Sample view of an electronic health record
An electronic health record (EHR), or electronic medical record (EMR), is the systematized collection of patient and population electronically-stored health information in a digital format. These records can be shared across different health care
settings. Records are shared through network-connected, enterprise-wide
information systems or other information networks and exchanges. EHRs
may include a range of data, including demographics, medical history, medication and allergies, immunization
status, laboratory test results, radiology images, vital signs,
personal statistics like age and weight, and billing information.
A decade ago, electronic health records (EHRs) were touted as key
to increasing of quality care. Today, providers are using data from
patient records to improve quality outcomes through their care
management programs. Combining multiple types of clinical data from the
system's health records has helped clinicians identify and stratify
chronically ill patients. EHR can improve quality care by using the data
and analytics to prevent hospitalizations among high-risk patients.
EHR systems are designed to store data accurately and to capture
the state of a patient across time. It eliminates the need to track down
a patient's previous paper medical records and assists in ensuring data
is accurate and legible. It can reduce risk of data replication as
there is only one modifiable file, which means the file is more likely
up to date, and decreases risk of lost paperwork. Due to the digital
information being searchable and in a single file, EMRs are more
effective when extracting medical data for the examination of possible
trends and long term changes in a patient. Population-based studies of
medical records may also be facilitated by the widespread adoption of
EHRs and EMRs.
Terminology
The
terms EHR, electronic patient record (EPR) and EMR have often been used
interchangeably, although differences between the models are now being
defined. The electronic health record (EHR) is a more longitudinal
collection of the electronic health information of individual patients
or populations. The EMR, in contrast, is the patient record created by
providers for specific encounters in hospitals and ambulatory
environments, and which can serve as a data source for an EHR.
In contrast, a personal health record
(PHR) is an electronic application for recording personal medical data
that the individual patient controls and may make available to health
providers.
Comparison with paper-based records
While
there is still a considerable amount of debate around the superiority
of electronic health records over paper records, the research literature
paints a more realistic picture of the benefits and downsides.
The increased transparency, portability and accessibility
acquired by the adoption of electronic medical records may increase the
ease with which they can be accessed by healthcare professionals, but
also can increase the amount of stolen information by unauthorized
persons or unscrupulous users versus paper medical records, as
acknowledged by the increased security requirements for electronic
medical records included in the Health Information and Accessibility Act
and by large-scale breaches in confidential records reported by EMR
users. Concerns about security contribute to the resistance shown to their adoption.
Handwritten paper medical records may be poorly legible, which can contribute to medical errors.
Pre-printed forms, standardization of abbreviations and standards for
penmanship were encouraged to improve reliability of paper medical
records.
Electronic records may help with the standardization of forms,
terminology and data input. Digitization of forms facilitates the collection of data for epidemiology and clinical studies. However, standardization may create challenges for local practice.
Overall, those with EMRs, that have automated notes and records, order
entry, and clinical decision support had fewer complications, lower
mortality rates, and lower costs.
EMRs can be continuously updated (within certain legal
limitations – see below). If the ability to exchange records between
different EMR systems were perfected ("interoperability"),
it would facilitate the co-ordination of health care delivery in
non-affiliated health care facilities. In addition, data from an
electronic system can be used anonymously for statistical reporting in
matters such as quality improvement, resource management and public
health communicable disease surveillance. However, it is difficult to remove data from its context.
Emergency medical services (pre-hospital care)
Ambulance services in Australia, the United States and the United Kingdom have introduced the use of EMR systems.
EMS Encounters in the United States are recorded using various
platforms and vendors in compliance with the NEMSIS (National EMS
Information System) standard.
The benefits of electronic records in ambulances include: patient data
sharing, injury/illness prevention, better training for paramedics,
review of clinical standards, better research options for pre-hospital
care and design of future treatment options, data based outcome
improvement, and clinical decision support.
Automated handwriting recognition of ambulance medical forms has
also been successful. For example, Intermedix TripTix offers handwriting
support across all elements of the NEMSIS 3.3.4 and 3.4.0 standard as
well as custom forms on Windows devices.
