I wanted to find out if the break-the-glass method is really needed where an emergency physician would use it to access a patient's electronic health record in the event of an emergency. Since an emergency physician would be treating patients that are not theirs, this would result in the emergency physician using the break-the-glass method the majority of the time unless the patient being treated has been treated by the physician in a non-emergency situation such as a GP visit. On the other hand, the break-the-glass method should not be over used, but it seems that it would be overused in an emergency situation and so this is why I am asking if it is really necessary in an emergency situation.

  • Quite simple: If you can't talk anymore (unconscious, severe head trauma, broken jar, medically induced coma as a life-saving measure etc.), who should give your medical background in a few minutes time? There is not much that is more important than medical background. If you're 3 months pregnant, treatment needs to vary hugely from normal treatment to ensure you and the foetus survives. There are many illnesses/disease emergency staff can't see on the spot that needs to be factored in because they are contrainidications of treatment methods.
    – Narusan
    Oct 20, 2018 at 9:16
  • Thanks for the detailed answer. One question regarding emergency patients that are conscious/can talk, would the emergency physician rely on the patient giving their medical background orally or would they be able to get this medical background from the patient's electronic health record without using break-the-glass through for example asking the patient for their consent?
    – synthesis
    Oct 20, 2018 at 9:42
  • I do not know. That's a law question solely related to the U.S. But google will probably tell you something.
    – Narusan
    Oct 20, 2018 at 9:42
  • An ER physician would accept medical history from a patient if they seemed mentally competent (sober, sane, rational). If electronic records were available they would certainly use those also, but unless the patient had been to that facility in the past it's unlikely there would be any electronic records available.
    – Carey Gregory
    Oct 20, 2018 at 15:34
  • There is procedural information available to read online. As for necessity, @Narusan gave a good example of the necessity to provide the system. Oct 26, 2018 at 7:48

1 Answer 1


I think there is a misunderstanding of the circumstances to which "break the glass" applies, or perhaps the rules by which physicians nurses and other patient care professionals are granted access to patient records.

Regarding accessing the chart in general, annual training is given to physicians and hospital staff on the laws and regulations (for example under HIPAA, the Health Insurance Portability and Accountability Act) that no one is allowed to even open a patient chart without specific reasons for doing so - such as direct patient care or billing. These rules are a professionalism expectation, and any EMR (electronic medical record) keeps a record of access that can be traced. Additionally, EMR can restrict who can view what. For example, in one of the most prevalent EMRs called EPIC, the interface differs between users' job roles such that access to some areas in the chart is not even available for some users.

Within the US medical system EMRs, "Break the Glass" is a mechanism within the EMR chart where it requires a two-step process (justification and signature) to view certain data in a chart, or other circumstances such as open a chart of a patient who has died. For most physician access, it is most commonly used when accessing any psychology or psychiatry notes; in that case one justification selection is "for direct patient care." However, note that psychiatric meds will still appear in the medications list, and psychiatric diagnoses will appear in the problems list.

It is assumed that a physician or nurse will only open a chart for whom they are participating in care, thus an ER physician will have full access to the EMR chart for a patient they are taking care of, and would only need to do the "break the glass" procedure to gain access to psych notes - and would only do so if it is pertinent to the visit.

When a patient registers to be seen at an ER, some of this is explained in the terms of treatment paperwork that they have to sign. An unconscious patient situation has unique laws and regulations that apply, including assumed consent for chart access for reasons of health and life preservation.

Don't assume, however, that EMR between institutions communicate with each other. The technology to do so, although it's been possible since the 1980s, has not been implemented between most healthcare organizations. Even within the same city, they still don't often interface. If you go to a new hospital, they likely have access to zero medical information on you. This can be a significant barrier to continuity of care.

Some information on HIPAA and its application to EMR:

  • 1
    Great insights! I just want to point out that to anyone without a background in the U.S. health system (myself included), all the acronyms make this really tough to read. It’s not a problem within the answe, it’s rather myself having no clue whatsoever what EMR/HIPAA actually is.
    – Narusan
    Oct 20, 2018 at 20:23
  • Good point! Fixed.
    – DoctorWhom
    Oct 20, 2018 at 20:27

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