Healthcare professionals today are at a crossroad as they understand the importance of advancing their practice to keep up with the fast pace changes in technology and healthcare informatics. The Electronic Health Record has caused much ethical debate for the healthcare professional, policy makers, and patients. The twenty-first century’s technological advancements have provided a way for medical professionals to gain access to a patient’s health record at the hospital, the clinic, or at home and provide a modern day convenience to healthcare. In addition to Provider access, Patients are now encouraged to go online and pre-register their demographics, insurance information, and medical history prior their next visit to the doctor. For many uploading personal information into a computerized system is a somewhat unnerving. How protected is the Electronic Medical Record? Who has access to this private and personal information? Why is it the center of ethical debates across the United States today?
Most people have experienced a moral dilemma at some point in their life. A moral dilemma is a question or circumstance that requires an answer that cannot be answered with a simple, clearly defined rule, fact, or authoritative view (McDonigle, 2012). Uncertainty is stressful during times when one is faced with a moral dilemma and does not know what to do, where to turn, or who to turn to for answers. Ethical decision making refers to the process of making informed choices about moral dilemmas based on a set of standards differentiating right from wrong (McDonigle, 2012). Ethical decision making requires a systematic framework to successfully navigate through the complex and often controversial moral dilemmas such as the Electronic Health Record.
Principalism is one theoretical framework used to assist in the ethical decision making process. This method is known for its broad guidelines that provide guidance to those involved in the ethical decision making process that support respect for autonomy, nonmaleficence, beneficence, and justice. The healthcare professional understands the importance of protecting the patient’s privacy, maintaining a professional client relationship all the while upholding their obligation to do no harm. This framework is one of many and was established in the late 20th century. All other frameworks were established using Principalism as its foundational framework and then added more guidelines to customize the approach. Principalism’s systematic framework is still applicable today when considering the Electronic Health Record.
The International Medical Informatics Association designed The IMIA Code of Ethics for Health Information Professionals to provide ethical guidance, to furnish a set of principles against which the conduct of the professionals may be measured, and to provide the public with a clear statement of the ethical considerations that should shape the behavior of the professionals themselves. This specific Code of Ethics also considers the importance of autonomy, equality and justice, beneficence, non-maleficence, and Integrity which follow the theoretical approaches to healthcare ethics (The Medical Informatics Association, 2013). Security is highly addressed in the IMIA Code of Ethics. It is written that Data that have been legitimately collected about a person should be protected by all reasonable and appropriate measures against loss, degradation, unauthorized destruction, access, use, manipulation, modification or communication. The Healthcare Informatics Professional is held to the highest level of standard of integrity regarding a person’s medical information. Any infringement of the privacy rights of the individual person, and of the right to control over person-relative data, must be justified to the affected person in good time and in an appropriate fashion (IMIA, 2013).
Ethical and Legal Responsibilities of the Informatics Professional
The Healthcare Informatics Professional (HIP) has an ethical and legal duty to the profession and commits to always act in such fashion to always bring credibility to the profession. HIPs assist in the development of the highest professional standards of competence, ensure the standards are publically addressed and are applied impartially and in a transparent manner. HIPs will refrain from damaging the reputation of colleagues; however, they will report dishonest and unprofessional acts to their employer or appropriate authority. HIPs have a duty to hold their colleagues to the highest moral and ethical standards of the profession. HIPs have a duty to promote understanding, appropriate utilization, and ethical use of Electronic Health Records, and advance the discipline of Healthcare Informatics (IMIA, 2013). HIPs have a duty to recognize the limits of their competence, consult when necessary or appropriate, maintain competence, take responsibility for all actions performed by them or under their control, avoid conflict of interest, give appropriate credit for work done, and act with honesty, integrity and diligence (IMIA, 2013).
Health and Human Services issued regulations requiring health care providers, health plans, and other entities covered by the Health Insurance Portability and Accountability Act (HIPAA) to notify individuals when their health information is breached (U.S. Department of Health and Human Services, 2013). The regulations require health care providers and other HIPAA covered entities to promptly notify affected individuals of a breach of information. This new federal law ensures that covered entities and business associates are accountable to the Department and to individuals for proper safeguarding of the private information entrusted to their care (U.S. Department of Health and Human Services, 2013).
The implementation and transition to the Electronic Health Record is a well-planned process for physicians, nurses and other caregivers, to ensure a productive work environment. These systems, however, pose certain legal risks for physicians and healthcare systems that should not go unnoticed (Becker’s Hospital Review, 2013). The risk for medical malpractice increases during the implantation phase of the Electronic Health Record due to errors in inputting and uploading patient information. However, while many believe EMRs improve patient safety, their impact on medical malpractice claims remains unclear (Becker’s Hospital Review, 2013).
Strategies to avoid Ethical errors related to EHRs
Avoiding Ethical errors is of utmost importance for the Healthcare Informatics Professional. Proper training and education for all EHR users is the first step towards avoiding ethical errors. Working with other Informatics Technicians to ensure that EHRs are kept on secured server with firewalls to protect the private and sensitive information from outside users which could be damaging to the client should specific information be release. Healthcare professionals and users of the HER must maintain professional use agreements ensuring privacy by signing off of the computer prior to leaving the computer for any reason. The Healthcare professional must maintain and uphold HIPPA compliance laws regarding patient confidentiality. EHR are never to be used for personal gain and the information obtained should be for the benefit of the client only.
Becker’s Hospital Review (2013). Business & Legal Issues for Healthcare System Leadership. Retrieved from: http://www.beckershospitalreview.com/legal-regulatory-issues/5-legal-issues-surrounding-electronic-medical-records.html
International Medical Informatics Association (2013). The IMIA Code of Ethics for Health Information Professionals. Retrieved from:
McGonigle, D. & Mastrain, K (2012). Nursing Informatics and the Foundation of
Knowledge, 2nd Ed. Jones & Bartlet: Burlington: MA
U.S. Department of Health and Human Services. (2013). Health Information Privacy Retrieved from: http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/breachnotificationifr