A patient record may be defined as any relevant record made by the healthcare professional from the time of consultation and/or examination to the application of health management (De Klerk, 1993). A patient record may contain information about the health of an individual, recorded by the healthcare professionals. The patient record documents the trend of medical activities over a particular period of time, including treatments, medications, prescription among others. There are at least two broad categories of medical records, namely: Electronic Health Records (EHR) and Personal Health Records (PHRs).
3.1.1 Electronic Health Records (EHRs)
An electronic health record is the electronic record of the medical information of a patient for a specific healthcare organisation, such as a hospital. EHRs have gained popularity in healthcare industry as an alternative to traditional paper-based health records. The basic concept of an EHR is to allow healthcare providers to store medically relevant data about a patient in the hospital database.
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The EHRs can exist on standalone computers, networked server computers, removable disks or mobile devices and can be accessible online from interconnected network systems providing the opportunity for healthcare organizations to improve healthcare delivery (Haux, 2006).
Electronic health records enable the efficient communication of medical information and thus reduce operating costs and administrative workload (Gunter & Terry, 2005). Other benefits of EHRs include; online lab test results, diagnoses, prescriptions, radiology reports, immunisation and medical histories (Garets & Davis, 2006; Robison, Bai, Mastrogiannis, Tan, & Wu, 2012).
In general, EHRs offer the potential for better access to records when they are needed. Modern EHRs are accessed via stable Internet connections and support efficient sharing of health records among patients and healthcare providers (Garets & Davis, 2006). These modern EHRs are of great importance, since they have presented new possibilities for electronic health or E-health.
The major shortcoming of EHRs is the issue of data portability. An EHR can lose a great deal of utility if the patient chooses to change providers or moves to a remote area with no Internet connections. In cases where the patient has no access to his/her personal health record, it becomes impractical to export the data from the previous provider to the new provider (Robison et al., 2012; PCAST report, 2010).
3.1.2 Personal Health Records (PHRs)
A new development of Personal Health Records (PHRs) has evolved from EHRs. PHRs allow patients to add and annotate their own health records, which is typically not the case with EHRs.
Unlike EHRs where providers control who adds or view patients’ records, PHRs empower patients to become the custodians of their health records. Patients have full control of their health records.
There are two categories of PHRs. Paper-based PHR and electronic PHR. Paper-based PHRs are generally less portable between providers and in many cases, the cost of physically transporting the records is burdensome (Halamka, Mandl, & Tang, 2008). Additionally, according to the medical record standards, patient records should be kept for a certain number of years, and should be available at all times in order to support continuity of patient care (Carpenter, Ram, Croft, & Williams, 2007). Thus, keeping paper-based records for certain number of years incurs overwhelming storage costs.
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Etzioni (2010) identified poor legibility as the major problem associated with paper-based PHRs, which in many cases results in serious medical errors. The interpretation of standard medical jargon and the standardisation of abbreviations are unreliable in paper-based PHR.
Additionally, studies show that paper-based PHRs are disorganized, and they primarily focus on episodes, rather than continuum of patient care (Meidani, Sadoughi, Maleki, Tofighi, &
Marani, 2012; Anokwa, 2010). The outcome is usually shortcomings in documentation in terms of accuracy, availability and legibility (Garrido, Jamieson, Zhou, Wiesenthal, & Liang, 2005;
De Mul & Berg, 2007).
One way to overcome such shortcomings is to make use of Electronic Personal Health Records (EPHRs). EPHRs take the current paper-based records and convert them into a digital format.
An EPHR is initiated by gathering health information of an individual from a single or multiple sources, such that information can be shared via the Internet with the authorised healthcare professional (s). The records include various types of data, such as physician’s notes, medical conditions (diagnosis and treatment), medications (dose, frequency), laboratory and diagnostic test results (Kim & Johnson, 2002). Besides these, some PHR also provide insurance information, tele-medical events and genetic code map (Adida & Kohane, 2006; Sood et al., 2008).
Using EPHRs allows real-time access to healthcare records by both the patients and healthcare providers. Physicians, lab specialist, nurses, and patients can access the records via the Internet (Adesina et al., 2011). Additionally, EPHRs provide the opportunity to backup health information more easily than paper-based PHR records. This limits possible loss of healthcare records (Meingast, Roosta, & Sastry, 2006). Accessing EPHRs is easy because records are stored at the server, which runs an access control program to verify that the parties (health workers, insurance companies and other healthcare organization) accessing patient’s records have appropriate permissions (Ssembatya, 2012). When a user makes a request to access the records, access control authorities verify the request and determine the access rights. A user with appropriate permission(s) is able to access the records. The process by which a user (patient) obtains his/her personal health records can be depicted in Figure 3.1.
Personal health records are accessed through personal devices such as a mobile phone via the Internet. The mobile phone-based PHR application interfaces to the hospital server to download the records onto the mobile device. The personal health records can also be continuously updated, irrespective of the location of the provider or patient. The ability to provide secure
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exchange of PHRs between providers and patients facilitates continuous access of health information and improve service delivery. Similarly, empowering patients to actively become involved in their healthcare and outcome provides many benefits to patients and healthcare providers. These benefits include: improving safety through better tracking of medications, improve the relationship between doctor and patient and generally improve the quality of care provided (Tang, Ash, Bates, Overhage, & Sands, 2006; Keselman et al., 2007; Detmer, Bloomrosen, Raymond, & Tang, 2008; Kaelber, Jha, Johnston, Middleton, & Bates, 2008).
Figure 3.1: An E-Health Scenario showing PHR
As the case in conventional Internet-based EHR systems, access to PHRs is done via the Internet, which makes it vulnerable to unauthorised access. Additionally, eavesdropping and skimming can also occur when sensitive data are transmitted wirelessly (Garson & Adams, 2008; Adesina et al., 2011). With paper-based PHR, patients need to appear in person at the healthcare facility in order to receive treatment and medication, which restricts the number of personnel that have access to patient’s information. Therefore, there is a greater challenge in ensuring security and integrity of PHRs compared to the traditional healthcare systems.