Kreuser, Karoline

English

Loyola University Chicago, School of Law: LAW eCommons

Annals of Health Law
Volume 16
Issue 2 Summer 2007 Article 7
2007
The Adoption of Electronic Health Records:
Benefits and Challenges
Karoline Kreuser
Loyola University Chicago, School of Law
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Recommended Citation
Karoline Kreuser The Adoption of Electronic Health Records: Benefits and Challenges, 16 Annals Health L. 317 (2007).
Available at: http://lawecommons.luc.edu/annals/vol16/iss2/7
The Adoption of Electronic Health Records:
Benefits and Challenges
Introduction by Karoline Kreuser*
I. INTRODUCTION
Dr. Kenneth W. Kizer, M.D., M.P.H., gave the keynote speech at Loyola
University Chicago School of Law's Sixth Annual Health Law and Policy
Colloquium, Diagnosing the Data. Dr. Kizer currently serves as the Presi-
dent, CEO, and Chairman of the Board of Medsphere Systems Corporation,
the leading commercial provider of open source information technology so-
lutions for the healthcare industry. Prior to this, Dr. Kizer held the position
of Under Secretary for Health in the United States Department of Veterans
Affairs (VA). In all, Dr. Kizer has accumulated over twenty-five years of
professional experience in the healthcare field, which has included work in
the private sector, academia, and federal and state governments.
In his keynote speech, Dr. Kizer contended that the widespread imple-
mentation of electronic health records (EHRs) is the most important means
by which to improve the safety, quality, and efficiency of health care in
America. However, he also pointed out that this digital transformation of
health care opens up vast quantities of personal health information for non-
direct uses as well, such as research, analysis, public reporting, provider
certification and accreditation, and marketing and other commercial activi-
ties. Dr. Kizer cautioned that while many secondary uses of health data
have the potential to greatly benefit the public good, there are other, less de-
sirable uses which, if not properly addressed by developing a national
framework, could halt the adoption of this technology.
The following introduction to Dr. Kizer's presentation briefly summa-
rizes the pressures on the healthcare industry, which are making the move
to EHRs inevitable. It then highlights the potential benefits and drawbacks
to EHRs, with particular emphasis on the privacy threat to patient informa-
tion.
" Student, Loyola University Chicago School of Law, Class of 2008. Ms. Kreuser
is a staff member of the Annals of Health Law.
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Kreuser: The Adoption of Electronic Health Records: Benefits and Challenge
Published by LAW eCommons, 2007
Annals of Health Law
II. FORCES DRIVING THE ADOPTION OF EHRS
Although the development and use of EHRs dates back to the 1970s,' the
widespread implementation of this technology has only recently been per-
ceived as a reality.2 The EHR is defined as "a longitudinal collection of
electronic health information about individual patients and populations."
3
Primarily, EHRs function as a mechanism for incorporating healthcare data
presently collected in both paper and electronic forms with the intent of im-
proving the state of the healthcare system in the United States.4
However, as of 2007, adoption of EHRs and other related technology has
been minimal in the United States, and it is largely not a routine practice of
medical providers.5 In fact, a recent study estimated that only one in four
physicians use EHRs, while the use of health information technology is
even lower among hospitals. 6 Still, in 2004, President Bush set a goal for
the majority of Americans to have an EHR within ten years.7 Although this
vision undoubtedly will require an extraordinary effort, 8 many believe that a
variety of forces at work in the healthcare industry make the widespread use
of EHRs unavoidable. 9
The pressures driving the implementation of EHRs include "the desire to
improve health care through timely access to information and decision-
support aids; the need for simultaneous access to records by doctors, nurses,
and administrators in modem, integrated provider and referral systems;" the
motivation to tailor healthcare systems to highly mobile patients; and the
push toward enhanced cost efficiency. 10 Furthermore, the heightened level
of computer literacy in the general population, combined with increased
1. Clement J. McDonald, The Barriers to Electronic Medical Record Systems and How
to Overcome Them, 4 J. AM. MED. INFORMATICS ASS'N 213, 215 (1997).
