Electronic Medical Records - The Pros and Cons by aihaozhe2


									In this digital age, more and more bulks of information which used to be paper-based,
from library catalogues to telephone books, are digitized and stored in a central
location for easy access. The idea of EMRs started about 40 years ago.

The main proponents of EMRs cite the following advantages:

(1) The use of EHRs supposedly reduces errors in medical records. There is no doubt
that handwritten records are subject to lots of human errors due to misspelling,
illegibility, and differing terminologies. With the use of EMRs standardization of
patient health records may eventually become acheivable.

(2) Paper records can be easily lost. We have heard how fires, floods and other natural
catastrophes destroy physical records of many years, data which are lost forever.
Digital records can be stored virtually forever and can be kept long after the physical
records are gone. EMRs also help keep records of health information that patients
tend to forget with time, i.e. inoculations, previous illnesses and medications.

(3) EMRs make health care cost-efficient by consolidating all data in one place.
Previously, paper-based records are located in different places and getting access to all
of them takes a lot of time and money. In a systematic review, Kripalani et al.
evaluated the communication transfer between primary care physicians and
hospital-based physicians and found significant deficits in medical information
exchange. The review recommended the use of EMRs to resolve these issues and
facilitate the continuity of care before, during and after hospitalization. EMRs
translates into better treatment for patients. Take the example of one asthma center's
experience with EMR: "A major benefit associated with EMR implementation was the
increase in the number of children who were hospitalized with an asthma exacerbation
and received an asthma action plan upon discharge. Prior to the EMR system, [only]
4% received an asthma action plan upon discharge. After implementation of the EMR
system, 58% received an asthma action plan upon discharge."

(4) EMRs can save lives. VeriChip, developed by VeriChip Corporation is the first one
of its kind ever approved by the US FDA. It enables rapid identification of at-risk
patients and access to their medical history, thereby enabling rapid diagnosis and
treatment especially in emergency situations. Classic examples are people with
diabetes and/or heart problems who have high risk of collapsing and having attacks.
VeriChip is also useful in vehicular accidents and other trauma incidents where the
victims aren't capable of answering questions. In cases of large-scale catastrophes,
VeriChip facilitates tracking and identification of victims. According to a coroner in
Mississippi, VeriChip helped identify victims during the Hurricane Katrina incident.

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

The HealthVault is another online health information storage service offered by
Microsoft with features similar to Google Health. Keith Toussaint, senior program
manager with Microsoft HealthVault recently stated " leading hospitals like Beth
Israel Deaconess Medical Center are actually 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 advocacy
groups are the main opponent of EMRs. Here 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 about having their entire medical
history recorded and digitized for almost just anybody to see - in other words,
incursion into people's privacy. The confidentiality of doctor - patient relationship is
still sacrosanct. Besides, medical data can be used against a person in some cases - be
it 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 are in the job market. The
planned incorporation of genetic data in EMRs further adds to people's fear of
incursion into their private sphere.

(2) EMRs can lead to loss of the human touch in health care. In the process of
digitalization, the interpersonal aspect in health care may be lost. In handwritten
hospital charts, doctors and other health care practitioners may write what they think
and they feel based on their personal observations in their very own words. EMR is
simply about ticking off boxes and crossing out things in electronic forms. The
doctors are forced to think in categories and can seldom express a personal opinion on
an individual case. Because of the lack of flexibility of many electronic reporting
systems, cases of misclassification of patients and their conditions have been reported.

(3) EMRs are not that efficient. Despite efforts in digitalization and standardization,
EMRs are actually far from being standardized and not as efficient as it is purported
to be. It often happens that one clinic's EMR system is not compatible with that of a
general practitioner or another clinic's system, thus belying the claim of added
efficiency. In addition, not all users of EMRs are satisfied with the current state of the
art. Although the objective is mainly efficiency and healthcare quality, one study
showed that nurses in the Netherlands are not completely satisfied with their EMR
implemented in 2006-2007.

(4) EMRs are not safe and secure. Google Health and HealthVault are quick in
assuring patients of the safety of their online health accounts. Access to the patient's
account is only possible using log ins and password. In addition, HealthVault assures
that "all health information transmitted between HealthVault servers and program
providers' systems is encrypted" and that Microsoft does it best to use the "highest
standards of security to safeguard consumer health information from theft, loss, or

However, there are cases wherein passwords and encryptions do not seem to be
adequate as data protection tools. Stories of data hacking, stolen identities and
blackmail abound. Even high security databases such as those run by banks and credit
institutions are often compromised. This impression was aggravated by the many
well-publicized incidences of data loss or breach. A few examples are listed below:

November 26, 2007, Canada. Hackers accessed medical information on HIV and
hepatitis from a Canadian health agency computer. - September 22, 2008, UK. The
National Health Service (NHS) reported the loss of 4 CDs in the mail containing
information on 17,990 employees. - September 30, 2008, US. The company Blue
Cross and Blue Shield of Louisiana confirmed 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, there is criticism over Google Health not being 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 is therefore not
subject to HIPAA privacy of individually identifiable health information. The
HealthVault terms and conditions do not mention HIPAA privacy laws so it is not
clear what its status is regarding this issue.

(5) VeriChip is not for humans. It is to be expected that although many of us are
amenable to the use of RFID chips in pets, the idea of implanting similar chips in
human beings is bound to raise hackles in humans, no matter what the US FDA says.
A big opponent of the VeriChip and similar chips of its kind is the consumer advocacy
group Spychip.com. In a position paper, Spychip and many advocacy and consumer
awareness groups see RFID tagging (be it on your person or on the items you buy) as
a major threat to privacy and civil liberties. They see the tagging as some kind of "Big
Brother" operation. Another group, the No VeriChip Inside Movement, likens
VeriChip as "cataloguing" humans similar to the way the Nazis have tattooed numbers
on the skin of concentration camp detainees. Popular Hollywood films on privacy
incursions (e.g. The Net, Public Enemy No. 1) increased further people's paranoia
about personal data.

Where do we go from here? Without doubt, we have the technology to make EMRs
standardized and efficient. Google Health, Microsoft HealthVault and similar online
personalized health information accounts are enabling patients to take control of their
medical records. The main issues that need to be overcome are data security,
protection of privacy and gaining the confidence of the patients. It doesn't seem
evident that the use of RFID and similar tagging chips will become acceptable or
popular anytime soon. However, we live in a digital world and we cannot hold back
progress indefinitely. With improved technology and data protection tools, let us hope
the EMR issue will be resolved soon.

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