Proposed legislation to make open disclosure of adverse incidents mandatory will only cover "serious" cases.
This could mean it will be left to doctors and other health care staff to decide what is considered serious, and therefore what they regard as lower-grade incidents may not be revealed to patients.
The promise to introduce mandatory disclosure of adverse incidents comes in the wake of the CervicalCheck scandal and the failure to tell 209 women who developed cervical cancer that an internal report had confirmed their smear result had wrongly given them the all-clear.
It was also one of the failures highlighted in the inquiry into the cases of 18 babies in Portiuncula Hospital, some of whom died or suffered severe disability. The maternity hospital report, which covered 2008-2014, found that there was a failure to inform parents about their babies.
In 17 of the 18 cases, investigated parents were not given proper details about the care of their babies.
It found that in eight of the cases the lack of information had a severe effect on the family.
The last government backed down on a pledge to make open disclosure mandatory.
The HSE's open disclosure policy of 2013, which has been repeatedly breached, was designed specifically "to deal with adverse events in a transparent and open manner".
It said that open disclosure involves an "open, consistent approach to communicating with service users" when things go wrong in healthcare.
"This includes expressing regret for what has happened, keeping the service user informed, providing feedback on investigations and the steps taken to prevent recurrence of an adverse event."
The Department of Health backed down on making it mandatory on the grounds that it could lead to doctors being even less likely to be upfront.
However, new regulations will now give doctors greater protection from being sued if they do disclose.
The HSE policy says that all communication with service users or their relatives "must be carried out in an empathetic, informed and timely manner".
The principles of open disclosure "form the basis of an ethical response and promote a fair and just culture within the HSE, and when employed effectively in the feedback process can lead to improved service user and staff acceptance of the outcomes," it claims.