Recommendations

The academic literature is prolific in suggestions to minimize potential ethical dilemmas while accessing EHRs (Myers et al., 2008; Simpson, 2005; Wynia & Dunn, 2010). These recommendations are designed to support health care workers, leaders and policy creators as they face the ethical challenges of accessing electronic health records (Layman, 2008). These proposed solutions can be categorized and summarized under the areas of ethical concern discussed previously.

Privacy & Confidentiality

• Creation and adherence to public and institution policy on the protection of remotely accessed health records. This includes policy prohibiting the long-term storage of sensitive  data on remote access devices and policy on the expunging of data appropriately (Myers et al., 2008)
•  Establish routine disclosure protocols and verification processes (Myers et al., 2008)
•  Employee education, including technical training and empowerment around the importance of privacy and confidentiality (Myers et al., 2008; Wynia & Dunn, 2010)
• Encryption of data with time limited passwords or biometric technology for authentication (Layman, 2008;Myers et al., 2008)
• Inventory control procedures and automatic deactivation policy for lost, stolen or security compromised remote devices (Myers et al, 2008)
• Adopt the use of  wallet sized “smart cards” which activate a particular remote device (according to Myers et al., 2008 there is less likelihood of misplacing these compared to the standard remote technology)
• Multifactor authentication process (Eg. require a PIN password and smart card; Myers et al., 2008)  

Equity

• Education for employees and clients who use or receive information from the EHR (Myers et al., 2008; Simpson, 2005; Wynia & Dunn, 2010)
• Targeted subsidies for those less likely to have access to EHR linked technology such as those with low literacy and socioeconomic status as well as new immigrants (Wynia & Dunn, 2010)
• Data should never be exposed in such a way that social discrimination could result (Layman, 2008)

Efficiency

•  Initial and continued education and technical support to ensure staff are utilizing the technology optimally and appropriately (Myers et al., 2008; Simpson, 2005)
• Continued research to confirm the health benefits of using EHRs and techniques to reduce the costs of using EHRs (Myers et al., 2008)
• Multiple, easy to restore back-ups of all electronic information are necessary to prevent the partial or total loss of patient records during temporary outages or program errors (Mercuri, 2010)

Integrity

• Continued critical assessment of the data to identify human error or compromised data(Myers et al., 2008)
•  Enhanced security networks, intranets and firewalls etc., to ensure the fidelity of the information (Layman, 2008)
• Patient access to EHR to identify errors (Patients might pick up errors in their data if they had access; Wynia & Dunn, 2010)

Accountability

• Healthcare professionals are concerned with being held accountable and making appropriate decisions based upon the data accessed in the EHR (Wynia & Dunn, 2010)
• Following an ethical model for decision making, as identified by McGonigle & Mastrian (2009),  facilitates health care professionals to take the best ethical action