Paper-based medical records were used in medicine for centuries, to keep track of patients health and their treatments. The data collected about patients was both quantitative and qualitative and allowed medical professionals to make informed decisions about an individual’s health and treatment.
Around 1920, the beginning of the health information management (HIM) industry started “this was the time in which healthcare professionals started using medical records to document details, complications, and outcomes of patient care”. Unlike earlier years, paper medical records were used regularly and systematically to store and collect patient’s medical information. To ensure the data collected was secure and used ethically a standardized way of handling medical records was established by the American College of Surgeons (ACOS) who created the Association of Record Librarians of North America (ARLNA) in 1928. So, in hospitals around the world, it was common practice to keep one copy of a patient’s health records available on paper. These records were maintained in folders divided into sections based on the type of note.
A large amount of patient data, collected on paper, came with many benefits such as enabling medical professionals to give patients individual care based on their unique medical background. Additionally, small amounts of data from many patients could be linked together to allow researchers and doctors to look for patterns and develop new ways of predicting or diagnosing illness.
However, the fact that the data was collected on paper came with several setbacks. Firstly, the flow of information throughout health care services was slow as the medical records had to be found, retrieved, deciphered and transfer each time a second opinion was required. Secondly, a clinical and administrative analysis was difficult to perform as the data had to be retrieved before it could be used to find trends. Thirdly, handwritten clinical records are often difficult to read. While this might seem like a superficial flaw in actuality this contributed to many preventable deaths. In a study done examining the defects of legibility such that the whole document was unclear, reported that 15% of the reports were illegible. Poor handwriting made valuable patient information inaccessible, and thus, irrelevant to auditors, researchers, and other clinicians involved in the patient’s care.
Despite the flaws of paper-based medical data collection up until around the 1960s/1970s these methods were widely used to collect patient information. However, as new computer technology developed in the 1960s and 1970s, the foundation for the development of the Electronic Health Record (EHR) was laid. EHR solved many of the problems that occurred when patient-data was handwritten and stored in files. Firstly, it allowed for the sharing of medical records with other medical professionals and the patients themselves; which saved both time and money. Secondly, far fewer paper files where lost, while the issue of illegible reports was eradicated. Moreover, this shift allowed researchers to aggregate useful data in their study of disease and treatment easily; ultimately advancing the field of medicine.
In 1992, impressed with the benefits of EHR ‘s, the Institute of Medicine advocated a shift from a paper-based to an electronic medical record system. However, shifting from a paper-based system deemed to be challenging as a large initial cost was associated with the change. Additionally, hospital workers had to be trained to implement and manage the electronic records, which prompted them to experience a significant amount of stress and was found to be linked with burnout.
Furthermore, the integration of the new digital system made both patients and physicians concerned with changes it would bring to healthcare. A common critique was the fact that recording data on screens would mean less facetime with patients, ultimately causing less connection with patients and fewer discussions with colleagues.
Also, the security and ethical use of patient data worried both patients and hospital workers as many believed that with digitalization, patient’s health data would be shared or linked without the patients’ knowledge; jeopardizing their autonomy.
Additionally, the risk revealing thousands of patients’ health data through mistakes or theft was a possibility with the new technology. Thus, security measures such as firewalls, antivirus software, and intrusion detection software were included to protect data integrity in medical institutions. Nevertheless, in 2018 alone, the healthcare sector saw 15 million patient records compromised in 503 breaches.
Now in 2020 most medical institutions made the shift from collecting patient data with paper to digital means. Yet, hospitals and other medical institutions are likely to make another shift in the way patent data is collected and stored. Many healthcare organizations are shifting from local data centers to cloud-based computing to store data. The aim of doing this is to reduce the cost of data storage and enhance the ability to share healthcare data within departments and among other entities.
Yet, concerns with data security, vendor stability, and a lack of IT skills is making many hospitals reluctant to make yet another change to the way patent data is collected; preventing them from integrating cloud computing into their facilities. Some believe that the fixation on data will inevitably distance managers from patients as individuals. Perhaps the fundamental notions of patient care will lose out to organizational or state concerns, because cost management and security, not care, might become the point of information collection.