Medical Ethics and Electronic Medical Records

“But what happens when your physician retires, moves or sells his/her practice? What happens when your electronic health record contains inaccurate information (a misdiagnosis, for example)? What happens when it has gaps (an unrecorded drug allergy)? What happens when a medical practitioner somewhere along the way has made a value judgment (high-maintenance patient, chronic complainer, hypochondriac) that could affect your access to care?” – Carol Goar

In the Toronto Star article, Medical ethics overtaken by technology, Carol Goar puts doctors, their clinics, and the technology they choose to use under the microscope. Through a series of questions, Goar expresses concern about the way in which medical technology is compromising Canadians’ privacy rights. While Goar may ask some hard questions, her thesis that patient records are no longer being kept safe for Canadians falls flat in the face of today’s EMR industry. Instead, Goar seems out of touch with the reality of the medical software industry and the physicians, clinics, and even patients who put their faith in it.

In fact, electronic medical record software has done nothing but improve the security of medical records in Canadian physicians’ clinics. Encryption ensures that records are kept safe from malicious intent, which is a massive improvement over the physical locks that have kept paper charts safe for decades. Tools built into the software such as password protection ensure confidential records are only accessed by physicians who have patient consent. All the life-saving benefits Goar acknowledges are combined with improved security and privacy. There is no downside for patients here.

Among her assumptions, Goar seems to believe that paper records represent a safer, more confidential type of record. What she seems to forget, however, is that paper records come with no encryption, no locks to prevent unauthorized staff, nurses, or physicians from accessing the record, and no back-ups to protect against natural disasters. If a clinic experiences a fire or flood, those paper records are gone, with no chance of recovery. Electronic medical records, on the other hand, when properly backed up, ensure a natural disaster doesn’t mean a data disaster. Paper records are not immune to the problems she claims are unique to electronic medical records. Mistakes such as misdiagnoses or unrecorded drug allergies happen on paper charts just as often as they may happen in electronic medical records. In fact, many EMR systems, including P & P’s CIS, are designed with checks in place to ensure misdiagnoses and overlooked allergies don’t happen.

Goar seems to believe that the biggest problem with electronic medical records arises when physicians retire. This is a complicated time for any patient and physician. Patients must begin their search for a new family doctor, while physicians dissemble their practice. Records must be retained in secure facilities for 10 years, while providing patients with their right to access their medical record. Paper records make this process more difficult and expensive for both parties, since retiring physicians must pay for large, secure storage facilies, and patients must pay the administrative costs to track down their record and deliver it to their new clinic. More often than not, patients start over, with a brand new record at their new doctors’ offices.

Electronic medical records, on the other hand, are far cheaper to store, and easier to access for patients who need them. There is no ‘involuntary handover’, and records are kept safely behind layers of encryption and back-ups. Goar, herself, admits that problems arising around electronic medical records are rare and most often related to broken rules, not problems with the software itself.

With all the benefits that electronic medical records are bringing to patient care and medical record safety and security, villianizing the whole industry for endangering the public’s privacy is misguided and, in many way, insulting to the physicians, clinics, and software companies that are working hard to ensure the exact opposite.