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Can Electronic Medical Record Technologies Make Healthcare Professionals More Ethical?

June 21, 2014

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Medical practices and hospitals are rapidly transitioning from paper to electronic medical record and dictation systems because they offer advantages in efficiency, legibility, communication of clinical data, and standardization and verification of required documentation. A number of ethical pitfalls in these technologies have been identified, including the potential to breach confidentiality, multiply errors, render authorship ambiguous, create a false appearance that prepopulated data was reviewed, and divert attention from the patient. An underexamined question is how these technologies might be used to promote, not just improved efficiency, quality, and safety, but also a higher ethical standard of medical care. One way would be to empower good intent with effective resources. The physician who is consistently morally conscientious can, I would argue, deliver better outcomes if supplied with more timely, up-to-date, and accurate data as well as access to relevant digital information about ethical principles and standards. The physician who intends always to be morally conscientious but, given the realities of medical practice and human limitations, is nevertheless subject to occasional error and rare lapses, could, I would argue, achieve better clinical outcomes with technology that fills gaps by, for example, detecting mistakes or omissions and supplying prompts and reminders. Emerging technologies might also be programmed to train moral habits, for example, by detecting and responding to word choice or proofing notes for completeness of informed consent discussions. No technology can ultimately succeed, however, in perfectly compelling virtue or producing clinical outcomes indistinguishable from those attained by a trustworthy, compassionate, and morally upright professional. Whereas computer prompts might direct someone correctly through the motions, machines can never command the emotions that engender empathy or by lines of software code replicate virtue. Because technology unchecked has the potential to magnify harms, virtuous human oversight will always be needed.

Keywords:
Health information technology; Compliance; Pharmaceuticals; Confidentiality; Research ethics; Informed consent; Clinical decision-making; AI; Artificial Intelligence