Reconceptualizing the Electronic Health Record for a new decade: A Caring Technology?

Our first featured article in ANS 42:3 is titled “Reconceptualizing the Electronic Health Record for a New Decade: A Caring Technology?” authored by Catherine Robichaux, PhD, RN; Mari Tietze, PhD, RN-BC, FHIMSS; Felicia Stokes, JD,MA, RN; and Susan McBride, PhD, RN-BC, CPHIMS, FAAN. This article examines and critiques a 2009 article published exactly 10 years ago in ANS that focused on the electronic health record and propose a virtue ethics framework for the future (see Dilemmas, Tetralemmas, Reimagining the Electronic Health Record). It is available for free download while it is featured, and we welcome your comments related to this important topic!  Here is a message from Dr. Robichaux about this work:

L to R – Felicia (Liz) Stokes, Mari Tietze, Catherine Robichaux

We are very happy to have this article published in the Critique and Innovation issue of ANS. This is our second collaborative publication and we each bring different experiences and perspectives to the complicated issues inherent in the development and use of the electronic health record (EHR). Susan and Mari are nurse informaticists, researchers and educators, Catherine’s background is ethics and education, and Liz (Felicia) is a nurse ethicist, policy expert and attorney. As with our first article, this manuscript evolved from Susan and Mari’s research exploring nurses’ experiences with the EHR in which the participants described a wide range of advantages and disadvantages.  Recognizing that it had been ten years since passage of the HITECH act in 2009, we were interested in whether some of the problems

Susan McBride

described in their research were identified ten years ago. Through our literature review, we discovered the article by Petrovskaya, McIntyre, and McDonald, Dilemmas, tetralemmas, reimagining the electronic health record.  This article beautifully analyzes advanced technologies with the ethical and philosophical constructs of caring in nursing.  Rather than viewing the use of technology and caring practice as an either/or dilemma, they suggested application of the tetralemma, a Buddhist approach which expands the range of choices.

Although positive aspects of the EHR have been realized since 2009, many problems identified by Petrovskya et al. continue. We discuss these ongoing challenges to patient safety and nursing practice and suggest integration of polarity thinking with the tetralemma as a viable approach to resolution.  Petrovskya et al. also addressed the potential negative impact of the EHR on ethical nursing practice and we explore the relevance of virtue ethics and technomoral wisdom in revisioning the EHR as a caring technology.

We believe that the roles of nursing leadership, education, research and organizational accountability are all critical in addressing the issues identified in this article.  We hope this discussion is helpful to readers and we look forward to your comments.