386 - To Share or Not to Share: Protecting Families Living with Intimate Partner Violence under the Cures Act

Children are witnesses to 50% of intimate partner violence (IPV) episodes in the US and are often evaluated in emergency departments (EDs) after IPV exposure. Abusers may access the electronic health records (EHRs) of victims and their children and learn of the IPV disclosure, leading to potential threats to safety. Implementation of the 21st Century Cures Act, a federal law mandating that healthcare providers give patients access to clinical notes without charge or delay, has increased the likelihood that EHRs will be accessed and therefore amplified concerns of worsening safety for victims of IPV and their children. It is unknown if providers are routinely discussing EHR safety with IPV survivors when they present to EDs for care for themselves or their children.

Objective:

We aimed to determine the frequency of EHR safety discussions and unsharing of clinician notes with patients presenting to EDs for IPV-related care since implementation of the 21st Century Cures Act.

Design/Methods:

We conducted a retrospective chart review of all adult and pediatric encounters for IPV-related care at three general EDs and one pediatric ED after implementation of the Cures Act from February 1, 2021 to June 14, 2022. We examined the frequency of discussion about EHR safety, defined as documentation that a patient was asked about abuser access to the patient’s records, and proportion of notes that were unshared from patient access.

Results:

In the 14-month study period, 165 adults and 25 children presented primarily for IPV-related care. The median age was 34 years old (IQR = 25-43) for adults and 6 years old (IQR = 0.5-13) for children (Table 1). Of the 101 adults and 13 children with activated patient portals, EHR safety was discussed significantly more frequently in adult than pediatric encounters (54.9% vs 15.4%, P=.03, Table 2). Almost all discussions about EHR safety were documented by social workers (98%). Unsharing of notes was infrequent in both adult and pediatric encounters (4.1% vs 15.4%, P=.14). Six notes containing sensitive information (e.g., contact information or addresses) were shared without discussion about EHR safety, and three were shared despite disclosure of concerns about abuser access to the patient’s account.

Conclusion(s):

Although the Cures Act may increase risk to IPV victims, discussions about EHR safety and unsharing of notes have been infrequent, especially in pediatric encounters. ED providers must recognize how immediate patient access to clinical notes may complicate IPV-related care and coordinate with social workers to optimize safety for adults and children living with IPV.