Healthcare // Electronic Health Records
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7/28/2014
09:06 AM
Mansur Hasib
Mansur Hasib
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When Patients Fear EHR

When patients believe paper medical records are safer and more private than electronic ones, their health can suffer.

Many members of the public mistakenly believe electronic health records (EHRs) are less secure than paper files. Magnified by misinformation and political distortion of facts, an unnecessary fear has taken root in the minds of many consumers -- often with serious consequences.

While states were rolling out their health insurance exchanges last year, a key service provided by the federal hub Healthcare.gov was automatic verification of the application data an applicant entered. Applicants could choose automated or manual verification of their data. The public was unclear about the consequences of their decisions.

[Doctors are warming up to cloud services. Now what? Read Healthcare IT Cloud Safety: 5 Basics.]

If applicants chose automated verification, their applications could be approved within seconds without needing any documentation. If they chose manual verification, their applications would get stuck in a case worker's queue. Workers would then contact the applicant, and require the applicant to bring various documentation to verify date of birth, citizenship, legal status, income, information regarding their family members, and various other things. Their health insurance application approval would be delayed by weeks or months.

Old-fashioned paper medical documents feel safer to some patients than electronic records. (Source: Wikipedia)
Old-fashioned paper medical documents feel safer to some patients than electronic records.
(Source: Wikipedia)

While working at several health fairs throughout the state of Maryland last year, I had the opportunity to talk to people about this issue. Here's what I found out:

  • Consumers thought that by choosing manual verification they would avoid having their information in electronic format.
  • People did not realize the choice would cause a delay in the approval of their application.
  • People had a general fear of computers and electronic information.

I explained to them that their information eventually would be in electronic format, even if they used a paper application form. If they chose automated electronic verification, the system would query the appropriate systems as well as the federal hub, verify the information entered, and provide a decision on the application within seconds. On the other hand, if they chose manual verification, they would need to bring in various documents that would have to be copied, scanned, and retained. It could take them a long time to gather all the necessary documentation; meanwhile, they would continue to be uninsured.

I then explained that paper records are far less secure than electronic records because of the following:

  • When someone views a paper record, no one knows who saw it, for how long they saw it, or when they saw it; we do not even know if they were authorized to view the record.
  • We cannot scramble or encrypt the data.
  • We are unable to retain backup copies in multiple locations to ensure protection in cases of fire or water damage.
  • Multiple physicians or other providers cannot easily see their complete medical records in order to make a life-saving decision for them.
  • Information is often hard to decipher because of variations in handwriting.
  • With electronic records, people have the power to determine how their information can be used and shared. They have the right and ability to view their information as well as correct any inaccuracies in their records. Custodians of their information are obligated by law to adequately protect their information or face severe fines and penalties.

I shared anecdotes of how patients' lives were saved because complete and accurate information was electronically available simultaneously to multiple specialists residing in various states, so they could agree on the least risky and most appropriate medication. This enabled the right decision to be made the first time. A wrong decision would have resulted in the death of the patient.

I then explained that electronic medical records are more secure than paper because:

  • We know exactly who sees their information, when they see it, for how long they saw it, and if they were authorized to see it.
  • Even in cases where an unauthorized access has been made, we have a better chance of catching the perpetrator.
  • We can scramble the information through encryption; we can also obfuscate the information and store it in a shredded file format instead of a complete file format.
  • We can keep the information in various geographically dispersed locations, ensuring availability even in case of disaster.

People felt empowered with the knowledge. It was truly heart-warming for me to watch as smiles spread across people's faces once they recognized the power, the promise, and the higher level of safety of electronic medical records. Once their insurance applications were approved within seconds, many complete strangers got up, shook our hands, and gave us their warmest hugs.

