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Electronic Medical Records: Privacy, Confidentiality, and Security



                Electronic Medical Records (EMRs) are the records of patient health information maintained by a single health practice that contains information about patient diagnosis, treatments, and medication. The push for widespread use of EMRs came in 2009 with the signing of the Health Information Technology for Economic and Clinical Health (HITECH) Act.  With a new age of health information technology approaching healthcare practice had to brace for what the implementation of EMRs would bring. Health practice both large and small around the world where provided with federal guidelines for which they had to follow regarding the aspects of EMRs. Some of these guidelines covered the areas of ethical use and collection, privacy, confidentiality, and security in implementing and maintaining ERMs. In this paper, we will look at the requirements laid out by federal regulations in adopting these ethical considerations, problems that may arise, and measures to overcome them.

Keywords: Electronic Medical Records (EMR), Patient Privacy, Patient Confidentiality, Patient Security, Data Integrity and Availability, HIPAA, Paper-based medical records, Patient Health Information (PHI).


Over the last few years, her in the United States, we have saw healthcare providers transition from the use of paper-based medical records to digital records. Those digital records are what we call Electronic Medical Records (EMRs). EMRs are a collection of patient data that is kept within a computerized software application. The data collected is a legal record of patient information and figures created during a patient visit to a hospital, clinician, physician, or any other health facility. The data may include assessments, plans, prescriptions for medications, and

notes by the care providers. EMRs typically contain patient’s medical history, and diagnoses and treatments. With all the information collected in EMRs there is a blatant concern for EMR ethical handling, patient privacy, confidentiality, security, and data integrity as well as availability. This paper discusses the privacy, confidentiality, and security considerations of EMRs, encompassing the issues and the measures taken to overcome them.

Transition to EMRs

        To understand many of the issues that encompass the use of EMRs it is important to understand the government legislation drafted for it and meaningful use. In 2009, the United States government began a strong national push for the implementation of the use of EMRs and passed the Health Information Technology for Economic and Clinical Health (HITECH). This Act was a bold step toward the widespread use of EMRs as with it came big incentives to physicians and hospitals use not only used EMRs but where able to demonstrate the meaningful use of them.  Consequently, by taking a monetary award to the implementation of EMRs, the US government create a pool of ethical errors for many providers. Physicians were so eager to receive the monetary award that they failed to review the research, guidelines, and gather further knowledge on EMRs before trying to use the.

Some organizations used EMRs applications and actions that left several areas of patient care vulnerable. The federal government had to later provide a definition of meaningful use in relation to EMRs and set guidelines and standards for the proper implementation of EMRs

Ethical Considerations of EMRs

        The data contained in EMRs aid physicians and medical professionals in clinical decision making, research, appraisal of quality and efficiency of patient care and coordination of patient services. Both patients and their healthcare have the opportunity to benefit greatly from EMRs but there are a few advantages and disadvantage of switching from paper based to electronic  medical records (see figure 1).As EMRs can be used and viewed by medical practitioners, stakeholders, government agencies and the patients themselves there are some ethical concerns that arise. The chief ethical considerations of electronic medical records are privacy and confidentiality, security, and data integrity and availability (Harman et al., 2012).

[pic 1][pic 2]

Privacy of Electronic Medical Records

        Privacy of a health record is defined as “the right of individuals to keep information about themselves from being disclosed to others.” (Harman et al., 2012). There are legal regulations on the disclosure of a person’s medical record, such as HIPAA (Health Insurance Portability and Accountability Act), that lay out clear guidelines for paper based medical record documents. However, due to the forever changing technological aspects and advancements that incorporate EMRs there are not to many that cover the privacy of digital medical records. As privacy is in the eyes of the beholder (the patient) the intrusion of privacy is dictated by the individual’s perception. Medical practices using EMRs have saw that the strict information privacy of paper based records are not being held to EMRs. With individual offices being able to share data from patients EMRs with the click of a button conflicts arise with goals of patient care, medical research, and public health, which require access of patient information without their consent (Barrows & Clayton, 1996).

        To ensure patient privacy, physicians must document their privacy policies and communicate to all patients and their clinical staff. HIPAA privacy rule standards address the use and disclosure of personal health information by organizations and should still be adhered to when using EMRs. HIPAA rules also provide standards for individual patient rights so that they can understand and control the manner in which their health information is used and disclosed. Patients also have the right to limit the health agencies from accessing their PHI. Patients should be notified by their doctor’s office of all uses of their health information, except those used by government.

Confidentiality of Electronic Medical Records

Confidentiality of health information is expressed as “the information that is shared as a result of a clinical relationship is considered confidential and must be protected” (Harman et al., 2012). This information includes the sharing of patient demographics, diagnosis, treatments, or laboratory data. Under HIPAA, patients can request that information that is deemed confidential be shared with others. This can be done by filling out a paper, emailing or writing your doctors office or verbal consent.  Even then your provider is to only provide the information the patient requested be shared and nothing more and only deliver it to the locations specified by the patient.


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