According to Sittig and Singh (2011), there are many issues and concerns with the use of electronic medical records, including the tendency to overlook key pieces of medical history due to the large amount of data that is available per patient record. This can be challenging ethically based on the demands of patient care and the demands of healthcare organizations which require efficient and timely chart review and patient treatment. For the purpose of this example, imagine that an individual had a serious childhood cardiac problem in his chart from thirty years ago which he never reported to his providers.
He arrives to the hospital for treatment for another condition and is sent home with a medication that is contraindicated for those who have his particular childhood cardiac condition, and this leads to complications and eventually death. In this scenario, the treating provider did not see records regarding this childhood heart problem, nor did the patient report the issue. Upon record review, it is noted that there was a single mention of the condition in scanned historical records from thirty years ago that the treating provider did not review. This presents a challenging health informatics and ethical dilemma, and an ethical decision making model can be helpful in guiding the decision making process about how to prevent this ethical issue from occurring again going forward.
The first step in the ethical decision making model (McGonigle & Mastrian, 2015) discussed in class is to examine the ethical dilemma with the knowledge that conflicting values may exist. During this step it is important to use critical thinking skills and also to gather as much data as possible. At this step, there needs to be a focus placed on objectively collecting data, because to limit the amount of data collected could potentially bias the eventual outcome. In this situation, the patient did not report the childhood heart condition, and only one historical record in the electronic health record made mention of this condition.
In terms of the possible alternatives that could have taken place, the nurse and treatment team working with this individual in the hospital could have had the patient fill out his most recent medical history including any medical problems. Had this happened, more recent updated information may have been known to the team. Furthermore, another alternative would have been to query the patient regarding his medical history more intensely. Finally, the electronic medical record could be reviewed periodically by support staff to ensure that all medical problems are up-to-date and not missed.
As for the ethical arguments present in this case, there is an argument that the hospital and staff should do no harm, and the patient has the right to appropriate medical treatment even if he does not appropriately report information from his medical history. There is also the argument that hospital staff are only capable of so much, and failing to report a significant medical issue is a responsibility that the patient must hold. Furthermore, some may argue that this childhood medical condition should have been well documented in the chart and not hidden years deep in the electronic medical record. The moral principles involve the notions of doing no harm, and providing the appropriate standard of care. Given the problem with the electronic health record not being up-to-date with this important health condition, there is question about things that would need to change for this system to be more effective.
Overall, the ethical thing to do after considering all sides is to make changes to the electronic health record so that any historical medical condition is up-to-date on the patient’s list of problems. The lack of this important information in an easily accessible part of the health record is a major problem, and patients may not always have the medical knowledge or the ability to report their medical conditions to staff. It is the staff’s job to do a thorough review of the medical record, but when there are thousands of notes and only one mention of a historical medical condition, this presents a challenge. Overall, in this instance, updating the electronic health record and the way that the health record is used within the organization is the best approach moving forward.