Legal and Ethical Issues in Health Informatics
The centrality of the patient-care relationship to the nursing discipline is reflected in the interpretive statement: “The primary commitment of the nurse is to the recipients of health care and services” (ANA, 2015, p. 5). Effective communication is critical to this relationship, and the EHR can have a negative impact. Research suggests that it may become a “third party” in this process, which could reshape interaction, alter the patient narrative, and distract the nurse from the patient (Rathert et al., 2016). The stress Nancy feels in the ED scenario is an example of this kind of moral distress. Specific issues reflected in the case scenario and identified in the qualitative review by Wolf and colleagues (2016) relate to moral burdens due to overemphasis on documentation, tasks and parameters at the expense of patient care, as well as role conflicts arising from hierarchical decisions. The same issues are reflected in a number of comments in Table 1 (e.g., too much emphasis on documentation and measurement, resulting in inefficiencies and distractions in patient care). A number of health organizations have implemented copy and paste guidelines for documentation in the EHEA. The copy and paste function includes copying, pasting, cloning, autofilling, transferring, replicating data, and reusing content from one section to another in the EHR (Scruth, 2014). The copy-paste phenomenon has sparked considerable debate from those who argue that the need for time efficiency is weighed against the significant risk of inaccuracies and errors in patient safety (Harrington, 2017). Copy-paste capabilities can lead to inadvertent reliance on clinically relevant outdated or inaccurate information, such as the treatment plan. distracted notes; diagnostic bias; inaccurate information for a particular patient visit; and symptoms and assessments of expired patients (Scruth, 2014; Weis & Levy, 2014). These practices can lead to problems with the timeliness or timeliness of documentation in each EHE.
With the passage of the Health Information Technology for Economic and Clinical Health Act in 2009, starting in 2017, the United States achieved 95% saturation of electronic health records as a means of documenting health care in acute care hospitals and guiding clinical decision-making. There is growing evidence that EHRs have unintended consequences that impact patient safety. Clinical teams face usability challenges that can raise ethical issues that require ethical decision-making models to help clinicians take appropriate action on behalf of safe and effective clinical care. The purpose of this article is to identify and address ethical issues raised by caregivers when using electronic health records. We provide a case scenario using the four-component model and describe a study of nurses` experiences with EHEA. The Code of Ethics for Care, the scope and standards of care, and legal implications are reviewed, and we conclude with recommendations and a call to action. Goodman, K. W. (2015). Ethics, Medicine and Information Technology: Intelligent Machines and the Transformation of Health Care (2nd ed.). Cambridge, England: Cambridge University Press.
A conceptual model reflecting the general common concepts identified in the thematic analysis was developed by the research group and is also presented in Figure 1. Note that “Patient Safety and Quality” is a major topic, with a minor topic “Documentation / Legality”. This indicates that practical challenges related to patient safety and quality have been encountered. We learned that these elements were reflected, among other things, in the EHR-based literature, which departed from established interprofessional standards of practice. While the Texas nurses` case study and feedback reflect the ethical issues raised by nurses, there are important implications for the entire nursing team because the EHR is the primary means of interprofessional communication. Incorrect entry into an EHR can haunt a patient for years. In addition, alarm fatigue and clinical information overruns need to be addressed within the organization. Legal concerns about reporting government-regulated drug interactions through pop-ups or warnings can be overwhelming or desensitizing to the nurse (Sittig & Singh, 2011).
Overwriting content in an often unwanted system design can lead to misinformation in records that can harm the nurse, patient, and health care organization. For example, incorrect entry into an EHR can haunt a patient for years. The patient is probably unaware of the wrong entry, but then applies for health or life insurance. The patient may be denied insurance coverage due to a single incorrect entry that has recurred over time. Ethical motivation All caregivers want to be ethical and live in a way that aligns with their personal and professional values. While they recognize an ethical issue and are aware of their obligations related to their role, personal and/or institutional barriers can impede their motivation to act. The third component of FCM, ethical motivation, is the bridge between decision-making and action (Robichaux, 2017). This case scenario can be considered in the overall context of the ethical implications of using the EHEA. We can also take into account the distress that may arise during protocols/policies; clinical decision support systems; the nurse-patient relationship; and clinical communication between teams and between teams is contrary to a nurse`s code of ethics. Healthcare in the United States is rapidly evolving to keep pace with the ever-increasing health needs of the population and for chronic disease management (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), the United States achieved 95% saturation in electronic health records (EHRs) in 2017 as a means of documenting health care in acute care hospitals and guiding clinical decision-making in health care (Office of National Coordinator for Health Information Technology, 2017). About 60% of U.S. physicians have implemented and deployed an EHR. The LHS is also an excellent example of what is known as the “secondary use” of health information and justifies it. In many ways, the term “secondary use” is a misnomer: it implies that health information collected in a clinic, for example, is and should be collected for a primary purpose, and that any other purpose is less justified. Similarly, it would be strange to collect public health information and then consider the use of that information in a clinic as secondary and subject to authorisation. Rather, it would be irresponsible to obtain information from a clinic, research study or public health surveillance and not use it to support any of the other 15 16 17. The widespread views and targeted regulations on how best to protect these three types of data and information are largely historical artifacts.
Clinic data is protected by privacy laws that have evolved to protect clinical data. The use of research data is subject to regulations designed to protect human subjects, including their privacy. Public health knowledge is and always has been acquired with the presumed or tacit consent of those who benefit from and trust the competent health authorities. Important and central ethical issues in the development and use of machine learning programs have been identified repeatedly and elsewhere. They can be formulated in the form of lessons learned or recommendations. Some are lessons for developers, others for users. While the context here is health and health care, the lessons can be useful in many other areas. While bioethics has made progress, the same cannot be said for the law, which lags behind as a source of formal governance and oversight in health informatics and other areas. It may be that the relationship between ethics and public policy is the greatest challenge facing health informatics and the society that health informaticians want to serve.
It follows from these two observations that we have an extraordinary opportunity, at a critical time, to ensure that the ideas and analyses provided by ethics continue to mature and, equally important, that they are taken up and taken up by academic and health institutions, businesses, professional associations and governments. While we should consider privacy and confidentiality universal rights, they are neither absolute nor have they ever been considered absolute. Trade-offs must be made: public health surveillance gives us better public health, inpatient surveillance gives us better hospital care, sharing research and other data gives us better medical treatments. In other words, if a doctor learns effective practice through the Epsilon patient`s response to treatment, is he violating Epsilon`s privacy or confidentiality six months later by using what he has learned to help the omega 10 patient? In fact, such a reductio ad absurdum makes it clear that not only does the doctor not violate confidentiality, but also that it would be irresponsible not to use one patient`s information to help another. 1Once again, I owe a debt of gratitude to my colleague Richard Bookman for his reflections on the intersection of social determinants and health information technology. The Institute of Medicine reports that To Err is Human and the subsequent Crossing the Quality Chasm have sparked increased attention to patient safety issues, particularly medication errors.