Ethical Concerns in Healthcare in the Digital Age

For healthcare administrators, there are many areas of concern from a digital perspective.  There are ethical and privacy concern and risks associated with the use of electronic health records and interchange of records promulgated through regional health information organizations.  There are ethical concerns associated with health care provider use of digital means to communicate with patients, such as e-mail and social media.  There are ethical worries related to the use of social media by health care employees in general, such as privacy and security related risks, or improper behavior.  These and other topics create a litany of challenges for health care leaders at all levels.

The electronic health record provides major advantages to health care organizations and their patients.  It provides immediate access to records at multiple sites of the same organization, or even different organizations if allowed by that patient and available in that area.  It allows for ready access to multiple pieces of information combined in one area, such as laboratory, radiology, physician office notes, inpatient hospital records, and any other types of information available for that patient.  As discussed by Kopala and Mitchell in the JONA's Healthcare Law, Ethics, and Regulation Journal, continuity of care will improve, medical errors will likely decrease, and generally the electronic health record is expected to advance health care education and research overall.  However, there are many risks.  Privacy and security of information in an electronic health record (EHR) creates innumerable risks.  Instead of a locked cabinet where files are kept, the information is simply kept in a ‘virtual file cabinet’, and those who make decisions on access must be prudent on choosing which keys are given.  Only those that require business access can be given the key, but even those keys can be abused.  During my time as a privacy and compliance official, I reprimanded and terminated employees for offenses as minor as looking up co-workers birthdays in the EHR, or as major as perusing the emergency room records of a celebrity that they knew had visited the facility.  The ethical ramifications of access to electronic records overall is a concern, but key to this issue is development of a solid policy on access, and maintenance of that policy through auditing.  Kopala and Mitchell also mention data integrity as a potential ethical concern as well.  Data integrity is a major issue in the EHR world, as providers are notorious for ‘cutting and pasting’ when allowed to do so in this setting.  This can wind up with inappropriate information in a record, resulting in poor documentation.  Due to this, many organizations turn off the ‘cut and paste’ function in their EHR, requiring providers to type out their narrative responses.

Another major area of concern for healthcare leaders is in the realm of allowing providers to communicate with patients via digital media.  Some organizations allow this with signed patient consent in advance, where others do not allow providers to participate in this activity at all.  There are a multitude of ethical and risk related concerns related to this activity.  Lambert, Barry, and Stokes speak of these topics in an article in the Journal of the American Society for Healthcare Risk Management.  By allowing providers to correspond with patients in this manner – e-mail, Facebook, Skype, other social media – you are potentially creating an expectation that the provider is available to the patient immediately.  If this patient is having an emergency medical condition, they may try to e-mail the physician instead of heading right to the emergency room as they should.  Also, there is a concern of the boundary of the patient/physician relationship.  By using a social media site to converse with a patient, is a physician crossing that boundary?  This physician seems to think so, and I’d think that many physicians would agree that Facebook is generally off limits to their patients.

Finally, the last major concern is with staff use of digital media.  There are innumerable ethical concerns in this area, as benign as the use of social media at work decreasing productivity, and as serious as sharing of patient information online.  I will share an issue that happened at a local hospital in my area a few years ago.  A staff member took photos of a patient while using the restroom and shared them via text message with other staff members. http://www.wbng.com/news/local/State-Issues-Citation-For-Bingamton-General--143750206.html

This situation was a great example of poor training, poor hiring practices, and poor control on the unit in that particular hospital.  I’m quite familiar with the hospital overall as my husband works in their emergency room, and sadly I wasn’t surprised to hear this happened to this patient.  Policy will not fix this situation, as I’m sure they had policy in place to prevent this.  Training for employees as well as hiring the right employees up front for your organization, and providing appropriate supervision is vital to appropriate application of these types of policies.

The digital age has brought amazing positive things to the health care industry.  There are many ethical challenges as well that must be overcome by health care leaders every day.  Make use of your compliance and privacy resources as they can often be of great help in many of these areas!