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4 reasons why healthcare needs a digital code of ethics

Eric Swirsky | July 6, 2016
As health information technology continues to transform healthcare and doctor-patient relationships, the resulting ethical dilemmas are making the need for a digital code of ethics more critical than ever

In the pursuit of cost-effective treatments, the patient narrative has been all but forsaken. Instead, we hear calls for inclusion ofthe data narrative which, in a certain sense, is an assault on patient autonomy and the shared decision-making process. It turns clinical paternalism on its head and exchanges goals of care and efficacy for cost-effectiveness. The fact is that improved outcomes and cost-containment are not mutually inclusive, and the data narrative may create adversarial relationships between patients and providers. With the business of health care guiding the use of HIT, the value systems are no longer aligned. The move toward a patient-centric, shared decision-making model ushered out the days of the doctor knows best - only to usher in the current meme of the data knows best.

2. Patients are more than consumers of treatment

Patients are vulnerable individuals as they pass through our health system. Many have medical and emotional needs and face challenges managing their own care and treatment in a consumer role. Consumers are well informed and typically consider cost as a part of their decision-making process outside of healthcare. Providers, on the other hand, are notorious for their general lack of transparency when it comes to pricing and hidden costs of care. While patients should be informed and educated, requiring a proactive consumer places many patients in a role that causes stress and unnecessary hardship when most patients want to address a specific medical needs and return to daily life. Educating the patient is the role of the healthcare provider, and information needs to be presented in a way that is meaningful to the patient's well-being instead of placing patients in the role of an information-seeking consumer.

But there is a larger issue here with this high tech, low touch consumer model-we sometimes employ information technology for its newness and without solid evidence to confirm its efficacy. Use of technology for the sake of using new technology is pure folly in a clinical environment, and it can leave patients in the cold feeling frustrated and afraid. Health information technologists like to think that they work in the state of the art, but that is not so because they have not had the proper apprenticeship. With technology, the state of the art is the newfangled; in healthcare, Hippocrates reminds us through the millennia that the art is long. Clinically speaking, the notion that HIT is state of the art is at once laughable and lamentable. The art of clinical practice comes from honing practice over time to meet the many and varied needs of patients, yet there is precious little training on how to incorporate these technologies into clinical encounters. That piece, the art, has been an afterthought in the world of health IT. We have been far more focused on value and revenue than what is meaningful to patients and their treating physicians. In a technological system, the personal touch cannot be taken for granted, and many patients would still prefer a person to an iPad or portal. Now, get the machine that goes, "Bing!"


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