Custom papers academic service


Legal and ethical considerations of an electronic medical record

Find articles by Fouzia F. This article has been cited by other articles in PMC. Abstract Electronic health record EHR is increasingly being implemented in many developing countries. It is the need of the hour because it improves the quality of health care and is also cost-effective.

Technologies can introduce some hazards hence safety of information in the system is a real challenge. Recent news of security breaches has put a question mark on this system. Despite its increased usefulness, and increasing enthusiasm in its adoption, not much attention is being paid to the ethical issues that might arise.

Securing EHR with an encrypted password is a probable option. The purpose of this article is to discuss the various ethical issues arising in the use of the EHRs and their possible solutions.

Physicians and hospitals are implementing EHRs because they offer several advantages over paper records. They increase access to health care, improve the quality of care and decrease costs.

However, ethical issues related to EHRs confront health personnel. When patient's health data are shared or linked without the patients' knowledge, autonomy is jeopardized. The patient may conceal information due to lack of confidence in the security of the system having their data. As a consequence, their treatment may be compromised. There is the risk of revelation of thousands of patients' health data through mistakes or theft.

Leaders, health personnel and policy makers should discuss the ethical implications of EHRs and formulate policies in this regard. The electronic medical record EMR is the tool that promises to provide the platform from which new functionality and new services can be provided for patients.

Its major drawback was in terms of accessibility, and it was available to one user at a time. Its completion was delayed anywhere from 1 to 6 months or more because it was updated manually. EHRs have several advantages over paper records. Production of legible records reduces many problems of wrong prescriptions, doses and procedure.

This can be done by not permitting prescription and order for drugs for which a known adverse reaction is known for a certain patient. They reduce the number of lost records, help research activities, allow for a complete set of backup records at low cost, speed data transfer and are cost-effective.

The physician and the organization is the owner of the physical medical record. Privacy and confidentiality, security breaches, system implementation, and data inaccuracies. When a patient is unable to do so because of age, mental incapacity the decisions about information sharing should be made by the legal representative or legal guardian of the patient. Information shared as a result of clinical interaction is considered confidential and must be protected. The key to preserving confidentiality is to allow only authorized individuals to have access to information.

This begins with authorizing users. The user's access is based on preestablished role-based privileges. The administrator identifies the user, determines the level of information to be shared and assigns usernames and passwords.

The user should be aware that they will be legal and ethical considerations of an electronic medical record for the use and misuse of the information they view. They have access to the information they need to carry out their responsibilities. Hence assigning user privileges is a major aspect of medical record security.

Additional security steps such as strong privacy and security policies are essential to secure patient's information. Two recent incidents at Howard University Hospital, Washington showed that inadequate data security can affect a large number of people. Prosecutors said that over a 17-month period, Laurie Napper used her position at the hospital to gain access to patients' names, addresses and Medicare numbers in order to sell their information. A few weeks earlier, the same hospital informed more than 34,000 patients that their medical data had been compromised.

A contractor working with the hospital had downloaded the patient's files onto a personal laptop, which was stolen from his car.

  • When any two systems are integrated, an interface is created;
  • The safe harbor protects an exchange that would otherwise violate Stark Law — which prohibits monetary or non-monetary exchanges for referrals — and the Antikickback Statute;
  • Economic factors come into play when it comes to this enforcement, as the administration has recognized HIPAA and HITECH violations as an ample avenue to recover funds and bring money back into a financially-addled government;
  • Professionalism in the age of computerised medical records;
  • Poorly designed user interface account for unintended adverse consequence leading to decreased time efficiency, poor quality of care and increased threat to patient safety;
  • The percent of primary care physicians using EMRs grew even more, roughly doubling from 20 to 39 percent in that same time frame.

The data were password protected, but unencrypted, which means anyone who guessed the password could have accessed the patient files without a randomly generated key. By encryption, we mean encoding of information in such a way that only authorized parties can read it.

It is usually done with the help of encryption key, which specifies that how the information should be decoded. Recently a hospital chain named Prime Health care Services Inc.

Ethical issues in electronic health records: A general overview

Keeping records secure is a challenge that doctors, public health officials and federal regulators are just beginning to understand. Cloud storage, password protection, and encryption are all measures health care providers can take to make portable EHRs more secure. Emphasis must be laid on encrypting mobile devices that are used to transmit confidential information.

Portable EHRs can be made more secure by using cloud storage, password protection, and encryption. Usage of two factor authentication system with security tokens and password are helpful in securing EHRs. Security measures such as firewalls, antivirus software, and intrusion detection software must be included to protect data integrity. Specific policies and procedures serve to maintain patient privacy and confidentiality.

INTRODUCTION

For example, employees must not share their ID with anyone, always log off when leaving a terminal and use their own ID to access patient digital records. A security officer must be designated by the organization to work with a team of health IT experts. Routine random audits should be conducted on a regular basis to ensure compliance with hospital policy.

All system activity can be tracked by audit trails. This includes detailed listings of content, duration and the user; generating date and time for entries and logs of all modifications to EHRs. This information is useful when determining whether the access is the result of an error or an intentional, unauthorized view.

The HIPAA Security Rule requires organizations to conduct audit trails, requiring that they document information systems activity[ 17 ] and have the hardware, software, and procedures to record and examine activity in systems that contain health information.

