Electronic Records and Confidentiality

At UAMS, we recently did a survey asking employees if they used the University for their health care and, if not, why not. A signficant percentage indicated that they elected to go elsewhere because of concerns about confidentiality of records.

Recently, at another local hospital, following a tragic homicide of a news anchorwoman at a local TV station, 7 employees were fired because they accessed her records without authorization.

At UAMS our compliance/HIPAA office indicated that, when they do audits of our EMR, they routinely discover MANY episodes of unauthorized access to our electronic medical records.

Electronic records have so many advantages, but this is one of the challenges that needs to be addressed. Communication, clear policies, and accountability measures are all critical to keeping folks' noses out of records where they don't belong.

One thing needs to be said in clarification, though. In the "old days" when paper records were the rule, I'm absolutely sure that confidentiality was just as big an issue, but we had no way of knowing if someone looked at records without authorization. Nowadays, if someone accesses a digital record, it leaves an electronic "footprint" that can be easily traced to the perpetrator. So, it could be that this is simply a problem that we now have more information about and can do something about, rather than actually being a new problem that is due to the EMR. On the other hand, it is likely that some occurrences of unauthorized access would not have occurred in the "paper era" because electronic lurking involves different settings, technology and skill than finding a paper chart and looking at it.

Can electronic records be constructed that assure that their confidentiality will be maintained? Probably not. Can more be done to safeguard patient online records? Without a doubt, yes.

This is an issue that the public needs to become educated about and weigh in on. What do you think? Do the advantages of an EMR outweigh confidentiality concerns? How concerned are you about this? Does it affect where you go and who you see for medical care?

Let us hear from you on this...