The overlooked risk in physician estate planning: Who can legally access the EHR?

Estate planning is no longer just about distributing physical assets but rather about managing a digital legacy. That includes everything from email accounts and billing software to cloud-based patient records. This shift has given rise to a new and essential responsibility: digital estate management.

Unlike traditional planning, digital estate management focuses on organizing, securing and delegating access to a professional’s full digital footprint before a crisis hits. For solo physicians, this becomes a critical safeguard for patients, staff and family members alike.

The most urgent and overlooked part of that digital estate plan? Access to electronic health records (EHRs). These systems house sensitive, federally protected data and are typically locked behind multiple layers of authentication. When a physician dies or becomes incapacitated, even well-prepared family members or clinic staff can find themselves legally and logistically frozen out.

Credentials are not enough. Legal authority must be clearly granted. Without that, a clinic stalls, patients suffer, and the physician’s estate may be exposed to regulatory risk. Digital estate management fills the gap that standard succession plans too often miss.

Why EHRs pose a unique challenge in estate planning

The Health Insurance Portability and Accountability Act (HIPAA) imposes strict requirements on how patient data are handled, including who is authorized to access them. After death, those responsibilities don’t automatically pass to the surviving family, office managers or trusted colleagues. Without explicit legal direction, no one can step in to manage those records.

What makes EHR systems especially tricky is that they’re typically viewed as assets of the practice entity, not the individual physician. If ownership or control of that solo practice isn’t clearly defined, there is no legally recognized custodian of record. Billing can stall, prescription requests can go unanswered, and patients may be left uncertain where to turn.

And here’s the most often overlooked point: Even the most carefully crafted estate plans can fall short if they don’t address digital assets like EHR access. Paper documents don’t open encrypted servers.

What effective digital estate management covers

Digital estate management turns passive planning into active preparation. For a solo practitioner, it means taking full control of your digital presence, including every clinical system you rely on. Here's what physicians must consider and develop for effective digital estate management:

• A complete inventory of digital systems. Catalog every software system tied to your clinic, including EHRs and telemedicine platforms, to secure messaging and patient portals.
• Secure credential storage. An encrypted, attorney-controlled vault should hold usernames, two-factor authentication keys and administrative access credentials so the right person can act quickly and lawfully.
• Designation of a digital fiduciary. Some states formally recognize digital executors; others allow powers to be assigned to trustees or personal representatives. Spell out that HIPAA-covered data fall within their authority.
• Governing documents with continuity instructions. Articles of organization, professional-corporation bylaws and malpractice policy riders should state who assumes custodianship of medical records and what steps transfer control.
• Routine updates. Digital platforms evolve, and so do data-retention laws. Annual reviews — ideally tied to malpractice-insurance renewals — keep your plan current.

Why it matters

When digital estate planning is missing, even the most organized solo practice can slip into chaos. One question sits at the center: Who has both the legal authority and the practical tools to take over for me? If that question goes unanswered, it endangers patient care and the future value of the clinic you built.

Without clear access in place, electronic health records become stranded, untouchable yet still carrying legal responsibility. Establishing access ahead of time, on the other hand, creates continuity, compliance and peace of mind for everyone involved.

Protecting what you built

Managing your personal digital estate is legally, medically and deeply personal. As more of your solo practice lives online, you owe it to your patients, employees and heirs to ensure those assets don’t vanish into the cloud.

Digital estate management guarantees that the systems you rely on every day remain a source of value, not chaos, once you’re no longer at the helm.

Howard Enders is the chief operating officer of The Estate Registry, where he leverages his extensive expertise in operations and management to drive growth and innovation.