Primary Care Physicians' Perspectives on the Ethical Impact of the Electronic Medical Record

Tania Moerenhout, MD, MPhil; Gary S. Fischer, MD; Marlies Saelaert, MPhil; An De Sutter, MD, PhD; Veerle Provoost, PhD; Ignaas Devisch, PhD

Disclosures

J Am Board Fam Med. 2020;33(1):106-117. 

In This Article

Abstract and Introduction

Abstract

Objective: The aim of this study is to explore whether specific ethical questions arise with the use of a shared electronic health record (EHR) system, based on the daily experience of primary care physicians (PCPs).

Methods: In this qualitative research project, we conducted 14 in-depth semistructured interviews with PCPs in a tertiary hospital setting.

Results: We identified 4 themes: 1) PCPs describe the EHR as a medicine with side effects, for which they provide suggestions for improvements; 2) A shared record raises ethical questions related to autonomy and trust; 3) Although use of the EHR often disturbs rapport with the patient, it can also support the patient-doctor interaction when it becomes an active part of the conversation; 4) A shared EHR may cause health care providers (and their relatives) to avoid seeking help for sensitive issues.

Discussion: PCPs fear access to results could cause confusion and anxiety in patients, resulting in tensions between autonomy and beneficence. Improved efficiency and quality of care with a shared EHR relies on doctors trusting each other's input to avoid duplicate tests. However, this might compromise a fundamental skeptical attitude in practicing medicine, and we should be aware of a risk of increased confirmation and anchoring bias.

Conclusion: The EHR is considered to be a work in progress—EHR design could be improved by examining physicians' coping strategies and implementing their suggestions for improvement. Ethical questions related to autonomy, trust, and the status of records that belong to doctor–patients need to be considered in future research and EHR development.

Introduction

Already in 1982, Mark Siegler described confidentiality as a "decrepit concept."[1] He estimated that somewhere between 25 and 100 health professionals and administrative personnel legitimately accessed a patient's record during a standard hospital stay, noting that a conflict arises between our traditional understanding of medical confidentiality and our desire to provide better and more comprehensive care to the patient.[1–2] The electronic health record (EHR) allows for much more information to be stored and accessed by a wider circle of both medical personnel and patients. At the same time, it has become a complex and multifunctional tool also serving other functionalities such as financial reimbursement, risk management and quality and safety improvement.[3] Although the EHR has been in use for quite some time now, its effect on the quality of care remains unclear.[4–9] Correspondingly, its impact on the patient-doctor relationship also remains a topic of research.[10,11] Two issues often arise: time spent on the computer for documentation takes away time directly spent with the patient, and the EHR can have a negative impact on the quality of the interaction (or rapport) with the patient.[12,13] However, patient satisfaction does not seem to be negatively influenced by EHR use.[14] With this study, we search to understand which ethical questions remain relevant today within a shared electronic record, specifically related to the triadic relationship between patient, doctor and EHR. Although several studies focus on challenges of EHR use, far fewer actually consider the lived experience of the physician.

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