A recent survey at the BC Centre for Disease Control (BCCDC) assessed client perspectives on the implementation of electronic health records (EHR) at the BCCDC Provincial Sexually Transmitted Infections (STI) clinic.
An EHR is a digital version of a patient’s medical record or chart, instead of a paper chart. EHRs are gaining popularity because they are thought to:
- improve data collection,
- provide almost instantaneous results to data queries,
- increase continuity of care (1;2), and
- increase cost savings (3).
Canada is on the edge of an EHR precipice and BC has already started to make health records available electronically to other healthcare workers with appropriate user-defined access permissions (4). Considering client perspectives on EHR implementation in different clinical settings is critical, given concerns and misconceptions around privacy and confidentiality, data security, and access to records (1; 5-9).
In sexual health care, fear of judgement and stigmatization creates a barrier to accessing sexual health services and results in avoidance of health care and sub-optimal STI screening (10). Clients who attend STI clinics generally express a desire for anonymity and non-judgemental care. As a result, the BCCDC decided to explore attitudes towards EHR in an STI setting where clinical charts contain highly sensitive information.
Between July 2012 and March 2013, a survey was offered to people who visited the BCCDC clinic for either HIV or STI testing. The objective of the survey was to:
- Assess client knowledge, attitudes and beliefs on EHR in an STI/HIV clinic.
- Assess the acceptability of EHR containing sensitive sexual health information which may be available to health care professionals outside of the BCCDC Provincial STI/HIV clinic.
Summary of Evidence
The vast majority (85%) of participants stated they were satisfied with the current system of keeping their personal information private.
While the majority of clients thought EHR was acceptable in general, a significant proportion of participants did not think it was acceptable for other health professionals to have access to their clinical data from the STI clinic, including family physician (23%), pharmacist (50%), medical specialist (25%), nurses in other STI clinics (26%), and public health nurses doing follow-up (20%).
Possibly of greatest concern, 31% of participants stated they would be less likely to get tested for STIs and HIV if health records from their visit to the BCCDC Provincial STI/HIV clinic were made available as part of the provincial EHR. There was no correlation between likelihood of not testing for STIs/HIV and age, gender, sexual orientation, cultural group, or education level.
Implications for Practice
These findings suggest that clients may have privacy and confidentiality concerns with regard to EHRs in the context of sexual health services. The introduction of an EHR should be considered with caution in STI health care settings, and should be introduced with an evaluation component to ensure that screening, case detection, and treatment are not negatively impacted.
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- Canada Health Infoway. https://inforway-inforoute.ca/index.php.
- Hunter, I. M., Whiddett, R. J., Norris, A. C., McDonald, B. W., & Waldon, J. A. (2009). New Zealanders’ attitudes towards access to their electronic health records: Preliminary results from a national study using vignettes. Health Informatics Journal, 15 (3), 212-228.
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- Hottes TS, Farrel J, Bondyra M, Haag D, Shoveller J, Gilbert M. Internet-based HIV and sexually transmitted infection testing in British Columbia, Canada: Opinions and expectations of prospective clients. J Med Internet Res. 2012 Mar 6;14(2):e41.