April 28, 2017
by Jami Starr, MD, Clarkson University Bioethics Policy Certificate 2017
E-H-ARRGH: The Frustrating Costs and Benefits of the Electronic Health Record
The concept of electronic medical recordkeeping was first introduced in the late 1960’s but it did not really become established until this century. Electronic Health Records (EHRs) are expected to provide a number of benefits, including: ability to track data over time, monitoring use of interventions (i.e. vaccinations), and identifying patients in need of preventive screening. Data are forthcoming as to how effectively EHRs meet these goals. What is clear, however, is that it is third party payers profit from EHRs as a result of improvements in claims processing.
The use of EHRs carries implicit hazards with respect to confidentiality. It seems no cyber security system today is impenetrable. We have witnessed multiple breaches in the past few years involving government agencies, major retail chains, and financial institutions. If a hospital database were hacked, not only would pertinent demographics be exposed (social security numbers, insurance policies, etc.) but also personal information about diagnoses, socioeconomic circumstances, and the like. While this is a risk with paper medical records as well, the rapid and potentially widespread dissemination of information though a computer data system is far more menacing in scope. In most clinical settings where EHRs are employed, paper charts have been eliminated and patients do not have an option as to how personal data are maintained. Vulnerability has been increased de facto by reliance upon this new medium.
Aside from the issues related to cyber security, there are start-up costs related to productivity, burnout and physician-patient relationships.
The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.