Benefits of med students 'tracking' former patients via EHRs outweigh potential harms

Medical students should be allowed to track former patients via electronic health records to improve their training, but only within certain limits and with patient permission, according to a new perspectives article in the Journal of the Association of American Medical Colleges.

The authors, from the Feinberg School of Medicine at Northwestern University, note that as EHRs have proliferated, many medical students use the systems to track former patients for educational purposes. Such tracking enables students to audit diagnostic impressions and follow the history of the patient's illness. 

However, there are potential legal and ethical issues pertaining to the patient's autonomy, as well as a potential conflict between education and patient privacy.   

The authors recommend that while this tracking is still of "ambiguous status," its benefits to education, patients and society outweigh any potential harms. Still, they say, the tracking should be limited.

For instance, patients should have the opportunity to give or refuse permission, according to the authors. Additionally, access to the records should not be absolute, tracking should be supervised and students should be trained in tracking before being permitted to do it.

Medical schools increasingly are incorporating EHR use and training into their curricula, although some schools restrict access to EHRs due to fears about attribution of note ownership, use of copy and paste functions, billing issues and patient safety. Medical students who lack adequate practice with EHRs may have a harder time during residency and afterward.

The authors also suggest that national guidelines be developed for this secondary use of EHRs.   

"It is particularly important to achieve consensus in advance of the planned Nationwide Health Information Network, which will greatly expand access to protected health information and increase the potential for harm," they write. "When it relates to matters of privacy and the EHR, confidence in the ethics of the system is 'mission critical.'"

Medical students vary in their acceptance of EHRs and have some of the same issues with the systems as established physicians.

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