Texas is imposing new transparency regulations on electronic health records (EHRs) and the diagnostic use of artificial intelligence (AI) under a new state law physicians must begin complying with as of Sept. 1.
Texas Senate Bill 1188, passed during Texas’ 2025 regular legislative session, requires physicians and health care practitioners who use AI for diagnostic purposes – including for any recommendations on a diagnosis or course of treatment based on a patient’s medical records – to, effective Sept. 1:
- Disclose such use of AI to their patients; and
- Review all records created by AI in a manner consistent with medical records standards.
Additionally, entities covered by the bill – businesses, including physician practices, that assemble, collect, analyze, use, evaluate, store, or transmit protected health information – to:
- Automatically allow a minor patient’s parent, guardian, or conservator to obtain “complete and unrestricted access” to the minor’s EHR, unless access to all or part of the record is restricted under state or federal law or by court order, also effective Sept. 1; and
- Physically maintain their EHRs only within the U.S. or a territory of the U.S. and only allow their data to be accessed by those who require the information to perform duties within their scope of their job related to treatment, payment, and other health care operations by Jan. 1, 2026. Covered entities have until Jan. 1, 2026 to ensure compliance relating to EHRs prepared before Sept. 1.
However, Texas physicians are now allowed three days to communicate the results of certain sensitive or serious test results to patients, including minors and their guardians, before they are made available via EHRs thanks to the passage of Senate Bill 922.
SB 1188 also prohibits covered entities from amending on an EHR an individual’s biological sex as recorded by a health care practitioner at birth and documented in the EHR, except to correct a clerical error, or, if the individual is diagnosed with a sexual development disorder, to change the individual’s listed biological sex to the opposite biological sex, in which case, information on the disorder must be also included in the EHR.
SB 1188 states regulatory agencies – including the Texas Medical Board, the Texas Department of Licensing and Regulation, and the Texas Department of Insurance – may take disciplinary action against a covered entity that violates the order three or more times in the same manner. The disciplinary action may include “license, registration, or certification suspension or revocation for a period the agency determines appropriate,” per the law.
Violations of SB 1188 can also result in civil penalties ranging from $5,000 to $250,000 per violation, depending on the violator’s intent and whether the violator used protected health information for financial gain.
Physicians should monitor for future guidance and check with their EHR vendor about compliance, especially as related to where patient data is stored, says Shannon Vogel, the Texas Medical Association’s associate vice president of health information technology.
For more information on health information technology, visit TMA’s related webpage.
Alisa Pierce
Reporter, Division of Communications and Marketing
(512) 370-1469