2. Eta S. Bemer & Jacqueline Moss, Informatics Challenges for the Impending Patient
Information Explosion, 12 J. AM. MED. INFORMATICS ASS'N 614, 614 (2005).
3. Tracy D. Gunter & Nicolas P. Terry, The Emergence of National Electronic Health
Record Architectures in the United States and Australia: Models, Costs, and Questions, 7 J.
MED. INTERNET RES. (2005), available at
http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=l 550638.
4. Id.
5. June M. Sullivan, Recent Developments and Future Trends in Electronic Medical and
Personal Health Records, 19 No. 3 HEALTH L. 16,18 (2007).
6. Id.
7. See Blackford Middleton et al., Accelerating U.S. EHR Adoption: How to Get There
From Here. Recommendations Based on the 2004 A CMI Retreat, 12 J. AM. MED.
INFORMATICS ASS'N 13, 18 (2005).
8. Id.
9. Thomas C. Rindfleisch, Privacy, Information Technology, and Health Care, 40
COMM. ACM 93,93 (1997).
10. Id.
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Adoption of Health Records
government investment in healthcare communications technology, suggest
that the transition to EHRs may occur in the near future.'
III. BENEFITS OF EHRS
Undoubtedly, there are a multitude of potential benefits to be derived
from the widespread adoption of EHR technology. Specifically, "integrated
electronic health records are increasingly seen as the way to achieve quality
and continuity in treatment," while also controlling costs.,2  In fact, elec-
tronic medical technology is perceived by some as the only feasible means
to markedly improve the healthcare system in the United States in the near
future.13 Additionally, the use of EHRs can provide physicians and other
healthcare providers with ready access to a patient's complete lifetime
medical history.14
EHRs are superior to paper records in several ways. Unlike paper re-
cords, EHRs have the capability of "provid[ing] a technical infrastructure
on which to build longitudinal medical records that can be integrated across
sites of care," including research, public health efforts, and clinical care.15
Furthermore, electronic records decrease the errors caused by handwrit-
ing--the problems which paper records pose. 16 At the same time, electronic
record technology eases physical storage requirements.17
Additionally, EHRs create the potential for computer-based tools to
greatly improve the quality of health care that is provided to patients. 18 The
computer functions that may be utilized "include reminder systems that
identify patients who are due for preventive care interventions, alerting sys-
tems that detect contraindications among prescribed medications, and cod-
ing systems that facilitate the selection of correct billing codes for patient
encounters."19
11. See Eta S. Berner et al., Will the Wave Finally Break? A Brief View of the Adoption
of Electronic Medical Records in the United States, 12 J. AM. MED. INFORMATICS AsS'N 3, 3
(2005).
12. Meredith Carter, Integrated Electronic Health Records and Patient Privacy: Possi-
ble Benefits but Real Dangers, 172 MED. J. AUSTL. 28,28 (2000), available at
https://www.mja.com.au/public/issues/172_01_030100/carter/carter.html.
13. Kenneth W. Kizer, President, CEO and Chairman, Medsphere Systems Corporation,
Keynote Address at the Loyola University Chicago School of Law's Sixth Annual Health
Law and Policy Colloquium (December 5, 2006).
14. Bemer & Moss, supra note 2, at 614.
15. Kenneth D. Mandl et al., Public Standards and Patients' Control: How to Keep
Electronic Medical Records Accessible but Private, 322 BMJ 283, 283 (2001).
16. Gunter & Terry, supra note 3.
17. Id.
18. Walter V. Sujansky, The Benefits and Challenges of an Electronic Medical Record:
Much More than a "Word-Processed" Patient Chart, 169 W. J. MED. 176, 176 (1998).
