BETHESDA, MD – Although physicians support the use of electronic health records, they still have concerns about potential privacy breaches, according to the Journal of the American Medical Informatics Association.

Those concerns were noted in two articles published in the January 2010 issue of JAMIA. The January publication, JAMIA's premiere issue, is one of 30 specialty titles published by the BMJ (British Medical Journal) Group, UK.

One study is based on views of more than 1,000 family practice and specialist physicians in Massachusetts who were asked whether they thought electronic health information exchange would drive down costs, improve patient care, free up their time and preserve patient confidentiality. They were also asked whether they would be willing to pay a monthly fee to use the system.

The responses showed widespread support for the use of HIE, even though a little more than half are using EHRs.

Eighty-six percent of those surveyed said HIE would improve the quality of care, and seven out of 10 think it would cut costs. Three out of four indicated it also would save time.

But 16 percent said they were "very concerned" about potential breaches of privacy, while 55 percent said they were "somewhat concerned."

The authors said the responses indicate a lower level of concern than those expressed by physicians in the UK, but suggest that this might change if more breaches occur.

Despite their overall enthusiasm, physicians said they wouldn't support the suggested $150 monthly fee, and nearly half were unwilling to pay anything.

Privacy concerns higher in mental health

The second study suggests that mental health professionals have significant concerns about the privacy and security of data on EHRs.

Of 56 responding psychiatrists, psychologists, nurses and therapists (120 who were sent the survey) based at one academic medical center, 81 percent said they felt the system permitted the preservation of "open therapeutic communications." Most also said electronic records are clearer and more complete than paper versions, although not necessarily more factual.

When it comes to privacy, 63 percent are less willing to record highly confidential information in an electronic record than they would on a paper record.

More than eight out of 10 said if they were to become a patient, they would not want their mental health records to be routinely accessed by providers.

The authors said previously published surveys of patients have reflected a lack of confidence in tight security, and that people with mental health issues already face stigmatization.

While the narrative data of patients' life histories and experiences inform clinical decision-making in psychiatric care, the threat of security breaches makes them vulnerable to potential misuse or misinterpretation, the authors said.

Adoption of EHRs has been slower than anticipated, the authors said. "Designers of future systems will need to enhance electronic file security and simultaneously maintain legitimate accessibility in order to preserve confidence in psychiatric and other (electronic health record) systems," they concluded.