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October 2017
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The electronic health record, it can save lives!

The electronic health record (EHR) is a controversial issue. The EHR has both supporters and opponents. Discussion about the EHR is often heated. Supporters emphasize the benefits of having digitally available patient information for the purpose of diagnosis or prevention of avoidable problems such as conflicting medications that can cause deaths. Opponents emphasize the privacy risks and abuse of medical data by, for example health insurance companies or the media. Many patients are frightened by the idea of their medical data being stored in digital form. But are these concerns really something to worry about? I asked Doctor Muñoz and doctor Mulder living in the Netherlands for clarification on the matter and their opinion about the HER.

First lets start of by looking at how the EHR in Holland really works. The EHR is a software application that preserves medical data from the patient in digital form. The purpose of the EHR is to support the current or future care process of a patient. Health care providers such as doctors, can request relevant patient information from other health care providers through AORTA. AORTA is the name of the Dutch health care infrastructure that makes electronic exchange of patient data possible. The starting point of AORTA is that data is not stored centrally. Caregivers continue to work with their own information database and exchange medical information with each other through AORTA when needed.

Doctor Muñoz points out that the message traffic through AORTA is logged and it can be tracked down which person requests medical data and when. ‘‘Doctors, pharmacists and medical specialists can only exchange patient data if the patient has given permission to do so. From 2012, explicit consent of the patient is required to participate in the EHR. All non-explicitly permitted applications will be deleted.’’ doctor Muñoz explains. This principle is called the opt-in principle and the patient can also revoke the consent.

‘‘The notion of the confidentiality of patient information is fundamental to the practice of medicine. Therefore data privacy and security concerns have been one of the major barriers to the adoption of the EHR at national level.’’ doctor Muñoz explains. ‘‘It should be guaranteed that the information contained in the EHR is shared over secure networks and counting with the consent of the patients.’’ Many people are scared of non-medical specialist having access to their medical health record. Patients fear that the EHR opens the door for access to medical records by parties with specific interests such as employers, health insurance companies or mortgage lenders. Doctor Mulder stresses ‘’Patients must know that current legislation already excludes this and that the patient him- or herself always has the last word on who can access their EHR.’’ To prevent abuse, the identity of the healthcare provider that consults the EHR has to be known. When consulting the EHR, caregivers identify themselves with a personal Unique Healthcare Identification card and PIN. Patients can rely on the deterrent effect of the log that makes all consults of the EHR traceable and heavy penalties for unjustified request minimize risks. Moreover, doctor Muñoz refers to 2012. The year in which The Association of General Practitioners announced a lawsuit against the four major health insurers, to prevent that obligatory participation of the EHR could be put in their contracts.

Opponents of the EHR are afraid of hackers that may break into the AORTA system and abuse medical data from the patients. An example could be certain media outlets giving orders to a hacker to find out all the details from the medical history of celebrities or politicians. When it turns out that a politician or a top businessman had a psychiatric history, this could be fatal for their career. Doctor Mulder says that the benefits of the EHR outweigh these risks. ‘‘The advantage of this system lies in allowing accurate recording and sharing of updated data that captures the actual state of the patient at all times.’’ Due to all the information being stored in AORTA and the accessibility from multiple locations, the EHR facilitates the sending and reception of orders, reports, and results and simplifies the co-ordination of the health care delivery. Doctor Muñoz adds ‘‘Although there is not yet direct evidence, it is expected that the EHR will facilitate accurate diagnosis and appropriate treatment as well as a positive impact on preventing drugs prescription errors by triggering warnings and reminders.’’ Due to all the information being digitally stored and made available to medical experts when needed, it makes it much more effective when extracting medical data for the examination of possible trends and long term changes in the patient.

Additionally doctor Mulder points out that a big benefit of the EHR is that electronic data eliminates the problem of unreadable handwriting. Another benefit is the velocity at which medical data can be transmitted. The exchange of electronic data is way faster than the exchange of paper files and the data can be made available 24 hours a day, 7 days per week. Lastly doctor Mulder adds that the EHR can can prevent or reduce needless repetition of an up to date research because the results of medical examinations, such as x-rays and blood tests can quickly and easily be exchanged electronically. This saves the patient time, money and inconvenience.

It is clear that the EHR can save lives since having digitally available patient information can facilitate diagnosis, further medical treatment or emergency care. Doctor Mulder and doctor Muñoz both agree that the EHR is a revolutionary development in the storage of medical information of patients.


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