Ethical and quality pitfalls in electronic health records

Hospitals and physicians' practices are rapidly implementing the electronic health record (EHR) because it offers many demonstrated advantages over paper records. Issues of misuse of the EHR previously identified include breaches in confidentiality and privacy and inappropriate record sharing. I describe a separate set of ethical and quality problems of the EHR that result from its otherwise beneficial timesaving features that inadvertently enable carelessness and harmful shortcuts. These problems include copying and pasting data obtained from other clinicians, authorship ambiguities, inadvertent inclusion of unobtained data in templated notes, misleading history and physical examinations, failure to review prepopulated data, inadequate discharge summaries, impairments to patient-physician communication, and the transformation of the purpose of the medical record to billing documentation. I offer a brief analysis and recommendations to mitigate these problems.