19. Id.
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Kreuser: The Adoption of Electronic Health Records: Benefits and Challenge
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Annals of Health Law
IV. SECONDARY AND UNDESIRABLE USES OF EHRS
Although there are many benefits to be derived from the implementation
of integrated EHR systems, there are concerns associated with the use of
this technology as well. 20 Not only is there a critical need to ensure that
public accountability for secondary use of personal information is pro-
moted, but it is equally important for patients' privacy to be adequately pro-
tected as well.21
A. Secondary Uses
In addition to the electronic collection of medical information for pur-
poses of patient treatment, there are also several secondary uses of this
data. 22 Secondary uses refer to functions of medical records that are not di-
rectly involved in patient care.23
Potential indirect uses of electronic medical information include "public
health management, social service and welfare system management, law en-
forcement, screening, and licensing" for some professions.24 Furthermore,
medical records may also be used for "quality reviews, administrative re-
views, and utilization studies to manage the business aspects of health
care. ' 25 Additionally, EHRs have the potential to greatly benefit medical
research as well, making it easier and more economical to conduct studies
and gather data.26
B. Threat to Privacy of Patient Information
However, given the multitude of uses and users of this technology, sig-
nificant threats to privacy, confidentiality, and consent must be addressed.2 7
In fact, the L.A. Times reported that approximately "150 people (from doc-
tors and nurses to technicians and billing clerks) have access to at least part
20. Carter, supra note 12.
21. Id.
22. Rindfleisch, supra note 9, at 95.
23. Id.
24. Id.
25. Id.
26. John Powell & lain Buchan, Electronic Health Records Should Support Clinical Re-
search, 7 J. MED. INTERNET RES. (2005), available at
http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&
artid= 1550635.
27. Rindfleisch, supra note 9, at 95-97.
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of a patient's records during a hospitalization., 28 Moreover, over 600,000
payors, providers, and other entities in charge of healthcare providers' bill-
ing data have at least partial access to these records as well. 29 Few controls
are currently in place to ensure that information obtained through EHRs is
used only for authorized purposes.30 Therefore, there is a great threat of
misuse of this sensitive medical information.
31
The implementation of EHR technology will place a vast amount of ad-
ditional information about the health care of identifiable individuals in the
hands of various agencies, which have not previously had access to such
data.32 An example of a potential misuse of EHRs is the sale of consumer
information to pharmaceutical companies.33
In addition, there are confidentiality and privacy issues inherent in the
nature of the patient-physician relationship, as patients often face a dilemma
regarding the disclosure of personal medical information to their physi-
cians.34 Although disclosure is necessary in order to receive treatment, this
disclosure often reveals sensitive information that individuals would rather
keep private. 35 Consequently, if patients do not have an expectation of pri-
vacy of their confidential information, they may fail to divulge necessary
medical data or even avoid seeking treatment.
36
Furthermore, privacy controls of electronic medical data are necessary
not only to ensure that patients can build trusting and open relationships
with their healthcare providers,37 but also to decrease the risk of personal
information becoming public. 38 In order to ensure that the adoption of elec-
tronic medical data does not threaten the privacy of patient information, it is
necessary to address the risk not only of disclosing confidential information
to the public, but of significant misuse of medical data.39
28. Judy Foreman, At Risk of Exposure: In the Push for Electronic Medical Records,
Concern is Growing About How Well Privacy can be Safeguarded, L.A. TIMES, June 26,
2006, at F3.
29. Id.
30. Rindfleisch, supra note 9, at 97.
31. See Carter, supra note 12.
32. Id.
33. Id.
34. Rindfleisch, supra note 9, at 94.
35. Id.
36. Mandl et al., supra note 15.
37. Id.
38. Rindfleisch, supra note 9, at 95.
39. Id. at 94-97.
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Kreuser: The Adoption of Electronic Health Records: Benefits and Challenge
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Annals of Health Law
V. CONCLUSION
The current pressures on the healthcare industry make the transition to
EHRs inevitable.40 Indeed, there are many important benefits to be reaped
from the widespread adoption of this technology, as well as secondary uses
of this data, including research, analysis of health trends, provider certifica-
tion, and licensure. However, in order to ensure that the implementation of
electronic health data does not threaten the privacy of patient information, it
is necessary to develop a national framework to address the issues of sec-
ondary uses and misuses of confidential medical information.41
In the transcript that follows, Dr. Kizer sets the stage for the move to
EHRs by addressing the problems plaguing our healthcare system and pro-
viding the context which makes this transition so important. Given the state
of health care in this country, Dr. Kizer proposes that the implementation of
this technology has the most potential to significantly improve the safety,
quality, and efficiency of American health care.
40. Id. at 93.
41. Kizer, supra note 13.
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