Electronic health records symposium examines privacy, workload issues

Speakers at Stanford Medicine’s second symposium on electronic health records discussed ways to increase patients’ access to data while maintaining security and decreasing the documentation burden for physicians.

Vanila Singh, center, said regulations around electronic health records must balance calls for greater openness with security and legal considerations. 
Rod Searcey

How can electronic health records empower patients and doctors to improve health without exposing data or overburdening clinicians?

That question was at the heart of Stanford Medicine’s second Electronic Health Records National Symposium, held Oct. 11 at the Li Ka Shing Center for Learning and Knowledge. The half-day event featured two panel discussions and several research presentations. Nearly two dozen speakers from government, academia and industry recounted struggles and successes with the technology.

Among the speakers was Lloyd Minor, MD, dean of the School of Medicine, who encouraged attendees to be optimistic about the future and the potential of electronic health records.

“There are absolutely legitimate, important concerns about privacy and about who should have access and how access should be protected,” he said. “But we should be able to address and affirm those concerns, protect privacy and still make health records more interoperable — and very importantly, make them more searchable — so we can derive actionable information from the vast amounts of data that now are in an electronic format.”

Patient access to their health data

During the event’s first panel, speakers discussed ways electronic health records could work better for patients.

A key consideration is ensuring that patients can access their own information. That sounds simple, but often isn’t in practice, even though de-identified data is frequently distributed to third parties without patient knowledge, said Harlan Krumholz, MD, a cardiologist and the founding director of the Yale New Haven Hospital Center for Outcomes Research and Evaluation.

Steven Lin has been working on a way to use artificial intelligence to create a patient record by transcribing conversations during medical appointments.
Rod Searcey

In a study of numerous hospitals, Krumholz said he identified several obstacles that patients can face when attempting to obtain their records. For example, some health systems charged a fee as high as $500, while others refused to share records, claiming that it would violate health privacy laws. “Health care systems aren’t even letting people have all of their data,” he said. “The law states, clearly, you are entitled to all of your records.”

Beyond access, those records should be understandable to a layperson, while also including medical terminology and other documentation needed by clinicians, said Bill Hagan, president of United Healthcare Clinical Services: “That’s one of the challenges.”

Another is making sure that all of a patient’s different providers — including those offering care in the home — can access relevant information, he said. These days, in addition to electronic health records, a person’s health data also includes numbers from monitoring apps and other outside sources.

Currently, those data streams aren’t always combined, but they should be integrated whenever possible to provide a more complete picture of a patient’s health and care, said Jennifer Schneider, MD, president of Livongo, a technology company that helps patients manage chronic disease. “I would love to see a little bit more unification,” she said.

Patients also are concerned about maintaining privacy — and their worries include who can tap into sensitive information in their records, said Vanila Singh, MD, clinical associate professor of anesthesiology, perioperative and pain medicine at Stanford and former chief medical officer in the Office of the Assistant Secretary for Health at the U.S. Department of Health and Human Services. Regulations around electronic health records must balance calls for greater openness with security and legal considerations, she said.

Minimizing documentation burden

The second panel discussion centered on ways to minimize physicians’ documentation burden, which many doctors say has increased since records were digitized.

“Our colleagues in the legal profession are not asked as lawyers and judges to simultaneously do their legal work and create the legal record of that work,” said Christine Sinsky, MD, vice president of professional satisfaction at the American Medical Association. “But we have asked that of health care professionals.”

Suggestions from panelists included helping doctors learn more efficient ways to use the technology, programming the systems to allow more succinct versions of the doctor’s note, and inviting physicians to play a larger role in developing the workflow and user experience.

Another way to ease a doctor’s workload is to involve other members of the caregiving team in some aspects of record-keeping, said Edward Lee, MD, executive vice president of information technology and chief information officer with the Permanente Federation: “We have to recognize the fact that not everything has to be done by a physician,” he said.

To that end, Steven Lin, MD, clinical assistant professor of medicine at Stanford, has been working on a way to use artificial intelligence to create a patient record by transcribing conversations during doctor visits. A challenge has been the limitations of direct transcripts, which cannot put a patient’s nonlinear health history in chronological order or pull in information from other encounters with health providers, said Lin, who studies primary care and population health. It could help, he said, to empower patients and family members to play a larger role in creating health records.

In the past year, the federal government has changed rules to allow medical students and other members of the health care team to help providers document a patient’s care, Lin said, “So why not patients and families?”

“After all,” he added, “what are notes except stories about patients? And shouldn’t patients have the right to be co-authors of their own stories?”



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