CC BY-NC-ND 4.0 · Yearb Med Inform 2020; 29(01): 104-114
DOI: 10.1055/s-0040-1701996
Section 3: Clinical Information Systems
Survey
Georg Thieme Verlag KG Stuttgart

Clinical Information Systems – Seen through the Ethics Lens

Ursula H. Hübner
1  Health Informatics Research Group, Dept. Business Management and Social Sciences Hochschule Osnabrück, Germany
1  Health Informatics Research Group, Dept. Business Management and Social Sciences Hochschule Osnabrück, Germany
,
Nicole Egbert
1  Health Informatics Research Group, Dept. Business Management and Social Sciences Hochschule Osnabrück, Germany
,
Georg Schulte
1  Health Informatics Research Group, Dept. Business Management and Social Sciences Hochschule Osnabrück, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
21 August 2020 (online)

Summary

Objective: The more people there are who use clinical information systems (CIS) beyond their traditional intramural confines, the more promising the benefits are, and the more daunting the risks will be. This review thus explores the areas of ethical debates prompted by CIS conceptualized as smart systems reaching out to patients and citizens. Furthermore, it investigates the ethical competencies and education needed to use these systems appropriately.

Methods: A literature review covering ethics topics in combination with clinical and health information systems, clinical decision support, health information exchange, and various mobile devices and media was performed searching the MEDLINE database for articles from 2016 to 2019 with a focus on 2018 and 2019. A second search combined these keywords with education.

Results: By far, most of the discourses were dominated by privacy, confidentiality, and informed consent issues. Intertwined with confidentiality and clear boundaries, the provider-patient relationship has gained much attention. The opacity of algorithms and the lack of explicability of the results pose a further challenge. The necessity of sociotechnical ethics education was underpinned in many studies including advocating education for providers and patients alike. However, only a few publications expanded on ethical competencies. In the publications found, empirical research designs were employed to capture the stakeholders’ attitudes, but not to evaluate specific implementations.

Conclusion: Despite the broad discourses, ethical values have not yet found their firm place in empirically rigorous health technology evaluation studies. Similarly, sociotechnical ethics competencies obviously need detailed specifications. These two gaps set the stage for further research at the junction of clinical information systems and ethics.