Clinical Informatics: Old Art, New Science

by Eric Swirsky, JD, MA

Through the millennia the science and practice of medicine have evolved and along with them the moral relationship that exists between doctor and patient.  While much has changed, the need for information exchange has not; it is a central component of the doctor-patient relationship and shapes its moral status.  The practice of medicine has been transformed with the rise of the health care industry. Traditional clinical values, such as respecting autonomy, promoting what is best for the patient, refraining from harm, and upholding principles of justice, have been joined by business needs for efficiency, cost effectiveness, and increased productivity. Changing policies and requirements for clinical documentation have influenced the type of information that is needed; who needs it; and how that information is recorded, stored, accessed, and exchanged.  Due to this diversity of interests, values can and do come into conflict and ethical issues arise. Although informaticians and information management specialists have been addressing with these matters for some time they have not received much attention from clinical ethicists, and that must change.  These concerns must be harmonized because nowhere are the conflicts more evident than in the clinical use of health information technology (HIT).

Computers are now ubiquitous in clinical contexts and have had a palpable effect upon the doctor-patient relationship and the practice of medicine in general.  HIT has come to fulfill a variety of functions and serve many masters along the course of its evolution.  Recognizing this is of critical importance because organizational dynamics and power relationships between front-end clinician users and back-end administrators, which can distort perceptions of technological benefit and therefore functionality, are commonly ignored (Wears and Berg 2005). 

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.