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To paraphrase the Bard, "Sigh no more techies, sigh no more;" the Library of Congress ruled this week that you may legally unlock the restrictions on your iPhones. Recent sinister allegations aside (in both definitions of that adjective), Apple has been criticized for forcing consumers to accept its approved method of use for its phones, which includes carrier choice (AT&T) and what apps one can install.

Picture a computer maker telling you what Internet Service Provider you could go online with, or forcing you to use only software it sells. As a matter of fact, I recall a lawsuit involving Microsoft a few years back that dealt with the latter issue. Dell is facing European Union scrutiny for marrying hardware/software requirements.

Regardless, iPhone users wanting liberation no longer have to wait for a law suit to give them the go-ahead. Now, the government has officially stepped into this tech debate to say that the Digital Millennial Copyright Act (DMCA) can not be used in the following instances:

"(2) Computer programs that enable wireless telephone handsets to execute software applications, where circumvention is accomplished for the sole purpose of enabling interoperability of such applications, when they have been lawfully obtained, with computer programs on the telephone handset.
(3) Computer programs, in the form of firmware or software, that enable used wireless telephone handsets to connect to a wireless telecommunications network, when circumvention is initiated by the owner of the copy of the computer program solely in order to connect to a wireless telecommunications network and access to the network is authorized by the operator of the network." —News from the Library of Congress

Being the strange person that I am, this story reminded me of the debate over opening up patient records. I briefly wrote on the subject yesterday in the context of patient led health, and found more coverage in this week's edition of Grand Rounds, the medical blog carnival.

One blogger, known only as the Medical Resident, wrote against opening medical records to patients. The writer voiced concerns about how inexperienced readers would react to the information, without the intensive training and experience providers have. In contrast, Dr. John Henning Schumann of the GlassHospital blog (and reprinted at the ACP Hospitalist) wondered why "we treat the medical record like some ancient biblical text," and advocated for granting patients more access to their medical records.

So, two very different points of view that I think are represented across the practice of medicine (not to mention all the the pundits and politicians interested in health care). Just as some iPhone users have no problems with the way Apple runs its business, while others think the company is engaged in draconian practices.

Here's my question in both instances: what are the legal ramifications?

In the case of Apple, while you can't be prosecuted for opening up your iPhone (in a practice known, ironically, as "jailbreaking"), you can violate your warranty and disqualify your device from receiving software updates ("IPhone owners can legally unlock them, but ...," USA Today). Therefore, users who are operating an open iPhone are required to accept some responsibility along with their freedom.

How does that same legal context apply in terms of opened medical records? If patients are to receive complete access and become empowered to make decisions about their treatment, can they still sue a doctor for not doing enough? Or does access necessarily curtail certain litigious arguments?

As an example, the Medical Resident pointed out that patients might become alarmed without cause when viewing what appeared to be a strange result in their lab work. "Only in the context of looking at hundreds of thousands of laboratory values and test results does a physician realize which findings are concerning and which are simply incidental." That's not an idle concern: Kaiser Permanente found that showing patients exactly what their doctor saw produced alarm, even when there weren't a real medical emergency ("As Health Files Go Digital, Patients May Spot Unpleasant Surprises," The Huffington Post Investigative Fund). In response to concerns by patients, the medical organization changed the way it displayed information about lab reports.

If a patient demanded unnecessary treatment due to misinterpreting this information, what should the doctor's response have been? What should it be now? Has the change impacted the way doctors read these charts?

For the record (so to speak), I want to have access to my medical information. A parent, child, or spouse should definitely be able to help a loved one cope with disease and treatment. I am not against patient advocacy, any more than I want a company dictating how I can use a product I purchased.

The OpenNotes study looks like a step in the right direction toward addressing both patient and provider concerns. Let's hope it and similar work will help us learn about what the consequences, both positive and otherwise, may be for opening up medical records.

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