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Mansur Hasib is the only Chief Information Officer (CIO) in the world with 12 years' experience as CIO, a Doctor of Science (DSc) in information assurance, CISSP (cybersecurity), PMP (project management), and CPHIMS (healthcare) certifications, who has written two books ... View Full Bio
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Alison_Diana
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Alison_Diana,
User Rank: Author
7/29/2014 | 9:26:59 AM
Re: Defending the value of EHR versus paper
@Jeff - I agree, EHRs are definitely here to stay. Is there any business that, having digitized, went back to paper? But I don't believe healthcare organizations are doing enough to promote security. They must do more. Sadly, I don't think that will happen until there's a huge Target-like breach. Then heads will roll and, "suddenly," resources for more healthcare security will become available at more organizations. That's not to say some healthcare orgs don't get it. Some do; some are doing a great job of securing their data, networks, devices, etc. But many, sadly, are not from what security experts in healthcare tell me. 
Alison_Diana
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Alison_Diana,
User Rank: Author
7/29/2014 | 9:24:20 AM
Re: Defending the value of EHR versus paper
I think the answer is secure EHRs, to be honest because I don't see healthcare going back to paper. The reasons I hear for witholding information from healthcare providers is 'big government' and 'intrusiveness' more than EHRs, necessarily. They are concerned their healthcare information is up for grabs by so many, that once "private" information is entered into a hospital system it becomes fodder for government, research, and educational institutions. They're also concerned about the weakening of doctor-patient confidentiality.
Alison_Diana
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Alison_Diana,
User Rank: Author
7/29/2014 | 9:19:40 AM
Re: Defending the value of EHR versus paper
Breaches in EHRs can definitely be life-threatening. If the hacker is not malicious and steals your data expressly to sell it (for the $50 we see bandied around), then someone else could use your medical ID for treatment, surgery, medications, etc. When you, the real patient, need surgery or other healthcare services, you could discover you cannot get treated because "you" owe the hospital thousands of dollars (in unpaid deductibles); you "have a drug problem" (courtesy of a doctor-shopping alter-ego), or "your record" shows you can't be pregnant because your insurance paid for a hysterectomy last year. Or it may show you have no allergies -- when, in fact, you are very allergic to a regularly prescribed antibiotic, for example, leading to health complications or even death. 

It's one reason we cannot let healthcare organizations slide on the amount and resources they spend on security. When we see studies like this -- Healthcare IT Security Worse Than Retail -- we must demand better.
DarrellP725
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DarrellP725,
User Rank: Moderator
7/28/2014 | 11:25:45 PM
Re: Defending the value of EHR versus paper
EHRs are both more expensive and more dangerous than paper records, Outside a totalitarian regime, that is a hard sell.
DarrellP725
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DarrellP725,
User Rank: Moderator
7/28/2014 | 11:22:33 PM
Re: Defending the value of EHR versus paper
Regardless what EHR stakeholders want - regardless what providers want. When patients lose their trust in EHRs - which is happening rapidly - the game ia over. They will simply keep secrets from healthcare providers, which will increase the danger of EHRs even more.

You say that there are no reasonable alternatives to EHRs, yet some providers are already rejecting digital. As costs and danger continue to accelerate, what is to keep more from following? Patriotism?
Jeff Jerome
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Jeff Jerome,
User Rank: Ninja
7/28/2014 | 11:18:26 PM
Re: Defending the value of EHR versus paper

vnewman - Electronic Medical Records are here to stay.  Sure there is potential risk but there is a strong set of security wrapped around them.  The benefits far outweigh the down side and paper records are to arcane to consider staying with, even if some believe that they are not safe.

vnewman2
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vnewman2,
User Rank: Ninja
7/28/2014 | 10:49:07 PM
Re: Defending the value of EHR versus paper
If by trapped you mean there are no reasonable alternatives to electronic medical records then yes I mean trapped.
DarrellP725
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DarrellP725,
User Rank: Moderator
7/28/2014 | 10:03:14 PM
Re: Defending the value of EHR versus paper
Let me see if I understand you correctly: Regardless of the ever-increasing cost and danger of EHRs, Americans are trapped?
vnewman2
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vnewman2,
User Rank: Ninja
7/28/2014 | 7:16:51 PM
Re: Defending the value of EHR versus paper
I don't think it's authoritarian at all.  It's a fact.  This IS how it is.  Hopefully it will change but the threat will never go away.  This is true of electronic anything.

I think the public has accepted it - what's the alternative?

So do you suggest going back to all paper records then?  That's an impossibilty.  

With great progress comes great challenges.

I'm not discounting dangers of data breaches just like I wouldn't discount the danger of driving on the highway, yet millions of people do it every day.  You take risks.  This is life.

Do I think security breaches are an issue?  Of course?  Do we scrap the whole system because of it?  I think not.  You try to make things better.  But you have to move forward not backward.

But if you don't want to take that chance, stay off line, don't use credit cards and don't give any of your personal information to anyone.  We all have that choice.
DarrellP725
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DarrellP725,
User Rank: Moderator
7/28/2014 | 5:48:15 PM
Re: Wall of Shame
According to Ponemon, here's the difference between paper breaches and digital: Only 5% of identities are breached from paper records, and most of these are because of improper disposal. On the other hand, hackers specifically target identities.

This is fun.
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