Introduction
Electronic health documentation (EHR) was introduced under the 111th American Recovery and Reinvestment Act in 2009. The aim was to achieve an electronic health record for every citizen of the USA by the year 2014. The technological change in the nursing field has been met with both accolades and criticism. Those who endorse the method of recording patient information argue that it is safer and more convenient relative to the traditional paper method. The critics argue that the method is open to abuse by the hospital administrators and can be shared without the consent of the owners. Among these debates, the implementation of the electronic health documentation has been faced with economic, political, as well as logistical issues.
The introduction of EHR poses a broad range of ethical issues in the medical field, which, according to the American Medical Association should not occur at any one point. Electronic health records could represent a breach of the beneficence principle in medicine due to the increased sharing of personal health information. Although there are instances where the exchange of patient information under the acceptable regulations is allowed, the advent of the EHR has a potential threat to other medical ethical principles such as autonomy. The latter relates to the sharing if patient information without their knowledge or consent. In addition, electronic health, documentation of patient records has been associated with an increase in the risk of theft or loss of patient personal data. Consequently, some patients may feel the inadequacy of confidence while at the hospital premises, making them conceal information that could be vital for their treatment. In this light, this paper aims to establish some of the ethical concerns surrounding the advent of the electronic health documentation.
Ethical Issues
1. Non-maleficence/ Beneficence
These are some of the core principles of medical ethics which focus on medical professional ‘doing good’ and ‘avoiding evil’ respectively. Various EHR systems are designed to increase the amount of raw data concerning patient medical history can be stored, which in turn improves the efficiency of medical activities. One of the bases of the development of the systems was to increase the sharing of patient information for the betterment of community health. As such, the systems should allow for the sharing of patient information to the relevant researchers and medical professionals for analysis of the data. This, however, presents ethical issues, as patients are not ready to publicize their personal information. Medical institutions found guilty of sharing personal health information face legal consequences.
As in the case of any other computer systems, electronic health documentation systems are bound to temporary failure. This could lead to disruption of vital activities concerning the treatment of patients, which could threaten the mortality, or morbidity of the patients (Harman & American Health Information Management Association 93). A total systems failure could result in complete loss of the patient’s data, which would present problems that are more adverse. As such, medical institutions are required to have backup systems to facilitate recovery of lost information. The security threats facing the electronic health documents are a wide source of ethical issues that may ensue between hospitals, who are the custodians of the sensitive data and the patients who trust the latter for the protection of their medical records.
2. Autonomy
In medicine, the ethical principle has two dimensions in its meaning. First, it dictates that a person has authority to make their choices concerning the medical procedures to be conducted on them. On the other hand, it infers that a person should not have power over another person. This presents another significant issue concerning the implementation electronic health record documents (Finkelman & Kenner 76). As such, it is vital that the design and administration of EHR systems ensure the autonomy of the patient data. At the same time, it is crucial that key decisions such as the access, content, and ownership of the records be clarified.
Currently, major technological advancements have led to the increase in the reliance on the internet for almost all organizational aspects. As such, patients expect that their medical health providers provide them with the autonomy to access their PHI for review and modification. However, this conflicts with the organizational standards and national legal standards concerning health records. On the other hand, it is arguable that granting patients’ access to their EHRs could provide a platform to improve the accuracy of health records, as the patients would proofread the records for accuracy and updating.
On the same issue of autonomy, the ownership of the patient’s health records presents an ethical issue. The patients claim ownership of the data since it contains sensitive information about their medical history. Companies that develop and maintain the EHR systems also have a claim to the ownership of the data. Similarly, health care provider, such as hospitals place a claim on the ownership of the data. The consequence is the development of the conflict between patients, systems developers, and health care providers (Harman & American Health Information Management Association 102). This presents an ethical dilemma concerning the autonomy of the EHRs.
3. Justice
In the medical scenario, justice refers to the creation of the same platform for all members of the society to access medical services. The basis of the development of electronic health records is the promotion of the society health, by increasing the access of patient medical records and enhancing the sharing of the same among medical organizations for specialized medical attention. Even with this, the advent of EHRs could have a potential new injustice in the provision of medical services. It is known that modern societies are highly stratified. Those in the lower class and middle classes of the society have little access to internet facilities relative to individuals in higher classes (Paola, Walker & Nixon 97). The technological gap between the classes presents an ethical issue in the future use of EHRs to promote societal health.
