Transferring Custody of a Chart to the Patient – Could That Drive Patient Engagement?

I recently wrote about the concept of health information disposal and how we’re going to have to reevaluate how we approach disposing of patients charts in this new digital world. Plus, EHR vendors are going to have to build the functionality to make it a reality. However, some replied to that article that in this new world we shouldn’t ever dispose of charts.

We’ll leave that argument for that article (or in the comments) and instead discuss another concept that Deborah Green from AHIMA told me about. Deborah suggested that one possible solution for digital chart disposal would be to transfer custody of the chart to the patient. I think that terminology might not sit right with some people since the patient should have access to the chart regardless. However I think the word custody has a slightly different meaning.

When a healthcare organization is ready to dispose of an electronic chart based on their record retention laws (which usually vary by state), then it’s the perfect time to give patients the opportunity to download and retain a copy of their paper chart before it’s destroyed. In that way, the healthcare organization could worry less about deleting the electronic chart since they’ve transferred “custody” of the chart to the patient.

This removes the responsibility of storing the patient chart from the healthcare organization and puts it on the patients that want to have their entire medical chart. The perfect custodian of the patient chart is the patient. At least it should be.

I wonder if a healthcare organization informing patients that their old charts will be deleted would be enough to actually drive patient engagement and download of their electronic record. While meaningful use has required the view, download and transmit of records by patients, most people have been gaming that requirement without patients really getting the benefit. I have a feeling that patients hearing the words “deleted chart” would wake a lot of them up from their slumber. They wouldn’t know why they’d want the paper chart, but I imagine many would take action and preserve their medical record. Once they download the chart, it would be the first step towards actually engaging with their health data.

What do you think? Is transferring custody of the electronic record the right approach to health information disposal? Would this drive a new form of patient engagement? Would it wake up the sleeping giant which is involved patients?

About the author

John Lynn

John Lynn

John Lynn is the Founder of, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference,, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.


  • Don’t know about the “wake up the sleeping giant” part, but it seems like a good idea… if implemented correctly.

    The records should be records should be transferred to a thumb drive in a simple directory structure and format (probably PDF), readable with no additional software for deciphering content — PC-neutral data only (pdf, txt, html, jpg, png, gif); no executables. The patient can read his personal records on the Mac or PC of his choice, and may also give a copy to another provider. Talk about portability!

    But then why wait until disposal time? Why not update the patient’s thumbdrive at his request (perhaps for a fee) as standard procedure?

  • I agree with transferring custody of a chart to the patient, but in the behavioral health world, that can be a problem without monitoring. Now that patients have a right to amend their records once they have them, it’s been a big problem. They sometimes don’t understand the medical terminology, they disagree with diagnoses, it can be a full out mess – especially if they are applying for disability and other benefits. We have not come to the point where we have had to destroy electronically yet because the EHR world for us started 2011, but that is definitely a viable solution. Thanks for the article

  • David,
    People can do it now, but they haven’t shown a propensity to do so. Saying that the info will be deleted will likely encourage people to actually do it. Once they’ve done it once, you can imagine that many of them will start doing it more often and not just at disposal time. So, I could see it as the starting point for more engagement. In fact, if you get the right news reports, it could start a wave of people choosing to archive their own records because they’re afraid of losing the info even when it’s not up for disposal.

    Behavioral health is different, but there are rules in place for when to share those and when not to share those. None of those rules would change. They’d still be followed under this scenario.

  • The only time I ever got a medical record, it was an Xray or MRI, put on a CD and requiring executable code (probably used by the hospital or imaging service). Since I didn’t have (or want) the required executable, the image(s) were useless to me.

    THAT’s what I meant by requiring a PC-neutral and data-only format.

  • David,
    Providing them the data in a usable format would be important. Luckily, there are a bunch of companies that are built for this now. Imaging is a little harder, but EHR records they can suck in quite nicely these days.

  • We have this fantasy that patients want or care about having all this data.. An authoritative and qualified survey to people other than to afflicted intellectuals may lead to a surprising result. I could care less about a medical record that has no bearing on current treatment…and one more thing …we still havent resolved whether the government or other nefarious groups have access to all of this ..And for all the question is..except for nodal events which should have a separate category altogether…who in their right mind wants to read the nonsense and redundancy that you all claim is needed in a medical record.

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