It’s time to bring MD’s medical records law into the digital era

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When a patient is harmed during medical care, one of the first steps toward understanding what happened is requesting their medical records from their providers. That instinct is both natural and necessary. But in Maryland, what patients receive in response to that request often reflects only part of the picture.

In most cases, patients are provided with the formal contents of their electronic medical record, the documentation that providers ultimately enter into the chart. While that record is essential, it does not always capture the full universe of information that informed clinical decision-making. As modern healthcare increasingly relies on digital communication tools and automated systems, this gap between the official record and digital decisions has become more pronounced. It’s time for Maryland’s EMR regulations to reflect the realities of healthcare in the 21st century and capture the full scope of patients’ care decisions.

Where the current framework falls short

Maryland’s Confidentiality of Medical Records Act broadly governs access to records relating to a patient’s care. In practice, however, what patients receive upon request is typically limited to the materials maintained in the formal chart. Other categories of information, while often preserved somewhere within a provider’s systems, are not routinely included in those disclosures.

Two examples illustrate the point.

First, provider-to-provider communications.

Today’s care teams regularly communicate through secure messaging platforms, internal electronic threads, and other digital tools embedded within hospital systems. These exchanges can shape clinical decisions in real time, sometimes more immediately than the documentation that is later finalized in the chart. Yet these communications are not typically included in the records produced to patients in response to a standard request. Patients seeking to understand why a particular decision was made may therefore be reviewing a record that reflects the outcome of a discussion, but not the discussion itself.

Second, clinical decision support and system-generated data.

Modern EMR systems incorporate sophisticated alert mechanisms designed to flag potential risks, such as dangerous drug interactions or concerning changes in a patient’s condition. These systems are intended to assist providers at critical decision points. But depending on how a system is configured, the underlying alerts and related data are not always captured in the patient-facing record. As a result, information about what the system identified, and how a provider responded, may not be apparent from the chart alone.

To be clear, this information is not beyond reach. In litigation, parties may seek additional materials through the discovery process, including communications and system data held by providers. But that process requires legal action, time, and expense. But to start, most patients are simply trying to understand what happened to them or a loved one; they are not yet in a position to initiate formal litigation to obtain a more complete account.

The gap between modern care and routine disclosure

This dynamic creates a disconnect between how care is actually delivered and what patients can readily access. Increasingly, clinical decisions are not made in isolation or reflected solely in a single chart entry. They emerge from a combination of team-based communication, digital tools, and system-generated insights. Yet the default record provided to patients often reflects only the final documented conclusions.

For many patients, that distinction matters. When outcomes are unexpected or adverse, understanding the sequence of decision-making (what was considered, what risks were identified, and how those risks were addressed) is central to evaluating their care. When that context is absent, the record can feel incomplete, even when it technically complies with current practices.

A path forward

As healthcare continues to evolve, Maryland’s approach to patient access should evolve with it. The goal is not to transform every internal communication into a formal chart entry or to disregard legitimate concerns about privilege, burden or system design. Rather, it is to ensure that patients have meaningful access to the information that materially informed their care.

Legislative or regulatory updates could clarify that, subject to appropriate safeguards, certain categories of digital information, such as provider-to-provider communications maintained within clinical systems and relevant system-generated data, should be treated as part of the patient’s accessible record, or at least made available through a more transparent and standardized process. Clear rules would benefit not only patients, but also providers, by reducing uncertainty about what must be preserved and disclosed.

Patients reasonably expect that their medical records will allow them to understand what happened during their care. In an era where critical decisions are shaped by digital communication and automated systems, that expectation is becoming harder to meet through the traditional concept of a chart alone.

Maryland’s framework for medical record access has served an important purpose, but it was developed in a different technological era. Updating it to reflect the realities of modern healthcare would not expand the scope of care; rather, it would simply ensure that patients can see it more clearly.

Timothy Fisher is a partner at Brockstedt Mandalas Federico, where he leads the firm’s practice focusing on medical negligence, wrongful death, birth injury, and catastrophic personal injury.