EMRs: Balancing Improved Access with Patient Privacy Concerns
By Debra Wood, RN, contributor
March 26, 2013 - Like them or not, electronic health records (EHRs), or electronic medical records (EMRs), are here to stay. While they offer greater patient access to diagnostic testing results, medical histories, treatment information, and even what clinicians have said about them, many patients feel uncomfortable with digital medical records.
Robert Wah, MD, called it critical that healthcare professionals remain mindful of patients’ privacy concerns.
“Clearly there is anxiety on the part of the public about digital information being available,” Robert Wah, MD, CSC, chief medical officer and medical director for the CSC Global Healthcare organization, based in Falls Church, Va. “It’s critical we are mindful of that concern. It’s a valid concern. There’s a big intersection between health information technology, cyber security and cloud computing, and in the middle is the patient.”
The federal government’s Meaningful Use stage 2 incentive requires more than 5 percent of patients actually view, download or transmit to a third party their information.
Bill Fera, MD, a principal in Ernst & Young Health Care Advisory Services, which is based in New York, added that although the requirement may not be fair, he expects patients will begin accessing their personal EMRs to a greater degree. But it has to start with availability.
Providing patient access may be easier than convincing patients to use and interact with their health information.
A 2012 survey for Xerox by Harris Interactive found only 26 percent of patients wanted their records to be kept digitally. More than 85 percent of respondents expressed concern about digital medical records. Chad Harris, group president, Xerox Healthcare Provider Solutions, reported a continued resistance to change from consumers.
The Xerox survey found patients are concerned about a number of potential problems: hackers, lost or damaged files, data being misused, or power outages that could prevent doctors from accessing their information. Only 15 percent expressed no worries.
Ben Marrone, principal with Impact Advisors of Naperville, Ill., indicated that publicity about hackers and incidents of patients’ records being compromised can cause people to worry and become skittish.
Wah considered it a valid concern.
“We have to pay a great deal of attention to the security and privacy of the digital information we are privileged to handle,” Wah said. “Patients recognize if their health information were to be exposed or distributed inappropriately, it’s a bell you cannot un-ring.”
However, Wah believes that as patients realize the importance of having their past medical history and a medication list available at the emergency department after an injury, people will become more accepting.
“The benefits will outweigh the risks to them at some point,” Wah said. “As physicians, we have always been good stewards of healthcare information…that we would not share inappropriately and safeguard it. The same trust given to us in paper format is inherent in digital.”
That care requires building in security and privacy, such as encryption, passwords, workflow and appropriate processes. Providers could benefit from hiring an outside expert, he added.
“We have to make sure we are using best practices in security,” Wah said.
Bill Fera, MD, suggested patients will need more information about electronic record safety measures.
Fera reported that security on health information must be as strong as that for financial or banking institutions, which have seen a huge increase in the number of people willing to bank online.
“If folks are made aware that the security is the same in terms of encryption and fail safes as in the banking world, that should create some safety,” Fera said. “Electronically, we are more secure than with paper. The notion that your records are safe on paper is a false concept.”
Acceptance of electronic patient information is complex. In fact, many physicians are not thrilled with easy patient access to medical records.
A new survey from the consulting firm Accenture in Orlando, Fla., showed that most U.S. doctors, 82 percent of those surveyed, would like patients to update their electronic health records, particularly demographics, family history, allergies, medications they are taking, and blood pressure and blood sugar readings taken at home. But only 31 percent of physicians believe a patient should have full access to his or her own record; another 65 percent believe patients should have limited access, and 4 percent say they should have no access.
Wah suggested that physicians are quite concerned about sensitive information, such as psychiatric histories and reproductive histories. Yet that information could be helpful to a physician treating a new health concern.
“Technology will give us the ability to access that information more appropriately with audit trails,” Wah said. “Audit trails allow us to know who has seen what information, and that becomes a bit of a governor.”
As he explained, people might hesitate to access someone’s record when they know others will be aware of it. Fera agreed that it could serve as a deterrent.
To get those Meaningful Use federal incentive dollars, hospitals and providers will have to provide access, and many have. A study from the research firm KLAS in Orem, Utah, released in November 2012, found that 57 percent of providers had a patient portal, primarily from their current EMR vendor.
Getting patients to use portals could prove challenging.
“It’s going to take education,” Fera said. He indicated that health insurers could offer incentives to patients through health savings accounts or other means to encourage them to become more engaged in their healthcare.
Ben Marrone recommended physician practices demonstrate to patients how to use the portals.
Marrone agreed about the importance of education. He also suggested that physician practices and hospitals provide training and demonstrations in how to use the portals. Hospitals also could provide written documentation at discharge about how to access the patient portal.
With the growing use of smartphones and handheld technologies, Marrone said he thinks more people will log on to review lab results, and they will begin to keep their own records. Young people and those most savvy with technology will likely embrace it more quickly than people without a computer. He recommended talking with patients about how their records are safeguarded.
“We see security as an enabler, because if patients do not accept digital network information, we won’t be able to have the digital networks we would like to have in [information technology],” Wah said. “Going from paper to digital and digital to network will lead to the third event--analytics and personalized medicine. That will lead to a change in how we deliver healthcare.”
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