Electronic Health Records

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Patients’ health records saved in databases could boost the efficiency of health markets in the EU but pose major challenges regarding interoperability and safeguarding patient privacy. 

Electronic Health Records (EHRs) are records, stored in electronic format, of a patient's health information as it evolves over a certain timespan. Their main source is Electronic Medical Records (EMRs): the legal records created in hospitals and ambulatory environments in the course of medical treatments or care delivery.

EHRs can include information on patient demographics, treatment progress, problems, medications, vital signs, past medical history, immunisations, laboratory data and radiology reports. 

For doctors, hospital operators, medical personnel and caretakers, the advantage of the electronic health record is the opportunity it provides to structure, automate and streamline their workflow. It can generate a complete record of encounters with clinical patients and support other care-related activities. 

Patient mobility 

As patients become more mobile within Europe, EHRs that are readable by clinicians in different settings and languages could enable safer treatments and reduce costs. 

The issue of mobility is closely linked to interoperability: If standards for EHR remain confined within one country's borders, they will raise new barriers to patient mobility. This means, however, that standards would have to overcome not only language barriers but also differences in countries' healthcare systems, from medical treatments to the way pharmaceuticals are marketed. 

The EU's e-Health action plan (2004) defines the development of interoperable healthcare systems across the Union by 2010 as a priority. In June 2006, the Commission's ICT for Health unit adopted a new strategy to promote the transformation of the European healthcare landscape, in line with the Commission's policy framework, i2010

Costs and Savings 

Following a comparatively low initial investment, electronic health records would enable doctors and medical personnel to share the results of medical exams more efficiently, thus avoiding a situation where the same kind of exam is performed on the same patient several times as they move from one clinic or doctor to another. 

In addition, computing power could be used to cut additional costs such as prescription pharmaceuticals and hospitalisation and travel fees. Anonymous healthcare data based on all patients could be used to make healthcare markets more efficient. For example, the effectiveness and safety of generic as opposed to original drugs could be tested independently and more efficiently. 

Rand estimates that the introduction of electronic health records in the US would lead to savings of around US$80bn (€55bn) a year, the lion's share of which would be through reductions in in-patients' length of stay and nursing time, followed by out-patients' drug use.  

Still, scientists are divided as to whether electronic health records will ultimately result in lower costs for national healthcare systems. They will also lead to a better evaluation of diagnoses, in particular when they are combined with genomics. This may result in more diseases and deficiencies being recognised and eventually more and better care, with higher life expectancy a consequence of this. 

Analysts also warn that, as electronic health records grow with time, it will take many years for them to realise their full potential. Research published in the Archives of Internal Medicine showed that "there was no significant difference in performance between [ambulatory] visits with vs. without EHR use".

Data protection and safety

Electronic health records concern some of a person's most sensitive data, which therefore deserves the highest degree of protection against all kinds of abuse. The challenge is clear: EHR can only be used to their full potential when medical personnel can access the data they need. At the same time, it has to be assured that data not needed in the context of a specific treatment is made inaccessible and that the data does not get dispersed or accessed by non-authorised persons or organisations. 

Recent data losses in the UK, the USCanada and elsewhere stress the importance of more effective protection measures. A November 2007 poll by British newspaper 
The Guardian
revealed how critical a challenge this will be: According to the research, almost 60% of general practitioners in the UK are unwilling to upload their patient data to a proposed national database, for fear that "sensitive personal data could be stolen by hackers and blackmailers". According to research commissioned by the UK Medical Research Council, this feeling is shared by the general public. 

On 15 February 2007, the Article 29 Working Party of national data protection officers issued a Working Document on the processing of personal data relating to health in electronic health records. In the document, it warned: "From a data protection point of view, the fact has to be stressed that EHR systems [...] have the potential not only to process more personal data (e.g. in new contexts, or through aggregation) but also to make a patient's data more readily available to a wider circle of recipients than before." 

The Working Party added: "In compiling existing medical information about an individual from different sources with the result of allowing for easier and more widespread access to this sensitive information, EHR systems introduce a new risk scenario, changing the whole scale of possible misuse of medical information about individuals." In the document, the Article 29 Working Party offers concrete guidance for healthcare operators and practitioners. 

Some of the most tricky questions in setting up EHR systems concern the introduction of integrated and interoperable solutions for access control and data security systems. 

"The EU's initiatives on eHealth intend to remove linguistic administrative and technical barriers, by making it easier for people to receive treatment even when they are away from their home country. I expect our recommendation and the SOS project to make an important contribution to saving patients' lives in emergencies," said EU Information Society Commissioner Viviane Reding  presenting the Recommendation on interoperability of EHR.

John Halamka, a medical professor and information officer from the US, wrote in the monthly newsletter of the Continua Health Alliance: "By placing the patient at the centre of healthcare data exchange and empowering the patient to become the steward of their own data, patient confidentiality becomes the personal responsibility of every participating patient. Patients could retrieve their records, apply privacy controls, and then share their data as needed with just those who need to know. Since policies are local, the security standards built into personal health records need to be flexible enough to support significant heterogeneity."

The 
New York Times
quoted David M. Cutler, a health economist at Harvard, who said: "Information is a dual-edged sword, especially in health care. Better information might blow apart some of the blockbuster markets in the pharmaceutical industry, for example. But it might also increase demand for other drugs in smaller, more focused markets. And if better information really helps us understand what is happening in health care, it could well lead to more care for more people and higher costs for the system as a whole."

Standing Committee of European Doctors (CPME) recognises the growing importance of e-Health technology in the delivery of healthcare and "strongly values its use in supporting the physician in his/her work". It notes that across EU-27 "considerable differences exist in the approach physicians adopt towards e-health, based on differing application of ethical principles, the degree of patient control over the record, and the level of integration of e-health solutions in healthcare systems." CPME argues that further study and development are needed to address the different technical and ethical approaches, as they currently represent a "considerable barrier" to the concept of an EU-wide system.

CPME also believes that "all patients, irrespective of background and the nature of their problem, should be able to seek medical assistance being confident that their sensitive personal data can only be accessed by health care personnel who need this information to provide appropriate care. The patient should be contacted to give explicit consent to extended use of the data." 

The role of technology in facilitating telemedicine is also supported by CPME (EURACTIV 3/7/09)

  • 20 Dec. 2007: Official launch of e-health lead market initiative.
  • 2 July 2008: The Commission presented a proposal for a directive on patients' rights in cross-border healthcare.
  • 2 July 2008: The Commission adopted a Recommendation on cross-border interoperability of electronic health record systems.
  • 2 July 2008: A large scale EU pilot project (S.O.S.) on interoperable EHR and ePrescriptions launched.

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