Does the implementation of electronic health reports and robotic surgeons violate doctor-patient confidentiality?
Point/Counterpoint Essay
Charlie McKee
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Save My Rights, Not My Life
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The obligations of a surgeon are not to their tools, but to their patients. Doing everything a doctor can to save the life of the patient is the surgeon's sole responsibility, and the tools are only a means of getting the job done. But where black and white turns to grey is a matter of the standardized use of medical technologies and their expanding capabilities. The success rate of surgeons has grown exponentially since the early cocoon stages of medicine. The increase in success is not magic, but rather a result of technological improvement. What started out as simple sharp stainless steel tools evolved into fully functioning mechanical devices capable of inserting, extracting, and stitching. Alongside the metal tools, the way nurses have kept up with their bookkeeping and health reports has also evolved. Digital warehouses have replaced lined sheets of 8x11 paper. The rapid expansion of the digital world has significantly reduced the limitations of these machines and mechanisms. Hospitals, like the surgeon, also have obligations to the patients. Their debts are to ensure the long-standing practice of doctor-patient confidentiality and the patient's right to privacy. And so it is up to the hospitals to decide if the mass implementation of technology and the growing lack of a human connection jeopardizes the patient's right to privacy and breaches patient-doctor confidentiality.
Innovative health information technology (HIT) has become a near reliance in hospitals around the world, and for good reason. According to Eta Berner, a professor in the Health Informatics Program at the University of Alabama at Birmingham, HIT is a "key mechanism to improve patient safety and health care quality... providing access to needed information and reducing handwriting errors through electronic health records" (Berner). However, there is a serious worry that the mainstream use of such technologies could violate the patient's right to privacy. This worry derives from what people fear is the inherent risk of using any electronically stored technology: leaked information (Schulte & Fry). Leaked information becomes such a worry to people because a simple mistake or misclick of a button could lead to the private information of thousands, and even millions of patients, in public hands. Despite the worry, Dr. Berner strongly believes that the support for the establishment of electronic health records (EHR) is a "key initiative" (Berner).
Dr. Berner further believes that the use of HIT and EHR poses a legitimate risk: "...the key ethical issues in the use of health information technology revolve around the principles of providing safe and effective care and avoiding harm” (Berner). In other words, Berner is saying that while HIT provides for a more effective surgery, the optimization of such technology comes with weakened security. Berner goes on to write, “health information technology can be considered like other interventions in that one needs to balance the benefits of using these systems with the potential risks to the patient" (Berner). This search to balance the benefits of using the systems and the potential risk of the systems to patient privacy is what baffles hospital executives. To put the matter another way, the hospital's priority to ensure patient privacy combats the potential benefits of establishing a comprehensive HIT.
Innovative surgical technology poses a similar threat to patient privacy. In the past, doctors and patients would have face-to-face conversations and would not only develop a relationship but establish a sense of security--security that the patient's private information would not be discussed outside of the patient's permission. However, as the capabilities of surgical technology increase, the necessity to have a doctor present in the room decreases. According to a reporter from the Evening Chronicle, "a surgeon in Newcastle could use the remote technology to carry out intricate, life-saving work via the robot on a patient in Africa or America" ("Enter the World"). While such a technological feat is impressive, this begs a question: does the transportation of the patient's private information digitally due to the doctor's physical absence breach the patient's right to privacy? The answer is unclear.
By taking the perspective of the surgeon, the best fit solution to the problem is the outcome in which the patient has the highest chance of survival and the least amount of recovery time. From this lens, surgical robots would be the way to go. According to the most top-rated surgeons in the United States, "robotic surgery assures a healthier post-operative life, causing minimal loss of blood, quicker healing of wounds and shorter hospital stays for those suffering from life-threatening conditions in vital body systems" ("Top US Surgeons"). So from this perspective, the choice seems obvious: go with the robot.
On the other side of the stage is the perspective of the hospital. The hospital’s priority is to maintain the patient's privacy. Even if there are obvious benefits to using robotic surgeons, if the use of technology poses a threat to the patient's privacy, then the new establishment should not be implemented. Dr. Mavroforou, from International Angiology, believes maintaining confidentiality while using robotic surgeons is of great concern, "In respect to ethical issues in robotic surgery, equipment safety and reliability, provision of adequate information, and maintenance of confidentiality are all of the paramount importance" (Mavroforou). This idea of the three aspects of a hospital's duty--equipment safety and reliability, adequate information, and confidentiality--all carrying grave importance is the crux of the hospital’s trouble, as the hospital must ultimately choose one to be more important than the others.
In the end, there is no absolute truth. EHR and robotic surgeons neither do nor do not violate the patient's right to privacy. In the end, they are just tools used to get the job done. In the end, the hospital executives are ultimately left with the decision. It is up to the executives to rank their priorities and decide if the mutual patient-hospital benefits of implementing EHRs and robotic surgeons outweigh the importance of patient-doctor confidentiality.
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Annotated Bibliography
Berner, Eta S. "Ethical and Legal Issues in the Use of Health Information Technology to Improve Patient Safety," HEC Forum, vol 20, no. 3, 2019. ProQuest, search.proquest.com /docview/229308678/8582A5833EEF4F2APQ/4?accountid=338
In the paper, Berner discusses the battle between the rapidly expanding world of computers and electronic health reports against ethical and legal issues regarding the sharing of health information between hospitals and agencies. This research will help me as I dive into the issues regarding sharing health information and the importance of doctor-patient confidentiality.
"Enter the World of the NHS's Robotic Surgeons" Evening Chronicle, May 08, 2014, pp. 8. ProQuest, search.proquest.com/docview/1523665326?accountid=338.
In this paper, a committee of Indian science researchers details the recent efforts in the robotic surgeon community and discusses the working mechanics of current and their robotic surgery technologies and their capabilities. This will be useful to me for my screenplay as the doctor works to comfort the parents with the reliability, practicality, and reasoning behind using the robotic surgeon.
Mavroforou, A, et al. "Legal and Ethical Issues in Robotic Surgery" International Angiology, vol. 29, no. 1, 2019. ProQuest, search.proquest.com/docview/365962762/fulltext/ 3A46E601B6814D48PQ/1?accountid=338.
Mavroforou carefully examines the use of robotics in the operating room and questions the computer's ability to deal with ethical dilemmas. In addition, the paper covers an array of legal issues such as suing and responsibility allocation in cases of malpractice. The article will be helpful to me as I examine the difficulties surgical robots and robotic companies could face in the future with the development of robotic surgeons.
Schulte, Fred, and Erika Fry. "Death By 1,000 Clicks: Where Electronic Health Records Went Wrong." Kaiser Health News, Kaiser Family Foundation khn.org/news/death-by-a-thousand-clicks/.
In this report, Fred Schulte and Erika Fry uncover the secrets and stories of the upcoming and promising EHR system. The report offers excellent insight into how the intricacies of the medical system, as well as how it failed to fulfill its hype. The source will be useful to me in explaining the inner workings of the EHR system as to why the system is flawed and supporting my claims regarding the adverse effects of using the EHR system.
"Top US Surgeons to Lead Robotic Surgeons' Meet at Kochi." IANS English, ProQuest, search.proquest.com/docview/1709617011?accountid=338.
Although the paper is short, the work highlights the future potential of robotic surgeons in a realistic manner and provides the reader with a superb foundation for understanding robotic surgeons in the grand scheme. I will be able to use this paper when addressing the future capabilities of robotic surgeons and providing background as to how many robotic surgeries have been done in the US