Confidentiality and Sensitive Information Release
Certainly the two biggest risk issues to watch for when using EMR with patients pertain to confidentiality and the appropriateness of information that is transmitted to patients. Confidentiality and HIPAA compliance just cannot be overemphasized, said Dr. Marple. It seems as if we are secure in e-mailing, but in fact, we’re not.
Explore this issue:January 2007
Many e-mail servers, he explained, especially those offsite from a practice, are not confidential. A physician communicating sensitive information to a patient may be exposing that patient to other onlookers. But among the many available EMR software systems, some have a feature that provides for competent, secure communication. We use a system called EPIC on our campus and a piece of that is a confidential way for physicians to communicate with their patients, which is called MyChart, said Dr. Marple. It gives patients access to their medical records in a confidential fashion. It also allows for release of reports and lab values to patients-for instance, a patient could have access to their hemoglobin A1C for diabetes so the patient could monitor that in real time, long-term. It also provides an opportunity communicate electronically with a patient.
Automatic settings may be particularly problematic. I order a radiologic procedure on the patient, said Dr. Marple, posing a hypothetical situation. The results that come to me frequently within the report include some normal variant that might appear alarming to the patient. In MyChart, I can affix a little note and forward it to the patient that says, ‘nothing to worry about; this is a normal examination.’
Physicians investigating EMR systems need to consider all the possible clinical scenarios through which they could be tripped up by premature release of information, Dr. Marple said. And that’s not to say we want to hold back information, but sometimes we need to be there in our supportive role as information is being relayed to patients.
Premature release of information to patients is especially troublesome in the case of delivering bad news. Particularly when a physician is in a rush, he said, if we’re not careful the way we relay information, patients may get the wrong impression. If I’m not careful in my explanations, that little aberrancy in a test that I think is relatively normal may be very worrisome to the patient.
Dr. Marple, who is on boards of the American Rhinologic Society and American Academy of Otolaryngic Allergy, and is active within the American Academy of Otolaryngology-Head and Neck Surgery and the AMA, among other organizations, said that physicians who are implementing these systems frequently voice concern that patients receiving these results electronically will be left to interpret their own medical results.