These systems allow traditionally paper-based medical documents to be
converted to digital at the time of entry with substantially less cost
overhead. The data can then be efficiently used for epidemiological
analysis, including de-identified data at the National level.
Technical features
- Digital formatting enables information to be used and shared over secure networks
- Track care (e.g. prescriptions) and outcomes (e.g. blood pressure)
- Trigger warnings and reminders
- Send and receive orders, reports, and results
- Decrease billing processing time and create more accurate billing system
Health Information Exchange
- Technical and social framework that enables information to move electronically between organizations
Using an EMR to read and write a patient's record is not only
possible through a workstation but, depending on the type of system and
health care settings, may also be possible through mobile devices that
are handwriting capable,
tablets and smartphones. Electronic Medical Records may include access
to Personal Health Records (PHR) which makes individual notes from an
EMR readily visible and accessible for consumers.
Some EMR systems automatically monitor clinical events, by
analyzing patient data from an electronic health record to predict,
detect and potentially prevent adverse events. This can include
discharge/transfer orders, pharmacy orders, radiology results,
laboratory results and any other data from ancillary services or
provider notes.
This type of event monitoring has been implemented using the Louisiana
Public health information exchange linking statewide public health with
electronic medical records. This system alerted medical providers when a
patient with HIV/AIDS had not received care in over twelve months. This
system greatly reduced the number of missed critical opportunities.
Philosophical views of the EHR
Within a meta-narrative systematic review of research in the field, there exist a number of different philosophical approaches to the EHR.
The health information systems literature has seen the EHR as a
container holding information about the patient, and a tool for
aggregating clinical data for secondary uses (billing, audit etc.). However, other research traditions see the EHR as a contextualised artifact within a socio-technical system. For example, actor-network theory would see the EHR as an actant in a network, while research in computer supported cooperative work (CSCW) sees the EHR as a tool supporting particular work.
Several possible advantages to EHRs over paper records have been
proposed, but there is debate about the degree to which these are
achieved in practice.
Implementation, end user and patient considerations
Quality
Several studies call into question whether EHRs improve the quality of care. One 2011 study in diabetes care, published in the New England Journal of Medicine, found evidence that practices with EHR provided better quality care.
EMRs may eventually help improve care coordination. An article in
a trade journal suggests that since anyone using an EMR can view the
patient's full chart, it cuts down on guessing histories, seeing
multiple specialists, smooths transitions between care settings, and may
allow better care in emergency situations.
EHRs may also improve prevention by providing doctors and patients
better access to test results, identifying missing patient information,
and offering evidence-based recommendations for preventive services.
Costs
The steep
price of EHR and provider uncertainty regarding the value they will
derive from adoption in the form of return on investment has a
significant influence on EHR adoption.
In a project initiated by the Office of the National Coordinator for
Health Information (ONC), surveyors found that hospital administrators
and physicians who had adopted EHR noted that any gains in efficiency
were offset by reduced productivity as the technology was implemented,
as well as the need to increase information technology staff to maintain
the system.
The U.S. Congressional Budget Office concluded that the cost
savings may occur only in large integrated institutions like Kaiser
Permanente, and not in small physician offices. They challenged the Rand Corporation's
estimates of savings. "Office-based physicians in particular may see no
benefit if they purchase such a product—and may even suffer financial
harm. Even though the use of health IT could generate cost savings for
the health system at large that might offset the EHR's cost, many
physicians might not be able to reduce their office expenses or increase
their revenue sufficiently to pay for it. For example, the use of
health IT could reduce the number of duplicated diagnostic tests.
However, that improvement in efficiency would be unlikely to increase
the income of many physicians." One CEO of an EHR company has argued if a physician performs tests in the office, it might reduce his or her income.
Doubts have been raised about cost saving from EHRs by researchers at Harvard University, the Wharton School of the University of Pennsylvania, Stanford University, and others.
Time
The implementation of EMR can potentially decrease identification time of patients upon hospital admission. A research from the Annals of Internal Medicine showed that since the adoption of EMR a relative decrease in time by 65% has been recorded (from 130 to 46 hours).
