Medical students use electronic health records to track their former patients, but they may not be doing it for right reasons, raising ethical and privacy concerns, according to a new study in JAMA Internal Medicine.
Tracking former patients allows medical students to audit their diagnostic impressions and observe patient outcomes. The researchers conducted the survey to establish the prevalence of such EHR tracking, interviewing 169 fourth year medical students in August 2013 at one academic health center.
They found that a whopping 96.1 percent of the students affirmed their use of EHRs to track former patients. Of those students, 92.9 percent found it beneficial from an educational standpoint. Most did so to confirm diagnoses and to follow up on the patient’s progress. And more than half (52.4 percent) learned to track patients on their own.
The researchers found the results “surprising” since the tracking occurred in the absence of institutional direction, indicating motivation. But only a few of the students expressed concern about the ethics of tracking, and almost 40 percent following their former patients did so because they liked the patient or were curious.
“Results of this survey suggest that tracking patients is a potentially valuable and widely practiced educational activity," the researchers said. "However, it is associated with ethical problems that students may not appreciate, and it is unclear how patients view this activity. This topic merits exploration to understand how to optimize tracking for education while protecting patient privacy."
A related editor’s note also published in JAMA Internal Medicine affirmed that tracking former patients can benefit not only the students, but also the patients. However, patients don’t provide express consent for such tracking, and HIPAA allows it only for educational and quality assurance purposes. The note suggested that physicians and students address tracking with the patients, and that medical schools teach students “to engage meaningfully and judiciously with patients’ data.”