Ethics or innovation: Which comes first?

To put it mildly, the transition to EHRs comes freighted with a whole host of expectations.

But how realistic are those expectation?  Or, put another way, was enough study  conducted on the potential benefits and risks prior to the decision, in the form of the HITECH Act, to push, pull and cajole healthcare providers across the digital frontier?

That’s the question this cardiologist asks in a lengthy reflection on whether or not suitable ethical guidelines have been followed by EHR advocates.

In his eyes,the promise of improved efficiencies to our health care system, improved patient safety and (especially) reduced cost for our health care system remain elusive. More importantly these goals remain unproven. In fact, examples that the opposite is occurring abound as doctors struggle to enter ever-increasing amounts of information of no relevance to the patient’s presenting problem just to prove they’re using the EMR in a “meaningful” way, health data security breeches continue, data-mining of patient information is occurring not just for patient care, but for marketing purposes, and the direct costs of health care for patients continues to rise, not fall.”

These observations aren’t necessarily unique.  Indeed, questions about cost savings and concerns about breeches appear almost daily in the various media dedicated to reporting on and discussing the health IT transition.

The difference, however, is that he casts his concerns not simply as a practical matter, but as an ethical one.

“So should we step back for a moment and ask ourselves if we are being ethical to patients with the deployment of this technology?” he asks. “(Do) the ends of presumed cost savings to our national health care system justify the deployment of poorly integrated, difficult-to-use systems? Are patients being subjected to new risks heretofore never considered with the adoption of this technology? Could a tiny programming error occur that negatively impacts not just one patient, but millions? If so, what are the safeguards in place to prevent catastrophic error? Who will be responsible?”

As a practical matter, of course, it’s not likely that questions like these are going to bring the health IT transition to a grinding halt.  But that doesn’t mean they’re not worth asking.  Whether or not they were asked sufficiently prior to HITECH is probably a question for the history books.  But at a time when technological innovation is an expected constant, and particularly when that innovation is looked to as the solution to so many vexing problems, at the very least those questions should be put at the top of the list for healthcare policymakers and IT advocates.