Software quality and usability deficiencies
The Healthcare Information and Management Systems Society,
a very large U.S. healthcare IT industry trade group, observed in 2009
that EHR adoption rates "have been slower than expected in the United
States, especially in comparison to other industry sectors and other
developed countries. A key reason, aside from initial costs and lost
productivity during EMR implementation, is lack of efficiency and
usability of EMRs currently available." The U.S. National Institute of Standards and Technology of the Department of Commerce studied usability in 2011 and lists a number of specific issues that have been reported by health care workers. The U.S. military's EHR, AHLTA, was reported to have significant usability issues.
Furthermore, studies such as the one conducted in BMC Medical
Informatics and Decision Making, also showed that although the
implementation of electronic medical records systems has been a great
assistance to general practitioners there is still much room for
revision in the overall framework and the amount of training provided. It was observed that the efforts to improve EHR usability should be placed in the context of physician-patient communication.
However, physicians are embracing mobile technologies such as
smartphones and tablets at a rapid pace. According to a 2012 survey by Physicians Practice,
62.6 percent of respondents (1,369 physicians, practice managers, and
other healthcare providers) say they use mobile devices in the
performance of their job. Mobile devices are increasingly able to sync
up with electronic health record systems thus allowing physicians to
access patient records from remote locations. Most devices are
extensions of desk-top EHR systems, using a variety of software to
communicate and access files remotely. The advantages of instant access
to patient records at any time and any place are clear, but bring a host
of security concerns. As mobile systems become more prevalent,
practices will need comprehensive policies that govern security measures
and patient privacy regulations.
Hardware and workflow considerations
When
a health facility has documented their workflow and chosen their
software solution they must then consider the hardware and supporting
device infrastructure for the end users. Staff and patients will need to
engage with various devices throughout a patient's stay and charting
workflow. Computers, laptops, all-in-one computers, tablets, mouse,
keyboards and monitors are all hardware devices that may be utilized.
Other considerations will include supporting work surfaces and
equipment, wall desks or articulating arms for end users to work on.
Another important factor is how all these devices will be physically
secured and how they will be charged that staff can always utilize the
devices for EHR charting when needed.
The success of eHealth interventions is largely dependent on the
ability of the adopter to fully understand workflow and anticipate
potential clinical processes prior to implementations. Failure to do so
can create costly and time-consuming interruptions to service delivery.
Unintended consequences
Per empirical research in social informatics, information and communications technology (ICT) use can lead to both intended and unintended consequences.
A 2008 Sentinel Event Alert from the U.S. Joint Commission, the organization that accredits American hospitals to provide healthcare services, states that "As
health information technology (HIT) and 'converging technologies'—the
interrelationship between medical devices and HIT—are increasingly
adopted by health care organizations, users must be mindful of the
safety risks and preventable adverse events that these implementations
can create or perpetuate. Technology-related adverse events can be
associated with all components of a comprehensive technology system and
may involve errors of either commission or omission. These unintended
adverse events typically stem from human-machine interfaces or
organization/system design." The Joint Commission cites as an example the United States Pharmacopeia MEDMARX database
where of 176,409 medication error records for 2006, approximately 25
percent (43,372) involved some aspect of computer technology as at least
one cause of the error.
The National Health Service
(NHS) in the UK reports specific examples of potential and actual
EHR-caused unintended consequences in their 2009 document on the
management of clinical risk relating to the deployment and use of health
software.
In a February 2010 US Food and Drug Administration
(FDA) memorandum, FDA notes EHR unintended consequences include
EHR-related medical errors due to (1) errors of commission (EOC), (2)
errors of omission or transmission (EOT), (3) errors in data analysis
(EDA), and (4) incompatibility between multi-vendor software
applications or systems (ISMA) and cites examples. In the memo FDA also
notes the "absence of mandatory reporting enforcement of H-IT safety
issues limits the numbers of medical device reports (MDRs) and impedes a
more comprehensive understanding of the actual problems and
implications."
