Literature Review on Electronic Health Record and Patient Confidentiality and Privacy

Running Head: ELECTRONIC HEALTH RECORD 1
Literature Review on Electronic Health Record and Patient Confidentiality and Privacy
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ELECTRONIC HEALTH RECORD 2
Introduction
Electronic Health Record (EHR) is a digital version of the patient's medical history.
Although EHR is mostly used interchangeably with Electronic Medical Record (EMR), the
two entities are quite different. EHR involves the systematic collection of the population and
patients' stored data in digital format. EHR focuses on the total wellbeing and health of
patients and goes beyond the scope of a clinical setting where EMR is mostly used (Anshari,
2019). EMR is a digital format of patients' paper charts that is only available for use by the
clinicians. EMRs contain the data of patients' medical history and treatment progression and
therefore doesn't travel easily out of the scope of clinical practice. EHR is therefore different
and travels out of the clinical setting and can be shared with other departments such as the
nursing homes, hospitals, security departments and can be used even when a person is
traveling from one state to another. The wide sharing of patients’ health information using
EHR is a cause for concerns over the privacy of the patient’s health records. Patients’ privacy
and confidentiality are important aspects of any health care system that improves public
confidence when seeking medical assistance. Disclosure of confidential patients’ information
can invite discrimination and stigma.
Several studies and literature have raised concerns over the effectiveness of EHR in
improving the quality of health care (Toussaint and Correia, 2018). This is despite other
studies finding evidence that EHR has significant input in providing quality care (White,
2015). The adoption of EHR is also influenced by the provider uncertainty concerning the
investment value they’ll get from implementing the system and cost. In some studies
physicians who had adopted EHR noted that gains obtained from implemented are always
offset by reduced productivity of the technology. Also, the cost of hiring IT staff to run the
system is significant. At one point the united states congress noted that cost savings from the
system can be incurred only in large integrated institutions such as Kaiser Permanente. These

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and other concerns can be detrimental to the implementation of EHR. Since most of the
literature has been concerned with the advantages of implementing EHR and the means of
overcoming concerns such as cost and quality, the impact on patients’ confidentiality and
privacy is often overlooked.
EHR has significant impacts on the confidentiality of the patient's medical history and
general health since the information can be accessed widely. To understand how EHR may
affect the security of patient’s information it is imperative to review the literature to know
how the information system in health has evolved and how it should become to minimize the
associated challenges. In reviewing the literature, documents that outlined and discussed the
relationship of EHR to patient’s privacy and confidentiality were included. The documents
were retrieved from webpages and databases such as google scholar. The articles were mainly
restricted to North-American Authors, especially Canada and U.S.A.
According to the Orion Health White Paper (2019), the EHR are secure and private
lifetime records of the patients' health and points-of-care histories within the healthcare
system. The fundamental role of EHR being the creation of longitudinal patients’ records
containing complete information regarding patients across all aspects of care that include,
clinical history, demographic details, diagnostic investigations, medication lists, and
laboratory and radiology histories among others. According to Alami and colleagues (2020),
EHR is a powerful lever for enabling value-based health systems. The challenges attributed to
the use of the system which includes unintended negative impacts and reduced satisfaction
among health workers and deterioration of work conditions led Alami et al. (2020), to
develop quadruple aims to rethink the design and implementation of EHRs in Canada.
The history of EHR in the United States can be traced to as early as 2004 when the
Bush administration announced its plans to make sure that most Americans have EHR by the
year 2014 (Terry & Francis, 2007). Although very good progress by the time Terry and

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Francis published their paper in 2007, some barriers had started to hinder the implementation
process. Acceptance of the project by the general public and physicians compounded
financial and other technical issues. Most physicians will be reluctant to accept the
implementation of the EHR system the same way as the patients because they share a lot of
common ground when it comes to privacy and confidentiality. The patients and physicians
had to be satisfied before the EHR is accepted. Patients' concerns regarding the
implementation of EHR were mainly security and privacy. The basis on which most patients
their concerns is their autonomy. Patients can practice autonomy right by accepting or
declining to share information regarding their privacy. Adoption of EHR needed to adopt a
rights-based approach to improve acceptance among the public. Terry and Francis compiled
information regarding patients’ information security and the implementation of EHR from
various articles and government databases.
Before the introduction of either EHR or EMR, patients’ medical records were a paper
repository that was reviewed from time to time for clinical, financial, administrative and
research purposes. (Harman et al., 2012). Having such a health records system was highly
limited in accessibility since they could only be available to one user at a moment. Delays in
updating the manual records were compounded with the inability of patients to view their
health records. Security of the records was also inefficient since the records were protected
with locks, identification cards, controlled doors and tiring sign-out procedures. Also,
unauthorized access to patients’ records could not be detected easily. The advent of EMR and
EHR is in large part, due to these shortcomings. The EHR is interactive and many
stakeholders, users, and reviewers can access the data (Harman et al., 2012). Since the
implementation of EHR is facilitated by the US government many agencies review the
records. Patients own information in the records while the physicians or organizations own
the physical document since it is their business (Odom-Wesley, 2009). But, since the patient