Weighing up the use of electronic health records

Much of our health information today is stored as electronic health records (EHRs). This is a boon for efficiency and cost savings, improving healthcare and medical research – but EHR systems can be costly to install and patients understandably have concerns about privacy. Thinking about medical records, one might imagine dog-eared papers covered in doctors’ scrawl, in orange cardboard boxes tucked away on a dusty hospital shelf.

But while some paper-based records can still be found in healthcare systems across the world, much of our medical information is now held in digital formats within electronic health records (EHRs). This can make things more efficient for healthcare staff and patients alike, but are there security and privacy risks in storing sensitive information digitally? And what opportunities might EHRs provide for improving patient safety and quality of care?

What are the advantages of EHRs?

While EHR software systems vary in usability and interfaces, they can provide real-time records with the functionality and interoperability needed to make information available instantly and securely to trusted and authorised users. In the US, for example, while an EHR does contain the basic medical and treatment histories of patients, an EHR system is built to go beyond standard clinical data collected in a doctor’s office or hospital and it can include a broader view of a patient’s care.

Typically, an EHR in the USA will contain a patient’s:

• medical history
• diagnoses
• medications
• treatment plans
• vaccinations and immunisation dates
• allergies
• radiology images
• laboratory and test results

It also allows access to evidence-based tools providers can use to make decisions about a patient’s care, and can automate and streamline the healthcare provider’s workflow.

Empower patients to take control of their own health

Rapid, convenient, and full access to personal EHRs is a key part of empowering patients to manage their health and collaborate with healthcare, according to an article published by Dr Maria Hägglund and colleagues in the British Medical Journal. A need for digital solutions to help manage our health became a top priority during the COVID-19 pandemic and it has brought about a step-change in the digital provision of information and access to care. Many more patients than ever before began to access their online electronic medical records (EMRs) via patient portals, and reported their Covid symptoms through mobile apps as well as carrying digital proof of vaccination and test results.

On the other side of the Atlantic, a US federal government ruling mandated healthcare providers to offer patients access to all their health information without charge.

In Europe, a European Health Data Space has been proposed to allow people to control and use health data in their home country. Meanwhile, in South Korea, the MyHealthWay app has been launched to give people control of their personal medical data in a single app.

Support decision-making and better outcomes

EHRs provide far more complete patient information than patient records scattered among different systems and formats. The comprehensive patient information available from EHRs helps providers make well-informed care decisions quickly, helping improve patient care and reducing safety risks from unforeseen contra-indications of different drugs a patient is taking, for example.

Save resources, costs and time

According to the US government website HealthIT.gov, healthcare providers have found EHRs help increase medical practice efficiencies and cost savings. This is because they reduce the costs of transcription and of accessing, storing and re-filing paper charts, as well as saving time through centralised records and providing shortcuts to information. They have better documentation and automated coding capabilities too. What’s more, they also produce fewer medical errors because of better access to patient data and error prevention alerts.

Allow better external communication

EHRs allow enhanced communication with other clinicians, labs, and health plans. That’s because patient health information can be easily accessed anywhere, beyond the point-of-care location and electronic messages between staff, hospitals and labs can be tracked. There are also automated drug prescription checks available through people’s health plans, which can make prescribing drugs easier for pharmacists. Furthermore EHRs can potentially be linked with public health systems, such as infectious disease databases.

Open up valuable research opportunities

Using health data, such as EHRs, for research helps scientists to better understand diseases and health conditions. For example, it can help to better understand causes and symptoms or find out how many people are affected. It provides new ways of identifying people most at risk of becoming ill, diagnosing diseases earlier, and providing better care and treatment. 

Health Data Research UK (HDR UK), the UK’s national institute for health data, is using health data in all its forms – from NHS patient data (including electronic health records), genomics, biomedicine and wearable devices, to develop targeted treatments and make new discoveries from real-world data.

For example, research on patient data part-funded by HDR UK provided a detailed population-level analysis that helped the UK Joint Committee on Vaccination and Immunisation to make critical decisions on which vaccines to prioritise during the COVID-19 pandemic. During the pandemic HDR UK also led population-level research using anonymised healthcare records from more than 2 million adults to look at vaccination and COVID-19 data in real-time and prove definitively that the new vaccines being rolled out were safe to use. This work was used to inform UK-level policy and clinical decisions and to reassure the public.

These are just two examples of many studies being carried out worldwide, which serve to show the powerful possibilities that emerge from research using electronic health data to improve healthcare.

What are the disadvantages of EHRs?

EHRs can be costly

Changing from a paper record system to an electronic health record system has a steep upfront acquisition cost and ongoing maintenance costs, which can be prohibitive for some clinical providers. For example, a study carried out in a 280-bed acute care hospital revealed a projected total cost for a 7-year-long EHR software installation project of around US$19 million.

Introducing them is disruptive

Undoubtedly there will be disruption to workflows when a new system is introduced, which can be off putting. Time is lost while staff learn how to use it, contributing to temporary losses in productivity.

Patients worry about privacy

Perhaps the biggest hurdle to adoption of EHRs is they are associated with potential perceived privacy concerns among patients. The reality however, is that electronic records which are encrypted online are actually much more secure than paper records which are kept in a filing cabinet. EHRs are considered to be a better solution in terms of protected privacy.

Electronic health data is, of course, extremely sensitive however and must be handled, managed and stored with the utmost care to avoid any breaches and maintain patient confidence. For this reason, the protection of patient data is enshrined in law.

In the UK, there are robust legal frameworks around how patient data must be looked after and processed. These are the Data Protection Act (DPA) 2018, which brought the EU General Data Protection Regulation (GDPR) into law, and the Common Law Duty of Confidentiality (CLDC). This data protection legislation requires that the collection and processing of personal data is fair, lawful and transparent. This means there must always be a valid lawful basis for the collection and processing of data as defined under data protection legislation, and the requirements of the CLDC must also be met.

In the USA, there is the Health Information Technology for Economic and Clinical Health (HITECH), a federal US law specifically for the protection of health information, which has resulted in the wide scale adoption of EHRs in the US healthcare system. It works with HIPAA (the Health Insurance Portability and Accountability Act) to promote the use of health information technology systems, to protect the privacy and security of protected health information and strengthen enforcement and compliance in the healthcare industry.

EHRs: the future?

Drawbacks aside, experts and policymakers believe there are significant benefits to patients and society to the wide adoption and meaningful use of EHRs. Moreover, the new NHS mandate prioritises electronic health record (EHR) targets, with at least 90% of NHS trusts and foundation trusts should have electronic health records by December 2023 and 95% by March 2025.

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