A 2010 Board Position Paper by the American Medical Informatics Association
(AMIA) contains recommendations on EHR-related patient safety,
transparency, ethics education for purchasers and users, adoption of
best practices, and re-examination of regulation of electronic health
applications.
Beyond concrete issues such as conflicts of interest and privacy
concerns, questions have been raised about the ways in which the
physician-patient relationship would be affected by an electronic
intermediary.
During the implementation phase, cognitive workload for healthcare professionals may be significantly increased as they become familiar with a new system.
EHRs are almost invariably detrimental to physician productivity,
whether the data is entered during the encounter or at some time
thereafter.
While it is possible for an EHR to increase physician productivity by
providing a fast and intuitive interface for viewing and understanding
patient clinical data, while minimizing the amount of clinically
irrelevant questions, this is almost never the case.
The other way to mitigate the detriment to physician productivity is to
hire scribes to work alongside medical practitioners, which is almost
never financially viable.
As a result, many have conducted studies like the one discussed
in the Journal of the American Medical Informatics Association "The
Extent And Importance Of Unintended Consequences Related To Computerized
Provider Order Entry", which seeks to understand the degree and
significance of unplanned adverse consequences related to computerized
physician order entry and understand how to interpret adverse events and
understand the importance of its management for the overall success of
computer physician order entry.
Governance, privacy and legal issues
Privacy concerns
In
the United States, Great Britain, and Germany, the concept of a
national centralized server model of healthcare data has been poorly
received. Issues of privacy and security in such a model have been of
concern.
In the European Union
(EU), a new directly binding instrument, a regulation of the European
Parliament and of the Council, was passed in 2016 to go into effect in
2018 to protect the processing of personal data, including that for
purposes of health care, the General Data Protection Regulation.
Threats to health care information can be categorized under three headings:
- Human threats, such as employees or hackers
- Natural and environmental threats, such as earthquakes, hurricanes and fires.
- Technology failures, such as a system crashing
These threats can either be internal, external, intentional and
unintentional. Therefore, one will find health information systems
professionals having these particular threats in mind when discussing
ways to protect the health information of patients. It has been found
that there is a lack of security awareness among health care
professionals in countries such as Spain.
The Health Insurance Portability and Accountability Act (HIPAA) has
developed a framework to mitigate the harm of these threats that is
comprehensive but not so specific as to limit the options of healthcare
professionals who may have access to different technology.
Personal Information Protection and Electronic Documents Act
(PIPEDA) was given Royal Assent in Canada on 13 April 2000 to establish
rules on the use, disclosure and collection of personal information.
The personal information includes both non-digital and electronic form.
In 2002, PIPEDA extended to the health sector in Stage 2 of the law's
implementation.
There are four provinces where this law does not apply because its
privacy law was considered similar to PIPEDA: Alberta, British Columbia,
Ontario and Quebec.
Legal issues
Liability
Legal
liability in all aspects of healthcare was an increasing problem in the
1990s and 2000s. The surge in the per capita number of attorneys in the
USA and changes in the tort system caused an increase in the cost of every aspect of healthcare, and healthcare technology was no exception.
Failure or damages caused during installation or utilization of an EHR system has been feared as a threat in lawsuits.
Similarly, it's important to recognize that the implementation of
electronic health records carries with it significant legal risks.
This liability concern was of special concern for small EHR
system makers. Some smaller companies may be forced to abandon markets
based on the regional liability climate. Larger EHR providers (or government-sponsored providers of EHRs) are better able to withstand legal assaults.
While there is no argument that electronic documentation of
patient visits and data brings improved patient care, there is
increasing concern that such documentation could open physicians to an
increased incidence of malpractice suits. Disabling physician alerts,
selecting from dropdown menus, and the use of templates can encourage
physicians to skip a complete review of past patient history and
medications, and thus miss important data.
Another potential problem is electronic time stamps. Many
physicians are unaware that EHR systems produce an electronic time stamp
every time the patient record is updated. If a malpractice claim goes
to court, through the process of discovery, the prosecution can request a
detailed record of all entries made in a patient's electronic record.
