Patient data is very valuable and must be protected from misuse by the third parties. Also, the rights of patient like privacy, confidentiality of medical information, information about possible risks of medical treatment, to consent or refuse a treatment are very much important. Individuals should have the right to access their health records and get these deleted from hospital records after completing the treatment. Traditional ways of keeping paper-based health records are being replaced by electronic health records as they increase portability and accessibility to medical records. Governments and hospitals across the world and putting huge efforts to implement the electronic health records. The present work explores the different aspects of health privacy and health records. Most important stakeholders, technological and legal aspects have been presented from both the Indian and international perspectives. A comparative analysis has been presented for the available EHR standards with a focus on their roles and implementation challenges.
TopIntroduction
Every person in the world is spending a huge share of earning on healthcare services. Considering this, worldwide governments and organizations are working hard to improve the health quality and safety of their citizens or employees. WHO (World Health Organization) has surveyed that total global expenditure for health is US$ 7.3 trillion in year 2015 which is approximately 10% of GDP. This includes both public and private expenditure on health. Developed countries are spending 12%, while developing and under-developed are spending 6%-7%. (World Health Organization, 2017). In this expenditure, a big amount is spent on maintaining the record of patients, doctors, diseases, health insurance etc. (Barhoun et. al., 2019). The traditional way of maintaining paper based records in file for patients is getting obsolete, due to challenges like incomplete information, data duplication, poor security and privacy, difficulties in data migration and sharing etc. Due to all these challenges, paper based records consume a lot of time in processing the patient information. Electronic Health Records (EHR) are gaining popularity and are being used worldwide for maintaining patient records (Galli, 2018). As per the report by Energias Market Research (2019), the global electronic health records (EHRs) market in 2018 has been valued at USD 24.7 billion and the same is expected to reach USD 36.2 billion by 2025 with an estimated CAGR of 5.6%. This increase is attributed, not only to the growing demand of better healthcare services, but also to the adoption of new technologies and solutions like machine learning, data mining, artificial intelligence, clinical decision support system etc (Sisodia & Agrawal, 2019). The ultimate aim is to achieve the better productivity of healthcare system with improved patient satisfaction. EHR of a patient contains personal information like age, weight; demographics like education, nationality, religion, medical history, medication, allergies, immunization status, laboratory test results, radiology images, vital signs and billing information etc. (Trends, 2014). Many researchers have defined the EHR in different ways and some of the prominent definitions of EHR have been presented in Table 1.
Table 1. Definition of electronic health records
| S. No. | Definition | Reference |
| 1 | Electronic Health Record is an information resource which is real time, secure, patient-centric and helps clinicians in decision support. | Taylor & Underwood, 2003 |
| 2 | EHR is a warehouse of information regarding the health of a subject in computer readable form, stored, transmitted securely and accessed by authorized users. | International Organization for Standardization, 2005 |
| 3 | EHR is a single point of care for patients and healthcare organizations which provide cost effective, errorless, safe and quality care. | Kwak, 2005 |
| 4 | EHR is information in electronic form which contains the past, present and future health status or healthcare provided to subject of care. | Katehakis & Tsiknakis, 2006 |
| 5 | EHR is a central database used by different persons and organizations to enter information about patients; it contains not only the clinical data but wellness data also. | Knaup et al, 2007 |
| 6 | Electronic Health Record contains information related to patients ranging from files in one department to longitudinal collections of patient data. | Häyrinen, et al, 2008 |
| 7 | Electronic Health Record is an object used to collaborate, learn from data and study new models from the information present in health records. | Hripcsk & Albers, 2012 |
| 8 | Electronic Health Records is used to accelerate clinical research and predictive analysis. It enables prediction of drug effects and improvements in patient health. | Miotto et al, 2016 |