Can You Identify Any Legal Ethical or Social Concerns with the Use Ehrs
Shoenbill K, Fost N, Tachinardi U, Mendonca EA. Genetic data and electronic health records: discussion of ethical, logistical and technological considerations. J Am Med Tell Assoc. 2014;21(1):171–80. The loss or destruction of data occurs during the transmission of data; This raises concerns about the accuracy of the database, as patient care decisions are based on them.  A growing problem is medical identity theft. This leads to the entry of inaccurate information into the victim`s file. The person`s insurance company is charged for medical services that are not provided to the actual policyholder, and the patient`s future treatment is guided by erroneous information that neither the patient nor the provider immediately recognizes. Ow Yong LM, Tan AWL, Loo CLK, Lim ELP. Risk Mitigation of the Common Electronic File System in Campus Institutions: Medical Social Work Practice in Singapore. Soc Work Healthcare.
2014;53(9):834–44. Although it has no legal status or associated direct financial penalties, the applied ethical framework of EPR can influence various actors to create value and benefits. In addition to its normative value and people`s intrinsic desire to behave ethically, the framework has instrumental value. Failure to respect ethical considerations can be socially costly, leading to demotivation of clinicians, decreased effectiveness of health workers, and decreased quality  and confidence in the integrity of patient care . In addition, financial implications may lead to the allocation of funds to technologies that do not have the necessary support to achieve the desired impact ; the bargaining power of the supplier, which leads to a decrease in the quality of service and an increase in prices; and more expensive clinical practices than necessary. Designers, software engineers, vendors, end users, and other relevant stakeholders can be guided by the framework to integrate these and other ethical considerations into each stage of the epd lifecycle. Patients and physicians report positive experiences with OpenNotes.42 Knowing that a patient can read a note can improve documentation. But full access can also call into question the doctor`s ability to write open notes, especially when it comes to sensitive information (e.g., about mental health, substance abuse, sexual behavior, or appearance). Would a doctor obscure information or a diagnosis if he knew that the patient could access the note? Take notes when it comes to patient satisfaction surveys? More attention needs to be paid to these issues.
EHW smart. Patient Medical and Similar Narratives: The Ethical Implications of Electronic Patient Records. Methods Inf Med. 1999;38(4–5):253–9. The role of the EPD supplier/supplier is crucial. Trust in the delivered product and its ongoing maintenance requires a partnership relationship between the healthcare organization and the supplier. Without this, the EPD provider may exert undue influence on the form and use of the technology. For example, vendor lock-in can occur if switching costs are prohibitive, data transfer is too difficult, or no alternative to the respective EPD system is available . Decisions on property rights, including ownership of data stored in the EPR [44, 45], are therefore just as important as system support agreements.
A provider that discontinues support for an application can leave the client with an unsecured system. Yes, the documentation of “quality standards” has greatly improved, but patient care and patient safety have not. In fact, sometimes nurses have to enter incorrect information and bypass the system (I use providers X, Y, and Z) and all of them have similar problems. I know first-hand 2 Sentinel events caused by systems (X and Y). System audits are also used to assess and discipline nurses; This is a big ethical question because nurses map things for the wrong reasons/…… Creation of a conflict of interest. Availability. If the system is hacked or overloaded with requests, the information may become unusable. To ensure availability, electronic health record systems often have redundant components called fault tolerance systems, so the system switches to a backup component in the event of a component failure or problems. Sittig, D.
F. and Singh, H. (2011). Legal, ethical and financial dilemmas in the introduction and use of electronic health records. Pediatrics, 127(4), e1047. doi:10.1542/peds.2010-2184 Healthcare in the United States (USA) is evolving at a rapid pace to keep pace with the ever-increasing health needs of the population and to manage chronic diseases (Healthy Aging Team, 2017). With the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009 (U.S. Department of Health and Human Services, 2012), in 2017, the United States reached a 95% saturation with electronic health records (EHRs) to document health care in acute care hospitals and guide clinical decision-making in healthcare (Office of National Coordinator for Health Information Technology, 2017). About 60% of U.S. physicians have implemented and used an EHR. The current and potential positive impact of EHEA on the quality of care is not disputed.
However, ethical issues related to the predominance of institutional priorities over patient-centered practice and autonomous care motivated by the application of decision support, models and/or clinical practice guidelines (GIC) have been documented (Lown and Rodriguez, 2012; McBride, Tietze, Hanley & Thomas, 2015; Sulmasy, López and Horwitch, 2017). Perhaps the most troubling ethical issue that has been identified is the potential erosion of the patient-nurse relationship (de Ruiter, Liaschenko, & Angus, 2016; Rathert, Mediator, Banerjee and McDaniel, 2016). All meetings require sufficient time and attention for an open discussion of patient concerns.12 Insufficient listening and relationship building can lead to undesirable outcomes. Physicians who focus on hard-to-use data requirements may overlook psychosocial and emotional cues that are “essential to contextual understanding, differential diagnosis, management, and ultimately compassionate, patient-centered care.” 13 Ethical sensitivity Ethical sensitivity is described as our ability to recognize an ethical problem, the moral implications of our decisions, and how our actions affect others (Milliken, 2016). Its development depends on understanding the ethical nature of the role as a commitment to the nursing profession (Milliken & Grace, 2017). In the case scenario, Nancy realized that compliance with CDS policy triggered by FSDs could lead to poor outcomes. She may also have been aware of her responsibility in the situation set out in the Code of Ethics for Nurses with ANA interpretive statements: “Systems and technologies that support clinical practice are appendices, not a substitute for the nurse`s knowledge and skills” (American Nurses Association [ANA], 2015, p. 16; hereinafter referred to as the Code of Ethics). After practicing in the emergency department for ten years, Nancy may be respected by her fellow nurses and doctors and wonder how her actions could potentially affect these professional relationships. Dr. Tietze is a professor in the College of Nursing at Texas Woman`s University (TWU) and teaches computer science courses with a focus on interprofessional collaborative practice and is the Director of the Graduate Certificate in Interprofessional Informatics program. Dr.
Tietze holds the Doswell Chair in Nursing Informatics with the goal of advancing nursing informatics at UTS. Since 2010, she has been co-chair of the Health Information Technology Committee of the Texas Nurses Association/Texas Organization of Nurse Executives to represent nurses` experiences with the use of information technology in their patient care practice. The research focuses on telemedicine with components of telemedicine, remote management and mobile health. Dr. Tietze has been certified by ANA in Computer Science since 2000.