ACP: EHRs Have Great Benefits, but Raise Ethical Questions, Too

Electronic health records (EHRs) should facilitate high value patient-centered care, strong patient-physician relationships, and effective training of future physicians, but they also raise ethical questions, the American College of Physicians (ACP) wrote in a new position paper published in the Journal of General Internal Medicine.

“Electronic health records can aid in the delivery of high quality care to patients,” said Nitin S. Damle, M.D., president, ACP. “However, health information technology also poses unintended ethical concerns that the medical profession must examine and address.”

The American College of Physicians is the largest medical specialty organization in the U.S. ACP members include 148,000 internal medicine physicians (internists), related subspecialists, and medical students.

In the paper produced by ACP's Ethics, Professionalism, and Human Rights Committee, “Ethical Implications of the Electronic Health Record: In the Service of the Patient,” ACP addressed how EHRs can best serve the patient-physician relationship and patient care; patient autonomy, privacy, and confidentiality; and professionalism, clinical reasoning, and training. ACP specifically stated three principles for EHR use:

• EHR and computer use should facilitate patient care, support physician ethical duties, and support the patient-physician relationship.
• EHR use should assist and enhance clinical reasoning and the development of cognitive and diagnostic skills. Features such as copy-and-paste should be employed judiciously, reflect thought processes about the current patient encounter, and meet the ethical requirements for an accurate and complete medical record.
• Privacy and confidentiality must be maintained in EHR use. EHR information retrieval, exchange, and remote access can improve care, but also create the risk of unauthorized disclosure and use of protected health information.

“The medical profession must constantly evaluate EHRs and other technological advances to ensure that they sustain the patient-physician relationship, minimize time taken away from direct patient care, assist in clinical reasoning and enhance diagnostic skills, and protect patient privacy and confidentiality,” Damle said.