Electronic Medical Records: The Pros and Cons

In this digital age, increasing volumes of information that used to be on paper, from library catalogs to telephone directories, are being digitized and stored in a central location for easy access. The idea for EMRs began about 40 years ago.

Leading proponents of EMRs cite the following advantages:

(1) The use of EHR supposedly reduces errors in medical records. There is no question that handwritten records are subject to many human errors due to misspellings, illegibility, and differing terminology. With the use of EMR, standardization of patient health records may become possible.

(2) Paper records can be easily lost. We have heard how fires, floods and other natural disasters destroy many years of physical records, data that is lost forever. Digital records can be stored virtually forever and can be retained long after the physical records are gone. EMRs also help keep records of health information that patients tend to forget over time, ie vaccinations, past illnesses, and medications.

(3) EMRs make healthcare cost-effective by consolidating all data in one place. Previously, paper records were located in different places and accessing all of them required a lot of time and money. In a systematic review, Kripalani et al. evaluated the transfer of communication between primary care physicians and hospital physicians and found significant deficiencies in the exchange of medical information. The review recommended the use of EMR to address these issues and facilitate continuity of care before, during and after hospitalisation. EMRs translate into better treatment for patients. Take the example of an asthma center’s experience with EMR: “A major benefit associated with EMR implementation was the increased number of children who were hospitalized with an asthma exacerbation and received an asthma action plan at discharge. Before the EMR system, [only] 4% received an asthma action plan at discharge. After implementation of the EMR system, 58% received an asthma action plan at discharge.”

(4) EMRs can save lives. The VeriChip, developed by the VeriChip Corporation, is the first of its kind to be cleared by the US FDA. It enables rapid identification of at-risk patients and access to their medical records, enabling rapid diagnosis and treatment, especially in emergency situations. Classic examples are people with diabetes and/or heart problems who are at high risk of collapsing and having seizures. VeriChip is also useful in motor vehicle accidents and other traumatic incidents where victims are unable to answer questions. In large-scale disasters, the VeriChip makes it easy to track and identify victims. According to a Mississippi medical examiner, the VeriChip helped identify victims during the Hurricane Katrina incident.

Earlier this year, Google Health, an online personalized health records service, was launched. Google Health is based on the principle that since it is the patient’s medical record, the patient must control it, decide what it contains and who has access to it. One of the features of the service includes records from hospitals and pharmacies that are enabled for Google Health or are registered partners of Google Health.

HealthVault is another online health storage service offered by Microsoft with similar features to Google Health. Keith Toussaint, senior program manager at Microsoft HealthVault, recently stated that “Leading hospitals like Beth Israel Deaconess Medical Center are integrating their systems with both us and Google, because some people like one or the other. It’s a Coke or Pepsi thing.”

What are the disadvantages of EMRs? Not surprisingly, privacy rights groups are the main opponents of EMRs. This is what they have to say:

(1) EMRs threaten our privacy. In this day and age when people’s mantra is “I need my privacy,” not many people are comfortable having their entire medical records recorded and digitized for almost anyone to see; in other words, intruding on people’s privacy. The confidentiality of the doctor-patient relationship remains sacrosanct. Also, medical data can be used against a person in some cases, whether it is for a job application, insurance coverage, or a college scholarship. Although it is against the law to discriminate against people with illnesses and disabilities, it is a fact of life that the fitter you are, the more competitive you will be in the job market. The planned incorporation of genetic data into EMRs further increases people’s fear of trespassing into their private sphere.

(2) EMRs can lead to loss of the human touch in healthcare. In the digitization process, the interpersonal aspect of healthcare can be lost. In handwritten medical records, doctors and other health professionals can write what they think and feel based on their personal observations in their own words. EMR is simply about checking boxes and crossing things off on electronic forms. Physicians are forced to think in categories and are rarely able to express a personal opinion on an individual case. Due to the lack of flexibility of many electronic reporting systems, cases of misclassification of patients and their conditions have been reported.

(3) EMRs are not as efficient. Despite digitization and standardization efforts, EMRs are actually far from standardized and not as efficient as they are supposed to be. It often happens that a clinic’s EMR system is not compatible with a GP’s or another clinic’s system, which belies the claim of greater efficiency. Also, not all EMR users are satisfied with the current state of the art. Although the goal is primarily the efficiency and quality of healthcare, a study showed that nurses in the Netherlands are not completely satisfied with their EMR implemented in 2006-2007.

(4) EMRs are not secure or protected. Google Health and HealthVault quickly assure patients of the security of their online health accounts. Access to the patient account is only possible using logins and password. In addition, HealthVault ensures that “all health information transmitted between HealthVault’s servers and the software providers’ systems is encrypted” and that Microsoft does its best to use the “highest security standards to protect consumer health information from theft, loss or damage.”

However, there are cases where passwords and encryption do not appear to be suitable as data protection tools. Stories of data hacking, stolen identities and blackmail abound. Even highly secure databases, such as those run by banks and credit institutions, are often compromised. This impression was compounded by the many well-publicized incidents of data loss or breach. Some examples are listed below:

November 26, 2007, Canada. The hackers accessed medical information about HIV and hepatitis from a computer at a Canadian health agency. – September 22, 2008, United Kingdom. The National Health Service (NHS) reported the loss of 4 CDs in the mail containing information on 17,990 employees. – September 30, 2008, the US company Blue Cross and Blue Shield of Louisiana confirmed a breach of personal data, including Social Security numbers, phone numbers and addresses of about 1,700 brokers. The data was accidentally attached to a general email.

In addition, it is criticized that Google Health is not a “covered entity under the Health Insurance Portability and Accountability Act of 1996 and the regulations promulgated thereunder (HIPAA)” under its terms and conditions and, therefore, is not subject to the HIPAA privacy of individually identifiable health information. HealthVault’s terms and conditions do not mention HIPAA privacy laws, so it’s unclear what their status is on this issue.

(5) VeriChip is not for humans. Hopefully, while many of us are willing to use RFID chips in pets, the idea of ​​implanting similar chips in humans is bound to upset humans, no matter what the US FDA says. A big opponent of the VeriChip and similar chips of this type is consumer advocacy group Spychip.com. In a position paper, Spychip and many consumer awareness and advocacy groups consider RFID tagging (whether on your person or on items you purchase) a major threat to privacy and civil liberties. They see labeling as a kind of “Big Brother” operation. Another group, the No VeriChip Inside movement, likens VeriChip to “labeling” humans in a similar way to the way the Nazis have tattooed numbers onto the skin of concentration camp detainees. Popular Hollywood movies about forays into privacy (for example, The Net, Public Enemy No. 1) further increased people’s paranoia about personal data.

Where do we go from here? We certainly have the technology to make EMRs standardized and efficient. Google Health, Microsoft HealthVault, and similar personalized online health information accounts allow patients to take control of their medical records. The main issues that need to be overcome are data security, privacy protection and gaining the trust of patients. It doesn’t seem obvious that the use of RFID and similar tagging chips will become acceptable or popular any time soon. However, we live in a digital world and we cannot stop progress indefinitely. With improved technology and data protection tools, hopefully the EMR issue will be resolved soon.