Audit trails track all system activity and generate timestamps for entries. detailed lists of what was consulted, for how long and by whom; and records of all changes to electronic health records [14]. Admins can even detail which reports were printed, how many screenshots were taken, or where a request was sent. Alerts are often configured to flag suspicious or unusual activity, such as reviewing information about a patient you are not treating or attempting to access information you are not authorized to do, and administrators have the ability to get reports on specific users or groups of users to review and record their activity. Software companies develop programs that automate this process. End users should keep in mind that, unlike paper-based recording activities, all EHR activities can be tracked based on credentials. Audit trails do not prevent inadvertent access or disclosure of information, but can be used as a deterrent to prevent potential breaches. Electronic health records (EHRs) enable several innovations that can reform health care. Despite their promises, many of the currently unanswered legal, ethical, and financial questions threaten the widespread adoption and use of EHRs. Key legal dilemmas that need to be resolved in the short term include the extent of clinicians` responsibility to review the entire computer-accessible clinical summary of multiple clinicians and institutions, liability arising from higher-level warnings and clinical decision support alerts, and mechanisms for clinicians to publicly report potential EHR safety issues. Ethical dilemmas that require further discussion include opt-out provisions that exclude patients from electronic record storage, the sale of anonymized patient data by EHR providers, the control of adolescents over access to their data, and the use of electronic data repositories to rethink the country`s health care and payment mechanisms based on statistical analysis.

Finally, an overwhelming financial question is who should pay for EHR implementation, as most users and current owners of these systems will not receive the majority of benefits. The authors recommend that key stakeholders discuss these issues in a national forum. These actions can help identify and prioritize solutions to key legal, ethical, and financial dilemmas so that widespread, safe, effective, and interoperable EHRs can contribute to healthcare transformation. The custodian of an electronic health record (EHR) has the same concerns as the custodian of a paper health record when the record is included in the court process. Most commonly, this occurs in a form of litigation where a party attempts to discover and present evidence of the protocol. The depositary must decide whether to disclose the registration, which parts of the registration should be distributed, and whether the registration is admissible as evidence. AHIMA defines statutory health record as “generated by or for a health care organization as a commercial record and is the record that is published upon request. This does not affect the possibility of finding other information held by the organization. The custodian of the legal health record is the person responsible for health information in collaboration with IT staff.

HIM experts oversee the operational functions related to the collection, protection and archiving of the statutory health record, while IT staff manage the technical infrastructure of the electronic health record. 1 Legal representative: a parent, guardian or other person authorized to act on behalf of a minor patient in health care decisions, unless the minor patient cannot legally consent to health care without the consent of an adult. In the case of adult patients, the legal representative means the legal guardian of an incapacitated patient, the health worker appointed in the health authority of an incapacitated patient, or the personal representative or spouse of a deceased patient. If no spouse survives a deceased patient, the legal representative also designates an adult immediate family member of the deceased patient.

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