In early 2009, as part of the massive effort to revive the economy, President Obama called for the modernization of health care by digitizing all health records. Following former President Bush’s call for ubiquitous electronic health records (EHRs) by 2014, Obama unveiled his plan for computerization of health records to provide a much needed boost for America’s healthcare system. Proponents of EHRs cite scores of possible benefits. If orchestrated correctly, EHRs have the potential to provide complete, accurate and searchable medical information to allow for more informed medical decision making on the part of the healthcare provider; they will allow for more efficient healthcare delivery by eliminating the tedious exchange of paperwork; they can help reduce the number of adverse events due to illegibility, disorganization and other sources of human error in reading medical files; they offer the opportunity for epidemiological research on a scale never before seen; and with the right protections, they can even provide a tool for law enforcement to track suspicious drug-activity, such as the abuse of painkillers.
However, there remain numerous technical impediments to mass digitization of health record. First, cost levels pose serious concerns. Independent studies from Harvard, RAND and the Commonwealth Fund have concluded that the expenses over the next ten years will total $75 billion to $100 billion. Moreover, the transition from paper to digital medical records will require technological innovation that many believe is lacking in America and comprehensive training for health care providers who cannot afford hours upon hours of learning a new system. Concerns about hackers and system failures also plague Obama’s proposal. It is feared not only that files may be breached but also that viruses threaten the irrecoverable deletion of medical records.
Additionally, several ethical concerns shroud the proposal in skepticism, most notably privacy. At the most fundamental level, issues arise about the sheer number of people who will have ready access to the health information of a vast patient population, as well as about unauthorized access via hacking. The EHRs of the Veterans Affairs Department, a model often looked at when discussing digitized medical records, has notably suffered from several security breaches over the past few years, including the theft of a laptop in 2006 containing the medical records of 26.5 million veterans. It only takes a single breach for a patient’s files to be endlessly replicated, rendering it virtually impossible to restore confidentiality after a security lapse.
Compounding the problem, computer scientists have proven that anonymous data can be re-identified fairly easily since eighty-seven percent of Americans can be uniquely identified using only their date of birth, gender and ZIP code. For instance, several years ago, AOL released thousands of anonymous health records. The New York Times shortly thereafter published a story including personal information about the patients. Additionally, many fear that data brokers may purchase medical and pharmaceutical records to sell them to markets and pharmaceutical companies to help them target their advertising.
However, the dilemma grows increasingly complex. Not only is there the potential for breaches of privacy, but even the very fear of such breaches has been shown to negatively impact patient-doctor interactions. According to the New Jersey Law Journal, when people feel that their medical records will not be kept private, they take steps to protect themselves. For example, out of fear that a potential employer may see their health records and reject them as a candidate, patients may ask doctors to alter diagnoses, for instance from “depression” to “dysthymia” to blunt its impression to the employer. Patients may resort to paying out of pocket to hide the record or certain medical tests. Some even avoid medical help altogether in order to circumvent receiving diagnoses which have stigmas associated with them, such as an addiction or sexually transmitted disease. This phenomenon has two major implications. First, electronic records could therefore potentially harm the quality of medical care rather than improve it. Second, EHRs could provide skewed data which might muddle research.
Steps have been taken, however, to help alleviate these concerns. One of the main methods of precaution is through an audit trail of precisely who accesses the electronic records. This not only allows the patient to see who has been viewing the record but also helps alert the hospital to improper access. The implications of this were seen at Yale this past fall following the tragic murder of Annie Le. Revealing its efficacy, an electronic audit revealed the names of several employees who had illegally accessed Le’s private medical records, allowing Yale University Health Services to punish the perpetrators. To further disincentivize breaches of privacy, legislators in several states are calling for the closure of loopholes which permit marketing of health information, as well as for harsh legal repercussions for improperly using EHRs.
As Obama has explained, digitizing health information is of the utmost importance for the future of our nation’s healthcare. It holds the prospects of reduced medical errors, more efficient medical care, and expanded research opportunitiesprovided that steps of precaution are taken to avoid abuse. With the proper safeguards, such as regular auditing, the criminalization of security breaches, and the creation of a secure, nationally trusted database, EHRs will be able to live up to their immense potential.
David Carel is a sophomore Economics major in Pierson College.