A Framework for Tracking Former Patients in the Electronic Health Record Using an Educational Registry
One challenge of contemporary medical education is that shorter lengths of stay and time-limited clerkships often interrupt a student’s relationship with a patient before a diagnosis is made or treatment is completed, limiting the learning experience. Medical students sometimes use electronic health records (EHRs) to overcome these limitations. EHRs provide access to patients’ future medical records, enabling students to track former patients across care venues to audit their diagnostic impressions and observe outcomes. While this activity has potential to improve clinical training, there is a risk of unintended harm to patients through loss of privacy. Students need guidance on how to perform this activity appropriately. This article describes an ethical framework for tracking using an “educational registry,” a list of former patients housed within the EHR that one follows longitudinally for educational purposes. Guiding principles include obtaining permission from patients, having legitimate educational intent, and restricting review of records to those essential for training. This framework could serve as a foundation for institutions seeking to develop a policy on tracking former patients, and may facilitate research on the use of EHRs to improve medical education, such as reducing diagnostic error and promoting self-directed learning.
KEY WORDSmedical education electronic health records medical ethics patient privacy legal issues in medicine
The authors wish to thank members of the Northwestern Memorial Hospital (NMH) Medical Ethics Committee for their spirited debate, which contributed to this framework. They would like to thank the members of the NMH Patient Family Advisory Council who generously participated in a focus group on the subject of this manuscript.
We have presented this topic at three conferences: Alliance for Academic Internal Medicine: “Innovating Medical Education: Updating Your Student Curriculum,” in March, 2017; “The Patient, The Practitioner and the Computer: Holding on to the Core of Our Healing Professions in a Time of Technological Change,” Warren Alpert School of Medicine of Brown University, March, 2017; and the American Society of Bioethics and Humanities national conference, October, 2017.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they do not have a conflict of interest.
- 2.http://www.aafp.org/news-now/education-professional-development/20130306med-students-ehrs.html. Accessed November 28, 2017.
- 6.Peled JU, Sagher O, Morrow JB, Dobbie AE. Do electronic health records help or hinder medical education? PLoS Med. 2009;6(5):e1000069.Google Scholar
- 11.Lawrence L. For med students, when does follow-up cross the line? 2017; https://acpinternist.acponline.org/archives/2017/03/medical-education.htm. Accessed November 28, 2017.
- 12.NIH Clinical Research Trials and You. http://www.nih.gov/health/clinicaltrials/registries.htm. Accessed November 28, 2017.
- 15.AHRQ Health Information Technology: Computerized Disease Registries. http://healthit.ahrq.gov/key-topics/computerized-disease-registries. Accessed November 28, 2017.
- 30.Miron-Shatz T, Elwyn G. To serve and protect? Electronic health records pose challenges for privacy, autonomy and person-centered medicine. Int J Pers Cent Med. 2011;1(2):405–9.Google Scholar
- 31.Beauchamp TL, Childress JF. Principles of Biomedical Ethics. 7th Edition ed. New York: Oxford University Press; 2009.Google Scholar
- 32.IMIA Code of Ethics for Health Information Professionals. http://imia-medinfo.org/wp/wp-content/uploads/2015/07/IMIA-Code-of-Ethics-2016.pdf. Accessed November 28, 2017.
- 33.Summary of the HIPAA Privacy Rule. 2013; https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html. Accessed November 28, 2017.
- 35.Winkelstein P. Ethical and Social Challenges of Electronic Health Information. In: Chen H, Fuller SS, C. F, Hersh W, eds. Medical Informatics: Knowledge Management and Data Mining in Biomedicine: Springer; 2005:144-145.Google Scholar
- 36.Kluge EH. The Ethics of Electronic Patient Records. New York: Peter Lang Publishing; 2001.Google Scholar
- 38.Committee on Diagnostic Error in Health Care, Board on Health Care Services, Institute of Medicine, The National Academies of Sciences, Engineering, and Medicine; Balogh EP, Miller BT, Ball JR, eds. Improving Diagnosis in Health Care. Washington (DC): National Academies Press (US); 2015.Google Scholar