What's Stalling Electronic Health Records?

Electronic Health Records (EHR) represent a rapidly developing branch of technology across Canada and around the globe that promises to streamline and otherwise benefit healthcare delivery in several ways but will also present challenges and risk. Speaking from my vantage point as a diagnostic imaging technologist, digitization of medical imaging over a decade ago allowed for remote reporting of tests, improved record keeping thanks to ever growing digital storage capacity, reduced expense and waste, and improved the ability to confirm the quality of images in real time (not to mention reduced exposure to the harmful chemicals required for developing film). The adoption of electronic health records promises to supply expedited results, improved patient access and awareness, as well as the afore mentioned remote physician access, more manageable and transferable records and reduced environmental impact through reducing waste, among other benefits. In this era of cellular everything and self-driving cars, many would be surprised to find that some branches of healthcare are somewhat behind in this trend toward a digital universe. I would like to share some thoughts as to why this is the case.

Cyber security is at the forefront of everything we do in 2019. In such a technologically driven world, everything is password protected and layered in security measures. Few people value privacy in any aspect of their lives more than that which relates to their health. Uncertainty as to how EHRs should be protected could be one problem that is slowing their universal implementation. Though nefarious infiltration of an electronic healthcare database by some unknown villain seems to be the greatest driver of security measures (Berger & Schneck, 2019), a recent investigation on the subject found that nearly seventy percent (1225 of 1798) of documented electronic hospital record breaches over a seven year period were perpetrated by health care providers (Bai, Jiang, & Flasher, 2017), many of whom likely had access to the data -though no legitimate reason to view it. As a solution to this epidemic of nosey employees, Choi, Kim, & Park (2015) have proposed a risk-based access software program that grants increased access in the case of an emergency situation, while restricting information when the patient’s condition is more stable. This requires a complex algorithm that users could over-ride when critical situations arise, though activating this feature would result in the file being flagged for audit to ensure that any breaches are identified promptly.

Aside from the realm of illicit access, another hurdle to be cleared is the question of what information the patient should be granted (Liyanage et al., 2018). A summary of pertinent facts, or the entire file? Some argue that providing the patient with anything more than a brief description of what is immediately required of them would be too overwhelming, and that important information would be lost in mountains of jargon. Liyanage et al. (2018) suggests that software upgrades can support helpful filters to allow the data display to be better tailored to the patient’s level of comprehension. Others fear that patients may be left to deal with life altering diagnoses without the proper physician counselling that would traditionally accompany such news (Glauser, Petch, & Cumpson, 2018).

Naturally following the question of what, is who. As in: who is given access to personal health records in the case of children (Glauser et al., 2018)? More specifically, at what age do parents forfeit this right? In the meantime, what effect might parental access have on teens seeking sensitive services regarding sexual health or unwanted pregnancy? Might this drive them away from mainstream healthcare in search of undocumented -and perhaps unregulated- treatments? Perhaps it would cause some to avoid necessary treatments or checkups altogether.

Perhaps surprisingly, some studies have correlated EHR use with increased medical errors (Patel & Kannampallil, 2014). Kunzmann (2018) attributes this to the excessive body of information contained in the system that may sometimes bury pertinent details. He adds that the computer system may also serve as a distraction that dilutes the focus of the provider, increasing the frequency of mistakes (Kunzmann, 2018).

Despite these challenges and concerns, EHRs have arrived and will continue to be integrated into the fabric of the healthcare system. The initial financial burden will likely be recovered through long term cost savings. Appropriate security systems will evolve to assuage privacy concerns. Policies and laws will be enacted to determine judicious sharing of personal health data among consumers. The next generation of physicians and other health care providers will know nothing other than a digital system, and their technological proficiency -along with the convenience of advanced software- will make electronic systems faster and more efficient than yesterday’s pen and paper method. For a Canadian healthcare system drowning in debt and inefficiency, technology represents a life raft capable of carrying us to shore. All we need to do is climb on and start paddling; with time and effort, we’ll get there.

References

Bai, G., Jiang, J. X., & Flasher, R. (2017). Hospital Risk of Data Breaches. JAMA Internal Medicine, 177(6), 878–880. https://doi.org/10.1001/jamainternmed.2017.0336

Berger, K. M., & Schneck, P. A. (2019). National and Transnational Security Implications of Asymmetric Access to and Use of Biological Data. Frontiers in Bioengineering and Biotechnology, 7(21), 7. https://doi.org/10.3389/fbioe.2019.00021

Choi, D., Kim, D., & Park, S. (2015). A Framework for Context Sensitive Risk-Based Access Control in Medical Information Systems. Computational and Mathematical Methods in Medicine, 9. https://doi.org/10.1155/2015/265132

Glauser, W., Petch, J., & Cumpson, D. (2018). Why can’t patients access their medical record online? Retrieved July 21, 2019, from Healthy Debate website: https://healthydebate.ca/2018/07/topic/patient-medical-record-online

Kunzmann, K. (2018). Why Are EMRs So Terrible? Retrieved July 21, 2019, from MD Magazine website: https://www.mdmag.com/medical-news/why-are-emrs-so-terrible

Liyanage, H., Liaw, S.-T., Konstantara, E., Mold, F., Schreiber, R., Kuziemsky, C., … Lusignan, S. de. (2018). Benefit-risk of Patients’ Online Access to their Medical Records: Consensus Exercise of an International Expert Group: Primary Health Care Informatics Working Group Contribution to the Yearbook of Medical Informatics 2018. Yearbook of Medical Informatics, 27(1), 156. https://doi.org/10.1055/S-0038-1641202

Patel, V. L., & Kannampallil, T. G. (2014). Human Factors and Health Information Technology: Current Challenges and Future Directions Introduction and Background. Yearbook of Medical Informatics, 58–66. https://doi.org/10.15265/IY-2014-0005