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Cited by 100Electronic Health Records SystemsThoreau and American LiteratureMedical Coding and Health Information

Legal, Ethical, and Financial Dilemmas in Electronic Health Record Adoption and Use

Open access
Sittig, Dean F., Singh, Hardeep·2011·Pediatrics
DOI 10.1542/peds.2010-2184PMC PMC3065078
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Abstract

Electronic health records (EHRs) facilitate several innovations capable of reforming health care. Despite their promise, many currently unanswered legal, ethical, and financial questions threaten the widespread adoption and use of EHRs. Key legal dilemmas that must be addressed in the near-term pertain to the extent of clinicians' responsibilities for reviewing the entire computer-accessible clinical synopsis from multiple clinicians and institutions, the liabilities posed by overriding clinical decision support warnings and alerts, and mechanisms for clinicians to publically report potential EHR safety issues. Ethical dilemmas that need additional discussion relate to opt-out provisions that exclude patients from electronic record storage, sale of deidentified patient data by EHR vendors, adolescent control of access to their data, and use of electronic data repositories to redesign the nation's health care delivery and payment mechanisms on the basis of statistical analyses. Finally, one overwhelming financial question is who should pay for EHR implementation because most users and current owners of these systems will not receive the majority of benefits. The authors recommend that key stakeholders begin discussing these issues in a national forum. These actions can help identify and prioritize solutions to the key legal, ethical, and financial dilemmas discussed, so that widespread, safe, effective, interoperable EHRs can help transform health care.

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  • Emerging evidence suggests that health information technology may cause new patient safety concerns and other unintended consequences due to usability issues, disruptions of clinical processes, and unsafe workarounds.

    “However, emerging evidence suggests that HIT may cause new patient safety concerns and other unintended consequences due to usability issues, disruptions of clinical processes, and unsafe workarounds to circumvent technology-related constraints.2–16”

    From An analysis of electronic health record-related patient safety concerns (2014) · cites this paper as [2]

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Authors
Sittig, D. F., & Singh, H.
Affiliations
  • Memorial Hermann (US)
  • Michael E. DeBakey VA Medical Center (US)
ORCID
Venue
Pediatrics
Publisher
American Academy of Pediatrics (AAP)
Published
2011-04-01
Volume
127
Issue
4
Pages
e1042-e1047
ISSN
  • 0031-4005 (ISSN-L)
  • 1098-4275
DOI
10.1542/peds.2010-2184
PMC
PMC3065078
OpenAlex
W2020917092
Cited by
100
References
48
Citations by year
2026: 1 · 2025: 4 · 2024: 6 · 2023: 3 · 2022: 7 · 2021: 5 · 2020: 6 · 2019: 8 · 2018: 7 · 2017: 4 · 2016: 5 · 2015: 9 · 2014: 12 · 2013: 13 · 2012: 6
FWCI
17.94
Type
journal article
Language
en
Open access
Locations
  • PEDIATRICS (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • DigitalGeorgetown (Georgetown University Library) (submittedVersion)
Funders
  • U.S. Department of Veterans Affairs
  • Health Services Research and Development (HFP90‐020)
  • National Institutes of Health (HFP90-020)
  • Agency for Healthcare Research and Quality
  • Office of the National Coordinator for Health Information Technology (10510592)
  • U.S. Public Health Service (ONC 10510592)
  • VA National Center for Patient Safety
  • National Cancer Institute (K23CA125585)
  • U.S. National Library of Medicine (R01LM006942)
Topics
  • Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
  • Physical Sciences › Computer Science › Information Systems › Thoreau and American Literature
  • Health Sciences › Health Professions › Health Information Management › Medical Coding and Health Information
Keywords
electronic health records, EHR adoption, clinical decision support alerts, opt-out provisions, health care payment reform, health information privacy, interoperability, health care reform
MeSH terms
Adolescent, Child, Child, Preschool, Confidentiality, Decision Support Techniques, Ethics, Medical, Financial Support, Health Plan Implementation, Humans, Infant, Physician's Role, United States, Liability, Legal, Safety Management, Health Care Reform, Electronic Health Records

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