Waiting to chart patient notes until the end of the day and making
addendums to records well after the patient visit can be problematic, in
that this practice could result in less than accurate patient data or
indicate possible intent to illegally alter the patient's record.
In some communities, hospitals attempt to standardize EHR systems
by providing discounted versions of the hospital's software to local
healthcare providers. A challenge to this practice has been raised as
being a violation of Stark rules that prohibit hospitals from
preferentially assisting community healthcare providers.
In 2006, however, exceptions to the Stark rule were enacted to allow
hospitals to furnish software and training to community providers,
mostly removing this legal obstacle.
Legal interoperability
In
cross-border use cases of EHR implementations, the additional issue of
legal interoperability arises. Different countries may have diverging
legal requirements for the content or usage of electronic health
records, which can require radical changes to the technical makeup of
the EHR implementation in question. (especially when fundamental legal
incompatibilities are involved) Exploring these issues is therefore
often necessary when implementing cross-border EHR solutions.
Contribution under UN administration and accredited organizations
The United Nations World Health Organization
(WHO) administration intentionally does not contribute to an
internationally standardized view of medical records nor to personal
health records. However, WHO contributes to minimum requirements
definition for developing countries.
The United Nations accredited standardisation body International Organization for Standardization (ISO) however has settled thorough word for standards in the scope of the HL7
platform for health care informatics. Respective standards are
available with ISO/HL7 10781:2009 Electronic Health Record-System
Functional Model, Release 1.1 and subsequent set of detailing standards.
Medical data breach
The
majority of the countries in Europe have made a strategy for the
development and implementation of the Electronic Health Record Systems.
This would mean greater access to health records by numerous
stakeholders, even from countries with lower levels of privacy
protection. The forthcoming implementation of the Cross Border Health
Directive and the EU Commission's plans to centralize all health records
are of prime concern to the EU public who believe that the health care
organizations and governments cannot be trusted to manage their data
electronically and expose them to more threats.
The idea of a centralized electronic health record system was
poorly received by the public who are wary that the governments may
extend the use of the system beyond its purpose. There is also the risk
for privacy breaches that could allow sensitive health care information
to fall into the wrong hands. Some countries have enacted laws requiring
safeguards to be put in place to protect the security and
confidentiality of medical information as it is shared electronically
and to give patients some important rights to monitor their medical
records and receive notification for loss and unauthorized acquisition
of health information. The United States and the EU have imposed
mandatory medical data breach notifications.
Breach notification
The
purpose of a personal data breach notification is to protect
individuals so that they can take all the necessary actions to limit the
undesirable effects of the breach and to motivate the organization to
improve the security of the infrastructure to protect the
confidentiality of the data. The US law requires the entities to inform
the individuals in the event of breach while the EU Directive currently
requires breach notification only when the breach is likely to adversely
affect the privacy of the individual. Personal health data is valuable
to individuals and is therefore difficult to make an assessment whether
the breach will cause reputational or financial harm or cause adverse
effects on one's privacy.
The Breach notification law in the EU provides better privacy
safeguards with fewer exemptions, unlike the US law which exempts
unintentional acquisition, access, or use of protected health
information and inadvertent disclosure under a good faith belief.
Technical issues
Standards
- ASC X12 (EDI) – transaction protocols used for transmitting patient data. Popular in the United States for transmission of billing data.
- CEN's TC/251 provides EHR standards in Europe including:
- Continuity of Care Record – ASTM International Continuity of Care Record standard
- DICOM – an international communications protocol standard for representing and transmitting radiology (and other) image-based data, sponsored by NEMA (National Electrical Manufacturers Association)
- HL7 – a standardized messaging and text communications protocol between hospital and physician record systems, and between practice management systems
- Fast Healthcare Interoperability Resources (FHIR) – a modernized proposal from HL7 designed to provide open, granular access to medical information
- ISO – ISO TC 215 provides international technical specifications for EHRs. ISO 18308 describes EHR architectures
- xDT – a family of data exchange formats for medical purposes that is used in the German public health system.
