Privacy is one issue, but there are others.

One of the concepts discussed in "The Myth of the Paperless Office" was
that of the affordances of paper records and those of electronic
records. The authors use the term affordance to discuss the properties
of the respective recordkeeping medium on how they can be used.  One
aspect of their research related to police investigators who were
interacting with victims and found they were missing critical
information when they focused on the computer to input the information
electronically as opposed to making notes on a form while making eye
contact during the interview (p118).  In addition, they found that the
discussions tended to be less fruitful because they were trying to
follow the structure of the form instead of following the thread of the
interview content and collaborating with the person being interviewed to
get to the real story.  

In a visit to my doctor last week, I had reason to realize how true this
is.  My doctor, whom I like very much, no longer makes eye contact or
real conversation with me - he is focused on the computer trying to make
sure he gets the information input - does this mean the records are more
legible, searchable and portable - yes.  Is the quality of my medical
care better - absolutely no.  He should have been observing me and
following up on things I said.  It was a wasted 15 minutes in my
opinion.

Now, this practice *could* spend the extra money to transcribe his notes
later but that is not going to happen.  So I have to decide if I want
the better health care that comes from having a strong interaction with
my doctor or the "improved" recordkeeping that electronic records
provide.

I am a huge proponent of electronic records - but the total process must
be considered and I hate to see our health care system become a slave to
data entry.

Mary Hilliard, CRM

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