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Pratt B, Parker M, Bull S. Equitable Design and Use of Digital Surveillance Technologies During COVID-19: Norms and Concerns. J Empir Res Hum Res Ethics 2022; 17:573-586. [PMID: 36069118 PMCID: PMC9676107 DOI: 10.1177/15562646221118127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Given the unprecedented scale of digital surveillance in the COVID-19 pandemic, designing and implementing digital technologies in ways that are equitable is critical now and in future epidemics and pandemics. Yet to date there has been very limited consideration about what is necessary to promote their equitable design and implementation. In this study, literature relating to the use of digital surveillance technologies during epidemics and pandemics was collected and thematically analyzed for ethical norms and concerns related to equity and social justice. Eleven norms are reported, including procedural fairness and inclusive approaches to design and implementation, designing to rectify or avoid exacerbating inequities, and fair access. Identified concerns relate to digital divides, stigma and discrimination, disparate risk of harm, and unfair design processes. We conclude by considering what dimensions of social justice the norms promote and whether identified concerns can be addressed by building the identified norms into technology design and implementation practice.
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Affiliation(s)
- Bridget Pratt
- Queensland Bioethics Centre, Australian Catholic University, Brisbane, Australia,School of Population and Global Health, University of Melbourne, Melbourne, Australia,Bridget Pratt, Queensland Bioethics Centre, Australian Catholic University, 1100 Nudgee Rd, Brisbane, Australia.
| | - Michael Parker
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Susan Bull
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK,Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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2
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Verosky A, Leonard LD, Quinn C, Vemuru S, Warncke E, Himelhoch B, Huynh V, Wolverton D, Jaiswal K, Ahrendt G, Sams S, Lin CT, Cumbler E, Schulick R, Tevis SE. Patient comprehension of breast pathology report terminology: The need for patient-centered resources. Surgery 2022; 172:831-837. [PMID: 35715235 DOI: 10.1016/j.surg.2022.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND As health care continues to evolve toward information transparency, an increasing number of patients have access to their medical records, including result reports that were not originally designed to be patient-facing. Previous studies have demonstrated that patients have poor understanding of medical terminology. However, patient comprehension of terminology specific to breast pathology reports has not been well studied. We assessed patient understanding of common medical terms found in breast pathology reports. METHODS A survey was administered electronically to patients scheduled for a screening mammogram within a multisite health care system. Participants were asked to objectively define and interpret 8 medical terms common to breast biopsy pathology reports. Patient perception of the utility of various educational tools was also assessed. Demographic information including health literacy, education level, previous cancer diagnosis, and primary language was collected. RESULTS In total, 527 patients completed the survey. Terms including "malignant" and "benign" were the most correctly defined at 80% and 73%, respectively, whereas only 1% correctly defined "high grade." Factors including race/ethnicity and education level were correlated with more correct scores. Patients preferred educational tools that were specific to their diagnosis and available at the time they were reviewing their results. CONCLUSION Patient comprehension of common medical terminology is poor. Potential assumptions of understanding based on patient factors including education, past medical history, and occupation are misinformed. With the newly mandated immediate release of information to patients, there is a pressing need to develop and integrate educational tools to support patients through all aspects of their care.
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Affiliation(s)
- Alexandra Verosky
- School of Medicine, University of Colorado, Denver, CO. https://twitter.com/veroskyalex
| | | | | | - Sudheer Vemuru
- Department of Surgery, University of Colorado, Denver, CO. https://twitter.com/sudheervemuru
| | - Emily Warncke
- Department of Radiology, University of Colorado, Denver, CO
| | - Ben Himelhoch
- Department of Radiology, University of Colorado, Denver, CO. https://twitter.com/BHimelhoch
| | - Victoria Huynh
- Department of Surgery, University of Colorado, Denver, CO. https://twitter.com/THuynhMD
| | | | - Kshama Jaiswal
- School of Medicine, University of Colorado, Denver, CO. https://twitter.com/KshamaRJaiswal
| | - Gretchen Ahrendt
- Department of Surgery, University of Colorado, Denver, CO. https://twitter.com/ahrendt50
| | - Sharon Sams
- Department of Pathology, University of Colorado, Denver, CO
| | - Chen-Tan Lin
- Department of Medicine, University of Colorado, Denver, CO. https://twitter.com/CTLin1
| | - Ethan Cumbler
- Department of Surgery, University of Colorado, Denver, CO; Department of Medicine, University of Colorado, Denver, CO. https://twitter.com/ECumbler
| | - Richard Schulick
- Department of Surgery, University of Colorado, Denver, CO. https://twitter.com/RichSchulickMD
| | - Sarah E Tevis
- Department of Surgery, University of Colorado, Denver, CO. https://twitter.com/SarahTevisMD
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3
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Liang Z, Xu M, Liu G, Zhou Y, Howard P. Patient-centred care and patient autonomy: doctors' views in Chinese hospitals. BMC Med Ethics 2022; 23:38. [PMID: 35395761 PMCID: PMC8994393 DOI: 10.1186/s12910-022-00777-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 03/29/2022] [Indexed: 11/29/2022] Open
Abstract
Background Patient-centred care and patient autonomy is one of the key factors to better quality of service provision, hence patient outcomes. It enables the development of patients’ trusts which is an important element to a better doctor-patient relationship. Given the increasing number of patient disputes and conflicts between patients and doctors in Chinese public hospital, it is timely to ensure patient-centred care is fully and successfully implemented. However, limited studies have examined the views and practice in different aspects of patient-centred care among doctors in the Chinese public hospitals. Methods A quantitative approach was adopted by distributing paper-based questionnaires to doctors and patients in two hospitals (Level III and Level II) in Jinan, Shandong province, China. Results In total, 614 doctors from the surgical and internal medicine units of the two hospitals participated in the survey yielding 90% response rates. The study confirmed the inconsistent views among doctors in terms of their perception and practice in various aspects patient-centred care and patient autonomy regardless of the hospital where they work (category II or category III), their unit speciality (surgical or non-surgical), their gender or seniority. The high proportion of doctors (more than 20%) who did not perceive the importance of patient consultation prior to determining diagnostic and treatment procedure is alarming. This in in part due to the belief held by more than half of the doctors that patients were unable to make rational decisions and their involvement in treatment planning process did not necessarily lead to better treatment outcomes. Conclusion The study calls for the development of system level policy and organisation wide strategies in encouraging and enabling the practice of patient-centred care and patient autonomy with the purposes of improving the quality of the service provided to patients by Chinese hospitals. Supplementary Information The online version contains supplementary material available at 10.1186/s12910-022-00777-w.
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Affiliation(s)
- Zhanming Liang
- The Second Affiliated Hospital of Shandong First Medical University, Taian, China.,James Cook University, Townsville, Australia
| | - Min Xu
- The Second Affiliated Hospital of Shandong First Medical University, Taian, China.
| | - Guowei Liu
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yongli Zhou
- Shandong University of Traditional Chinese Medicine, Jinan, China
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4
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Leonard LD, Himelhoch B, Huynh V, Wolverton D, Jaiswal K, Ahrendt G, Sams S, Cumbler E, Schulick R, Tevis SE. Patient and clinician perceptions of the immediate release of electronic health information. Am J Surg 2021; 224:27-34. [PMID: 34903369 DOI: 10.1016/j.amjsurg.2021.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/28/2021] [Accepted: 12/01/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The 21st Century Cures Act requires that institutions release all electronic health information (EHI) to patients immediately. We aimed to understand patient and clinician attitudes toward the immediate release of EHI to patients. METHODS Patients and clinicians representing distinct specialties at a single academic medical center completed a survey to assess attitudes toward the immediate release of results. Differences between patient and clinician responses were compared using chi-square and student's t-test for categorical and continuous variables, respectively. A two-sided significance level of 0.05 was used for all statistical tests. RESULTS 69 clinicians and 57 patients completed the survey. Both patients (89.7%) and clinicians (80.6%) agreed or strongly agreed-here after referred to as agreed, that providing patients with access to their health information is necessary in delivering high-quality care. However, 62.7% of clinicians agreed that results released immediately would be more confusing than helpful, whereas the minority of patients agreed with this statement (15.8%) (p < 0.05). Providers were also more likely to disagree that patients are comfortable independently interpreting blood work results (p < 0.05), radiology results (p < 0.05) and pathology reports (p < 0.05). With regard to timing, the majority of patients (75.1%) felt their provider should contact them within 24 h of the release of an abnormal result, whereas only 9.0% of clinicians agreed with this timeframe (p < 0.05). DISCUSSIONS Patients and clinicians value information transparency. However, the immediate release of results is controversial, especially among clinicians. The discrepancy between patient and clinician perceptions underlines the importance of setting expectations about the communication of results. Additionally, our results emphasize the need to implement strategies to help improve patient comprehension, decrease patient distress and improve clinician workflows.
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Affiliation(s)
- Laura D Leonard
- Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, 12631 East, 17th Ave. 6th Floor, Aurora, CO, 80045, USA.
| | - Ben Himelhoch
- Department of Radiology, University of Colorado School of Medicine, Anschutz Medical Campus, 12401 East 17th Ave, Aurora, CO, 80045, USA
| | - Victoria Huynh
- Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, 12631 East, 17th Ave. 6th Floor, Aurora, CO, 80045, USA
| | - Dulcy Wolverton
- Department of Radiology, University of Colorado School of Medicine, Anschutz Medical Campus, 12401 East 17th Ave, Aurora, CO, 80045, USA
| | - Kshama Jaiswal
- Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, 12631 East, 17th Ave. 6th Floor, Aurora, CO, 80045, USA
| | - Gretchen Ahrendt
- Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, 12631 East, 17th Ave. 6th Floor, Aurora, CO, 80045, USA
| | - Sharon Sams
- Department of Pathology, University of Colorado School of Medicine, Anschutz Medical Campus, 12631 East 17th Ave, 2nd Floor, Aurora, CO, 80045, USA
| | - Ethan Cumbler
- Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, 12631 East, 17th Ave. 6th Floor, Aurora, CO, 80045, USA; Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, 12631 East 17th Ave, 8th Floor, Aurora, CO, 80045, USA
| | - Richard Schulick
- Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, 12631 East, 17th Ave. 6th Floor, Aurora, CO, 80045, USA
| | - Sarah E Tevis
- Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, 12631 East, 17th Ave. 6th Floor, Aurora, CO, 80045, USA
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Scheibner J, Sleigh J, Ienca M, Vayena E. Benefits, challenges, and contributors to success for national eHealth systems implementation: a scoping review. J Am Med Inform Assoc 2021; 28:2039-2049. [PMID: 34151990 DOI: 10.1093/jamia/ocab096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/27/2021] [Accepted: 05/21/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Our scoping review aims to assess what legal, ethical, and socio-technical factors contribute to or inhibit the success of national eHealth system implementations. In addition, our review seeks to describe the characteristics and benefits of eHealth systems. MATERIALS AND METHODS We conducted a scoping review of literature published in English between January 2000 and 2020 using a keyword search on 5 databases: PubMed, Scopus, Web of Science, IEEEXplore, and ProQuest. After removal of duplicates, abstract screening, and full-text filtering, 86 articles were included from 8276 search results. RESULTS We identified 17 stakeholder groups, 6 eHealth Systems areas, and 15 types of legal regimes and standards. In-depth textual analysis revealed challenges mainly in implementation, followed by ethico-legal and data-related aspects. Key factors influencing success include promoting trust of the system, ensuring wider acceptance among users, reconciling the system with legal requirements, and ensuring an adaptable technical platform. DISCUSSION Results revealed support for decentralized implementations because they carry less implementation and engagement challenges than centralized ones. Simultaneously, due to decentralized systems' interoperability issues, federated implementations (with a set of national standards) might be preferable. CONCLUSION This study identifies the primary socio-technical, legal, and ethical factors that challenge and contribute to the success of eHealth system implementations. This study also describes the complexities and characteristics of existing eHealth implementation programs, and suggests guidance for resolving the identified challenges.
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Affiliation(s)
- James Scheibner
- Department of Health Sciences and Technology, Health Ethics and Policy Laboratory, ETH Zürich, Zürich, Switzerland.,College of Business, Government and Law, Flinders University, Adelaide, Australia
| | - Joanna Sleigh
- Department of Health Sciences and Technology, Health Ethics and Policy Laboratory, ETH Zürich, Zürich, Switzerland
| | - Marcello Ienca
- Department of Health Sciences and Technology, Health Ethics and Policy Laboratory, ETH Zürich, Zürich, Switzerland
| | - Effy Vayena
- Department of Health Sciences and Technology, Health Ethics and Policy Laboratory, ETH Zürich, Zürich, Switzerland
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6
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Bernaerdt J, Moerenhout T, Devisch I. Vulnerable patients' attitudes towards sharing medical data and granular control in patient portal systems: an interview study. J Eval Clin Pract 2021; 27:429-437. [PMID: 32886953 DOI: 10.1111/jep.13465] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 06/04/2020] [Accepted: 07/17/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The collection, storage and exchange of medical information are becoming increasingly complex. More parties are involved in this process, and the data are expected to serve many different purposes beside patient care. This raises several ethical questions regarding privacy, data ownership, security and confidentiality. It is vital to consider patients' moral attitudes and preferences in this digital information exchange. The voice of vulnerable patients is rarely heard in research addressing these questions. This study aims to address this void. METHOD Fourteen vulnerable patients without prior experience with patient portal systems were interviewed for this study. First, participants were introduced to the portal and given time to read their personal medical data. Afterwards, semi-structured interviews were conducted and analysed thematically to explore participants' first experience with the portal and their views on sharing medical information with care providers and other parties. RESULTS Data analysis resulted in four themes: barriers to and benefits of portal access, emotional responses to reading medical information, diverging views on sharing information with third parties and balancing granular control and the best possible care. First, participants appreciated access to their health information in the portal despite experiencing obstacles. Second, reading medical information online could evoke emotional responses. Third, patients were generally unaware of the meaning and value of medical data to third parties, resulting in inconsistent views on data sharing. Finally, although patients generally supported granular control, they were willing to give up on their autonomy if that would ensure them to receive the best possible care. CONCLUSIONS Patient portal design should take into consideration the obstacles that discourage vulnerable patients' access and hamper meaningful use. There is a need for more transparency on secondary use of medical data by third parties. Patients should be better informed about the potential consequences of sharing data with them.
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Affiliation(s)
- Jodie Bernaerdt
- Department of Public Health and Primary Care, Research Group Philosophy of Medicine and Ethics, Ghent University; Ghent, Belgium
| | - Tania Moerenhout
- Department of Public Health and Primary Care, Research Group Philosophy of Medicine and Ethics, Ghent University; Ghent, Belgium.,Department of Philosophy and Moral Sciences, Ghent University; Ghent, Belgium
| | - Ignaas Devisch
- Department of Public Health and Primary Care, Research Group Philosophy of Medicine and Ethics, Ghent University; Ghent, Belgium
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7
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Jacquemard T, Doherty CP, Fitzsimons MB. The anatomy of electronic patient record ethics: a framework to guide design, development, implementation, and use. BMC Med Ethics 2021; 22:9. [PMID: 33541335 PMCID: PMC7859903 DOI: 10.1186/s12910-021-00574-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 01/12/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This manuscript presents a framework to guide the identification and assessment of ethical opportunities and challenges associated with electronic patient records (EPR). The framework is intended to support designers, software engineers, health service managers, and end-users to realise a responsible, robust and reliable EPR-enabled healthcare system that delivers safe, quality assured, value conscious care. METHODS Development of the EPR applied ethics framework was preceded by a scoping review which mapped the literature related to the ethics of EPR technology. The underlying assumption behind the framework presented in this manuscript is that ethical values can inform all stages of the EPR-lifecycle from design, through development, implementation, and practical application. RESULTS The framework is divided into two parts: context and core functions. The first part 'context' entails clarifying: the purpose(s) within which the EPR exists or will exist; the interested parties and their relationships; and the regulatory, codes of professional conduct and organisational policy frame of reference. Understanding the context is required before addressing the second part of the framework which focuses on EPR 'core functions' of data collection, data access, and digitally-enabled healthcare. CONCLUSIONS The primary objective of the EPR Applied Ethics Framework is to help identify and create value and benefits rather than to merely prevent risks. It should therefore be used to steer an EPR project to success rather than be seen as a set of inhibitory rules. The framework is adaptable to a wide range of EPR categories and can cater for new and evolving EPR-enabled healthcare priorities. It is therefore an iterative tool that should be revisited as new EPR-related state-of-affairs, capabilities or activities emerge.
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Affiliation(s)
- Tim Jacquemard
- FutureNeuro, the SFI Research Centre for Chronic and Rare Neurological Diseases, RCSI, 123 Stephen’s Green, Dublin 2, Ireland
| | - Colin P. Doherty
- FutureNeuro, the SFI Research Centre for Chronic and Rare Neurological Diseases, RCSI, 123 Stephen’s Green, Dublin 2, Ireland
- St. James’s Hospital, James’s Street, Dublin 8, Ireland
- Trinity College Dublin, Dublin 2, College Green, Ireland
| | - Mary B. Fitzsimons
- FutureNeuro, the SFI Research Centre for Chronic and Rare Neurological Diseases, RCSI, 123 Stephen’s Green, Dublin 2, Ireland
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8
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Jacquemard T, Doherty CP, Fitzsimons MB. Examination and diagnosis of electronic patient records and their associated ethics: a scoping literature review. BMC Med Ethics 2020; 21:76. [PMID: 32831076 PMCID: PMC7446190 DOI: 10.1186/s12910-020-00514-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 08/03/2020] [Indexed: 02/22/2023] Open
Abstract
Background Electronic patient record (EPR) technology is a key enabler for improvements to healthcare service and management. To ensure these improvements and the means to achieve them are socially and ethically desirable, careful consideration of the ethical implications of EPRs is indicated. The purpose of this scoping review was to map the literature related to the ethics of EPR technology. The literature review was conducted to catalogue the prevalent ethical terms, to describe the associated ethical challenges and opportunities, and to identify the actors involved. By doing so, it aimed to support the future development of ethics guidance in the EPR domain. Methods To identify journal articles debating the ethics of EPRs, Scopus, Web of Science, and PubMed academic databases were queried and yielded 123 eligible articles. The following inclusion criteria were applied: articles need to be in the English language; present normative arguments and not solely empirical research; include an abstract for software analysis; and discuss EPR technology. Results The medical specialty, type of information captured and stored in EPRs, their use and functionality varied widely across the included articles. Ethical terms extracted were categorised into clusters ‘privacy’, ‘autonomy’, ‘risk/benefit’, ‘human relationships’, and ‘responsibility’. The literature shows that EPR-related ethical concerns can have both positive and negative implications, and that a wide variety of actors with rights and/or responsibilities regarding the safe and ethical adoption of the technology are involved. Conclusions While there is considerable consensus in the literature regarding EPR-related ethical principles, some of the associated challenges and opportunities remain underdiscussed. For example, much of the debate is presented in a manner more in keeping with a traditional model of healthcare and fails to take account of the multidimensional ensemble of factors at play in the EPR era and the consequent need to redefine/modify ethical norms to align with a digitally-enabled health service. Similarly, the academic discussion focuses predominantly on bioethical values. However, approaches from digital ethics may also be helpful to identify and deliberate about current and emerging EPR-related ethical concerns.
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Affiliation(s)
- Tim Jacquemard
- FutureNeuro, the SFI Research Centre for Chronic and Rare Neurological Diseases, 123 Stephen's Green, Dublin 2, Ireland.
| | - Colin P Doherty
- FutureNeuro, the SFI Research Centre for Chronic and Rare Neurological Diseases, 123 Stephen's Green, Dublin 2, Ireland.,Department of Neurology, St. James's Hospital, James's Street, Dublin 8, Ireland.,Trinity College Dublin, College Green, Dublin 2, Ireland
| | - Mary B Fitzsimons
- FutureNeuro, the SFI Research Centre for Chronic and Rare Neurological Diseases, 123 Stephen's Green, Dublin 2, Ireland
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D'Costa SN, Kuhn IL, Fritz Z. A systematic review of patient access to medical records in the acute setting: practicalities, perspectives and ethical consequences. BMC Med Ethics 2020; 21:18. [PMID: 32122332 PMCID: PMC7053049 DOI: 10.1186/s12910-020-0459-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 02/17/2020] [Indexed: 11/10/2022] Open
Abstract
Background Internationally, patient access to notes is increasing. This has been driven by respect for patient autonomy, often recognised as a primary tenet of medical ethics: patients should be able to access their records to be fully engaged with their care. While research has been conducted on the impact of patient access to outpatient and primary care records and to patient portals, there is no such review looking at access to hospital medical records in real time, nor an ethical analysis of the issues involved in such a change in process. Methods This study employed a systematic review framework in two stems, to integrate literature identified from two searches: Medline, CINAHL and Scopus databases were conducted, (for (1) hospitalised patients, patient access to records and its effects on communication and trust within the doctor-patient relationship; and (2) patient access to medical records and the ethical implications identified). The qualitative and quantitative results of both searches were integrated and critically analysed. Results 3954 empirical and 4929 ethical studies were identified; 18 papers representing 16 studies were identified for review (12 empirical and 6 ethical). The review reveals a consensus that our current approach to giving information to patients – almost exclusively verbally – is insufficient; that patient access to notes is a welcome next step for patient-centred care, but that simply allowing full access, without explanation or summary, is also insufficient. Several ethical implications need to be considered: increased information could improve patient trust and knowledge but might transfer an (unwelcome) sense of responsibility to patients; doctors and patients have conflicting views on how much information should be shared and when; sharing written information might increase the already significant disparity in access to health care, and have unforeseen opportunity costs. The impact on medical practice of sharing notes in real time will also need to be evaluated. Conclusions The review presents encouraging data to support patient access to medical notes. However, sharing information is a critical part of clinical practice; changing how it is done could have significant empirical and ethical impacts; any changes should be carefully evaluated.
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Affiliation(s)
- Stephanie N D'Costa
- Gonville and Caius College, Cambridge University, Trinity Street, Cambridge, CB2 1TA, UK
| | - Isla L Kuhn
- THIS Institute (The Healthcare Improvement Studies Institute), Cambridge University, Clifford Allbutt Building, Cambridge, CB2 0AH, UK
| | - Zoë Fritz
- THIS Institute (The Healthcare Improvement Studies Institute), Cambridge University, Clifford Allbutt Building, Cambridge, CB2 0AH, UK.
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10
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Lupton D. 'I'd like to think you could trust the government, but I don't really think we can': Australian women's attitudes to and experiences of My Health Record. Digit Health 2019; 5:2055207619847017. [PMID: 31069106 PMCID: PMC6492356 DOI: 10.1177/2055207619847017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 04/07/2019] [Indexed: 12/17/2022] Open
Abstract
The Australian government’s Australian Digital Health Agency is working towards
its goal of enrolling every Australian in My Health Record, its national
electronic health record system. This article reports findings from a
qualitative project involving interviews and focus groups with Australian women
about their use of digital health across the range of technologies available to
them, including their attitudes to and experiences of My Health Record. A
feminist new materialism perspective informed the project, working to surface
the affordances, affective forces and relational connections that contributed to
the opening up or closing off potential agential capacities when people come
together with digitised systems such as My Health Record. These findings
demonstrate that people’s personal experiences and feelings, the actions of
others such as the agencies responsible for system implementation and function,
their healthcare providers and broader social, cultural, technological and
political factors are important in shaping their knowledge, interest in and
acceptance of an electronic health record system. Even among this group of
participants, who were experienced and active in finding and engaging with
health information online, uncertainty and a lack of awareness of and interest
in My Health Record were evident among many. Affordances such as technical
difficulties were major barriers to enrolling and using the system successfully.
No participants had yet found any benefit or use for it. Affective forces such
as lack of trust and faith in the Australian government’s general technological
expertise and concerns about data privacy and security were also key in many
participants’ accounts.
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Affiliation(s)
- Deborah Lupton
- News & Media Research Centre, University of Canberra, Australia
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11
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Contemporary views of dental practitioners' on patient safety. Br Dent J 2017; 219:535-9; discussion 540. [PMID: 26657441 DOI: 10.1038/sj.bdj.2015.920] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND There is little known about general dental practitioners' (GDPs) views on patient safety in dentistry; we believe this to be the first paper describing their opinions and ideas for maintaining or improving safe practices. METHODS Focus groups were used to gather the views of 12 GDPs (who also hold university teaching contracts) on the following topics: Defining patient safety, the important issues in patient safety, safeguards and tools for maintaining safe care, never events and research priorities. Thematic analysis was performed on the verbatim transcripts. RESULTS Key themes from the practitioners included: Medical history (polypharmacy and co-morbidities), competence and skill level, the use of safeguards and tools to ensure safety, the importance of effective communication (including working with a chaperone) and the role of reflective practice. Suggestions for improvement included: effective sharing of information with other healthcare professionals, easy access to guidelines and educational tools, adoption of practice protocols, team working and the use of universal charting systems to limit ambiguity. CONCLUSIONS GDPs are well versed in the concept of patient safety and are keen to implement evidence based tools and/or interventions designed to improve safety for their patients.
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12
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Myhre SL, Kaye J, Bygrave LA, Aanestad M, Ghanem B, Mechael P, Frøen JF. eRegistries: governance for electronic maternal and child health registries. BMC Pregnancy Childbirth 2016; 16:279. [PMID: 27663979 PMCID: PMC5035445 DOI: 10.1186/s12884-016-1063-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 09/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The limited availability of maternal and child health data has limited progress in reducing mortality and morbidity among pregnant women and children. Global health agencies, leaders, and funders are prioritizing strategies that focus on acquiring high quality health data. Electronic maternal and child health registries (eRegistries) offer a systematic data collection and management approach that can serve as an entry point for preventive, curative and promotive health services. Due to the highly sensitive nature of reproductive health information, careful consideration must be accorded to privacy, access, and data security. In the third paper of the eRegistries Series, we report on the current landscape of ethical and legal governance for maternal and child health registries in developing countries. METHODS This research utilizes findings from two web-based surveys, completed in 2015 that targeted public health officials and health care providers in 76 countries with high global maternal and child mortality burden. A sample of 298 public health officials from 64 countries and 490 health care providers from 59 countries completed the online survey. Based on formative research in the development of the eRegistries Governance Guidance Toolkit, the surveys were designed to investigate topics related to maternal and child health registries including ethical and legal issues. RESULTS According to survey respondents, the prevailing legal landscape is characterized by inadequate data security safeguards and weak support for core privacy principles. Respondents from the majority of countries indicated that health information from medical records is typically protected by legislation although legislation dealing specifically or comprehensively with data privacy may not be in place. Health care provider trust in the privacy of health data at their own facilities is associated with the presence of security safeguards. CONCLUSION Addressing legal requirements and ensuring that privacy and data security of women's and children's health information is protected is an ethical responsibility that must not be ignored or postponed, particularly where the need is greatest. Not only are the potential harm and unintended consequences of inaction serious for individuals, but they could impact public trust in health registries leading to decreased participation and compromised data integrity.
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Affiliation(s)
- Sonja L. Myhre
- Department of International Public Health, Norwegian Institute of Public Health, P.O. Box 4404, Nydalen, N-0403 Oslo Norway
| | - Jane Kaye
- Centre for Health, Law and Emerging Technologies, Nuffield Department of Population Health, University of Oxford, Rosemary Rue Building, Old Road Campus, Headington, Oxford, OX3 7LF UK
| | - Lee A. Bygrave
- Department of Private Law, Faculty of Law, University of Oslo, Postboks 6706, St Olavs plass, 0130 Oslo, Norway
| | - Margunn Aanestad
- Department of Informatics, University of Oslo, Gaustadalléen 23 B, N-0373 Oslo, Norway
| | - Buthaina Ghanem
- Palestinian National Institute of Public Health, Qaddoura Street, Ministry of Health Building, 1st Floor, Postbox 54812, Ramallah, Palestine
| | - Patricia Mechael
- School of Advanced International Studies, Johns Hopkins University, 1717 Massachusetts Ave, NW, Washington, DC 20036 USA
- HealthEnabled, Unit D11, Westlake Square, Westlake Drive, Westlake, Cape Town, South Africa 7945
| | - J. Frederik Frøen
- Department of International Public Health, Norwegian Institute of Public Health, P.O. Box 4404, Nydalen, N-0403 Oslo Norway
- Centre for Intervention Science in Maternal and Child Health, University of Bergen, Postbox 78000, 5020 Bergen, Norway
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Hemsley B, Georgiou A, Carter R, Hill S, Higgins I, van Vliet P, Balandin S. Use of the My Health Record by people with communication disability in Australia: A review to inform the design and direction of future research. Health Inf Manag 2016; 45:107-115. [PMID: 27269277 DOI: 10.1177/1833358316652060] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND People with communication disability often struggle to convey their health information to multiple service providers and are at increased risk of adverse health outcomes related to the poor exchange of health information. OBJECTIVE The purpose of this article was to (a) review the literature informing future research on the Australian personally controlled electronic health record, 'My Health Record' (MyHR), specifically to include people with communication disability and their family members or service providers, and (b) to propose a range of suitable methodologies that might be applied in research to inform training, policy and practice in relation to supporting people with communication disability and their representatives to engage in using MyHR. METHOD The authors reviewed the literature and, with a cross-disciplinary perspective, considered ways to apply sociotechnical, health informatics, and inclusive methodologies to research on MyHR use by adults with communication disability. RESEARCH OUTCOMES This article outlines a range of research methods suitable for investigating the use of MyHR by people who have communication disability associated with a range of acquired or lifelong health conditions, and their family members, and direct support workers. CONCLUSION In planning the allocation of funds towards the health and well-being of adults with disabilities, both disability and health service providers must consider the supports needed for people with communication disability to use MyHR. There is an urgent need to focus research efforts on MyHR in populations with communication disability, who struggle to communicate their health information across multiple health and disability service providers. The design of studies and priorities for future research should be set in consultation with people with communication disability and their representatives.
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Brisson GE, Neely KJ, Tyler PD, Barnard C. Should medical students track former patients in the electronic health record? An emerging ethical conflict. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:1020-1024. [PMID: 25565261 DOI: 10.1097/acm.0000000000000633] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Medical students are increasingly using electronic health records (EHRs) in clerkships, and medical educators should seek opportunities to use this new technology to improve training. One such opportunity is the ability to "track" former patients in the EHR, defined as following up on patients in the EHR for educational purposes for a defined period of time after they have left one's direct care. This activity offers great promise in clinical training by enabling students to audit their diagnostic impressions and follow the clinical history of illness in a manner not possible in the era of paper charting. However, tracking raises important questions about the ethical use of protected health information, including concerns about compromising patient autonomy, resulting in a conflict between medical education and patient privacy. The authors offer critical analysis of arguments on both sides and discuss strategies to balance the ethical conflict by optimizing outcomes and mitigating harms. They observe that tracking improves training, thus offering long-lasting benefits to society, and is supported by the principle of distributive justice. They conclude that students should be permitted to track for educational purposes, but only with defined limits to safeguard patient autonomy, including obtaining permission from patients, having legitimate educational intent, and self-restricting review of records to those essential for training. Lastly, the authors observe that this conflict will become increasingly important with completion of the planned Nationwide Health Information Network and emphasize the need for national guidelines on tracking patients in an ethically appropriate manner.
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Affiliation(s)
- Gregory E Brisson
- G.E. Brisson is assistant professor in clinical medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. K.J. Neely is assistant professor in medicine, Feinberg School of Medicine, Northwestern University, and chair, Medical Ethics Committee, Northwestern Memorial Hospital, Chicago, Illinois. P.D. Tyler was a final-year medical student, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, at the time this article was written. He is now a first-year resident, Beth Israel Deaconess Medical Center, Boston, Massachusetts. C. Barnard is director of quality strategies, Northwestern Memorial Hospital, and research associate professor, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Lassere MN, Baker S, Parle A, Sara A, Johnson KR. Improving quality of care and long-term health outcomes through continuity of care with the use of an electronic or paper patient-held portable health file (COMMUNICATE): study protocol for a randomized controlled trial. Trials 2015; 16:253. [PMID: 26040644 PMCID: PMC4473843 DOI: 10.1186/s13063-015-0760-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 05/18/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The advantages of patient-held portable health files (PHF) and personal health records (PHR), paper or electronic, are said to include improved health-care provider continuity-of-care and patient empowerment in maintaining health. Top-down approaches are favored by public sector government and health managers. Bottom-up approaches include systems developed directly by health-care providers, consumers and industry, implemented locally on devices carried by patient-consumers or shared via web-based portals. These allow individuals to access, manage and share their health information, and that of others for whom they are authorized, in a private, secure and confidential environment. Few medical record technologies have been evaluated in randomized trials to determine whether there are important clinical benefits of these interventions. The COMMUNICATE trial will assess the acceptability and long-term clinical outcomes of an electronic and paper patient-held PHF. METHODS/DESIGN This is a 48-month, open-label pragmatic, superiority, parallel-group design randomized controlled trial. Subjects (n = 792) will be randomized in a 1:1:1 ratio to each of the trial arms: the electronic PHF added to usual care, the paper PHF added to usual care and usual care alone (no PHF). Inclusion criteria include those 60 years or older living independently in the community, but who have two or more chronic medical conditions that require prescription medication and regular care by at least three medical practitioners (general and specialist care). The primary objective is whether use of a PHF compared to usual care reduces a combined endpoint of deaths, overnight hospitalizations and blindly adjudicated serious out-of-hospital events. All primary analyses will be undertaken masked to randomized arm allocation using intention-to-treat principles. Secondary outcomes include quality of life and health literacy improvements. DISCUSSION Lack of blinding creates potential for bias in trial conduct and ascertainment of clinical outcomes. Mechanisms are provided to reduce bias, including balanced study contact with all participants, a blinded adjudication committee determining which out-of-hospital events are serious and endpoints that are objective (overnight hospitalizations and mortality). The PRECIS tool provides a summary of the trial's design on the Pragmatic-Explanatory Continuum. TRIAL REGISTRATION Registered with Clinicaltrials.gov (identifier: NCT01082978) on 8 March 2010.
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Affiliation(s)
- Marissa Nichole Lassere
- Prince William Wing, St George Hospital, South Eastern Sydney Local Health District, Gray St, Kogarah, Sydney, 2217, NSW, Australia.
- School of Public Health and Community Medicine, Faculty of Medicine, University of NSW, Level 2 Samuels Building, Samuels Ave, Kensington, Sydney, NSW, 2033, Australia.
- St George and Sutherland Clinical School, Faculty of Medicine, University of NSW, Level 2 Clinical Sciences (WR Pitney) Building, St George Hospital, Short St, Kogarah, Sydney, 2217, Australia.
| | - Sue Baker
- Prince William Wing, St George Hospital, South Eastern Sydney Local Health District, Gray St, Kogarah, Sydney, 2217, NSW, Australia.
- St George and Sutherland Clinical School, Faculty of Medicine, University of NSW, Level 2 Clinical Sciences (WR Pitney) Building, St George Hospital, Short St, Kogarah, Sydney, 2217, Australia.
| | - Andrew Parle
- St George and Sutherland Clinical School, Faculty of Medicine, University of NSW, Level 2 Clinical Sciences (WR Pitney) Building, St George Hospital, Short St, Kogarah, Sydney, 2217, Australia.
| | - Anthony Sara
- Clinical Information Services, Prince of Wales Hospital, South Eastern Sydney Local Health District, Barker St, Randwick 2031, Sydney, Australia.
| | - Kent Robert Johnson
- School of Public Health and Community Medicine, Faculty of Medicine, University of NSW, Level 2 Samuels Building, Samuels Ave, Kensington, Sydney, NSW, 2033, Australia.
- St George and Sutherland Clinical School, Faculty of Medicine, University of NSW, Level 2 Clinical Sciences (WR Pitney) Building, St George Hospital, Short St, Kogarah, Sydney, 2217, Australia.
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Meslin EM, Schwartz PH. How bioethics principles can aid design of electronic health records to accommodate patient granular control. J Gen Intern Med 2015; 30 Suppl 1:S3-6. [PMID: 25480724 PMCID: PMC4265222 DOI: 10.1007/s11606-014-3062-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Ethics should guide the design of electronic health records (EHR), and recognized principles of bioethics can play an important role. This approach was recently adopted by a team of informaticists who are designing and testing a system where patients exert granular control over who views their personal health information. While this method of building ethics in from the start of the design process has significant benefits, questions remain about how useful the application of bioethics principles can be in this process, especially when principles conflict. For instance, while the ethical principle of respect for autonomy supports a robust system of granular control, the principles of beneficence and nonmaleficence counsel restraint due to the danger of patients being harmed by restrictions on provider access to data. Conflict between principles has long been recognized by ethicists and has even motivated attacks on approaches that state and apply principles. In this paper, we show how using ethical principles can help in the design of EHRs by first explaining how ethical principles can and should be used generally, and then by discussing how attention to details in specific cases can show that the tension between principles is not as bad as it initially appeared. We conclude by suggesting ways in which the application of these (and other) principles can add value to the ongoing discussion of patient involvement in their health care. This is a new approach to linking principles to informatics design that we expect will stimulate further interest.
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Affiliation(s)
- Eric M Meslin
- Indiana University School of Medicine, Indianapolis, IN, USA,
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Pearce C, Bainbridge M. A personally controlled electronic health record for Australia. J Am Med Inform Assoc 2014; 21:707-13. [PMID: 24650635 DOI: 10.1136/amiajnl-2013-002068] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE On July 1, 2012 Australia launched a personally controlled electronic health record (PCEHR) designed around the needs of consumers. Using a distributed model and leveraging key component national eHealth infrastructure, the PCEHR is designed to enable sharing of any health information about a patient with them and any other health practitioner involved in their care to whom the patient allows access. This paper discusses the consumer-facing part of the program. METHOD Design of the system was through stakeholder consultation and the development of detailed requirements, followed by clinical design assurance. RESULTS Patients are able to access any posted information through a web-accessible 'consumer portal.' Within the portal they are able to assert access controls on all or part of their record. The portal includes areas for consumers to record their own personal information. DISCUSSION The PCEHR has the potential to transform the ability of patients to actively engage in their own healthcare, and to enable the emerging partnership model of health and healthcare in medicine. The ability to access health information traditionally kept within the closed walls of institutions also raises challenges for the profession, both in the language clinicians choose and the ethical issues raised by the changed roles and responsibilities. CONCLUSIONS The PCEHR is aimed at connecting all participants and their interventions, and is intended to become a system-wide activity.
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Affiliation(s)
- Christopher Pearce
- Inner East Melbourne Medicare Local, Burwood East, Victoria, Australia Monash University Department of General Practice, Clayton, Victoria, Australia
| | - Michael Bainbridge
- School of Health Information Science, University of British Columbia, Victoria, British Columbia, Canada ASE Consulting Pty Ltd., London, UK National E-Health Transition Authority, Sydney, New South Wales, Australia
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