Ethics of implementing Electronic Health Records in developing countries: points to consider.

Electronic Health Record systems (EHRs) are increasingly being used in many developing countries, several of which have moved beyond isolated pilot projects to active large-scale implementation as part of their national health strategies. Despite growing enthusiasm for adopting EHRs in resource poor settings, almost no attention has been paid to the ethical issues that might arise. In this article we argue that these ethical issues should be addressed now if EHRs are to be appropriately implemented in these settings. We take a systematic approach guided by a widely accepted ethical framework currently in use for developing countries to first describe the ethical issues, and then propose a set of 'Points to Consider' to guide further thinking and decision-making.

[1]  D. Chalmers,et al.  Commercialisation of biotechnology: public trust and research , 2004 .

[2]  Ariel Pablos-Mendez,et al.  An agenda for action on global e-health. , 2010, Health affairs.

[3]  Timothy Caulfield,et al.  Biobanks and Blanket Consent: The Proper Place of the Public Good and Public Perception Rationales , 2007 .

[4]  A. Campbell.  The Ethical Challenges of Genetic Databases: Safeguarding Altruism and Trust , 2007 .

[5]  E. Layman,et al.  Ethical Issues and the Electronic Health Record , 2008, The health care manager.

[6]  Ilene V. Goldberg.  Electronic medical records and patient privacy. , 2000, The health care manager.

[7]  C. Anandan,et al.  The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview , 2011, PLoS medicine.

[8]  R. Epstein.  Responsiveness in quality-of-life assessment: nomenclature, determinants, and clinical applications. , 2000, Medical care.

[9]  Randolph C. Barrows,et al.  Review: Privacy, Confidentiality, and Electronic Medical Records , 1996, J. Am. Medical Informatics Assoc..

[10]  B M Dickens,et al.  Bioethics for clinicians: 13. Resource allocation. , 1997, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[11]  Wolzt,et al.  World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. , 2003, The Journal of the American College of Dentists.

[12]  E. Meslin,et al.  Biobanks and Electronic Health Records: Ethical and Policy Challenges in the Genomic Age , 2009 .

[13]  Marcus Randall,et al.  Faculty Ownership of Medical Facilities: Inappropriate Conflict or an Opportunity that Benefits Physicians and Patients? , 2004, Academic medicine : journal of the Association of American Medical Colleges.

[14]  Suzanne Austin Boren,et al.  The role of the electronic medical record (EMR) in care delivery development in developing countries: a systematic review. , 2008, Informatics in primary care.

[15]  Alexander M Clark,et al.  Attaining adequate consent for the use of electronic patient records: an opt-out strategy to reconcile individuals' rights and public benefit. , 2005, Public health.

[16]  Eric M. Meslin,et al.  Shifting paradigms in health services research ethics consent, privacy, and the challenges for IRBs , 2006, Journal of General Internal Medicine.

[17]  E. Kluge.  Security and privacy of EHR systems--ethical, social and legal requirements. , 2003, Studies in health technology and informatics.

[18]  Melissa Steward.  Electronic Medical Records , 2005, The Journal of legal medicine.

[19]  B. Knoppers.  Consent revisited: points to consider. , 2005, Health law review.

[20]  Paul G. Biondich,et al.  The OpenMRS Implementers Network , 2009, Int. J. Medical Informatics.

[21]  Finding a Liability‐free Space in Which Personalized Medicine can Bloom , 2007, Clinical pharmacology and therapeutics.

[22]  J. Kaiser.  Ethics. Private money, public disclosure. , 2009, Science.

[23]  William M. Tierney,et al.  Creation and evaluation of EMR-based paper clinical summaries to support HIV-care in Uganda, Africa , 2010, Int. J. Medical Informatics.

[24]  Ruth Chadwick,et al.  Solidarity and equity: new ethical frameworks for genetic databases , 2001, Nature Reviews Genetics.

[25]  R. Veatch,et al.  Abandoning informed consent. , 1995, The Hastings Center report.

[26]  William M. Tierney,et al.  Evaluating a scalable model for implementing electronic health records in resource-limited settings , 2010, J. Am. Medical Informatics Assoc..

[27]  Ezekiel J Emanuel,et al.  What makes clinical research in developing countries ethical? The benchmarks of ethical research. , 2004, The Journal of infectious diseases.

[28]  R. L. Caplan,et al.  Benchmarks of Fairness for Health Care Reform , 1996 .

[29]  Wilson W. Odero,et al.  Application of Information Technology: Installing and Implementing a Computer-based Patient Record System in Sub-Saharan Africa: The Mosoriot Medical Record System , 2003, J. Am. Medical Informatics Assoc..

[30]  T. Beauchamp,et al.  Principles of biomedical ethics , 1991 .