The U.S. federal government has issued new rules of electronic health records.
Open specifications
- openEHR: an open community developed specification for a shared health record with web-based content developed online by experts. Strong multilingual capability.
- Virtual Medical Record: HL7's proposed model for interfacing with clinical decision support systems.
- SMART (Substitutable Medical Apps, reusable technologies): an open platform specification to provide a standard base for healthcare applications.
Common Data Model (in health data context)
Common
Data Model (CDM) is a specification that describes how data from
multiple sources (e.g., multiple EHR systems) can be combined. Many CDMs
use a relational model (e.g., the OMOP CDM). A relational CDM defines
names of tables and table columns and restricts what values are valid.
- Sentinel Common Data Model: Initially started as Mini-Sentinel in 2008. Use by the Sentinel Initiative of the USA's Food and Drug Administration.
- OMOP Common Data Model: model that defines how electronic health record data, medical billing data or other healthcare data from multiple institutions can be harmonized and queried in unified way. It is maintained by Observational Health Data Sciences and Informatics consortium.
- PCORNet Common Data Model: First defined in 2014 and used by PCORI and People-Centered Research Foundation.
- Virtual Data Warehouse: First defined in 2006 by HMO Research Network. Since 2015, by Health Care System Research Network.
Customization
Each
healthcare environment functions differently, often in significant
ways. It is difficult to create a "one-size-fits-all" EHR system. Many
first generation EHRs were designed to fit the needs of primary care
physicians, leaving certain specialties significantly less satisfied
with their EHR system.
An ideal EHR system will have record standardization but
interfaces that can be customized to each provider environment.
Modularity in an EHR system facilitates this. Many EHR companies employ
vendors to provide customization.
This customization can often be done so that a physician's input interface closely mimics previously utilized paper forms.
At the same time they reported negative effects in communication,
increased overtime, and missing records when a non-customized EMR
system was utilized.
Customizing the software when it is released yields the highest
benefits because it is adapted for the users and tailored to workflows
specific to the institution.
Customization can have its disadvantages. There is, of course,
higher costs involved to implementation of a customized system
initially. More time must be spent by both the implementation team and
the healthcare provider to understand the workflow needs.
Development and maintenance of these interfaces and
customizations can also lead to higher software implementation and
maintenance costs.
Long-term preservation and storage of records
An
important consideration in the process of developing electronic health
records is to plan for the long-term preservation and storage of these
records. The field will need to come to consensus on the length of time
to store EHRs, methods to ensure the future accessibility and
compatibility of archived data with yet-to-be developed retrieval
systems, and how to ensure the physical and virtual security of the
archives.
Additionally, considerations about long-term storage of
electronic health records are complicated by the possibility that the
records might one day be used longitudinally and integrated across sites
of care. Records have the potential to be created, used, edited, and
viewed by multiple independent entities. These entities include, but are
not limited to, primary care physicians, hospitals, insurance
companies, and patients. Mandl et al. have noted that "choices about the
structure and ownership of these records will have profound impact on
the accessibility and privacy of patient information."
The required length of storage of an individual electronic health
record will depend on national and state regulations, which are subject
to change over time. Ruotsalainen and Manning have found that the
typical preservation time of patient data varies between 20 and 100
years. In one example of how an EHR archive might function, their
research "describes a co-operative trusted notary archive (TNA) which
receives health data from different EHR-systems, stores data together
with associated meta-information for long periods and distributes
EHR-data objects. TNA can store objects in XML-format and prove the
integrity of stored data with the help of event records, timestamps and
archive e-signatures."
In addition to the TNA archive described by Ruotsalainen and
Manning, other combinations of EHR systems and archive systems are
possible. Again, overall requirements for the design and security of the
system and its archive will vary and must function under ethical and
legal principles specific to the time and place.
