Journal of the American Medical Informatics Association

December 15, 2009

Although physicians support the use of electronic health records, concerns about potential privacy breaches remain an issue, according to two research articles published in the January 2010 issue of the Journal of the American Informatics Association (JAMIA), in its premiere issue as one of 30 specialty titles published by the BMJ (British Medical Journal) Group, UK.

One published study is based on views of more than 1,000 family practice and specialist physicians in Massachusetts who were asked whether they thought electronic health information exchange (HIE) would drive down costs, improve patient care, free up their time and preserve patient confidentiality. They were also asked whether they would be willing to pay a monthly fee to use the system.

The electronic exchange of health information (HIE) among different long- distance providers has become the focus of intense national interest, following recent legislation and moves to offer cash incentives for those who switch to the system.

The responses showed widespread support for the use of HIE, even though only just over half were actually using electronic health records.

Most (86%) said that HIE would improve the quality of care and seven out of 10 thought it would cut costs. Three out of four (76%) felt that it also would save time.

But 16% said they were "very concerned" about potential breaches of privacy, while a further 55% were "somewhat concerned."

The authors note that the responses indicate a lower level of concern than expressed by physicians in the UK, but suggest that this might change if breaches occur to a greater extent than currently recognized.

Despite their overall enthusiasm, physicians were not willing to support the suggested $150 monthly fee, and nearly half were unwilling to pay anything at all.

A second study reported in JAMIA, suggests that mental health professionals have significant concerns about the privacy and security of data on electronic health records.

Of 56 responding psychiatrists, psychologists, nurses, and therapists--out of 120 who were sent the survey--based at one academic medical center, most (81%) felt that the system permitted the preservation of "open therapeutic communications." Most also felt that electronic records were clearer and more complete than paper versions, although not necessarily more factual.

When it came to privacy, almost two-thirds (63%) were less willing to record highly confidential information to an electronic record than they would to a paper record.

More than eight out of 10 (83%) said they if they were to become a patient, they would not want to include their own mental health records to be routinely accessed by other providers.

The authors point out that previously published surveys of patients/consumers have reflected a lack of confidence in tight security, and that people with mental health issues already face stigmatization.

While the narrative data of patients' life histories and experiences inform clinical decision-making in psychiatric care, the threat of security breaches makes them vulnerable to potential misuse or misinterpretation, the authors say.

Adoption of electronic health records has been slower than anticipated, the authors add. And they conclude: "Designers of future systems will need to enhance electronic file security and simultaneously maintain legitimate accessibility in order to preserve confidence in psychiatric and other [electronic health record] systems."

"The ramifications of data security cover more than the psychiatric domain, implying a need for considerable reflection," they say.
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A new JAMIA website is currently under construction as a result of the new JAMIA-BMJ Group relationship. To find JAMIA archives, go to http://www.jamia.org

American Medical Informatics Association

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