Karen Boyd, ASQ CQA IMO - Patient portals / electronic record databases are personally handy, however they are limited in a couple ways and to several populations. First, since each practice utilizes their own system, there is no centralized portal to hold all of one's medical history in one location. Broken data and room for inconsistencies can exist. Second, not everyone is computer savvy nor willing to go online to utilize patient portals. I see this being a problem with the current elderly population as well as those aging populations that did not grow up using computers.

For sure, a fraction of the population have access to technology. Its going to be a long haul and one that requires better telecom methods to reach those with limited tech access. Something our current systems cannot achieve. There is no "lite-universal EMR"

Karen Boyd, ASQ CQA Yes, and those with limited (or no) tech access that do not want it, don't use email, and prefer the telephone and snail mail. Long haul or don't force the technology on those generations that cannot or will not utilize them. I would say Gen X and later would be the populations most adept to technology and most willing to electronically go the distance.

Karen Boyd, ASQ CQA Glad you brought this topic forward, Mark.
I'm anxious to read other member's views on it as well.

Julie Omohundro How would making a patient's health care records available to them electronically jeopardize their privacy more than making them electronically available to other parties, such as insurance companies, government agencies, and/or other healthcare providers? The technical security issues are the same, regardless of who is doing the accessing, aren't they?

Aaron Liang When we talk about data security and privacy, the weakest link in the defense is often the users themselves. In theory you would expect a well resourced organization (i.e. insurers, government agencies, healthcare groups) to maintain strict access controls and information systems for managing the security and privacy of data. Individual users have much more variation in terms of technological skills and capacity as previous posters have mentioned and based on this variability are more vulnerable to mistakes and/or attacks which can lead to cascading privacy failures.

However, given the recent track record or lack thereof by many major government and private sector actors to secure their data, I don't think there would be a major shift in the risk profile regarding the privacy of electronic health records if they were made more accessible to the general public.

Julie Omohundro Aaron, are there any data that support the notion that the users are the weakest link?

What are the other, stronger links? Even in a "well resourced organization," the systems are used by users. As you describe it, the strengths or weaknesses seem to be in the controls and systems that are in place, not in the users.

Julie Omohundro Patients don't need electronic access to their healthcare records. I know of no patients who wouldn't be perfectly happy to receive copies of their healthcare records in paper form. The only patients I know who would prefer to have their records in electronic form have the technological skills and resources to scan them themselves, and wouldn't mind doing it themselves. At least then they would have some control over the quality of the output.

For patients, the challenge is to get access; the format is irrelevant. And, as the article shows, as long as patients must depend on actions by their healthcare providers to get that access, electronic versus paper doesn't really matter. If a patient wants to improve their access to their healthcare records, they would do much better to get a lawyer than a tablet or a smartphone.

All of this is being driven by the fact that Congress passed a law requiring healthcare providers to give patients copies of their records. It is not the patients who want electronic access, but the healthcare system that wants to be able to give patients electronic access, because of the costs associated with providing the same records in paper format.

Beyond that, while many patients may like the idea of having "access" to their healthcare records, it doesn't seem to me that patients as group actually want their healthcare records, in any format. They virtually never ask for them on their own initiative.

Karen Boyd, ASQ CQA There's probably a small segment of the patient population that are more proactive in their healthcare and want their records. There is also a segment of the population, whereby patients that desire / need medical management and assistance in their daily living and healthcare, assign a 3rd party to access and utilize those records. This second population could range from a young adult suffering an auto accident induced traumatic brain injury to an elderly person with degenerative, cognitive deficits.

Lakshman Srinivasan Are doctors/hospitals reluctant to give a patient access due to fear of malpractice lawsuits?

Julie Omohundro Lakshman, that's what everyone will tell you, and that's what probably part of it, but things were actually worse in the 60s, when medical malpractice lawsuits were not a major concern. At the time, a patient's records were legally the property of the healthcare provider, and the patient had no rights to them at all. How dare you even ask.

Julie Omohundro Karen, I would be inclined to include the latter group with patients who ask for their records only because they have a clear medical need for them. When I say "on their own initiative," I mean simply because they are their records and they want to have them in hand.

Lakshman Srinivasan Julie, thank you for your response. Now that more patients are getting their records, for whatever reason, I would be interested in seeing how malpractice trends evolve. If something goes wrong during treatment of a condition, I guess this gives more leverage for a patient or his/her legal beagle to have the diagnosis and treatment reviewed by another expert. In some sense, I can understand why healthcare providers would like to claim ownership of patient records. :-)