While it is currently unknown precisely how long EHRs will be
preserved, it is certain that length of time will exceed the average
shelf-life of paper records. The evolution of technology is such that
the programs and systems used to input information will likely not be
available to a user who desires to examine archived data. One proposed
solution to the challenge of long-term accessibility and usability of
data by future systems is to standardize information fields in a
time-invariant way, such as with XML language. Olhede and Peterson
report that "the basic XML-format has undergone preliminary testing in
Europe by a Spri project and been found suitable for EU purposes. Spri
has advised the Swedish National Board of Health and Welfare and the
Swedish National Archive to issue directives concerning the use of XML
as the archive-format for EHCR (Electronic Health Care Record)
information."
Synchronization of records
When
care is provided at two different facilities, it may be difficult to
update records at both locations in a co-ordinated fashion. Two models
have been used to satisfy this problem: a centralized data server solution, and a peer-to-peer file synchronization program (as has been developed for other peer-to-peer networks).
Synchronization programs for distributed storage models, however, are
only useful once record standardization has occurred. Merging of already
existing public healthcare databases is a common software challenge.
The ability of electronic health record systems to provide this function
is a key benefit and can improve healthcare delivery.
eHealth and teleradiology
The
sharing of patient information between health care organizations and IT
systems is changing from a "point to point" model to a "many to many"
one. The European Commission is supporting moves to facilitate
cross-border interoperability of e-health systems and to remove
potential legal hurdles, as in the project www.epsos.eu/. To allow for
global shared workflow, studies will be locked when they are being read
and then unlocked and updated once reading is complete. Radiologists
will be able to serve multiple health care facilities and read and
report across large geographical areas, thus balancing workloads. The
biggest challenges will relate to interoperability and legal clarity. In
some countries it is almost forbidden to practice teleradiology. The
variety of languages spoken is a problem and multilingual reporting
templates for all anatomical regions are not yet available. However, the
market for e-health and teleradiology is evolving more rapidly than any
laws or regulations.
European Union: Directive 2011/24/EU on patients' rights in cross-border healthcare
The
European Commission wants to boost the digital economy by enabling all
Europeans to have access to online medical records anywhere in Europe by
2020. With the newly enacted Directive 2011/24/EU on patients' rights
in cross-border healthcare due for implementation by 2013, it is
inevitable that a centralised European health record system will become a
reality even before 2020. However, the concept of a centralised
supranational central server raises concern about storing electronic
medical records in a central location. The privacy threat posed by a
supranational network is a key concern. Cross-border and Interoperable
electronic health record systems make confidential data more easily and
rapidly accessible to a wider audience and increase the risk that
personal data concerning health could be accidentally exposed or easily
distributed to unauthorised parties by enabling greater access to a
compilation of the personal data concerning health, from different
sources, and throughout a lifetime.
In veterinary medicine
In UK veterinary
practice, the replace of paper recording systems with electronic
methods of storing animal patient information escalated from the 1980s
and the majority of clinics now use electronic medical records. In a
sample of 129 veterinary practices, 89% used a Practice Management System (PMS) for data recording.
There are more than ten PMS providers currently in the UK. Collecting
data directly from PMSs for epidemiological analysis abolishes the need
for veterinarians to manually submit individual reports per animal visit
and therefore increases the reporting rate.
Veterinary electronic medical record data are being used to
investigate antimicrobial efficacy; risk factors for canine cancer; and
inherited diseases in dogs and cats, in the small animal disease
surveillance project 'VetCOMPASS' (Veterinary Companion Animal Surveillance System) at the Royal Veterinary College, London, in collaboration with the University of Sydney (the VetCOMPASS project was formerly known as VEctAR).
Turing test
A letter published in Communications of the ACM
describes the concept of generating synthetic patient population and
proposes a variation of Turing Test to assess the difference between
synthetic and real patients. The letter states: "In the EHR context,
though a human physician can readily distinguish between synthetically
generated and real live human patients, could a machine be given the
intelligence to make such a determination on its own?" and further the
letter states: "Before synthetic patient identities become a public
health problem, the legitimate EHR market might benefit from applying
Turing Test-like techniques to ensure greater data reliability and
diagnostic value. Any new techniques must thus consider patients'
heterogeneity and are likely to have greater complexity than the Allen
eighth-grade-science-test is able to grade."
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