Center for Improvement in Healthcare Quality Newsletter
November 2021


Considering the Patient’s Perspective Regarding Confidentiality of the Medical Record

By: Kim McGuire
In healthcare, whether inpatient or outpatient, when one thinks of or hears” confidentiality of the medical record or health information”, the initial thought is CMS §482.24(b)(3). We often immediately start thinking of how the medical record is secured, what processes are in place to ensure there is not unauthorized access to the patient’s health information, or that policies are in place to ensure that the regulatory requirements are satisfied. Secondly, or maybe even further down the list, is the consideration of how patients perceive their medical record and health information to be secure and confidential. Additionally, does this perception affect the patient’s participation in the healthcare process and the judgement of receiving quality care? Let’s take a little time to explore this perspective.
Medical record confidentiality and the perception of it, not only applies to the patient’s chart used in the hospital or outpatient setting, but also to the sharing of healthcare information via patient portals and online health information apps that many healthcare systems have adopted. Many studies have been completed to better understand how the patients’ perception of confidentiality, in both the inpatient and outpatient setting, affects all aspects of their care, attitude, and expectations.
The patients’ perception of their healthcare information’s confidentiality and how the information will be used has been found to be the major influence of the amount and quality of information that is shared with the care provider. Trust in the provider and the healthcare system has been found to directly impact the perception of information privacy as well. This has been witnessed even more with the increased use of telemedicine services for both inpatient and outpatient care. Withholding healthcare information from the provider can impede the ability to care for the patient effectively and efficiently. During a pandemic, this can also lead to inaccuracies of public health data reporting (DePuccio, et al, 2020).
Studies have shown that when patients have concerns about the confidentiality of their medical information and record, it is three times more likely that their health information will be withheld from care providers. These concerns include who has access to their medical record information, as well as how and why their information is being shared. Hospitalized patients expected increased access by healthcare personnel to their medical records. With that expectation also came a hesitancy of sharing sensitive and vulnerable information if the patient knew healthcare workers, of any capacity, that worked where they received care.
In addition, with the increased availability of online patient portals and healthcare information apps, there is another level of concern regarding confidentiality of information that patients are faced with. The same concerns that may lead to withholding health information also contribute to decreased engagement. This is compounded with the fear that online communication will take the place of face-to-face consultation and the security of personal devices used to access sensitive health data and share vulnerable health information. Many times these concerns outweigh the advantages that are present for patient’s and caregivers with utilizing these tools.
These are concerns that as healthcare providers, we can address with our patients. Patient education regarding the safety and security of health information is important. This can include direct patient education and demonstrating behavior with medical information that ensures the patient that their information is secure. For instance; securing medical records in areas that non-authorized personnel may have access and logging out of the electronic medical record when finished in the patient’s presence. It can also include reinforcing the patient that portals and apps can enhance the care experience rather than detracting from it.
Privacy concerns reduce patient frequency of accessing health records and fully engaging in the healthcare process. Patients who have positive attitudes toward health information exchange, confidence in the confidentiality of their health information, and security of their medical record are more open and honest when sharing health information. Creating trust for the patient regarding health information privacy and the belief in the effectiveness of information security safeguards increases the perception of patient’s care quality as well. (Kisekka & Giboney, 2018).


Abdekhoda, M., Dehnad, A. & Khezri, H. The effect of confidentiality and privacy concerns on adoption of personal health record from patient’s perspective. Health Technol., (9)463–469, (2019).
Centers for Medicare and Medicaid Services, (2020). State Operations Manual, Appendix A – Survey Protocol, Regulations, and Interpretive Guidelines for Hospitals. Retrieved from
Cherif E., Bezaz N., & Mzoughi M., Do personal health concerns and trust in healthcare providers mitigate privacy concerns? Effects on patients’ intention to share personal health data on electronic health records, Social Science and Medicine, Volume 283, 2021.
DePuccio, M.J., Di Tosto, G., Walker, D.M. et al. Patients’ Perceptions About Medical Record Privacy and Security: Implications for Withholding of Information During the COVID-19 Pandemic. J GEN INTERN MED, (35)3122–3125 (2020).
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