Preclinical Alzheimer Disease and the Electronic Health Record: Balancing Confidentiality and Care

Seth A. Gale, Judith Heidebrink, Joshua Grill, Jonathan Graff-Radford, Gregory A. Jicha, William Menard, Milap Nowrangi, Susie Sami, Shirley Sirivong, Sarah Walter, Jason Karlawish

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Because information technologies are increasingly used to improve clinical research and care, personal health information (PHI) has wider dissemination than ever before. The 21st Century Cures Act in the United States now requires patient access to many components of the electronic health record (EHR). Although these changes promise to enhance communication and information sharing, they also bring higher risks of unwanted disclosure, both within and outside of health systems. Having preclinical Alzheimer disease (AD), where biological markers of AD are identified before the onset of any symptoms, is sensitive PHI. Because of the melding of ideas between preclinical and "clinical"(symptomatic) AD, unwanted disclosure of preclinical AD status can lead to personal harms of stigma, discrimination, and changes to insurability. At present, preclinical AD is identified mainly in research settings, although the consensus criteria for a clinical diagnosis may soon be established. There is not yet adequate legal protection for the growing number of individuals with preclinical AD. Some PHI generated in preclinical AD trials has clinical significance, necessitating urgent evaluations and longitudinal monitoring in care settings. AD researchers are obligated to both respect the confidentiality of participants' sensitive PHI and facilitate providers' access to necessary information, often requiring disclosure of preclinical AD status. The AD research community must continue to develop ethical, participant-centered practices related to confidentiality and disclosure, with attention to sensitive information in the EHR. These practices will be essential for translation into the clinic and across health systems and society at large.

Original languageEnglish
Pages (from-to)987-994
Number of pages8
JournalNeurology
Volume99
Issue number22
DOIs
StatePublished - Nov 29 2022

Bibliographical note

Publisher Copyright:
© American Academy of Neurology.

ASJC Scopus subject areas

  • Clinical Neurology

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