Literature review
Developments in technology and the increase in the use of computers have resulted in great improvements in the medical/ nursing field. With the growth in more specialized health care services and the growth in patient’s awareness of their rights, it is vital that healthcare organizations stay ahead of technology, which facilitates the improvement of medical services. According to Finkelman & Kenner (113), the core factor to improving medical services is the availability of the pertinent patient information. The introduction of the EHRs has helped improve the accuracy of patient’s data and at the same time improved the ease of access.
According to the HIPPAA rules and regulations concerning the security and safeguarding of personal health information, personal medical data is considered a property of patients and other parties such as the system administrators and the healthcare organizations are custodians. At the same time, the rules stipulate that the PHI should only be shared with the consent of the patients or otherwise a guardian of the patient (Paola, Walker & Nixon 187). In other circumstances where an immediate relative is unavailable, and the patient may not be in a position to grant permission to share the information, health organizations are permitted to share the information for the well-being of that patient’s health (Brown & Brown 215). The autonomy of the electronic health data of patients has been the major issues affecting the popularity and endorsement of the method among the public. Patients fear that malicious persons might access their personal health information. At the same time, some feel their information might be discussed openly by medical professionals or systems administrators. This has been known to be a problem in patients opening up during medical visits, which presents significant effects on the patients’ health wellbeing.
The implementation of EHRs increases the risk of medical malpractice in the sense that the transition from the traditional systems to the EHRs could lead to loss or omission of vital data. The risk of errors during the implementation stage increases the patient's risk contrary to the goals of the EHRs, which is to boost the efficiency of the health care services. According to Brown & Brown (176), it is, however, unclear whether the implementation of the EHRs has increased or decreased the risk of medical malpractices. The management of electronic health management data and information is also characterized by numerous challenges especially in relation to the freedom of exchange. There have been various institutions that developed systems aimed at facilitating the exchange of information between various health care institutions, but the majority has failed because of various challenges, especially related to funding.
The US department of health and human safety takes note of any cases of patient information breach more than 500. Since the introduction of electronic patient data storage means such as EHRs and EMRs, cases of information breach have been on the rise. For instance, in 2010 5.4 million people reported a breach of information compared to the 2.4 million people in 2009 (Paola, Walker & Nixon 129). This indicates that the advent of the new method of storing patient’s data increases the risk of access personal and sensitive by authorized individuals as well as theft of the same. For example, there has been cases of theft of computers storing a larger amount of patient information. This includes the theft of computers from a Sutter Health organization in Sacramento, California (Brown & Brown 11). Such a theft puts the information stored on the device at risk of misuse and exposure of the protected information.
As such, the implementation of electronic methods to store patient information presents a wide range of conflicts, most of which has ethical implications. For instance, cases of unauthorized access to patient records. As seen above might discourage patients from sharing confidential information that may help nurses improve their medical conditions. In itself, this presents a significant ethical issue on the part of the hospitals. In some instances, medical organizations fail to implement sufficient software or physical securities to protect the EHRs. This represents a breach of an agreement to protect the patients’ health information. In other instances, medical professional makes errors during the transition from the paper-based data storage to electronic methods (Brown & Brown 75). This represents significant risks to the hospitals and the medical professionals.
Personal Position
Since the introduction of electronic systems for storing patient information, there have been great improvements in the provision of health services by health organizations around the country. For instance, patients scheduling and appointments have been made easier with the use of EHRs. In addition, the implementation of EHRs has facilitated the sharing of medical information between institutions, which has mostly aided in the handling of emergency cases for patients. Even with the wide range of potential benefits presented by the advent of electronic data storage, there are several ethical concerns surrounding it. One of the most significant issues is the autonomy of sharing the data. My opinion is that patients should be the owner of medical data in the EHRs and not the hospitals. In this case, the hospitals should implement the necessary security safeguards to ensure the safety of the data.
