophthalmoscope was present, so either this was some kind of multispecialty clinic and the physician is a serious outlier or it was simply erroneous.

By this point, I was knee-deep in EHR deployments. I recognized it as either laziness or unwillingness for the provider to spend time customizing his exam template or inappropriately restrictive behavior by IT folks unwilling to support personalization due to fears of increasing their maintenance burden. Now, many of the consultation notes I see are so much gibberish that I end up talking more with the patient to understand what actually happened.

From the patient perspective, I can’t stand errors in my chart. It’s one thing if they’re in a narrative or free text box that isn’t discrete data. As the reader noted, these are seen by insurance folks when notes are sent as documentation of the need for a prior authorization or other approval, so they’re certainly problematic. However, when discrete data is wrong, that’s a different kind of problem since it could be used behind the scenes in various algorithms that form care recommendations and no one is aware that they’re incorrect.

Errors aren’t just a nuisance, but can keep you from getting the care you need and can prevent you from receiving recommendations for care you might not even know you needed. Still, because of the traditional power imbalance between physicians and patients, it’s hard to bring it up.

I’ve had to bring it up myself and have used different strategies depending on the level of the error. For minor errors, I’ve sent messages through the patient portal and asked the clinician to update the note. I think it’s important to have that written record. For more serious errors, I’ve addressed them in person at a subsequent visit and somewhat forced the correction or amendment to be done real time.

For major errors, I’ve invoked my rights under HIPAA and sent a formal communication to the physician and asked for them to modify the chart and send me a corrected copy of the documentation. HIPAA requires that patients submit these requests in writing, after which providers have to either make the changes or provide a written denial with explanation. I’ve also specifically requested that they reach out to downstream systems that may have consumed the erroneous data and address it there or notify me where their data is flowing so I can make the appropriate requests.

For the major errors, I’ve also sent letters to the higher-ups making sure that they know what is going on in their practices. At one, a clinician put inaccurate information into my chart three visits in a row, so I cited that as my reason for leaving the practice and removing them from my referral list as a physician. Shockingly, I’ve never received a response from any of those administrative communications, which I think is a reflection on how little people value accuracy or loyalty these days.

Have you had to correct your medical record, and how did you approach it? Leave a comment or email me.

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