Confessions of a Health Plan CEO

Health Technology, Digital Healthcare

Article | August 21, 2023

Discover the potential of EHR implementation in revolutionizing clinical processes. Uncover strategies for addressing EHR ethical issues, ensuring integration that prioritizes patient-centered care. Amidst the fusion of healthcare and technology, integrating electronic health records (EHRs) has emerged as a transformative element in modern medical practice. As a digital repository for a patient's medical journey, EHRs present unprecedented prospects for elevated care quality, improved data accessibility, and cost-effectiveness. Nevertheless, these advancements bring forth an array of EHR ethical issues that demand meticulous attention. In this context, establishing and adhering to the best practices for the ethical training of EHRs assumes paramount importance and a moral obligation. By skillfully navigating the intricate convergence of technology, patient confidentiality, and conscientious healthcare, these ethical EHR best practices illuminate the path toward a future where innovation and ethical principles harmoniously coexist. 1. Upholding Privacy and Confidentiality Revealing a patient's information to external parties should strictly happen with the patient's explicit consent or within the parameters defined by legal regulations. Data stemming from clinical interactions is confidential and requires rigorous protection. The effective operation of EHRs requires authorized access by healthcare institutions, insurers, and related entities. Access by users is contingent upon predefined role-based privileges. The administrator identifies users, specifies the extent of information accessibility, and allocates exclusive usernames and passwords. Users must be conscientious about responsibly utilizing the information they access within their designated roles. Therefore, assigning user privileges plays a pivotal role in securing medical records. However, while regulating data access remains crucial, it doesn’t completely ensure confidentiality. Strengthening security through comprehensive privacy and security protocols remains essential for reinforcing patient data's inviolabilit. 2. Safeguarding Against Data Breaches Ensuring patient privacy and safeguarding sensitive medical data is paramount in EHR ethical training. The imperatives of inadequate data security, encompassing compromised medical information, unauthorized access due to weak password safeguards, and the lack of encryption, accentuate the immediate need for a holistic approach. Employing strategies such as secure cloud storage, robust password protocols, two-factor authentication, and encryption is pivotal in enhancing data security, preventing the mishandling of patient records, and abiding by ethical standards. The potential legal and financial consequences of breaches underscore the criticality of these practices in maintaining patient trust and confidentiality within the digital healthcare domain. 3. EHR System Implementation The integration of EHRs within healthcare organizations poses significant challenges, including resource waste, provider dissatisfaction, diminished patient trust, and potential safety risks. Successful EHR development, implementation, and upkeep demand substantial investment and collaboration among stakeholders, including clinicians, IT experts, educators, and consultants. Clinicians' active engagement is often underestimated, leading to the failure of EHR projects; therefore, clinician-led guidance is crucial in tasks such as EHR selection, workflow design, and quality improvement. Thoroughly mapping workflows before selecting an EHR is crucial, while maintaining user-friendly interfaces remains essential for success. Neglecting these aspects can reduce efficiency, compromise care, and increase safety threats. By prioritizing comprehensive planning, engaging clinicians, and optimizing user interfaces, healthcare institutions can ensure ethical and efficient EHR integration, ultimately enhancing patient care and safety. 4. Maintaining Data Accuracy Upholding data accuracy stands as a fundamental principle in the ethical EHR domain. The integrity of information guarantees its unaltered and precise nature, contributing significantly to the enhancement of patient safety, reduction of healthcare errors, mitigation of health disparities, and betterment of public health. Nevertheless, concerns have been voiced regarding the reliability of data input into electronic records. The improper utilization of functionalities such as 'cut and paste' can lead to misleading portrayals of a patient's condition and treatment, breaching ethical standards. This practice poses elevated risks to patients and increases the liability of clinicians and institutions. Challenges also arise from drop-down menus that limit a clinician's choices, potentially giving rise to substantial errors, especially under time constraints. The collaborative efforts of clinicians and vendors can address software concerns, promoting user-friendly, reliable EHRs while tackling EHR ethical issues. Furthermore, data loss during transfers raises pertinent concerns about the accuracy of the database, a critical aspect as patient care decisions hinge on this data. 5. Guaranteeing Data Authenticity The assurance of documentation integrity pertains to the accurate and precise nature of the comprehensive health record. This includes principles of information governance, identifying patients, validating authorship, handling amendments and corrections in records, and auditing documentation validity while submitting reimbursement claims. EHR tools offer flexible documentation options through the utilization of templates and smart phrases, assisting in precise record-keeping. However, if these tools are misused, doubts about data integrity can arise, making information unreliable and possibly raising concerns about fraudulent activity. Established policies and procedures, including audit functions, must be in place to ensure proper billing. With adequate safeguards, records may accurately represent the patient's condition at admission and over time. Providers must understand the importance of reviewing and refining default data to ensure that only patient-specific information for that visit is recorded. In contrast, irrelevant data from default templates is removed. 