Electronic medical records in low-resource settings: a review of privacy risks and ethical challenges

Abstract

Abstract Background The use of Electronic Medical Records has been widely adopted across healthcare settings around the world. Hence, there is a corresponding increase in the adoption of EMR in low-resource settings. However, the peculiarities of technical constraints, privacy risks and ethical tension in these settings suggest the need for adjustment in the current adoption of EMR systems. This review aims to synthesise evidence on privacy risks, ethical challenges and contextual factors associated with EMR use in low-resource settings, with a focus on Sub-Saharan Africa. Methods The review employed the PRISMA 2020 guidelines. Relevant literature was identified through database searches in PubMed, Scopus, AJOL and Google Scholar, using key terms related to electronic medical records, privacy, ethics, developing countries, and Africa. Empirical studies conducted in LMICs discussing privacy risks or ethical concerns in EMR adoption were included. Data extraction and thematic synthesis using a deductive approach were conducted. Results Findings were synthesised into four domains: privacy risks, ethical challenges, contextual implementation challenges, and mitigation strategies. Privacy risks included unauthorised access and weak security systems. Ethical challenges involved informed consent, data governance, and autonomy concerns. Contextual barriers such as poor infrastructure and limited training shaped these risks, while mitigation strategies included encryption, policy development, and context-specific system design. Conclusion This review highlights significant shortcomings of the current approach of adopting EMR systems in low-resource settings. These include security vulnerabilities, data misuse, unauthorised access, difficulty obtaining informed consent, and AI adoption, among others. Feasible solutions targeting these peculiar problems, like legal policies, contextual frameworks for healthcare privacy departments, lean physical backups, personnel training and healthy competition among EMR companies, will increase the benefits of EMR adoption in low-resource settings while mitigating associated risk. Clinical trial number Not applicable.