Medical Informatics and How to Protect Privacy

Individual patient records have been used for centuries, with some of the first comprehensive case records being maintained in the early 1800s (Seigler, 2010). However, medical records were not always employed as they are now. Early medical records were used less to maintain continuity of care or reduce medication errors, and more for instructive purposes, such as teaching medical students (Seigler, 2010). Whereas medical records were relatively arbitrary until recently, lacking formal standards or methods of recording, medical recordkeeping is now much more standardized (“Medical Records: A Brief History,” n.d.). Medical records evolved over the centuries to be more patient-centered, less about doctor perceptions of their work and more about how to improve quality of care for patients.
Because medical records contain sensitive personal information about health history, privacy issues abound. One of the most important considerations with safeguarding medical records is with regards to employment discrimination. Another consideration is how insurance companies can leverage medical records to excuse denial of coverage. At the same time, medical records live up to their potential when they are readily accessible and available to healthcare practitioners and emergency services workers (Barrows & Clayton, 1996). Balancing the interests of medical care quality with privacy remains a core concern of how to develop and maintain effective medical records.
One of the best ways of balancing the needs for privacy with the dictates of top quality patient care is through accreditation and agency licensing. Instead of outsourcing medical records keeping to unreliable third parties, healthcare institutions can and should rely on accredited agencies for developing effective encryption methods and ensuring data security. Unfortunately, there has yet to be a standardized system of medical records keeping. The 1996 The Health Insurance Portability and Accountability Act (HIPPA) does help promote higher standards and accreditation with regards to electronic health records. Yet especially given the trend towards population mobility, maintaining standards of medical records across various geographic regions and even across international borders remains a main concern. HIPPA also ensures standards of privacy but “a good deal of medical information falls outside the protection of this law,” (Hasson, n.d., p. 1). Some types of medical records may be available to insurance companies. While insurance companies do not have access to medical records legally, there are situations in which patients may unwittingly allow disclosure of their medical records. For example, “insurers may access individual doctors' files for underwriting purposes,” and often do request medical records when evaluating a claim (Hasson, n.d., p. 1). Nurses are at the forefront of patient advocacy by helping all patients understand their rights regarding medical records and privacy.
Electronic medical records are far preferable to paper ones for several reasons. One, electronic medical records are better protected against fire, theft, and other risks, and can be stored in a decentralized database that precludes security breaches. Electronic medical records are easier to share among providers, helping to provide ultimate continuity of care and quality of care for patients when they move or seek services at different institutions. Moreover, electronic medical records can be standardized far easier than paper records. Electronic medical records make it possible for pharmacists to reduce medication errors, and for all healthcare providers to access files in emergency situations. There are some concerns about electronic records and security and privacy breaches. However, these concerns can be mitigated by robust software engineering, use of new technologies like blockchain, which can decentralize data storage, and by passing more effective laws that help standardized medical records.











References

Barrows, R.C. & Clayton, P.D. (1996). Privacy, confidentiality, and electronic medical records. Journal of the American Medical Informatics Association 3(2): 139-148.
Hasson, J. (n.d.). How private is your medical info? AARP. https://www.aarp.org/caregiving/health/info-2017/how-private-is-medical-information.html
“Medical Records: A Brief History,” (n.d.). https://medicalcodingdegree.org/medical-records-history/
Seigler, E.L. (2010). The evolving medical record. Annals of Internal Medicine 153(10): 671-677.