Two prominent physicians this week pointed out a basic but, in the era of information as a commodity, sometimes overlooked truth about EMRs: They increase the number of people with access to your medical data thousands of times over.
Dr. Mary Jane Minkin said in a Wall Street Journal video panel on EMR and privacy that she dropped out of the Yale Medical Group and Medicare because she didn’t want her patients’ information to be part of an EMR.
She gave an example of why: Minkin, a gynecologist, once treated a patient for decreased libido. When the patient later visited a dermatologist in the Yale system, that sensitive bit of history appeared on a summary printout.
“She was outraged,” she told Journal reporter Melinda Beck. “She felt horrible that this dermatologist would know about her problem. She called us enraged for 10 or 15 minutes.”
Dr. Deborah Peel, an Austin psychiatrist and founder of the nonprofit group Patient Privacy Rights, said she’s concerned about the number of employees, vendors and others who can see patient records. Peel is a well-known privacy advocate but has been accused by some health IT leaders of scaremongering.
“What patients should be worried about is that they don’t have any control over the information,” she said. “It’s very different from the paper age where you knew where your records were. They were finite records and one person could look at them at a time.”
She added: “The kind of change in the number of people who can see and use your records is almost uncountable.”
Peel said the lack of privacy causes people to delay or avoid treatment for conditions such as cancer, depression and sexually transmitted infections.
But Dr. James Salwitz, a medical oncologist in New Jersey, said on the panel that the benefits of EMR, including greater coordination of care and reduced likelihood of medical errors, outweigh any risks.
The privacy debate doesn’t have clear answers. Paper records are, of course, not immune to being lost, stolen or mishandled.
In the case of Minkin’s patient, protests aside, it’s reasonable for each physician involved in her care to have access to the complete record. While she might not think certain parts of her history are relevant to particular doctors, spotting non-obvious connections is an astute clinician’s job. At any rate, even without an EMR, the same information might just as easily have landed with the dermatologist via fax.
That said, privacy advocates have legitimate concerns. Since it’s doubtful that healthcare will go back to paper, the best approach is to improve EMR technology and the procedures that go with it.
Plenty of work is underway.
For example, at the University of Texas at Arlington, researchers are leading a National Science Foundation project to keep healthcare data secure while ensuring that the anonymous records can be used for secondary analysis. They hope to produce groundbreaking algorithms and tools for identifying privacy leaks.
“It’s a fine line we’re walking,” Heng Huang, an associate professor at UT’s Arlington Computer Science & Engineering Department, said in a press release this month “We’re trying to preserve and protect sensitive data, but at the same time we’re trying to allow pertinent information to be read.”
When it comes to balancing technology with patient privacy, healthcare professionals will be walking a fine line for some time to come.