Risks of Computerized Medical Records

An electronic medical record, or EMR, is a computerized version of the traditional paper-based medical record. According to the Open Clinical organization, evidence shows that paper-based systems do not deliver sufficiently safe, efficient, high-quality and cost-effective health care. While primary care practices in countries such as Norway, Sweden and Denmark have already made the switch to computerized systems, the United States has been slower to integrate EMRs.

Transition

• The introduction of EMRs may encounter resistance from physicians and nurses used to traditional paper-based systems. In some instances this can result in confused records which are partly digitized and partly handwritten. According to the Journal of Usability Studies, many EMRs take a long time for physicians to learn to use. During this learning process, health-care professionals may be perceived by patients as spending more time with the computer than attending to their needs.

Reliability

• Like any digital document, computerized records rely on the computers that store them. The programs used to access digital records cannot crash, freeze or otherwise behave unexpectedly without potentially life-threatening consequences. Human reliability is also a major factor. Medscape cites a case of a neurologist mistakenly using a template for a normal neurological examination for a one year old boy. The boy's record subsequently stated that he was oriented as to space, time and person, which is impossible to determine at such a young age.

Accountability

• Documents, such as progress notes or medical orders, often require a signature from a physician as a legal statement of responsibility. In some electronic systems, this signature is replaced by the physician entering a secret login key. This key, like all forms of password, is subject to theft and hacking. There is also the possibility for one clinician's entries on a record to be listed under the name of another. This may happen if the first clinician does not log off or sign off the record.

Patient Privacy

• Medical records contain extremely sensitive information about anyone who has ever come into contact with the healthcare industry. A patient's history may include drug abuse, life threatening illnesses, contagious diseases or genetic susceptibility to disease. The disclosure of these details could cost a patient her job or insurance coverage, or damage relations with her family. Computer-based records have the potential to be accessed by far more people than their paper-based counterparts. Given that authorized medical practitioners can give access to medical records to anyone working in the healthcare industry, from physical therapists to health insurance providers, the key problem is defining exactly who is granted access to medical records and then preventing those who do not have access from illegally gaining it.