Healthcare // Electronic Health Records
Commentary
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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DarrellP725
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DarrellP725,
User Rank: Moderator
7/30/2014 | 9:43:00 PM
Re: Defending the value of EHR versus paper
Susan, your argument isn't with me. It's with CBS.
mhasib
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mhasib,
User Rank: Author
7/30/2014 | 8:42:21 PM
Re: Disaster Recovery?
@Susan - luckily disaster/emergency operations in healthcare is a very mature field and there are many great experts (who are not my students) in this field.
Susan_Nunziata
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Susan_Nunziata,
User Rank: Strategist
7/30/2014 | 8:21:04 PM
Re: Defending the value of EHR versus paper
@DarrellP725: This is quite true. Although it can happen both electronically and on paper. A good friend of mine had his identity stolen at a doctor's office in Florida where he was required to write his social security number on a new-patient form. Turned out one of the employees at the doctor's office was selling patient identity--and no electronic records were involved. It took my friend over 5 years and cost him thousands of dollars to clear his name. The use of Social Security Numbers as identifiers in medical facilities should be eliminated altogether, whether records are on paper or electronic.
Susan_Nunziata
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Susan_Nunziata,
User Rank: Strategist
7/30/2014 | 8:18:24 PM
Re: Disaster Recovery?
@mhasib: Thanks for your response, much appreciated. I hope that if I'm ever in a healthcare facility during a disaster, that its recovery and continuity plans will have been developed by one of your former students!
DarrellP725
IW Pick
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DarrellP725,
User Rank: Moderator
7/30/2014 | 8:13:05 PM
Re: Defending the value of EHR versus paper
"Medical identity theft can threaten health as well as bank account," by Julia Dahl for CBS News, July 28, 2014.

http://www.cbsnews.com/news/medical-identity-theft-can-threaten-health-as-well-as-bank-account/
mhasib
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mhasib,
User Rank: Author
7/30/2014 | 7:37:35 PM
Re: Disaster Recovery?
@Susan - I teach an entire semester long graduate course on disaster recover and business continuity so I will not be doing justice to your question here. Most often, when EHR is unavailable other healthcare equipment will also cease to function. This has to be planned for. Basically every organization must create plans and conduct exercises using various scenarios. A more common scenario is a lengthy power loss. Most health organizations have emergency operations departments who are real experts at this and can work with IT and other teams to plan scenarios and training and then lead the execution during an actual crisis. It was really fascinating for me to to see what a great job various departments from the City of Baltimore did during major storm power outages. Good strategists always maintain EHRs in multiple geographically distant locations. For most organizations EHR is only 1 of many IT as well as non IT systems and risks for every system has to be planned for.
Susan_Nunziata
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Susan_Nunziata,
User Rank: Strategist
7/30/2014 | 6:55:37 PM
Disaster Recovery?
@mhasib: I find it fascinating in your field conversations with people that they did not realize their records would ultimately be rendered in electronic form anyway, as well as run thru a copier where the information could be stored and easily retrieved in the copier's hard drive.

I'm joining this robust discussion late, so you may have already talked about this. My biggest concern about elecronic health records is in the instances of natural disater or other mass disruption, as with Hurricane Sandy in NYC. what do you advise recgarding patient records -- espeically for hospital or ciritcal care facilities -- in terms  of disaster recovery if there is no power available, as was the case for some facilities where generators were underwater and mobile phone service was knocked out.

 
mhasib
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mhasib,
User Rank: Author
7/30/2014 | 9:06:53 AM
Re: Selling the change
@tzubair - Thanks. Personally I try not to "sell" people on anything. Rather I try to explain their choices and the consequences in a balanced way. People feel empowered once they are educated. I also explain their rights to them and the fact that the custodians of their data have a legal obligation to protect the privacy of their information. I also explain the questions they should be asking any provider and how they should be engaged in making sure that their providers provide better service and correct any incorrect information.
tzubair
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tzubair,
User Rank: Ninja
7/30/2014 | 5:32:55 AM
Re: How will they know?
"I think the only concern is the misconception that the good 'ol way of pen & paper is more 'secure' than digital"

@pcharles09: I think more than security, people are concerned about the privacy issue when it comes to EHR. Most people try to relate whatever technology they interact with to an existing technology. When it comes to EHR, a lot of people might relate it to social media because that's very common. They know their pictures and content that they put on social media is secure but they also know that anyone can view it. Hence, the fear that they feel with EHR for the information to get leaked out is natural.
tzubair
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tzubair,
User Rank: Ninja
7/30/2014 | 5:29:19 AM
Re: Storage Costs and Retrieval
"I know of a healthcare organization that keeps paper records and duplicates the information electronically, which doesn't seem too logical to me."

@freespiritny25: I think they may be doing that as a pressure from different stakeholders. Having the information stored electronically may be a requirement from the authorities while their patients would be more comfortable with the paper records. To please both stakeholders, they might be caught in the middle and be forced to maintain the information in both forms.
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