Electronic medical records subject of ongoing controversy

April 1, 2006

Dr. EMR, a technologically oriented dermatologist, has been using electronic medical records for two years.

Dr. EMR, a technologically oriented dermatologist, has been using electronic medical records for two years.

Recently, he was the subject of a lawsuit based on outsiders getting access to his electronic medical records. A colleague has also now told him that because he does not have hard copies of his medical records, he may not be covered for medical malpractice coverage. The friend contends electronic medical records only create problems. What should Dr. EMR do?

Playing catch-up

Healthcare, at least at the national level, has lagged behind. What is clear, though, is that electronic medical records have the potential to do great things for the healthcare industry. Such a system ideally would decrease healthcare costs, increase the quality of patient care, facilitate better communication, create less paper confusion, allow use only with authorized access, allow storage of digital images and increase overall efficiency.

However, concerns continue to arise regarding the transformation of the traditional paper system by which medical records are kept and stored. Electronic medical records can clearly be beneficial to physicians from a cost and efficiency standpoint, but are our patients clearly better off with such a system?

Enter HIPAA

It was because of these privacy concerns that the Health Insurance Portability and Accountability Act (HIPAA) of 1996 was promulgated to require the Department of Health and Human Services (HSS) to adopt standards for electronic medical transactions.

HIPAA's Administrative Simplification sections outline a process for protecting the privacy of health information. These regulations focus on the need to protect the security, integrity and authenticity of health information. Unfortunately, HIPAA provides very little guidance with regard to these security issues.

Arguments against HIPAA

It is because of these security issues that there has been much opposition to HIPAA and implementation of a national electronic health information system.

Opponents continue to believe that storing medical records electronically may result in a major violation of patient privacy. According to the American Health Information Management Association, an average of 150 people have access to a patient's medical records during the course of a typical hospital stay. Needless to say, many of those who have access have a legitimate need to see the records, but there are no clearly defined laws that govern who those people are, what information they can see, and what they can and cannot do with patients' personal information once they have access. In addition, much of the sharing of medical information actually occurs without the affected patient's knowledge. Although the magnitude of the problem in a dermatologist's office is clearly less, the substance of the problem remains the same.

Proponents of a full national electronic medical record system argue that monitoring record access is easy.

It is not difficult to monitor who enters into the system, when they enter into the system, and what they are looking for. Unfortunately, although today's technology may allow usage of a patient's record to be monitored, such monitoring is a reactive measure, available only after the information has been viewed.

Bottom line

Despite all the concerns, almost all parties involved recognize the need for the electronic transformation of written medical records.

In fact, some insurance companies have reduced malpractice premiums by as much as 10 percent based on electronic medical record use, simply because the electronic documentation of patient progress and visits may offer a strong defense against claims of substandard care.

It is clear, then, that we need stricter regulations that address on-going privacy concerns. In addition, more demanding regulations concerning the monitoring of who may come in contact with patient information must coincide with tougher sanctions for those who do not follow proper privacy procedures.

Dr. EMR's electronic medical record approach represents the future of healthcare in the United States. He will not have problems obtaining medical malpractice coverage. Although there clearly are challenges to the conversion to electronic medical records, Dr. EMR is to be congratulated for his efforts.