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Medical records

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Medical records

Medical records are documents that contain patients’ health history, diagnosis, treatment plans, medications, and progress. In the past, medical records documentation was in paper files. However, with the advancement in technology, these records are now kept electronically. Electronic medical records are prone to various legal and ethical issues. First, is the occurrence of medical errors, in as much as EMR software reduces errors, there still exits several medication errors such as inflexible ordering formats that generated wrong orders. Second, is vulnerability to fraud claims, ERMs pose a risk concerning Shark Law and Antikickback statute. For instance, in May 2013, a medical technician in Howard university hospital, Washington, by the name Laurie Napper was caught violating the HIPAA. The prosecutors said she used her position to obtain patients’ confidential information for sale. She was found guilty in a plea hearing and sentenced for six months and a fine of twenty-one hundred dollars (“PMC,” 2015). Without a carefully structured written agreement, hospitals and physicians risk legal repercussions. Third, is the possibility of breaches, unauthorized access to confidential health care information that could result in loss of healthcare equipment, and exposure of private information. When such cases occur, health facilities end up paying large amounts of money for HIPAA violations, which are seriously enforced by the law.

Additionally, patients suffer the consequences of medical errors when they get wrong prescriptions, medications, and dosages. Patients’ files with vital information may also be misplaced or destroyed by viruses and malware associated with EMR software. Most importantly, breach of patient information confidentiality and integrity through theft of electronic files is another challenge. EMR also exposes healthcare workers to privacy and security lawsuits if medical information is misused or misplaced. Also, accidental medical errors caused by any healthcare work may result in being sued and loss of jobs for the responsible healthcare personnel. Policies set for the medical record include privacy and confidentiality of the data records, information security, integrity, and availability of the information at all times. These policies safeguard private patients’ information. Violation of these policies result in compensations and serious lawsuits.

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