Employee-only access to the EMR requires any external vendor to access and navigate the record under the authorization and oversight of an employee. The development, implementation, and maintenance of EHRs requires adequate funds and the involvement of many individuals, including clinicians, information technologists, educators, and consultants. Many EHR implementation projects fail because they underestimate the importance of one or more clinician to serve as opinion leaders for providers in the clinic.

  • EMRs are also regularly upgraded and hospitals aren't required to maintain a copy of the old environment, since doing so would be quite costly;
  • Russell Localio, Joshua P;
  • EMRs are also regularly upgraded and hospitals aren't required to maintain a copy of the old environment, since doing so would be quite costly;
  • Documentation in electronic form is often organized, detailed and more legible;
  • Engaging Physicians in a Shared Quality Agenda;
  • This begins with authorizing users.

Thus, clinician must guide colleagues in understanding their roles in the implementation and enlisting their involvement in tasks as EHR selection, workflow design, and quality improvement. This blind spot results in inadequate planning for successful implementation. Without identifying a standardized best practice method to do the work, every user is left to struggle.

Clinics should map and standardize their workflows before EHR selection. When any two systems are integrated, an interface is created.

By the user interface, we mean an interface between the user and the computer system. These interfaces are critical to the overall success of the implementation process. Interface issues are the greatest system risk because these failures can be invisible initially.

Lack of systemic consideration of users and tasks often results in poor user interface. Poorly designed user interface account for unintended adverse consequence leading to decreased time efficiency, poor quality of care and increased threat to patient safety. Improperly designed user interface fail to deliver the much needed quality of care, which lead to user dissatisfaction. The faulty user interface issue, which was small earlier on, increases over a period of time that leads to abandonment of EHR.

5 Legal Issues Surrounding Electronic Medical Records

Maintenance and testing of these interfaces on a routine basis is essential in controlling this major risk. Practice disruption during EHR implementation can negatively impact the quality of care or endanger patient safety along with financial loss.

EHRs serve as a way to improve the patient's safety by reducing healthcare errors, reduce health disparities and improve the health of the public.

  • The number of patients affected by health data breaches has been on the rise, with 5;
  • It is usually done with the help of encryption key, which specifies that how the information should be decoded;
  • A few weeks earlier, the same hospital informed more than 34,000 patients that their medical data had been compromised;
  • Beyond boosting the mere risk of lawsuits, EMRs also affect the course of such litigation by increasing the availability of data and documentation that can either defend or prove a malpractice claim;
  • Two recent incidents at Howard University Hospital, Washington showed that inadequate data security can affect a large number of people.

This practice is unacceptable because it increases the risk for patients and liability for clinicians and organizations. Such menus limit the choices available to the clinician who in a hurry may choose the wrong one leading to major errors.

  1. These systems, however, pose certain legal risks for physicians and healthcare systems that should not go unnoticed.
  2. Hence assigning user privileges is a major aspect of medical record security. Economic factors come into play when it comes to this enforcement, as the administration has recognized HIPAA and HITECH violations as an ample avenue to recover funds and bring money back into a financially-addled government.
  3. Generally, the "print medical record" function in an EMR generates a report that bears no resemblance to what a physician was looking at when he or she made clinical decisions at the time of treatment. The safe harbor protects an exchange that would otherwise violate Stark Law — which prohibits monetary or non-monetary exchanges for referrals — and the Antikickback Statute.
  4. Privacy and confidentiality; p. But just as a reliance on spell check can leave an email peppered with spelling blunders, too much dependence on an EMR can result in small mistakes that can quickly turn into medical errors.
  5. Although EMRs present significant opportunities for long-term gain, they are quite a thorn in physicians' side at first. The Health Information Technology Dictionary.

Clinicians and vendors have been working to resolve software problems to make EHRs both user-friendly and accurate. This results in the input of inaccurate information into the record of the victim.

The person's insurance company is billed for medical services not provided to the actual policy holder and the patient's future treatment is guided by misinformation that neither the patient nor provider immediately recognize. India is now one of the favorite destinations for the health care services.

Considering rapid pace of growth of health care sector in India, Government of India in April 2013, came out with definitive guidelines for EHR standards in India. Guidelines were based on the recommendations made by EMR standards committee, which was constituted by an order of Ministry of Health and Family Welfare. The guidelines recommend set of standards to be followed by different health care service providers in India and hence that medical data becomes portable and easily transferable.

Creating a useful EHR system will require the expertise of physicians, technology professionals, ethicists, administrative personnel, and patients. Although EMRs offer many significant benefits, the future of health care demands that their risks be recognized and properly managed or overcome. Multiple strategies are available to reduce risks and overcome barriers in the implementation of digital health records. Leadership, teamwork, flexibility, and adaptability are keys to finding solutions.

EMRs capacities must be maximized in order to enhance improve the quality, safety, efficiency, and effectiveness of health care and health care delivery systems. Footnotes Conflict of Interest: The impact of electronic health records on time efficiency of physicians and nurses: J Am Med Inform Assoc.

Social, ethical and legal barriers to e-health. Int J Med Inform. Barriers and opportunities in the 21 st century. Patient compliance with paper and electronic diaries. Professionalism in the age of computerised medical records. Guide to privacy and security of health information.