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Keeping track of patients’ health records is a growing ethical concern, due not only the ever-increasing number of patients, but also because of the increase of record keeping that technology facilitates. While electronic record keeping provides various benefits to the health care industry, several concerns have been raised about the practice.
A. Summary of ethical concerns
Risks are inherent in the utilization, development and maintenance of the institution-owned electronic health records and the provider-owned electronic medical records. (EHRs) require the development of procedures and policies, (Kopala and Mitchell, 2011). “Although EMRs offer many significant benefits, the future of healthcare demands that their risks be recognized and properly managed or overcome” (Kopala and Mitchell, 2011). In order to make improvements, the EHR capacities need to be maximized so they can enhance the communication and create a better safety record, quality, effectiveness and efficiency, (Kopala and Mitchell, 2011). Teamwork, leadership, adaptability, and flexibility are important to finding ways to create effective solutions.
Nurses appear to prefer the EHRs over the traditional paper records, based on interviews and a survey of 46 nurses in intensive care units and medical-surgery units, (Kossman and Scheidenhelm, 2008). However, using these records can get in the way of the nursing work due to decreased interdisciplinary communication, impaired critical thinking, and a high demand on the work time. In fact, 73% said they spend at least half of their shift on the records, and this takes away from the time they could be spending caring for patients, (Kossman and Scheidenhelm, 2008).
In 2009, the American Recovery and Reinvestment Act started an international and national debate about the potential ethical implications associated with the mandated EHRs. There is a need for transparency in the way that medical records are kept, because this information is vital to patients, (Milton, 2009). “Transparency fosters both individual organizational, and community integrity, confidence, and trust in the discipline of nursing” (Milton, 2009). Nurses play a part in creating the disciplinary role that they have with the EHRs, and this makes their position vitally important at ensuring the proper outcomes are met when it comes to privacy and transparency about procedures, (Milton, 2009).
B. Critique of each article
Kopala and Mitchell’s “Use of Digital Health records Raises Ethics Concerns,” does an effective job at outlining the general issues that are currently prevalent in the addition of EHRs to the health care scene. The article goes over the various benefits, but also the drawbacks of having EHRs, and I found that the writers take a very objective, balanced approach in their article. This makes the conclusion more credible, because all sides are explored in a fair and clear way. Ultimately, the authors’ assert that paying attention to the security of the health records will help improve health care delivery.
Kossman and Scheidenhelm’s “Nurses’ Perceptions of the Impact of Electronic Health Records on Work and Patient Outcomes” provides a useful look at the impact that keeping EHRs has on the performance of the health care professionals. The article states that a considerable amount of time is being spent entering data, so that accurate health records are kept. I agree with the statement that this is decreasing the quality of care, and with the assertion that steps need to be made in order to focus more on the patient, rather than on the way the health records are being kept.
The reading by Constance Milton, “Information Sharing: Transparency, Nursing Ethics, and Practice Implications With Electronic Medical Records,” gave a good overview of the issues related to EHRs, but it did not provide enough specific information about where the ethical issues arise. In the article, Milton says there is the need for transparency in medical record keeping, but he does not specify how this could be done in a cost-effective way. While allowing the patients to have access to their own medical records is a great, it is not practical, and this is where Milton fails to provide a possible solution to the problem.
C. Explore current practice in my work setting
In my work setting, the practice is relatively simple. The information about the patient is kept in a paper file, much like it has been done for a very long time. This file is kept at the foot of the patient’s bed, so that it is not close to a door, where someone could take it. Also, it prevents the file from getting mixed up with another patient’s. The current issues that the patient is experiencing are listed on the chart, as well as any relevant notes that would affect the status of the patient.
Each evening a nurse is responsible for entering the daily information about the patient into the computer. This helps to ensure that no information is lost, or that a progression in the patient’s health has not been documented. This is an area where I think EHRs have really improved the record keeping. This is one of the major advantages that has also been pointed out in the readings. The process of adding the new health information by a nurse at the end of the night is an extra step that helps ensure nothing is missed.
However, similar to how the reading suggested, there are issues that arise because of the increased amount of time that nurses are spending on entering this information. I know that where I work, the nurse who is responsible for entering the updates about the health of the current patients takes up to three hours. The same nurse needs to enter the information of the people who came into the facility that day, and that adds another 1.5 hours to the process. So, at a time when the hospital is more understaffed than ever, it can be very difficult to have the personnel available to attend to the patients, and then also the nurse to enter the information about the patients. Sometimes, the information takes a long time before it is entered, and the work piles up for the nurse who is responsible for entering the information. When multiple days add up, it can create too much burden for one person to enter all the information. That means the nurse requires someone to help, and the problem of being under-staffed only gets worse.
While the EHRs have improved my work’s ability to keep accurate health information, it has also created a lag in patient delivery. With so much information to enter, it becomes exceedingly difficult to fulfill all of the patient requests. I think this could make it difficult to improve the transparency of record keeping to each patient, because that would likely create a bigger strain on a limited number of staff members.
D. Reflections (what I learned that will guide my career)
After reading these articles, I learned that it is exceedingly important to pay special attention to the way that the medical records are kept. I had not realized what a major deal keeping proper medical records was, but it has become apparent that great scrutiny is needed when entering the information about the patient into the computer. Also, I learned that there should be greater transparency about how the medical records are kept. By letting the patients know the process, and who will have access to their health information, there will be better outcomes because the credibility of the nursing profession will be better maintained.
This information will guide my career because I will be extra sensitive to the medical information. I now understand how important it is for people to have their medical information kept as private as possible. Prior to these readings, I did not think it was a big deal to not have high security on the medical records, but I can now see that many people are more private than I am, and have good reason to want to keep their personal information secure.
When I had first started reading about EHRs, I had thought that this type of technology had been around for decades. But I can now understand that there have been significant changes to the technology over the years, and there are many components that have not yet been sorted out. The security of these health records requires a considerable amount of scrutiny, and I do not think the best process has been put in place yet. This is because of such a high level of ethical concerns in relation to entering the information.
Kopala, B. and Mitchell, M. (2011). Use of digital health records raises ethics concerns. JONA’s Healthcare Law, Ethics, and Regulation, Vol. 13 (3).
Kossman, S., and Scheidenhelm, S. (2008). Nurses’ perceptions of the impact of electronic health records on work and patient outcomes. Computers, Informatics, Nursing.
Milton, C. (2009). Information sharing: Transparency, nursing ethics, and practice implications with electronic medical records. Nursing Science Quarterly.