SERIES: eHealth in primary care. Part 2: Exploring the ethical implications of its application in primary care practice

Abstract

The impact of eHealth on primary care is paired with ethical implications including questions of autonomy and professional responsibilities Practice-specific ethical guidance for the use of eHealth in primary care should be developed Primary care professionals should be aware of the ethical implications when using eHealth approaches ABSTRACT Background: eHealth promises to increase self-management and personalised medicine and improve cost-effectiveness in primary care. Paired with these promises are ethical implications, as eHealth will affect patients' and primary care professionals' (PCPs) experiences, values, norms, and relationships. Objectives:We argue what ethical implications related to the impact of eHealth on four vital aspects of primary care could (and should) be anticipated. Discussion: (1) EHealth influences dealing with predictive and diagnostic uncertainty. Machinelearning based clinical decision support systems offer (seemingly) objective, quantified, and personalised outcomes. However, they also introduce new loci of uncertainty and subjectivity. The decision-making process becomes opaque, and algorithms can be invalid, biased, or even discriminatory. This has implications for professional responsibilities and judgments, justice, autonomy, and trust. (2) EHealth affects the roles and responsibilities of patients because it can stimulate self-management and autonomy. However, autonomy can also be compromised, e.g. in cases of persuasive technologies and eHealth can increase existing health disparities. (3) The delegation of tasks to a network of technologies and stakeholders requires attention for responsibility gaps and new responsibilities. (4) The triangulate relationship: patient-eHealth-PCP requires a reconsideration of the role of human interaction and 'humanness' in primary care as well as of shaping Shared Decision Making. Conclusion: Our analysis is an essential first step towards setting up a dedicated ethics research agenda that should be examined in parallel to the development and implementation of eHealth. The ultimate goal is to inspire the development of practice-specific ethical recommendations.

SERIES: eHealth in primary care. Part 4: Addressing the challenges of implementation

“…questions related to roles and responsibilities). This topic is further discussed in the second article of this series [ 24 ].…”

SERIES: eHealth in primary care. Part 3: eHealth education in primary care

“…There is an issue of potential generational differences, with trainees, younger doctors and younger patients being more familiar with digital solutions compared to older doctors and patients. Furthermore, from a provider perspective, digital competence includes digital skills and knowledge about aspects such as safety issues and ethics concerning online support [32]. Patient privacy must be guaranteed, and careful consideration should be given to determining the type of care that could be replaced or complemented with eHealth, in such a way that the quality of care remains unaffected.…”

Clinical Information Systems – Seen through the Ethics Lens

“…Alongside the algorithms, all papers on AI and ML addressed the paramount importance of the data sets on which the algorithms were trained. Low quality, inherent biases (e.g., due to under-represented groups), and subjectivity in clinical notes led to the amplification of errors on a large scale and very often to disparities and discrimination of disadvantaged groups [25,26,35,36]. In turn, clean, reliable, and valid data would bring AI into the position to mitigate injustice in decision making arising from human preconceptions [37].…”

“…In turn, clean, reliable, and valid data would bring AI into the position to mitigate injustice in decision making arising from human preconceptions [37]. Justice and equality were also discussed in the context of availability of technologies and competencies to use them, which could widen the digital divide even more between those who have it and those who do not have it [28,36,38]. This also held for digital literacy on the part of physicians and patients, an asset that could make the difference [26].…”

“…Ashton and Sullivan [55] Baldini et al [38] Boers et al [36] Bourla et al [45] Brill et al [49] Brisson et al [33] Carter et al [35] Davenport and Kalakota [25] De Riel et al [31] Duckett [29] Eberlin et al [52] Erikainen et al [28] Evans and Whicher [47] Galvin et al [48] Gensheimer et al [54] Gooding [46] Graham et al [26] Ho and Quick [57] Lenca et al [56] Kogetsu et al [21] Kuhnel [53] Laurie [58] Lehmann et al [23] Loftus et al [37] Macdonald et al [50] Mars et al [51] McBride et al [40] McWilliams et al [20] Meredith et al [30] Moscatelli et al [22] Musher et al [39] Natsiavas et al [43] Pathak and Chou [44] Rashidi et al [27] Robichaux et al [41] Sánchez et al [34] Sanelli-Russo et al [24] Stockdale et al [42] Wilburn [32] [56] provided an overview of ethical themes grouped as families and subfamilies. There was a preponderance of studies found on independence and safety considerations.…”