Electronic Health Record Documentation of Clinical Ethics Consultations: Insights Post-21st Century Cures Act

Chelsey Patten, DBe – Director of Clinical Ethics, Center for Bioethics and Humanities, University of Colorado, Anschutz Medical Campus

Abstract: Since the enactment of the 21st Century Cures Act in 2021, there has been a notable gap in research examining the documentation of ethics consult services (ECS) in individual patient cases. There is extensive literature pre-dating the Cures Act that comments on what should be documented and even studied the frequency of documentation, however little has been reviewed since Cures. Despite the maturation of the field, the necessity of ethics consult documentation in the electronic health record (EHR) is still debated, stemming from the nature and scope of notes, lack of ties to billing for services, and comparisons from disciplines such as legal and risk – who often refrain from documenting in the EHR. Prior to the implementation of the Cures Act, and continuing today, concerns persist about how ethics consult information should be disseminated across current and future care team members. Perhaps increasing concerns, is the added dimension of the Cures Act that allows patients or their representatives to readily view this information. Per the Act, notes should be documented in real time and only hidden from patients when there is concern for harm.

To address the gap in post Cures Act data, we conducted a survey-based study of ECS documentation practices from various institutions, diverse in size and consultation models, to explore current practices. The survey included questions such as, frequency of documentation in the EHR, concerns or pushback on documentation, frequency and rationale of hiding documentation from patients.

Keywords: 21st Century Cures Act, Clinical Ethics Documentation, Documentation Transparency