Evidence of public value and public risk of electronic health records: an issue for social justice?

OVERVIEW Since 1999, the federal and other governments in Canada have repeatedly emphasized the value to healthcare of electronic health records. In 2004, a substantial UK investigation questioned the evidence of public value of largescale, government initiatives in healthcare information technology, and of electronic health records in particular. Citing an authoritative source, which holds that justice requires meeting healthcare needs fairly under resource constraints, and that this involves limiting healthcare in a publicly accountable way, the present study drew upon social justice as the frame of reference. Within this frame, it examined the evidence pertaining specifically to electronic health records as represented in eight major health policy papers at the national level published in Canada from 1999 to early 2005. Using a quantitative method, the study found during the period a decline in the concerns expressed in the eight policy papers about privacy, security and availability of electronic health records systems. It also found that some risks were barely considered, if at all. Yet, during the same period, the Auditor General of Canada issued strongly worded warnings about the wide range of risks affecting information technology in government. The Auditor General is denied domain over Canada Health Infoway, which is mandated nationally to promote and implement electronic health records, among other things electronic. The Health Council of Canada, which is mandated as an independent council for informing Canadians on healthcare matters, while promoting accountability and transparency, has predetermined as favourable its conclusion about electronic health records. The Canadian Coordinating Office for Health Technology Assessment, also armed with a national mandate, has decided that assessment of electronic health records lies outside its expertise. This study concludes that (a) evidence of public value and public risk of electronic health records should be subject to the standards increasingly used for and expected of evidence-based medicine, and of assessments of pharmaceuticals and medical devices; (b) at the national level, Canada lacks an independent public accountability mechanism for analyzing public value and public risk from electronic health records; (c) to the extent that, for electronic health records, the public risks are plausible and the public values are debatable, this lack is an issue of social justice.