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The Ethical Case for Electronic Records
The first principle of a medical or health professional should be to do no harm. There are many ways in which professionals unintentionally harm patients. High on the list of preventable risks are two key areas:
- adverse reaction to prescribed medications. Over 770,000 people are injured or die each year in US hospitals from adverse drug events (source: Agency for Healthcare Research and Quality).
- ignorance of medical history. A further source of errors are due to key pieces of clinical information not being available to clinicians at the point of care.
Clinicians professional codes of conduct require them to keep good records as part of their professional duties. This is not new, but traditionally these have been personal aide-memoires for their own use. In an age where electronic medical records are in use, the principle of doing no harm, requires clinicians to both contribute to and refer to electronic records when giving care.
Computers are not psychic however, or even intelligent, but they can prompt a clinician to act in a number of cases:
· For example electronic records can hold information that show that a proposed action would contra-indicate with an existing therapy. Most commonly, this is used with medication, because this is the area where we have the most evidence. However, there is considerable potential to extend its use to a wide range of therapies.
· Similarly, the records may hold information that show that a proposed action would contra-indicate with this particular patient due to an allergy or existing condition.
· In some cases, the system can highlight errors in prescriptions. For example, checking the dosage, preventing overdoses, or when a dosage is too small.
· Many other reasons can be found in an article about the benefits of electronic records.
In spite of this, there remains resistance to the use of electronic records for clinical purposes. For example,
A few years ago, I was visiting an outpatient clinic as a patient. Not wanting to miss an opportunity, I called in on the IT department before hand and discussed their planned deployment of an electronic patient records system.
“Are the clinicians on-board?” I asked.
“Oh yes!” I was assured
Thirty minutes later I was conversing with my doctor as readily as it is possible to do so, with a large uncomfortable tube up my nasal passages:
“I hear that you’re getting a new computerised patient records system”
“They’d better not bring it anywhere near me!”
In order to uphold the principle of first do no harm, and to honour their professional obligations to keep good records, it would seem that clinicians can no longer treat electronic records as just a management tool.
As their use becomes more widespread, non-use may become a legal issue. For example, over 98% of prescriptions issued in UK primary care are now being issued using computers with decision support. Therefore, should an adverse event follow a paper prescription when technology was available, legal defence could prove difficult.