Ethical and quality pitfalls in electronic health records
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Abstract
Hospitals and physicians' practices are rapidly implementing the electronic health record (EHR) because it offers many demonstrated advantages over paper records. Issues of misuse of the EHR previously identified include breaches in confidentiality and privacy and inappropriate record sharing. I describe a separate set of ethical and quality problems of the EHR that result from its otherwise beneficial timesaving features that inadvertently enable carelessness and harmful shortcuts. These problems include copying and pasting data obtained from other clinicians, authorship ambiguities, inadvertent inclusion of unobtained data in templated notes, misleading history and physical examinations, failure to review prepopulated data, inadequate discharge summaries, impairments to patient–physician communication, and the transformation of the purpose of the medical record to billing documentation. I offer a brief analysis and recommendations to mitigate these problems.
GLOSSARY
- EHR=
- electronic health record
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the author, if any, are provided at the end of the article.
- Received September 17, 2012.
- Accepted October 30, 2012.
- © 2013 American Academy of Neurology
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Disputes & Debates: Rapid online correspondence
- Re:Electronic health records-physician's friend or foe?
- James L. Bernat, Dartmouth-Hitchcock Medical Centerbernat@dartmouth.edu
- James Bernat
Submitted April 11, 2013 - Electronic health records-physician's friend or foe?
- Nitin K. Sethi, Assistant Professor of Neurology, New York-Presbyterian Hospital, Weill Cornell Medical Center, 525 East 68th Street, New York, NY 100sethinitinmd@hotmail.com
- Nitin K Sethi, New York, NY
Submitted April 02, 2013
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- Article
- Abstract
- GLOSSARY
- COPYING AND PASTING
- AMBIGUITIES OF AUTHORSHIP AND TIMING
- Templated notes
- PSEUDOHISTORY AND PSEUDOEXAMINATION
- PREPOPULATED DATA
- HOSPITAL DISCHARGE SUMMARIES
- IMPEDIMENTS TO THE PATIENT–PHYSICIAN RELATIONSHIP
- TRANSFORMATION OF THE PURPOSE OF THE MEDICAL RECORD
- CORRECTIVE ACTIONS
- AUTHOR CONTRIBUTIONS
- STUDY FUNDING
- DISCLOSURE
- Footnotes
- REFERENCES
- Figures & Data
- Info & Disclosures