Privacy at what cost? Saving the lives of HIV patients with electronic medical records

By: Laura Derksen, Anita M. McGahan and Leandro Pongeluppe

Abstract

We show that the use of electronic medical records (EMRs) can prevent AIDS deaths by enabling patient tracing. Paradoxically, patients who initially state a preference for privacy in fact benefit most from improved tracing practices. HIV patients receive antiretroviral therapy (ART), a highly effective treatment that also prevents transmission, for free in many parts of the world. Yet patients frequently lapse from care, resulting in increased community transmission and unnecessary deaths. EMRs allow health providers to manage patient data, trace lapsed patients, and encourage lapsed patients to reinitiate treatment. We implement an event study analysis using data from 106 Malawian clinics between 2007 and 2019. We find that the introduction of EMRs leads to an increase in the number of patients actively in care and to a decline in patient deaths. After five years of implementation, facilities with EMRs have approximately 34 percent more patients in care and 28 percent fewer annual deaths than facilities without EMRs. These effects are concentrated among patients under 50 years of age, and are larger among young children. Effects are also concentrated among patients who do not wish to be traced despite the fact that these patients are more likely to lapse from care and require tracing. Robust to additional specifications and supported by interview findings, the results demonstrate that an initial preference for privacy gives way to patient reinstatement in care when the health consequences are critical.

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