|Electronic Medical Records: the pros and cons|
|An electronic health record (EHR) or electronic medical record (EMR) is nothing but a medical record of a patient in digital form. The digital information is usually stored in a database and is accessible from everywhere via a network. A patient’s medical information is normally recorded on paper written in a patient’s record at every doctor’s office the patient has visited or in the medical chart hanging at the foot of a patient’s hospital bed. EMRs contain mainstream data normally found on a patient’s medical records, e.g. blood type, blood tests, inoculations, and X-ray films. Recently, the integration of patient-specific genomic information has also been proposed.|
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 itself started about 40 years ago. However, there is surprisingly a strong resistance against the use of EMRs. Let us take a look at what the proponents and opponents of EMR have to say.
What are the advantages of EMRs?
The main proponents of EMR are health care providers, hospitals, clinics, and other sectors of the healthcare industry. Here are some of their arguments:
EMRs minimize errors
EMRs keep records safe
EMRs also help keep records of health information that patients tend to forget with time, i.e. inoculations, previous illnesses and medications. Online services such as the Cleveland Clinic’s MyChart, HealthVault and Google Health can help patients in record keeping. These will be discussed in detail below.
EMRs make health care cost-efficient
Last month, the first city-wide electronic health information exchange in the US was implemented in Indianapolis. The Indiana Network for Patient Care was developed from the Regenstrief Medical Record System which is a database of 9.6 million patients. The system is expected to improve health and lower costs.
EMRs facilitate coordination between health professionals
The Cleveland Clinic has been always been on the leading edge in health information technology and was one of the very first to offer secure online services. The DrConnect service provide primary care clinicians “real-time electronic medical record information about the treatment their patients receive at Cleveland Clinic.”
EMRs translates into better treatment for patients
EMRs can save lives
VeriChip, developed by VeriChip Corporation is the first one of its kind ever approved by the US FDA. It is an implantable RFID microchip, not only for pets, but also for humans. The 16-digit code in the VeriChip, which can be read by a chip reader, can be used to access online databases, including EMRs.
VeriChip offers the following benefits:
Some types of EMRs give patients control over their health records
Earlier this year, Google Health was launched, an online personalized health record services. The service 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. "Personal health records is an area that's just beginning," said Roni Zeiger, the Google Health product manager. "The fact that only few people are using those tools means we--the computing and health care industries--haven't gotten it right yet."
Some of the nifty features of the service are:
Several prestigious medical institutions are working closely with Google Health. One of the major partners is Cleveland Clinic.
“Working with Google Health, Cleveland patients can now import their Cleveland Clinic medical records into their own, secure Google Health Account. This allows patients to maintain comprehensive medical records about themselves, including accurate medication histories, and other invaluable information. Cleveland Clinic's partnership with Google broadens the ability of all patients to utilize secure online technology to coordinate their own health care services, thereby furthering Cleveland Clinic's ultimate goal of empowering patients and transforming medicine through the use of innovative health information technology.”
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." Aside from medical records, Google Health also keeps fitness records and has joint projects with the American Heart Association to run online cardiovascular health monitoring platforms for patients such as Heart360 and the HeartHub. Cleveland Clinic also has recently announced “to pilot the patient-controlled data exchange between Microsoft HealthVault, a Web-based personal health platform; a suite of widely-used digital medical devices; and eCleveland Clinic MyChart, Cleveland Clinic's electronic personal health record …system.”
What are the disadvantages of EMRs?
EMRs threaten our privacy
EMRs can lead to loss of human touch in health care
EMRs are not that efficient
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. Furthermore, there was no marked improvement in time efficiency.
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 damage.”
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.
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.
VeriChip is not for humans
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?
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