6. Validating Dictation to Prevent Errors Voice recognition systems lacking a validation step pose considerable challenges in maintaining data accuracy and preventing documentation errors within organizations, particularly when it comes to ethical issues with electronic health records. EHR companies need to implement a protocol requiring providers to promptly assess, modify, and validate dictated information. Given these documents' frequent use and sharing, precise and high-quality documentation in EHR systems is of utmost significance. The adoption of EHRs has led to substantial shifts in provider workflows and documentation processes. However, providers still need to clearly outline or fully understand comprehensive best practices for maintaining high-quality documentation in EHRs. Advancements are necessary to enhance documentation tools and methods, with a renewed emphasis on the essential aspects of data accuracy and quality. This should precede the widespread implementation of interoperable health information exchange initiatives. 7. Ensuring Accurate Documentation Maintaining the integrity of documentation is compromised when incorrect information finds its way onto the wrong patient's health record. Patient identification errors can influence clinical decisions, endanger patient safety, violate privacy and security, and lead to redundant testing and escalated expenses for patients as well as providers. The propagation of patient identification mistakes can rapidly expand within EHR, personal health records, and Health Information Exchange (HIE) networks as information disseminates. Failing to implement advanced front-end solutions that incorporate robust matching algorithms or innovative techniques like biometrics or fingerprinting can expose organizations to risk. EHRs can incorporate targeted alerts to anticipate safety problems, like blood type inconsistencies or allergies, during treatment, addressing EHR issues. Organizations must institute a patient identity integrity program, integrating performance improvement metrics to monitor error rates and duplicate records in their electronic master patient index. Policies and procedures must ensure the accuracy of critical demographic data, facilitating the linkage of records within and across systems. Addressing the initial point of data capture as a primary front-end verification is also vital within policies. 8. Preserving the Authenticity of Audit Trails Effective audits are crucial to ensuring that the health record documentation aligns with the reported level of service, fulfills reimbursement requirements set by payers, and guarantees that only authorized personnel access patient medical records and make entries. The audit trail must encompass the user's name, the triggering application, workstation details, the specific document, a description of the audited event (such as amendments, corrections, or deletions), and the timestamp. This audit trail outlines modifications (including deletions) within the health record and provides auditors with a foundation for compliance audits. Inadequate audit trail functionality within EHRs raises concerns about the integrity of health record documentation, potentially exposing organizations to legal liabilities and inadvertently fostering or shielding criminal activities. It may become challenging to ascertain if corrections or amendments were executed, who authorized the changes, or the nature of the modifications. In addition to the inherent unintentional errors that documentation might encounter, audit trail functionality can aid in detecting instances where records are altered to obstruct the disclosure of detrimental information. Organizations can utilize EHR trends to leverage audit trail features for identifying and analyzing patterns in health record usage. Typically, users can generate reports over specific time frames categorized by provider or provider type, with results directed to a compliance committee or the organization's governing body. 9. Fostering Compliance Awareness Enhancing ethical EHR training involves a strategic focus on ensuring providers are well-versed in compliance and legal risks, starting from the EHR training phase. To address EHR problems, organizations should implement educational initiatives aimed at mitigating compliance issues. Staff education must emphasize the integrity of health record documentation, with a continuous program monitored and provided quarterly or annually. Addressing the 'who, what, why, and how' ensures a solid grasp of organizational practices that uphold individual best practices, encompassing identifying potential fraud, universal and administrative security measures, data validity, authorship, continual education's significance, and strategies for daily fraud prevention. 10. Conducting Feedback Sessions Contrary to common assumptions, ongoing training is essential post-EHR implementation. After installing the EHR and initiating patient interactions, challenges inevitably emerge—be it staff unfamiliarity with functions or the need to revamp workflow processes. Promptly identifying these concerns to prevent errors and swiftly resolving them involves collecting feedback from EHR users among the staff, particularly in relation to EHR ethical issues. During the weeks after the system's launch, contemplate arranging routine meetings to gather insights. Ensuring diverse representation, including clinical staff, physicians, administrators, billing, and front desk personnel, is crucial. Seek input on their adaptation to changes and areas requiring improvement. Determine if specific training concepts need reinforcement. Surveys can be used in place of frequent meetings. Subsequently, prioritizing problem areas aids focused resolution by promptly addressing critical matters. The introduction of incremental changes helps staff adapt to the EHR seamlessly, safeguarding patient care continuity during the transition. The Path Ahead Following these ethical EHR training best practices ensures the accuracy and reliability of patient data, leading to improved clinical decision-making and patient safety. By maintaining documentation integrity, professionals can confidently provide quality care and reduce the risk of errors. Ethical EHR training further strengthens compliance with legal regulations, safeguarding both the organization as well as the healthcare provider from potential legal liabilities. Moreover, adhering to best practices promotes efficient workflows, enhancing productivity, and streamlining operations. Patient trust and confidence are strengthened as professionals demonstrate their commitment to data security, confidentiality, and ethical conduct. Ultimately, by upholding ethical EHR training standards, professionals contribute to a robust healthcare system by fostering positive patient outcomes, maintaining trust, and supporting the principles of ethical healthcare delivery.