Electronic Health Records (EHR) records the medical details, such as history, physical examination results, diagnosis and treatment (Ozair, Jamshed, Sharma& Aggarwal, 2015). All this information is stored in a digital format. The EHRs have immense advantages, such as increasing access to health care, improving the quality of care provided, and decreasing healthcare costs. Notably, the use of this technology has led to ethical issues that face health professionals. This occurs when a patient’s data is shared or leaked without the knowledge of the patient hence jeopardizing the law of confidentiality. This could also make the patients to reveal less information. Hence leading to a compromise in the treatment provided. This paper will examine three ethical issues that accompany the use of electronic health records.
The first ethical issue is privacy and confidentiality. This is the right of an individual to prevent information concerning themselves from being shared with others. The individuals seek to maintain autonomy and rid themselves from surveillance or interference by the individual or government. The information concerning a patient can only be released to other people with the patient’s permission or as per the provisions of the law (Goldstein et al., 2018). In case a patient cannot give informed consent due to age or mental incapacitation, the decisions concerning sharing of information are left in the hands of a lawyer or a legal guardian. Similarly, information that can be shared generally without pointing out the identity of an individual patient, for example, the number of coronary heart disease patients admitted in the hospital in the past six months.
Besides, health care facilities and insurance agencies that may require access to patient data can only do so through an integrated interface (Ozair et al., 2015). This is also done in such a way that the information of a patient is confidential, and only authorized people access such information for treatment or billing of care costs. Notably, the system manager controls who can access such information based on pre-defined privileges (McBride, Tietze, Robichaux, Stokes & Weber,2018). The system administrator has to identify the user based on credentials, the level of information that needs to be shared, and the need to log in to the system using an individualized username and password. The user is equally held accountable for the information use and misuse. This means that user privileges are restricted in some quotas to uphold the security of medical records.
The second ethical issue is a security breach. This threatens the patient’s privacy, especially when the information concerning a patient is shared with others without their authorization. For example, an incident at Howard University Hospital revealed that poor data security has extensive effects on the patients and families concerned. Upon further scrutiny, the federal prosecution found a hospital staff guilty of violating the HIPAA rules. This is because she used her position to access patient names, Medicare numbers, and home addresses and sold such information to unauthorized individuals. This hospital staff sentenced to six months and fined for violation of data privacy. In some cases, the facilities have been forced to pay up to $ 275,000 to stop a federal investigation concerning reports of violation of patient privacy. Past surveys show that up to 73 percent of physicians share information with other physicians concerning their work (Ozair et al., 2015). Such information in mobile devices can easily fall into the hands of terrorists who may extort money from the patients. However, those designed to be used as portable EHRs can be protected from unauthorized access through cloud storage of data, password protection and encryption of information (McBride et al., 2018). At the same time, the use of two-factor authentication with security codes and passwords help to secure EHRs.
Security measures should equally be put in place, such as antivirus software, spyware, and firewalls can be used to protect data integrity. Institutional policies and procedures should be made in such a way that employees use their own ID when accessing electronic patient information (McBride et al., 2018). This can work well with routine audits where system activity can be tracked using trails that reveal the content accessed user, date and time and entries of all modifications performed in the EHRs. The system can also reveal the names of individual gaining unauthorized access for possible legal action. External vendors equally create special safety issues. This is because employees can only access the EHRs; however, in case of system update, the vendor should only navigate the portal in the presence of the IT expert and a health professional (McBride et al.,2018).
The third ethical issue in the implementation of EHRs are inaccuracies of data. The ethical standards of honesty and truthfulness require the health personnel to give accurate data that has not been altered (American Nurses Association, 2015). The EHRs are used to improve the safety of patients by reducing medical errors, health disparities and improve the health of the community. However, several ethical issues have been raised concerning the accuracy and reliability entered into the system (Chiu, Jean, Hoag, Freedman-Weiss, Healy& Pei, 2018). For example, the use of cut and paste technology has led to the inaccurate entry of the current condition of the patient and subsequent treatment (McKeown, Mourby, Harrison, Walker, Sheehan, & Singh, 2021). This increase the risks for patients and litigation against the concerned clinicians and organizations. Simultaneously, using a drop-down menu may cause clinicians to pick the wrong choice among the many when they are in a hurry leading to significant medical errors.
Further, loss of data can occur during data transfer. This situation also raises concerning the accuracy of the information in the database since the decisions on patient care are based on such stored information (McKeown et al., 2021). A significant concern that is on the rise in the theft of medical theft. This leads to the input of wrong information in the record of the victim (Chiu et al.,2018). The concerned insurance company will be billed for medical services not provided to the patient who is the policyholder. Similarly, the future medical assessment of the patient will be guided by wrong information that the patient may not recognize for an extended period.
In conclusion, EHRs play an essential role in medical care delivery. The use of EHRs ensures that the words written are legible, eliminating the wrong prescription, dosage, and procedure. Simultaneously, adverse drug reactions can be reduced by a more significant margin when pharmacies access the EHRs. The doctors can put a disclaimer of not permitting prescription and order for certain drugs where an adverse reaction is known for a particular patient. The EHRs are also accessible from any place and can be stored indefinitely such that backup records of the patient can be accessed in case of system failure. Therefore, EHRs enhance quality care, reduce medical errors, and improve patient compliance to prescription requirements. These benefits can be maximized if ethical issues such as privacy and confidentiality, security breaches and data inaccuracies are addressed proactively by using a hospital policy framework and constant monitoring of audit trails.
References
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: American Nurses Association.
Chiu, A. S., Jean, R. A., Hoag, J. R., Freedman-Weiss, M., Healy, J. M., & Pei, K. Y. (2018). Association of lowering default pill counts in electronic medical record systems with postoperative opioid prescribing. JAMA Surgery, 153(11), 1012-1019.
Goldstein, C. E., Weijer, C., Brehaut, J. C., Fergusson, D. A., Grimshaw, J. M., Horn, A. R., & Taljaard, M. (2018). Ethical issues in pragmatic randomized controlled trials: a review of the recent literature identifies gaps in ethical argumentation. BMC medical ethics, 19(1), 1-10.
McBride, S., Tietze, M., Robichaux, C., Stokes, L., & Weber, E. (2018). Identifying and addressing ethical issues with the use of electronic health records. Online J Issues Nurs, 23(1).
McKeown, A., Mourby, M., Harrison, P., Walker, S., Sheehan, M., & Singh, I. (2021). Ethical Issues in Consent for the Reuse of Data in Health Data Platforms. Science and Engineering Ethics, 27(1), 1-21.Ozair, F. F., Jamshed, N., Sharma, A., & Aggarwal, P. (2015). Ethical issues in electronic health records: A general overview. Perspectives in clinical research, 6(2), 73–76. https://doi.org/10.4103/2229-3485.153997
