A trip to the doctor’s office or a hospital stay for most patients involves medical staff going through paper charts and records while providing care. This is still the case despite the increasing importance of electronic communication in other aspects of our job and personal lives.

The increased use of information technology (IT) in healthcare settings–most notably through the use of electronic health records (EHRs), which allow information to be easily communicated and shared among healthcare providers–has been advocated as a means of improving care quality and assisting in the long run cost control of healthcare.

Paperless hospitals, also known as digital hospitals or EMR hospitals, are healthcare institutions that have removed or greatly decreased the usage of paper-based records in favor of a digital system for handling patient information and medical data. The adoption of electronic health records (EHRs) and other digital technology to expedite and improve healthcare operations is part of this change.

The upsides of a paperless system include easy access to patient information, better communication between the doctor and the patient, improved patient engagement, and better quality of care. Only a small percentage of healthcare institutions have converted to a paperless system, despite the advantages. Along with the potential for security, security holes and hacker attacks remain a risk with electronic health records (EHRs).

In late 2022, one of the most feared ransomware attack was launched against the All-India Institute of Medical Sciences (AIIMS), the largest medical facility in India. For more than 15 days, the attack rendered the government-run hospital’s computerized services inaccessibly

The medical faculty  had no choice but to switch to manual mode. The server failure had a significant impact on the inpatient and outpatient digital hospital services, as well as the smart lab, billing, report generating, and appointment system. Such incidents infact hamper the functionality and the care delivered to the patient.

EHRs also present certain threats to patient privacy and data security. Their usage has grown dramatically in recent years. Healthcare providers must put strong security measures in place, such as access limits, encryption, and frequent data backups, to protect the security of EHRs.

Identity theft, which is particularly lucrative on the black market, can result from data breaches in the healthcare sector. According to Verizon’s most current data breach report, which was published in May 2021, a human factor was involved in 85% of all incidents. In data security events involving all industries during the COVID-19 global pandemic, phishing was also one of the most often utilized strategies.

In the healthcare sector, phishing is the most common attack vector, according to a study report released by the Healthcare Information and Management Systems Society (HIMSS).

Healthcare providers must put strong security measures in place, such as access limits, encryption, and frequent data backups, to protect the security of EHRs. Additionally, as a typical method for hackers to access them, healthcare organizations should regularly teach their personnel on recognizing and preventing phishing scams and other social engineering assaults.

To determine the degree to which human factors contributed to data security events, an exploratory investigation of previous data breaches in healthcare organizations from January 2015 to December 2020 was conducted. It was discovered that the great majority of medical records had been hacked because of lax human security.

The average number of records impacted by a breach brought on by accidental insider risks was more than twice as high as the average number of records impacted by breaches brought on by malevolent outsiders, such as external cyberattacks and theft.

EHR switching may be expensive and disruptive. It also poses a variety of clinical and operational hazards, not the least of which is the serious possibility that you may lose access to both patient and company information or that the data will be inaccurate or damaged. The considerable transition expenses can include paying for outside help and the staff’s time spent on the system changeover.

Doctors complete a wide range of responsibilities during outpatient appointments. The most crucial tasks are those related to patient care, such as talking and listening to the patient, conducting a physical examination, or performing procedures like removing sutures, as well as those related to clinical documentation, like writing down a diagnosis or looking up test results, prescribing medication, or typing a letter of referral.

Much of the valuable consultation time is spent in updating the EHR which impacts the doctor as well as patient satisfaction. Also, in an Indian context, clinicians find it easier and more effective to keep written records. For the patient’s viewpoint, the vast majority of the population carry medical records and are more comfortable with this format

According to research, an electronic health record (EHR) also poses a risk to the growth of the patient-physician bond.  Some doctors have a propensity for juggling many activities at once; they converse with the patient while simultaneously writing down the responses they provide. But doing so may give patients the impression that the doctor is not giving them enough attention.

Power outages can affect the functionality of EHR and EMR systems and be hazardous to patients and organizations, especially if backup plans are inadequate and don’t include the essential infrastructure recovery mechanisms. According to the functionality and capabilities of the program, the cost of installing and maintaining the system might be as high as 50 lakh rupees.

Even if accurate documentation is not mandatory in a nation like India, it can be helpful to both sides in a medicolegal dispute. The hospital may be held liable in some circumstances when the documentation is incomplete, and this can be expensive to handle.

One of the most important component of this transition is a server that stores all data critical for use. The vast majority of server technology now in use is not ecologically friendly and produces significant amounts of carbon dioxide emissions, which raises the carbon footprint. Including data storage, it makes up around 2% of the overall carbon footprint.

If however, you decide to implement the system, involve important stakeholders including physicians, IT personnel, administrators, and patient advocates. Consider the experience, certifications, references, and dedication to data security and privacy of an EHR vendor before choosing one with a good track record

Adopt stringent access restrictions, authentication procedures, and encryption approaches to protect data both in transit and at rest. You should also keep your software up to date and patched to fix any vulnerabilities.

Always keep in mind that adopting EHR securely calls for continuous monitoring, education, and cooperation between healthcare professionals, IT staff, and other stakeholders to guarantee the privacy and security of patient information.

References:

1. 5 AIIMS Servers Hacked, 1.3 TB Data Encrypted in Recent Cyberattack, Govt Tells RS (thewire.in)
2. Joukes E, Abu-Hanna A, Cornet R, de Keizer NF. Time Spent on Dedicated Patient Care and Documentation Tasks Before and After the Introduction of a Structured and Standardized Electronic Health Record. Appl Clin Inform. 2018;9(1):46-53. doi:10.1055/s-0037-1615747
3. Koczkodaj WW, Masiak J, Mazurek M, Strzałka D, Zabrodskii PF. Massive Health Record Breaches Evidenced by the Office for Civil Rights Data. Iran J Public Health. 2019;48(2):278-288.
4. Keeping the power on in healthcare facilities – Energy and Power (healthcarefacilitiestoday.com)
5. Menachemi, N., & Collum, T. H. (2011). Benefits and drawbacks of electronic health record systems. Risk management and healthcare policy, 47-55.
6. What is the Carbon Footprint of Data Storage? (greenly.earth)
7. Salaria, C. Kumar and A. Mishra, “Cyber Security Enhancement with an Intelligent Android Prototype,” 2023 International Conference for Advancement in Technology (ICONAT), Goa, India, 2023, pp. 1-7, doi: 10.1109/ICONAT57137.2023.10080464.

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