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Learning Medical Ethics in E-Healthcare

As technology continues to be integrated into medical practices, one area of continued interest remains medical ethics. Many of the decisions a doctor makes may have ethical implications for the patient or other providers.

While the well-being of the patient remains the top priority, physicians also must be mindful of their responsibilities to other healthcare professionals, society and to themselves. The American Medical Association’s Ethics Group helps healthcare professionals navigate this evolving landscape by establishing ethics policies and developing educational programs, and of course there are the guiding principles adopted by the AMA as an ethical standard of conduct.

Ethical Issues Ahead – What are the ethical issues facing medical professionals?

Quality care vs. efficiency:
What will be the driving force behind healthcare industry decisions: quality care and safety or time- and cost-saving efficiency? How can healthcare leaders strike the right balance?

Access to care:
According to many ethicists, one signpost marking a civilized society is that every person has access to basic care. As the new healthcare reform law implementation continues, experts will be watching to see if the intended access goals are reached.

Sustaining a healthcare workforce into the future:
The need for healthcare workers will continue to grow as the post-World War II baby boomers age. Experts wonder if there will be enough doctors, nurses and caregivers to support that population for a sustained period of time.

“This is not just a supply issue,” Cynda Hylton Rushton, Ph.D, R.N., and a professor of Clinical Ethics at Johns Hopkins University, told AMN Healthcare News. “This is a sustainability issue. And one of the real threats to keeping the people we train in practice is having an ethical practice environment where they can actually practice with integrity, and where they are not constantly barraged with morally distressing situations that burn them out.”

End-of-life Issues:
Also ahead are the issues that come with longer life expectancies. People are living into their 90s now, but where will the money come from to pay for their care? The elderly and their families face many decisions, and how the healthcare industry responds will be important to them.

Availability of medication:
The Food and Drug Administration expects drug shortages to continue into the future. Part of the problem rests with the lack of economic incentive for manufacturers, as some generic drugs have a slim profit margin. 

“Until we fix some of the perverse incentives that we’ve built into the system for the creation and distribution of drugs in this country, I think it’s going to continue to happen,” said Philip Rosoff, M.D., director of clinical ethics for Duke Hospital and Duke University School of Medicine, in the AMN Healthcare report.

Why the Field of Health Informatics Has its Own Code of Ethics

Health information technology raises ethical issues not covered by medical or computing ethics. The IMIA’s code of ethics for health information professionals addresses industry-specific challenges.

Healthcare Data Collection Gets a High-Tech Makeover

The information pertinent to the healthcare industry generally can be broken down into three categories:

  • Patient information, a federally protected item as outlined by the HIPAA law of 1996
  • Hospital and office management information, which usually pertains to protocols, research and data management for statistics and risk management, as well as logistics of staffing and inventory
  • Insurance industry records related to healthcare coverage maintenance and data-based risk assessment

With the evolution of information technology, there has been a dramatic change in the way this information is collected, stored and transferred as computerized systems and software applications replace labor-intensive paper systems.

The Ethics of Healthcare Informatics

Health information professionals are embedded in the constantly evolving relationships between electronic health records and the subjects of those records. This creates ethical constraints unique to the field, according to the International Medical Informatics Association.

National and international medical organizations have codes of ethics that touch upon healthcare informatics issues, but the IMIA developed its own code of ethics specific to health information professionals to address the challenges specific to the industry.

There are three categories of ethics HIPs must adhere to: general, informatics and software ethics.

General ethics relate to social responsibilities and involve integrity, equality, justice, autonomy and the good of society. Informatics ethics address rights to privacy, security, access and accountability, as delineated by the HIPAA law. Software ethics address quality product production, maintenance and education, adaptability and upgrades, as well as organized, effective system implementations.

Learning from Past Mistakes

Ethical and professional standards unique to the healthcare informatics field are necessary to avoid causing harm. Case in point: When the US. Department of Veterans Affairs (VA) introduced a new integrated computer system to handle patient information, surgical scheduling and inventory management, the system was tested in a busy VA hospital in Florida.  Within weeks, problems led to unpaid vendors, lack of inventory, elective surgery cancellations and restrictions on patient access to their own records. The test resulted in lawsuits and job losses, including the resignation of a top VA official.

E-Health Ethics

Driven by the desire for more reliable information on the Internet, a panel of ethics experts drafted an E-Health Code of Ethics in February 2000. The result was eight guiding principles that experts hope individuals and organizations will use when providing health information online:

Candor:
Site creators should be upfront about the purpose of the site, who has a financial interest in or benefits from the site, and any relationship that would affect the user’s understanding or use of the site.

Honesty:
Site creators should describe their products and services truthfully and not present information in a misleading way. Content should distinguish whether it is promoting a product, service or organization, or whether it is intended to be informational and/or educational. 

Quality:
The site should strive to provide health information that is accurate, easy to understand and up to date so the user can make informed judgments. For example, the information should have citations (if appropriate) and be written in language that is not deceptive. 

Informed consent:
The site should tell the user how their personal data may be collected, used or shared, and it should note that the user is taking a privacy risk by submitting their information. 

Privacy:
The site has an obligation to protect the user’s right to privacy. Site users expect that the site creator will protect the information (encrypting, for example), have ways of updating incorrect information, and have tracking mechanisms that would produce an audit trail of that information. 

Professionalism in online health care:
Healthcare professionals who provide care or advice online should follow the same ethical codes they would use in face-to-face meetings, such as putting the patient’s needs first, protecting confidentiality and being upfront about fees, charges and payments. In addition, the site should make note of the limitations of online healthcare.

Responsible partnering:
The site creators should ensure that the other sites and organizations that they are affiliated with are trustworthy. Sites should make a reasonable effort to ensure that affiliates are upholding the same ethical standards.

Accountability:
The site should provide users with an opportunity to give feedback on the site. The creators should note clearly how they can be contacted, make the tools easy to use, and review and respond to feedback in a timely manner.

Looking to the Future

The developing world of health informatics includes ethical considerations that require both specific and flexible standards for addressing issues as technology continues to evolve. Data contained in electronic healthcare records provide the raw materials that healthcare institutions, governments and other agencies rely upon for decision-making.  Without these records, the healthcare system would cease to function properly.

By facilitating the construction, storage, maintenance, access, use and manipulation of EHRs, the HIP plays a role distinct from that of other informatics specialists. This distinction necessitates a separate – and fluid – code of ethics specific to health informatics.

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