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Is Your EMR Compromising Patient Privacy?

Posted on November 20, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

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.

TURF: An EHR Usability Assessment Tool

Posted on October 22, 2013 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following is a guest post by Carl Bergman from EHR Selector.

To paraphrase Mark Twain, everyone talks about EHR usability, but no one does anything about it, at least until now. Led by Dr. Jiajie Zhang, the University of Texas Health Science Center at Houston’s National Center for Cognitive Informatics and Decision Making (NCCD) has developed several tools for measuring usability.

Now, Zhang’s team at NCCD has put several EHR usability tools into a Windows based app, TURF, an acronym for Task, User, Representation, Function. Funding for the project comes from ONC’s Strategic Health IT Advanced Research initiative.

TURF’s Tools. TURF has two major tools, Heuristic Evaluation and User Testing:

  • Tool One. Heuristic Evaluation: Expert Screen Capture and Markup. This tool takes EHR screen snapshots and let you compare them to usability standards. You can markup the screen and document the problem.
    Turf Expert Markup Tool - Showing Problem and Documentation
    For example, you can note if the error is minor, moderate, major or catastrophic. The system has a review function, so others can look at your markup and comment. The system also compiles your edits and can generate various statistics.

    • Administration. To work with groups, the system has several preset admin template forms and a template editor. The furnished templates cover these areas:
      • Demographics
      • Expert Review
      • Performance Evaluation, and
      • System Usability. This form asks 10 questions about the EHR, such as:
        • I think I would like to use the system frequently,
        • I thought there was too much inconsistency in this system,
    • Standards. The system uses the National Institute of Standards and Technology’s (NIST) EHR usability protocol, NISTIR 7804. You may also add your own rules to the system. (Also, see, June 14, 2012.)
    • EHR Sections. Using the NIST protocol, the system’s review areas are:
      • Clinical Decision
      • Clinical Information Reconciliation
      • Drug-drug, drug-allergy interactions
      • Electronic Medical Administration
      • ePrescribing
      • Med – Allergies
      • Medications list
      • Order Entry
      • User defined
  • Tool Two. Live Session Testing. TURF’s user test tool sits on top of an EHR and recording each movement. TURF’s designers have created a system that not only tracks use, but also adds these major functions:
    • User Sessions. TURF captures live screens, keystrokes, mouse clicks and can record a user’s verbal comments in an audio file.
    • Administration. The tool is designed for testing by groups of users as well as individuals. It captures user demographics, consent forms, non disclosures, etc. All of these can be tailored.
    •  Testing for Specifics. TURF allows managers to test for specific problems. For example, you can see how users eprescribe, or create continuity of care documents.
    • Comparing Steps. Managers can set up an optimum selection path or define the steps for a task and then compare these with user actions.
    • Reporting. TURF builds in several counting and statistical analysis tools such as one way ANOVA.

  • Running TURF. TURF isn’t your basic run and gun app. I downloaded it and then tried to duff my way through, as I would do with most new programs. It was a no go. Before you can use it, you need to spend some time setting it up. This applies to both its tools.

    Fortunately, TURF has about 30 YouTube tutorials. Each covers a single topic such as Setup for Electronic Data Capture and runs a minute or so. Here’s what they cover:
    Turf Tutorials Screen
  • Hands On. Installing TURF was straightforward with one exception. If you don’t have Microsoft’s .Net Framework 4.5 installed, put it up before you install TURF. Otherwise, the install stops for your to do it. TURF will also want the Codex that it uses for recordings installed, but the install deals with that.

    TURF is a Windows program, so I ran it in a virtual Win 7 session on my iMac. Given the environment, I kept the test simple. I ran TURF on top of a web based EHR and had it track my adding an antibiotic to a patient’s meds. TURF stayed out of the way, recording in the background.

    Here’s how TURF captured my session:
    Turf Playback Screen
    The left side screen played back my actions click for click. It let me run the screen at various speeds or stop it to add notes. The right screen lists each move’s attributes. You can mark any notable actions and document them for review by others. You can save your sessions for comparisons.

I found TURF to be a versatile, robust tool for EHR usability analysis. Its seeming complexity masks an ability to work in various settings and tackle hosts of problems.

If you aren’t happy with your EHR’s interface, TURF gives a remarkable tool to show what’s wrong and what you want. Indeed, with some adaptation you could use TURF to analyze almost any program’s usability. Not bad for a freebie.