Medical students are continually using electronic health records (EHRs) in training, using the technology to track former patients after they have left one’s direct care, according to new research published in JAMA Internal Medicine.
By providing longitudinal access to future clinical data, EHRs allow students to audit their diagnostic impressions and observe patient outcomes, the researchers, from Northwestern University and Beth Israel Deaconess Medical Center, respectively, found. Fourth-year medical students at an academic health center were included in the survey, which totaled 103 respondents; 99 of them affirmed use of EHRs to track former patients.
Of those who track former patients, 92 students found it beneficial from an educational perspective. Most students indicated that they track patients to confirm diagnoses and follow up on their progress, and 54 students (52.4 percent) learned to track patients on their own. Tracking demonstrates self-directed learning and curiosity about patient outcomes, qualities that can improve clinical reasoning, the researchers said.
The authors of the study do note that historically, while some medical students track patients, this activity is generally extracurricular and it is unclear why they do it. Furthermore, tracking former patients raises ethical questions about the appropriate use of protected health information. They concluded, “Only a few respondents expressed concerns about the ethics of tracking patients, and almost half did not distinguish between tracking for education (to confirm diagnosis or follow treatment) and tracking out of curiosity about patients, an action that may not represent appropriate use of EHRs. These results suggest that students may benefit from guidance on tracking former patients in an ethically appropriate manner.”
The authors attest that the 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 said.
In a separate piece on the study, titled “Teaching Medical Students to Engage Meaningfully and Judiciously With Patient Data,” and also published in JAMA Internal Medicine, Rachel J. Stern, M.D., noted that there are a few important problems with medical students tracking former patients via EHRs as it is currently practiced.
Stern, from the University of California, San Francisco wrote, “First, patients do not explicitly provide consent to be tracked after their care ends, a problem that physicians and students could easily address through discussion with their patients. Second, some tracking is extracurricular. The Health Insurance Portability and Accountability Act [HIPAA] likely only permits tracking of patients for education and quality assurance. However, 39.8 percent of medical students in the study tracked former patients because they were curious about what had happened or liked the patient. Medical school informatics and EMR curricula need to teach students to engage meaningfully and judiciously with patients’ data.”
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