ACP 2019: Overcoming the ethical challenges of EHRs

Electronic health records hold significant potential for improving patient care, but they also present doctors with new ethical challenges they didn’t face in the era of paper charts.

The benefits and ethical dilemmas posed by EHRs were the subject of a panel discussion and series of role-playing exercises titled “EHRs in the Service of the Patient” held at the 2019 American College of Physicians Scientific conference in Philadelphia. “EHR’s provide clinicians with ready access to lots of information from numerous practitioners, as well as safety features like popups for drug interactions and allergies, said Carrie A. Horwitch, MD, MACP, a faculty member with the Department of General Internal Medicine at Virginia Mason University in Seattle and a member of the panel.

On the other hand, Horwitch says, EHRs facilitate the practice of cutting and pasting, or copying forward, information they’ve previously entered in the patient’s chart. That can pose safety issues if the patient’s condition has changed or if the original information was incorrect. Moreover, some doctors are cutting and pasting information entered by other providers, a practice Horwitch refers to as “clinical plagiarism.”
EHRs also pose confidentiality issues, Horwitch notes. “I always remind my residents they shouldn’t be in any patient records where they don’t belong because everything is documented in the EHR--who looks at the record, when, and for how long. And that is how some people lose their jobs.”

Templates are another aspect of EHRs that present both opportunities and ethical challenges. When designed well, they can contain information that aids physicians in their clinical decision-making. Horwitch cites the example of a template for treating acute low back pain. “A good review of systems template should list all red flag symptoms, so if doctor goes through all of them with patient should get good idea whether patient needs imaging or any further studies,” she says.

The ethical/professional issue doctors face, Horwitch says, is the temptation to click through the ROS template without performing all the tasks on it. As with cutting and pasting notes, it means “you could be transmitting inaccurate information, which could be a patient safety issue,” she says.

Healthcare systems, academic medical centers and other provider institutions that recognize the impact of EHR templates on patient care often appoint task forces to develop their own evidence-based templates, or review those designed by others before implementing them. “The goal is to make sure it meets proper medical standards and they are based on information that is accurate and up to date,” she says.

In any situation involving the use of EHRs, Horwitch adds, it’s important to keep in mind the ultimate purpose of patient records, which is to “help patient care for by transmitting necessary information to the next provider responsible for caring for that patient. In other words, the EHR should facilitate providing appropriate care for our patients and support our doctor-patient relationships.”