Digital vs paper – electronic medical records
IMPORTANT STRIDES have been made in health sectors worldwide to move forward with achieving a complete digital ecosystem with electronic medical records (EMR) central to this.
Jamaicans are highly suspicious of technology, especially those that require the sharing of personal information. I was recently privy to a discussion among doctors and they were of the view that there should be great concern if EMR is implemented in government health facilities as too many people would be able to access individuals’ health records.
It became clear to me that to fully introduce EMRs we will need to have some public education about how digital health works.
PAPER RECORDS
Before we speak to access, let’s look at what is in place now and how it compares to EMR. Most government and private health facilities in Jamaica still use paper records. There are rooms with shelves upon shelves of thick stacks of paper in manila folders.
Most complaints include that there is very little or no space for storage. Many of the storage areas are not temperature controlled, which does not make them ideal for storing paper. In addition, paper is at risk of burning, water damage, fading text and crumpling because of age.
Paper files often get lost and are duplicated to the point where one patient may end up having three or more files with no way to properly link the information. There are problems when files which are needed to substantiate or refute medical-legal claims go missing. In addition, information can be changed without any kind of audit trail. EMR would solve these issues.
There would be no need for physical storage space as information would be stored in the cloud at a data centre with backup. There would be no worry about damage to files, lost files or duplication. The quality and reliability of the information increases when it is digital and there is an audit trail of all users, including information added, viewed and removed.
Let’s now look at the issue of access. While there is currently no statute that directly regulates EMR, a patient’s common-law rights prevent the doctor from sharing information without important confidentiality considerations. When the Data Protection Bill is passed, there will be wider regulation to address access and sharing of individuals’ information.
With respect to the current practice, we have seen several breaches of access where paper records are concerned. I remember some years ago a journalist (Tyrone Reid) walked into a hospital, went to the medical records department and accessed several patient files without being checked by staff.
The journalist then did an exposé on the matter of how easy it was to access this ‘confidential’ information and the risk to both patient and hospital. As it relates to doctors’ concerns then of everyone being able to access records, it has been proved to be the case with paper files.
There are more controls when it comes to EMR. First, no person can access records without an authorised user’s assistance. The situation with the journalist would very likely not happen in a digital environment.
ENCRYPTED FILES
The information is encrypted as another level of security. Also, most digital systems, such as the one at the University Hospital of the West Indies, require role-based access. This means that each user will only be able to access information pertinent to their job.
A receptionist, for example, would see only the basic patient information such as name, date of birth, date, time of appointment and doctor scheduled to be seen. So there is no wide-scale access to patient records in a digital environment unlike when paper records are used.
Let’s look at banking information, which is highly confidential, as an example. Imagine if we were still using hand written ledger cards and physically updating passbooks, how easy it would be for unauthorised persons to access and change your information without an audit trail. Digitisation has taken banking to another level with tremendous benefits to customers.
The many benefits of EMR must be why we have seen more requests for this over the last year and why countries, including Jamaica, are putting systems in place to achieve healthcare digitisation. Full digitisation would mean a quantum leap for patient care and efficiency.
Doug Halsall is the chairman and CEO of Advanced Integrated Systems. Feedback: Doug.halsall@gmail.com or editorial@gleanerjm.com.