Medical students using electronic health records to track former patients

Many medical students are using electronic health records (EHRs) to track former patients but the practice, which students report as being educational, raises some ethical questions, according to an article published online by JAMA Internal Medicine.

While EHRs let students to check their diagnostic impressions by monitoring patient outcomes, the practice raises ethical questions about the appropriate use of protected health information.

In a research letter, Gregory E. Brisson, M.D., and Patrick D. Tyler, M.D., of the Northwestern University Feinberg School of Medicine, Chicago, discuss the results of a survey of fourth-year medical students at an academic health center in 2013.

A total of 103 of 169 students completed the survey and 99 students (96.1 percent) reported using EHRs to track former patients. Most said they did it to confirm diagnoses and follow up on patients' progress. Of the 99 students who tracked patients, 17 (17.2 percent) students had ethical concerns about it, primarily whether it was appropriate to access patient records when they were no longer directly involved in the care, according to the survey results.

The authors note the survey results were surprising because the tracking of patients happened in the absence of institutional direction. The authors note study limitations including the size of the student group and the lack of a validated survey tool.

"Results of this survey suggest that tracking patients is a potentially valuable and widely practiced educational activity. However, it is associated with ethical problems that students may not appreciate, and it is unclear how patients view this activity. This topic merits exploration to understand how to optimize tracking for education while protecting patient privacy," the authors conclude.