As some members of the society, lack access to internet facilities, it is only ethical that health organizations take for the maintenance of the EHRs as opposed to the proposition for individuals to be responsible for maintaining their EHRs. This would provide an equal platform for all members of the society to access better and improved medical services, which would go a long way in achieving the goals of the health care sector. When it comes to the breach of confidentiality of the PHI, I feel that organizations should develop and train their staff concerning the ethical standards concerning the handling of patient’s personal data. This should include the clarification of the hierarchy of command that should be followed before the access of the information. This would help avoid ethical issues in handling the patient information as it has been seen in previous years.
Ethical Justification
The various conflicts and issues surrounding the use of electronic health records can be analyzed using some of the most common nursing theories. This helps shed light on the moral outcomes in the case of the conflicts and issues discussed above. Using the Deontology theory, which is based on the premise that duties should be conducted in a stipulated manner, regardless of the outcomes, it is clear that most of the issues surrounding the implementation and use of EHRs are unethical. Deontology emphasizes on the intention rather that the outcome. For instance, the intention of the EHRs is the improvement of patients handling and health by increasing the accessibility and sharing of personal health information. Since deontology requires adherence to rules and regulations to the latter, it would be unethical for medical professionals to discuss patients’ medical information in a nonprofessional manner. At the same time, it would not within the acceptable code of conduct for the hospitals to disseminate the patient information without their consent. Following the wide criticism of this theory, however, it is prudent that hospitals and other medical organizations assess the ethical implication of sharing or discussing patient information in inevitable circumstances. This is because strict adherence to the rules and regulations as in this theory can sometimes prove detrimental to a patient’s health.
The second ethical theory, consequentialism, is based on the premise that the morality of an act should be related to the consequences or outcomes. After the introduction of the EHRs, cases of breach of patient information as well as theft of the same has been on the rise. This indicates a failure on the part of hospitals to ensure the safety of the patients’ data, which represents a breach of the ethical standards a hospitals promise to its customers.
Concerning the segmentation of the society into classes, where some have limited access to internet facilities, it is arguable that the implementation of electronic health documents further hinders the improvement of the public health. This presents an ethical challenge to both the government and medical organizations to develop measures to ensure that not only those with access to internet facilities enjoy the benefits of the electronic systems. The information gap in the society challenges the effective adoption of electronic health data adoption because some people have little understanding of how it operates. Additionally, it also affects the outcome of health, especially in the disadvantaged societies because of ineffectiveness in the exchange of information.
Conclusion
This paper has discussed some of the potential and apparent ethical conflicts that arise with the use of electronic data storage systems in the health care industry. Some of the major conflict areas concerning healthcare include non-maleficence, confidentiality, autonomy, and beneficence. It is vital that hospitals and medical care professional respect the autonomy of patient’s medical records as per the principles of medical ethics. Following this unauthorized sharing of patients’ information represent a breach of the ethical principles. The authorized share of health records has been a contentious issue, but with the challenges facing the health care sector and the need to improve the quality of health care information exchange is becoming a necessity.
However, it is acceptable for the breach of this principle for the well-being of a patient’s condition. This includes a circumstance where a patient is in no condition to permit access to their information and require emergency medical assistance. In fact, this is one of the circumstances under which the HIPAA PHI security rules allow medical professional to access and or disseminate patient’s medical records without their consent. However, it is vital that organizations dealing with PHI ensure the safety of patient data, in line with the ethical standards of medical professionals and the established rules and regulations concerning the protection of individual information. However, it is essential to acknowledge various challenges that have affected the adoption of electronic health care records, especially concerning private institutions that lack funding for their operations.
Works Cited
Brown, Steven A, and Mary Brown. Ethical Issues and Security Monitoring Trends in Global Healthcare: Technological Advancements. Hershey: Medical Information Science Reference, 2011. Print.
Finkelman, Anita W, and Carole Kenner. Professional Nursing Concepts: Competencies for Quality Leadership. Sudbury: Jones and Bartlett Publishers, 2010. Print.
Harman, Laurinda B. Ethical Challenges in the Management of Health Information. Sudbury: Jones and Bartlett Publishers, 2006. Print.
Paola, Frederick A, Robert Walker, and Lois L. C. Nixon. Medical Ethics and Humanities. Sudbury: Jones and Bartlett Publishers, 2010. Print.
Scott, Ronald W, and Ronald W. Scott. Legal, Ethical, and Practical Aspects of Patient Care Documentation: A Guide for Rehabilitation Professionals. Burlington: Jones & Bartlett Learning, 2013. Print.
