Ethical issues surrounding electronic health record adoption and meaningful use

¶ … 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)

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:

(1) Major ancillary clinical systems feed data to clinical data repository (CDR) that provides physician access for retrieving and reviewing results.

(2) CDR contains a controlled medical vocabulary (CMV) and the clinical decision support system and rules engine for rudimentary conflict checking.

(3) Optional for extra points - Information from document imaging systems may be linked to the CDR. (HIMSS Analytics, 2012)

Summary and Conclusion

This study has examined the legal, financial, and ethical considerations of the organization when adopting and implementing EHR as well as the additionally funding potentials. EHR 'meaningful use' takes place in several stages and provides the organization with the potential to improve safety, efficiency, and quality of patient care as well as presenting opportunities for financial savings. There is still a high level of ongoing debate concerning the exact process that will be used for consent by patient and as to what standards and measures this consent should regulated and controlled for legal and ethical purposes. Problems that remain for which answers have not yet been stated include numerous inconsistent laws regarding patient consent and information disclosure. Workflow challenges relating to consent acquisition, management, technical difficulties, and procedural capacity in the area of data management. Also stated as issues in this report is concern relating to security, privacy, and the necessity to balance stakeholder interests that are often competing.