Should individuals and organizations with assess to the database be identified to the patient?

Patients should be aware of what information will be released and to who - that is the whole reason we have the HIPPA (healthcare information privacy and portability act - I think) law. It's not perfect, and realistically there are a lot of people who can view the patient record. For most of them, though, it's just a matter of making sure things are recorded correctly or completely, and they have no direct interest in the patient as a person. That includes insurance reviewers, case managers, and anyone else who is involved in paying for health care.