Electronic curative Records - The Pros and Cons

Security Shield - Electronic curative Records - The Pros and Cons

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

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The main proponents of Emrs cite the following advantages:

(1) The use of Ehrs supposedly reduces errors in curative records. There is no doubt that handwritten records are field to lots of human errors due to misspelling, illegibility, and differing terminologies. With the use of Emrs standardization of outpatient health records may ultimately come to be acheivable.

(2) Paper records can be truly 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 facts that patients tend to forget with time, i.e. Inoculations, former illnesses and medications.

(3) Emrs make health care cost-efficient by consolidating all data in one place. Previously, paper-based records are settled in different places and getting way to all of them takes a lot of time and money. In a systematic review, Kripalani et al. Evaluated the communication replacement in the middle of customary care physicians and hospital-based physicians and found requisite deficits in curative facts exchange. The describe recommended the use of Emrs to decree these issues and facilitate the continuity of care before, while and after hospitalization. Emrs translates into great rehabilitation for patients. Take the example of one asthma center's feel 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 operation plan upon discharge. Prior to the Emr system, [only] 4% received an asthma operation plan upon discharge. After implementation of the Emr system, 58% received an asthma operation plan upon discharge."

(4) Emrs can save lives. VeriChip, advanced 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 way to their curative history, thereby enabling rapid determination and rehabilitation especially in urgency situations. Classic examples are citizen with diabetes and/or heart problems who have high risk of collapsing and having attacks. VeriChip is also beneficial 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 while 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 curative record, the outpatient should control it, decree what should be in it, and who gets way to it. One of the features of the assistance includes records from hospitals and pharmacies that are Google Health-enabled or are registered Google health partners.

The HealthVault is an additional one online health facts storehouse assistance offered by Microsoft with features similar to Google Health. Keith Toussaint, senior agenda owner with Microsoft HealthVault recently stated " leading hospitals like Beth Israel Deaconess curative center are truly integrating their systems with both us and Google -- because some citizen like one or the other. It's a Coke or Pepsi thing."

What are the disadvantages of Emrs? Not surprisingly, privacy possession 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 citizen are comfortable about having their whole curative history recorded and digitized for approximately just anyone to see - in other words, incursion into people's privacy. The confidentiality of physician - outpatient relationship is still sacrosanct. Besides, curative 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 citizen 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 understanding on an personel 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 truly 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 an additional one 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 thoroughly 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 protection of their online health accounts. way to the patient's catalogue is only possible using log ins and password. In addition, HealthVault assures that "all health facts transmitted in the middle of HealthVault servers and agenda providers' systems is encrypted" and that Microsoft does it best to use the "highest standards of protection to safeguard buyer health facts from theft, loss, or damage."

However, there are cases wherein passwords and encryptions do not seem to be sufficient as data protection tools. Stories of data hacking, stolen identities and blackmail abound. Even high protection 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 curative facts on Hiv and hepatitis from a Canadian health department computer. - September 22, 2008, Uk. The National health assistance (Nhs) reported the loss of 4 Cds in the mail containing facts on 17,990 employees. - September 30, 2008, Us. The enterprise Blue Cross and Blue Shield of Louisiana confirmed breach of personal data, including public protection numbers, phone numbers and addresses of about 1,700 brokers. The data was accidentally attached to a general email.

In addition, there is annotation 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 field 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 concerning this issue.

(5) VeriChip is not for humans. It is to be thinkable, 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 buyer advocacy group Spychip.com. In a position paper, Spychip and many advocacy and buyer 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. an additional one 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 facts accounts are enabling patients to take control of their curative records. The main issues that need to be overcome are data security, protection of privacy and gaining the belief of the patients. It doesn't seem clear that the use of Rfid and similar tagging chips will come to be thorough or Popular anytime soon. However, we live in a digital world and we cannot hold back advance indefinitely. With improved technology and data protection tools, let us hope the Emr issue will be resolved soon.

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