Ethics and the Electronic Health Record in Dental School Clinics

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This is a critical review of a published article in PubMed.


Electronic health records (EHRs) are a major development in the practice of dentistry, and dental schools and den- tal curricula have bene tted from this technology. Patient data entry, storage, retrieval, transmission, and archiving have been streamlined, and the potential for teledentistry and improvement in epidemiological research is beginning to be realized. How- ever, maintaining patient health information in an electronic form has also changed the environment in dental education, setting up potential ethical dilemmas for students and faculty members. The purpose of this article is to explore some of the ethical issues related to EHRs, the advantages and concerns related to the use of computers in the dental operatory, the impact of the EHR on the doctor-patient relationship, the introduction of web-based EHRs, the link between technology and ethics, and potential solu- tions for the management of ethical concerns related to EHRs in dental schools.



The increasing use of electronic health record (EHR) brings with it the issues of ethics challenging their use in a dental school environment. The privacy and security of the health information of a patient are protected by legislation such as the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009.[1]

The authors in this article explored the challenges with the introduction, use, ethical issues, advantages, and impact of EHR in dental operatory and potential solutions for managing these ethical concerns.

Ethical issues

The authors relayed the ethical issues related to the electronic form of patient health information. They reported the disadvantage of issues related to breach of patient information by dental students or faculty member involved with improper access to the health information, or hacking into or stealing passwords of the faculty or modifying the codes of procedures done etc. While paper based records have their limitations when compared to electronic records, the alterations or breaches are easier to hide in the digital environment.

Using computers in the operatory

The authors reported that 55.6 per cent of dentists had workstations in their operator as published by the American Dental Association (ADA) in 2006. The use of computers in the operatory takes a way face time with the patients and the resultant depersonalization could be considered an ethical breach.

EHRs in the Educational Environment

The authors are concerned about the use of EHR in the dental educational environment and recommended the need for understanding the level of computer knowledge of student dentists and developing the dental school curriculum to include workflows and learning software systems in use in each individual dental school. They found that patient doctor relationship is at stake when the doctor is using the computer for most part of the dental visit to enter the patient information which led to patient distrust and later led to malpractice lawsuits.

EHR challenges in the Dental School Environment

The authors reported of surveys that showed many dental students involved in some short of cheating in EHR and this could have been to steal faculty passwords to change dental codes of procedures done, unethical attitude with regard to patient info in an EHR are some of the challenges.

Potential Solutions

The authors mention some potential solutions some of which are already in use which reiterate the importance of maintaining ethical integrity while providing efficient dental care to patients. The use of video surveillance while students use an EHR, grades in ethics to be an important part of providing clinical care, upholding professionalism in the courses and ethical modeling by the school faculty and its members.


The authors explored some difficult issues related to the use of EHR in dental environments. The increasing use of EHR means there needs to be increased ethical modeling and professionalism while using an EHR to maintain its integrity and usefulness.


Due to the efficiency of the electronic availability of patient health information, the need to enhance security and ethics of using an electronic health record must be reinforced on a regular basis in order to safeguard the EHR.


  1. Ethics and the Electronic Health Record in Dental School Clinics.