Ethical Issues Surrounding the Adoption of Electronic

¶ … Ethical Issues Surrounding the Adoption of Electronic Health Records (EHR) by Health Care Organizations and Meaningful Use

The objective of this work in writing is to examine why health care organizations are hesitant to adopt electronic health records (HER) in light of the potential of HER to improve quality, increase access, and reduce costs. This issue will be examined from a legal, financial, and ethical standpoint and in relation to 'meaningful use'.

The use of information technology in the health care field shows a great deal of potential toward improving quality, efficiency, and safety in medical care. (DeRoches, Campbell, and Rao, 2008, paraphrased; Frisse & Holmes, 2007, paraphrased; and Walker, et al., 2005, paraphrased) The American Recovery and Reinvestment Act (ARRA) of 2009 is reflective of the unprecedented interest of the Federal government in the area of bringing about increases in the use of IT in health care for system optimization. (American Recovery and Reinvestment Act of 2009) The amount of $19 billion has been earmarked for increasing the health information exchange participation levels and specifically "the electronic sharing of health-related information according to nationally recognized standards for interoperability, privacy, and data security." (The National Alliance for Health Information Technology, 2008) The stated goal is the creation of regional health information organizations that are to be linked in the formation of a Nationwide Health Information Technology. (Ibid, paraphrased)

I. Legal Issues in the Use of EHR

Legal issues that arise in the use of Electronic Health Records (EHR) are reported to include the following 'core consent options':

(1) No consent -- health information of patients is automatically included -- patients cannot opt out;

(2) Opt-out -- default is for health information of patients to be included automatically, but the patient can opt-out completely;

(3) Opt-out with exceptions -- default is for health information of patients to be included but the patient can opt out completely or allow only select data to be included;

(4) Opt-in -- Default is that no patient health information is included; patients must actively express consent to be included, but if they do so then their information must be all in or all out; and (4) Opt-in with restrictions -- default is that no patient health information is made available, but the patient may allow a subset of select data to be included. (Daniel and Goldstein, 2010, p.ES-1)

Reported as issues that contain specific significance are those as follows:

(1) Numerous and sometimes inconsistent federal and state laws regarding patient consent generally, and disclosure of sensitive information specifically;

(2) Provider workflow challenges associated with obtaining and managing consent;

(3) The lack of difficulty in achieving technical and procedural capacity to segment and manage data in the manners desired by various constituents;

(4) Concern that existing security and privacy provisions are inadequate; and (5) The need to balance multiple and often conflicting stakeholder interests to ensure adequate participation. (Daniel and Goldstein, 2010, p. ES-2)

II. Financial Issues in the Use of EHR

Goldstein and Rein (2010) report that providers have "expressed concern about the increased financial and administrative burden associating with initiating and maintaining a consent management process" for EHR. (p.26) Providers already face challenges relating to the adoption and use of EHR and "eventually, demonstrating 'meaningful' use…" (Goldstein and Rein, 2010, p.26) Goldstein and Rein (2010) additionally state "experience from HIPAA implementation shows that upfront capital costs for training staff, implementing new patient consent procedures and changing workflow processes to ensure compliance can increase along with the size of the provider organization." (p.26)

III. Ethical Issues in the Use of EHR

Policy decisions in regards to "how and to what extent patients exercise control over the electronic exchange of their health information have been discussed at times as representing the degree to which patient privacy and autonomy are preserved in a networked health environment. Autonomy is the ethical principle underlying the individual's right to make and carry out informed decisions that arise from unbiased and thoughtful deliberation." (Goldstein and Rein, 2010, p.27)

IV. Meaningful Use of EHR

The work of Gray, Bowden, Johansen, and Koch (2001) states that the U.S. has been slow as compared to other countries in adopting the use of EHRs in patient care however, with the enactment of the Technology for Economic and Clinical Health Act (HITECH) of 2009, making provision of "$27 billion over 10 years for federal incentive payments to hospitals and clinicians for adopting EHRs" that is changing. It is reported that there are "… Substantial sums at stake -- $44,000 from Medicare and $63,750 from Medicaid for individual clinicians and millions for individual hospitals." (Gray, Bowden, Johansen, and Koch, 2001)

It is required that providers adopt HER systems as well as make "meaningful use" to improve patient care of incentive payments to receive that funding. It is reported that this means not only "translating paper records into electronic form, but creating an electronic infrastructure that would improve the health care system and the health of Americans." (Gray, Bowden, Johansen, and Koch, 2001) In 2010 the Office of the National Coordinator in the Department of Health and Human Services set forth standards for defining 'meaningful use' of EHRs and stated objectives and measures include such as maintenance of an active medication list for patients and recording at least one entry as structured data for at least 80% of patients. (, Bowden, Johansen, and Koch, 2001, paraphrased)

VI. Stage 2 EHR Implementation

The present organize at focus in this study is at stage 2 of the EHR meaningful use and implementation of EHR. Stage 2 in EHR implementation is inclusive of the following: