Legal and Ethical Considerations in the Implementation of Electronic Health Records

Legal and Ethical Considerations in the Implementation of Electronic Health Records

Karen Ervin (Pennsylvania Hospital Librarian, USA)
DOI: 10.4018/978-1-4666-4466-3.ch012
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This chapter examines the literature of healthcare in the United States during the transitioning to electronic records. Key government legislation, such as the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH), which were part of the American Recovery and Reinvestment Act (ARRA) and the Affordable Health Care Act, are reviewed. The review concentrates on patient privacy issues, how they have been addressed in these acts, and what recommendations for improvement have been found in the literature. A comparison of the adoption of electronic health records on a nationwide scale in three countries is included. England, Australia, and the United States are all embarking in and are at different stages of implementing nationwide electronic health database systems. The resources used in locating relevant literature were PubMed, Medline, Highwire Press, State Library of Pennsylvania, and Google Scholar databases.
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Setting The Stage

The literature that investigates the process of automating patient records and confidentiality, as defined in the HIPAA Act, must be explored in order to address questions of legal and ethical aspects involved. In order to address the confidentiality concerns one needs to understand the similarities and differences between electronic and paper records and to define exactly what is contained in each type. According to the Council on Ethical and Judicial Affairs (CEJA) of the American Medical Association (AMA), electronic medical records, also called electronic health records (and referred to as EHR hereafter), “are not merely digitized versions of paper records” (Sade, 2010, p. 40). Electronic records contain “large amounts of highly detailed clinical information,” they are extremely compact, can be easily stored and rapidly transmitted between healthcare professionals and institutions (Sade, 2010, p. 40). Paper medical records do not present these characteristics; they are usually official forms and charts found in one central location, limited to each institution housing its own set of records for each individual served by the organization. Breaches of paper records usually do not occur outside of or beyond the individual organization. The potential for breaches of electronic records is much greater due to their inherent vulnerability. The characteristics which make them so attractive (ease of use, rapid transmission between providers, etc.) also make them potentially vulnerable. The USA Patriot Act of 2001 and the renewal of the law in 2006, made it legal for the FBI to search confidential medical records as part of counterterrorism efforts (Landa, 2006). The HIPAA Privacy Rule does not restrict disclosure of de-identified health information, which may be used by law enforcement officials, making it easier for these officials to have access to private health information, without the knowledge or consent of the patient. The AMA Council on Ethical and Judicial Affairs does not address this concern at all (Sade, 2010).

In order to fully appreciate what is considered protected health information, one must read the statement on confidentiality or at least the Summary of the HIPAA Privacy Rule (U.S. DHHS, 1996). Protected health information refers to the protection of all “individually identifiable health information” held or transmitted by a covered entity or its business associates. This includes all forms: paper, electronic, and oral.

Individually identifiable health information is information, including demographics, that relates to:

  • 1.

    The individual’s past, present or future physical or mental health or condition.

  • 2.

    The provision of health care to the individual.

  • 3.

    The past, present or future payment for the provision of health care to the individual (U.S. DHHS, 1996, p. 1).

Complete Chapter List

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Editorial Advisory Board and List of Reviewers
Table of Contents
Daniel O. O’Connor
Janice M. Krueger
Janice M. Krueger
Chapter 1
Tracy L. McPeck
This case study examines the user experience of six public library catalogs (OPACs) in terms of the next-generation characteristics identified by... Sample PDF
Electronic Resources and Next-Generation Public Library Catalogs
Chapter 2
Aiping Chen-Gaffey
The rapid growth of electronic resources continues to challenge traditional methods of cataloging library collections, forcing a cataloging... Sample PDF
Managing Vendor Records for Monographic E-Collections at a Medium-Sized Academic Library
Chapter 3
Daniel Gelaw Alemneh, Ralph Hartsock
Important products in an academic library’s collection are Masters Theses and Doctoral Dissertations since they represent a wealth of scholarly and... Sample PDF
Theses and Dissertations from Print to ETD: The Nuances of Preserving and Accessing those in Music
Chapter 4
Shu-Fen Hung Lin, Hsueh-Hua Chen
The digitized collections and their associated metadata records are one of the most important electronic resources that require constant and ongoing... Sample PDF
Construction of a Culture-Rich Database System for Indigenous Documentary Records: Conceptual Model, Flexible Classification, and Methodology
Chapter 5
Rhonda L. Clark
Local history and genealogical collections provide valuable information to the public, when adequate reference services and access to the collection... Sample PDF
Challenges in Representing Local Image Collections: The Case of the Titusville Historical Society
Chapter 6
Sally Stieglitz
The American Memory Project is a digital collection of historical resources maintained by the Library of Congress and freely available to the public... Sample PDF
The American Memory Project
Chapter 7
Lindsay Lauridsen
The Topaz Japanese-American Relocation Center Digital Collection was a digitization project carried out by the Digital Initiatives Department of... Sample PDF
Topaz Japanese-American Relocation Center Digital Collection: A Case Study
Chapter 8
Samuel C. Avemaria Utulu, Adebayo A. Akadri
This case is about the influence of the Internet on scholarly communication and the emergence of various access-to-knowledge initiatives. Major... Sample PDF
A Case of Redeemer’s University Adoption of Institutional Repository Using the Principles of Electronic Information Management Systems
Chapter 9
Janice M. Krueger
This chapter highlights how a graduate program in library science structured a university’s course management system to address the data gathering... Sample PDF
Building a Digital Repository for Accreditation through Courseware
Chapter 10
Daniel Stafford, Robert Flatley
The Rohrbach Library of Kutztown University manages its electronic resources using a disconnected array of resources including spreadsheets, paper... Sample PDF
Choosing and Implementing an Open Source ERMS
Chapter 11
ERMS Druthers  (pages 181-191)
Cynthia Snell
In an effort to find an online-automated electronic resource management system that provides licensing, acquisitions, and statistical information... Sample PDF
ERMS Druthers
Chapter 12
Karen Ervin
This chapter examines the literature of healthcare in the United States during the transitioning to electronic records. Key government legislation... Sample PDF
Legal and Ethical Considerations in the Implementation of Electronic Health Records
Chapter 13
Jami M. Clark
Seneca Medical Center is a primary care practice that implemented an electronic medical record system in 2005. Since implementation, the practice... Sample PDF
Implementation of Electronic Records in a Medical Practice Setting
Chapter 14
Ann Glusker, Elisa Hoelscher
The Pacific Health Organization’s Medical Library transitioned from its holdings being entirely in print to entirely online in an extremely short... Sample PDF
Transitioning from Print to Online-Only Resources: The Experience of a Medium-Sized Healthcare Organization Library
Chapter 15
YooJin Ha
The global conglomerate enterprise called libraries has spent over a century providing access to specialized trans-language and trans-alphabet... Sample PDF
Access to Scholarly Information across Disciplines, Languages, and Alphabets
Chapter 16
Nurussobah Hussin, Rusnah Johare
Technological change has always been a challenge to archivists, record practitioners, and IT personnel. The management of physical records fails to... Sample PDF
Conceptual Framework of Functional Requirements for the Management of Electronic Court Records in the Superior Court of Malaysia
Chapter 17
Vanderlei Batista dos Santos, Daniela Francescutti Martins Hott, Luís Marcelo de Oliveira Braz
This chapter presents a case study concerning the digital files of the legislative proposals1 produced by the Chamber of Deputies (CD), one of the... Sample PDF
Digital File of the Legislative Proposal: A Case Study on Applying the InterPARES Project Guidelines in the Brazilian Chamber of Deputies
Chapter 18
Kristen Cissne
The National Archives and Records Administration (NARA) is considered the official record keeper of the United States of America. In existence for... Sample PDF
NARA: A Digitization Case Study
Chapter 19
Sabrina Catani
In the last few years, the Province of Forlì-Cesena has started a records digitization process aimed at producing digital records to be preserved... Sample PDF
The Preservation of Electronic Records: Decision Acts Signed by the Department Heads
Chapter 20
Susan M. Hendrickson, Margo E. Young
This chapter provides an overview of the electronic records management initiatives by the Records and Engineering Document Services Group at the Jet... Sample PDF
Electronic Records Management at a Federally Funded Research and Development Center
Chapter 21
Daniela Simonini
In the last twenty years, the organization of the administrative divisions of the Italian state has been deeply modified to improve the provision of... Sample PDF
Guidelines for the Creation of the Electronic Protocol Register in an Electronic Records Management System
Chapter 22
Amanda Snyder
The Environmental Protection Agency (EPA) provides access to information on a variety of topics related to the environment and strives to inform... Sample PDF
Environmental Protection Agency
Chapter 23
Edith K. Beckett
The New Jersey State Library has managed a successful print depository program for the last 55 years. In the mid-1990s, many state government... Sample PDF
Creating a 21st Century State Publications Depository
About the Contributors