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Despite risks, Electronic Medical Records will likely soon replace paper-based records

Electronic Medical Records (EMR) are computerized databases that store all relevant personal and medical information necessary for a patient’s care and revenue collection by health care providers. The systems currently on the market are designed to be implemented by individual medical practices or groups of providers. However, currently there are no regional or national central storage systems, and the existing systems do not allow automatic data sharing between unrelated networks on a regional or national level.

Under the Patient Protection and Affordable Care Act signed into law last year, physicians and hospitals can receive a financial incentive of up to $63,750 if they switch from paper records to an EMR system. At the same time, starting with 2015 providers will be penalized by being denied a certain percentage of their Medicare and Medicaid collections if they do not switch from paper to electronic records.

Advantages and risks of an easier exchange of information among various medical providers

Especially for providers in a hospital or multi-specialty clinic, the centralized electronic storage of data brought about by the EMR greatly reduces logistical issues. Enhancing and streamlining the data flows ensures that providers can more easily coordinate their care with that of the patients’ other providers. From a financial perspective, a centralized database simplifies the billing of medical services.

The greatly increased flow of information also has its still unresolved issues, however. For example, physicians may receive unsolicited information from insurance companies about the medical condition of their patients that pertain to an unrelated specialty, such as, for example, an orthopedic surgeon who finds out by chance about an endocrinologic condition of one of his patients. Is this physician legally or ethically obligated to contact the patient’s primary care physician in order to ensure that the patient receives the endocrinologic care he needs?

Potentially increased malpractice risk

Many medical providers are concerned that implementing Electronic Health Records may increase rather than decrease their malpractice liability risk. Apart from possible mistakes stemming from the transition to a new and unfamiliar technology, other potential sources of errors are information entered incorrectly, crashes, “bugs” and other technical failures. Furthermore, documentation gaps may arise if the practice uses a combination of paper and electronic records. A recent study in the New England Journal of Medicine revealed that practices that use a combination of paper and electronic records have a higher rate of failure to inform patients of abnormal test results than practices that worked with either only paper or only electronic records. On the plus side, prescribing drugs electronically can reduce errors, as the Electronic Medical Records system analyses the patient’s existing medications and provides specific instructions and warnings to physicians regarding their compatibility with the drug to be prescribed. Also, paper records are often poorly legible – this potential source of error is eliminated by an EMR.

Potential benefits in medical research vs. abuse of data leakage

While EMRs currently are standalone systems used in a single organization, they can be theoretically expanded to cover entire networks of differing entities. That would entail a number of benefits, for example, in the area of medical research: data could be gathered quickly from a large number of patients. On the other hand, wide scale use of individual patient data raises serious privacy concerns. Limiting access to this sensitive medical data to those absolutely necessary (medical providers and billing clerks) is a serious concern. Medical data privacy is regulated by the Health Information Portability and Accountability Act (HIPAA).

Some commentators predict that the interoperability of EMR systems will lead to massive privacy breaches. The unauthorized access to such interconnected data by only one person would enable him or her to abuse a plethora of information.

Current technology does not yet adequately ensure that information will be adequately made anonymous. Insurance companies could potentially use electronic medical records to single out unwanted patients. Especially life insurance companies are very interested in this data.


Electronic Medical Records provide many convenient features to the medical community: ease of record-keeping and information sharing among various providers, storage of large amounts of data, as well as a better accountability regarding past occurrences. Therefore, despite its many potential drawbacks and unresolved risks, Electronic Medical Records will likely replace paper-based records in the next ten to fifteen years.

About the Author

Imola Esche

Imola Esche is a 2L at Columbia Law School.
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