Medical students track former patients via EHRs, but is that ethical?

Rebecca Vesely

About Rebecca Vesely

Rebecca Vesely is AHCJ's topic leader on health information technology and a freelance writer. She has written about health, science and medicine for AFP, the Bay Area News Group, Modern Healthcare, Wired, Scientific American online and many other news outlets.

Photo: rosefirerising via Flickr

Photo: rosefirerising via Flickr

Medical students are accessing patient electronic health records after those patients are no longer in their care, raising some interesting ethical, educational and patient rights issues.

The results of the small survey of about 100 fourth-year medical students, published in JAMA Internal Medicine this week, offer some insights into the reasons why medical students access former patient EHRs and any ethical dilemmas about doing so.

Most surprising to those who conducted the survey was that nearly all of the medical students did access patient EHRs after the patients were no longer in their care. (Out of 103 students surveyed, 99 accessed former patient EHRs.)

Only a small fraction of students who looked at patient EHRs – 17 students – said they had ethical concerns about it. The students did not access the EHRs under the direction of their learning institution (the Northwestern University Feinberg School of Medicine).

Students cited three main reasons why they looked at EHRs after patients left their care (they could choose more than one reason):

  • To confirm a diagnosis or follow up on pending studies (85 percent)
  • To follow up on patient progress during treatment (85 percent)
  • Because they “liked the patient and [were] curious to see how he or she was doing“ (40 percent)

The study authors noted that tracking former patients out of curiosity “might not represent appropriate use of EHRs.”

About half of the students said they learned on their own how to track former patients via EHRs. Only two students said they learned how to do it from attending physicians.

“These results suggest that students may benefit from guidance on tracking former patients in an ethically appropriate manner,“ the survey authors wrote. They suggested that other medical schools probably would have similar findings.

Patient views on this activity by medical students are unknown, the authors added.

The survey is one of the first to look at medical students’ actions and opinions around access to former patient EHRs. Considering the widespread adoption of EHRs and the (general) tech-savviness of this generation of students, it will be interesting to see a broader examination of these issues.

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