Patients’ “charts” once hung at the feet of their hospital beds. Their purpose was to serve as the record of care for a particular patient. A chart’s clinical functions were to document clinicians’ communications, actions, orders, and observations, particularly about noteworthy changes in a patient’s condition. Over time, charts began to serve legal functions, as they can be subpoenaed by a court and used to review and assess organizational compliance with federal and state regulations. Chart information has also long been assigned Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes, which are the primary mechanism by which most clinicians are paid in the United States. Charts have also long served as valuable sources of data to be mined for quality assurance and investigational research purposes. Charts are now called electronic health records (EHRs), but they still serve the functions just named and more.
With all these different functions and stakeholders, questions about how the chart is created and who should have access or ownership are numerous and complex. Which stakeholders should have access to information in patients’ EHRs? How should access be restricted? Whom should we regard as the final author of what is written in the chart or its end users? How have EHRs changed our conceptions of the ethical and clinical relevance of privacy? Which values should guide our integration and use of new audio and video recording and artificial intelligence-assisted transcription in EHRs? This theme issue investigates which kinds of work EHRs should do and for whom, whose perspectives EHR content should represent or protect, and whose interests EHRs should serve when information is entered, organized, reviewed, responded to, extracted, or amended. This issue also investigates which values and technologies should inform EHR stewardship and innovation decisions and from whose perspectives those decisions should be made.
We welcome wide-ranging perspectives on these and kindred topics for inclusion in this November 2025 issue of the AMA Journal of Ethics®. Manuscripts submitted for peer review consideration must follow Instructions for Authors and be submitted by 31 December 2024.
The AMA Journal of Ethics® invites original, English-language contributions for peer review consideration on the upcoming themes.