Do you ever wonder how your health records are entered and stored? Increasingly, from a routine visit to your primary care physician to an emergency room visit, your health records are being stored electronically. This record is known as an electronic health record (EHR).
While it might seem convenient to have all your health history stored electronically in one place, is this information secure? And if there's a mistake on your record, how can you fix it?
To learn more about EHRs and how they affect you, we spoke to Dean Sittig, professor in the School of Biomedical Informatics at the University of Texas Health Science Center in Houston. His research interests include the design and implementation of clinical information systems, including EHRs.
What is an electronic health record (EHR)?
The electronic health record is a system used by doctors, nurses and health care systems to record the activities happening in the health care setting.
So if you go to the hospital, you're admitted, which is recorded in the system. The nurse does an admission assessment including a review of your past medical history and physical exam findings and enters this information into computer. Then, say, the doctor orders a bunch of tests – these orders are added to the system as well as the test results. This is what we call an electronic health record.
Also, the electronic health record is responsible for managing billing and allowing medical professionals to see what's happening with those patients, in terms of quality of care, for example.
So let's say I get a checkup, and my doctor decides to do a few tests. Are the results I'm able to see in my personal account the same as what my doctor sees?
Usually you will see a subset of what the physician can see.
If you went to a doctor and she ordered a mammogram and it came back abnormal, typically, the health care system won't release abnormal results automatically because you probably want to get those results in person, or at least over the phone so someone can talk to you about it.
What are the major pros and cons of the EHR system?
There are many pros to the EHR system because in the old days, we wrote all our orders and notes on paper. The data were difficult to share with physicians in other locations and very difficult to read.
The computer has a tremendous advantage in improving the availability, legibility and usability of the data recorded in the health care system.
The con is that it requires physicians to do a lot more work -- and there's a lot more oversight of the entire healthcare delivery process.
You say there are many errors in our current health care system. Can you give some examples of the most common types of errors? How can these errors affect a patient?
According to a highly quoted report from 1999, an estimate of between 44,000 and 98,000 people die every year in the United States because of medical errors. More recent estimates have placed the number of deaths from medical errors between 210,000 and 400,000 per year.
Not all those errors -- or deaths -- are preventable. We may find not as many people are dying today from medical errors as they used to, but it's a very difficult thing to measure and a difficult thing to quantify.
However, there are many instances in which people get the wrong medication, the wrong surgery, or procedure. All in all, I think the EHR is reducing the number of mistakes that are happening.
I also think EHRs are making errors more visible. The computer can read a thousand notes in a second, making it easier to find errors. In a paper-based world, that would've been a weeklong project for someone to read through a thousand records looking for errors.
If you find an error in your health record, what can you do to fix it?
Part of the HIPAA (Health Insurance Portability and Accountability Act) law says patients have the right to request a change to their electronic health record.
So if I review my record and it says I broke my right arm, but it's clear I broke my left arm, the doctor or the health care system should quickly fix that record.
However, say the computerized record says I'm morbidly obese and I'm suffering from diabetes and depression. If I call the hospital and say I'm not morbidly obese, I'm just a little overweight -- even if I’m 5 feet 6 inches tall and I weigh 300 pounds -- I can't change the facts unless (what's in the file is) wrong.
So when you discover a fact that's wrong, it's very easy to get it changed. All you have to do is make a request to your physician.
The most recent federal incentives for use of EHRs, require that patients have electronic access, via the internet, to at least a portion of their medical record. I'm a big believer in this kind of transparency, and it's great that more people will be able to review their own medical data.
Are there any privacy concerns for patients if their medical records are accessible electronically?
Well, privacy is a difficult subject; in our modern society, we have very little privacy. By putting records in an electronic format and making them accessible over the internet, we've increased the likelihood of a data breach or an illegitimate person accessing your records.
However, the ability for you and all your physicians to see what's wrong with you (through the EHR) and to come together and help you the best they can, is a tremendous benefit.
In (most cellphones), there's a way you can review on the internet, if you have (Google's location software) enabled, it'll show you everywhere you've been during the past day. You may think of it as an invasion of your privacy, but you gave that up to get the phone and all your apps to work better, such as your navigation or restaurant recommendation apps.
I think the same thing is true with electronic health records; we've given up a little of our privacy for a much better functioning health care system in general.
What if the database goes down or there's a glitch; is there something that can back up those records?
All of your health records should be backed up by the health care organization, so we've just written a paper about what hospitals can do to make sure their records are safe and available.
Computers will break and your disk drive will lose data if you don't have a backup, so every hospital should have a backup in place and they should have a plan for what's going to happen when their records are not available, for example during a long power outage like occurred following hurricane Sandy along the east coast in 2012.
Like your cellphone, if you don't have it backed up to the [cloud], it's very easy to lose your phone or drop your phone and lose all of your pictures [and other information].
So you should back up your pictures just like hospitals should back up their records because the same things can happen to a hospital -- we should be prepared for either manmade or natural disasters at all times because they happen more often than we would like.