In the wake of the HITECH Act of 2009, office-based physician adoption of electronic medical records (EMRs) has nearly doubled as providers have taken advantage of meaningful use incentives. While the trend toward implementation of systems to maintain, manipulate, and share data has been palpable, there is no cohesive code of ethics addressing the issues related to the use of aggregated data. Informatics is by its nature multidisciplinary, and these varied stakeholders are governed by value systems that differ in significant ways.

The resulting IT systems and use cases present ethical challenges including threats to patient autonomy and shared decision-making, the provider-patient relationship, and the Big Data that is leveraged to inform evidence-based medicine. Despite their many benefits, both actual and aspirational, health information technology (HIT) and data science offer no panacea for the ills of our beleaguered healthcare system. In some cases the tech serves to exacerbate old problems, in others new problems spring from the socio-technical sandbox, and ultimately it is the patient who bears the greatest burden.

Many of the issues that we face with the use of HIT result from a battle that has been raging over the soul of healthcare – the clash of values between the business of medicine and the care of the patient. Business is winning the battle – it has been for some time – and it has shaped the development and



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