A Framework for Tracking Former Patients in the Electronic Health Record Using an Educational Registry

Gregory E. Brisson; Cynthia Barnard; Patrick D. Tyler; David M. Liebovitz; Kathy Johnson Neely

doi:10.1007/s11606-017-4278-5

A Framework for Tracking Former Patients in the Electronic Health Record Using an Educational Registry

Gregory E. Brisson^*, Cynthia Barnard, Patrick D. Tyler, David M. Liebovitz, Kathy Johnson Neely

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

8 Scopus citations

Abstract

One challenge of contemporary medical education is that shorter lengths of stay and time-limited clerkships often interrupt a student’s relationship with a patient before a diagnosis is made or treatment is completed, limiting the learning experience. Medical students sometimes use electronic health records (EHRs) to overcome these limitations. EHRs provide access to patients’ future medical records, enabling students to track former patients across care venues to audit their diagnostic impressions and observe outcomes. While this activity has potential to improve clinical training, there is a risk of unintended harm to patients through loss of privacy. Students need guidance on how to perform this activity appropriately. This article describes an ethical framework for tracking using an “educational registry,” a list of former patients housed within the EHR that one follows longitudinally for educational purposes. Guiding principles include obtaining permission from patients, having legitimate educational intent, and restricting review of records to those essential for training. This framework could serve as a foundation for institutions seeking to develop a policy on tracking former patients, and may facilitate research on the use of EHRs to improve medical education, such as reducing diagnostic error and promoting self-directed learning.

Original language	English (US)
Pages (from-to)	563-566
Number of pages	4
Journal	Journal of general internal medicine
Volume	33
Issue number	4
DOIs	https://doi.org/10.1007/s11606-017-4278-5
State	Published - Apr 1 2018

Funding

The authors wish to thank members of the Northwestern Memorial Hospital (NMH) Medical Ethics Committee for their spirited debate, which contributed to this framework. They would like to thank the members of the NMH Patient Family Advisory Council who generously participated in a focus group on the subject of this manuscript. We have presented this topic at three conferences: Alliance for Academic Internal Medicine: “Innovating Medical Education: Updating Your Student Curriculum,” in March, 2017; “The Patient, The Practitioner and the Computer: Holding on to the Core of Our Healing Professions in a Time of Technological Change,” Warren Alpert School of Medicine of Brown University, March, 2017; and the American Society of Bioethics and Humanities national conference, October, 2017. The authors declare that they do not have a conflict of interest.

Keywords

electronic health records
legal issues in medicine
medical education
medical ethics
patient privacy

ASJC Scopus subject areas

Internal Medicine

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10.1007/s11606-017-4278-5

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title = "A Framework for Tracking Former Patients in the Electronic Health Record Using an Educational Registry",

abstract = "One challenge of contemporary medical education is that shorter lengths of stay and time-limited clerkships often interrupt a student{\textquoteright}s relationship with a patient before a diagnosis is made or treatment is completed, limiting the learning experience. Medical students sometimes use electronic health records (EHRs) to overcome these limitations. EHRs provide access to patients{\textquoteright} future medical records, enabling students to track former patients across care venues to audit their diagnostic impressions and observe outcomes. While this activity has potential to improve clinical training, there is a risk of unintended harm to patients through loss of privacy. Students need guidance on how to perform this activity appropriately. This article describes an ethical framework for tracking using an “educational registry,” a list of former patients housed within the EHR that one follows longitudinally for educational purposes. Guiding principles include obtaining permission from patients, having legitimate educational intent, and restricting review of records to those essential for training. This framework could serve as a foundation for institutions seeking to develop a policy on tracking former patients, and may facilitate research on the use of EHRs to improve medical education, such as reducing diagnostic error and promoting self-directed learning.",

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author = "Brisson, \{Gregory E.\} and Cynthia Barnard and Tyler, \{Patrick D.\} and Liebovitz, \{David M.\} and Neely, \{Kathy Johnson\}",

note = "Funding Information: The authors wish to thank members of the Northwestern Memorial Hospital (NMH) Medical Ethics Committee for their spirited debate, which contributed to this framework. They would like to thank the members of the NMH Patient Family Advisory Council who generously participated in a focus group on the subject of this manuscript. We have presented this topic at three conferences: Alliance for Academic Internal Medicine: “Innovating Medical Education: Updating Your Student Curriculum,” in March, 2017; “The Patient, The Practitioner and the Computer: Holding on to the Core of Our Healing Professions in a Time of Technological Change,” Warren Alpert School of Medicine of Brown University, March, 2017; and the American Society of Bioethics and Humanities national conference, October, 2017. The authors declare that they do not have a conflict of interest. Publisher Copyright: {\textcopyright} 2017, Society of General Internal Medicine.",

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N2 - One challenge of contemporary medical education is that shorter lengths of stay and time-limited clerkships often interrupt a student’s relationship with a patient before a diagnosis is made or treatment is completed, limiting the learning experience. Medical students sometimes use electronic health records (EHRs) to overcome these limitations. EHRs provide access to patients’ future medical records, enabling students to track former patients across care venues to audit their diagnostic impressions and observe outcomes. While this activity has potential to improve clinical training, there is a risk of unintended harm to patients through loss of privacy. Students need guidance on how to perform this activity appropriately. This article describes an ethical framework for tracking using an “educational registry,” a list of former patients housed within the EHR that one follows longitudinally for educational purposes. Guiding principles include obtaining permission from patients, having legitimate educational intent, and restricting review of records to those essential for training. This framework could serve as a foundation for institutions seeking to develop a policy on tracking former patients, and may facilitate research on the use of EHRs to improve medical education, such as reducing diagnostic error and promoting self-directed learning.

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A Framework for Tracking Former Patients in the Electronic Health Record Using an Educational Registry

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