Front Matter - Jones & Bartlett Learning

Loading...

THIRD EDITION

Ethical Health Informatics

Challenges and Opportunities

Laurinda Beebe Harman, PhD, RHIA, FAHIMA Associate Professor Emeritus Department of Health Information Management College of Public Health Temple University Philadelphia, Pennsylvania

Frances H. Cornelius, PhD, MSN, RN-BC, CNE Professor and Chair MSN Advanced Practice Role Department & Complementary and Integrative Health Programs Coordinator of Clinical Nursing Informatics Education College of Nursing and Health Professions Drexel University Philadelphia, Pennsylvania

9781284053708_FMxx_i-xxxviii.indd 1

17/11/15 4:11 pm

World Headquarters Jones & Bartlett Learning 5 Wall Street Burlington, MA 01803 978-443-5000 [email protected] www.jblearning.com Jones & Bartlett Learning books and products are available through most bookstores and online booksellers. To contact Jones & Bartlett Learning directly, call 800-832-0034, fax 978-443-8000, or visit our website, www.jblearning.com. Substantial discounts on bulk quantities of Jones & Bartlett Learning publications are available to corporations, professional associations, and other qualified organizations. For details and specific discount information, contact the special sales department at Jones & Bartlett Learning via the above contact information or send an email to [email protected] Copyright © 2017 by Jones & Bartlett Learning, LLC, an Ascend Learning Company All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission from the copyright owner. The content, statements, views, and opinions herein are the sole expression of the respective authors and not that of Jones & Bartlett Learning, LLC. Reference herein to any specific commercial product, process, or service by trade name, trademark, manufacturer, or otherwise does not constitute or imply its endorsement or recommendation by Jones & Bartlett Learning, LLC and such reference shall not be used for advertising or product endorsement purposes. All trademarks displayed are the trademarks of the parties noted herein. Ethical Health Informatics: Challenges and Opportunities, Third Edition is an independent publication and has not been authorized, sponsored, or otherwise approved by the owners of the trademarks or service marks referenced in this product. There may be images in this book that feature models; these models do not necessarily endorse, represent, or participate in the activities represented in the images. Any screenshots in this product are for educational and instructive purposes only. Any individuals and scenarios featured in the case studies throughout this product may be real or fictitious, but are used for instructional purposes only. This publication is designed to provide accurate and authoritative information in regard to the Subject Matter covered. It is sold with the understanding that the publisher is not engaged in rendering legal, accounting, or other professional service. If legal advice or other expert assistance is required, the service of a competent professional person should be sought. Production Credits VP, Executive Publisher: David D. Cella Publisher: Michael Brown Associate Editor: Nicholas Alakel Associate Production Editor: Rebekah Linga Senior Marketing Manager: Sophie Fleck Teague Manufacturing and Inventory Control Supervisor:   Amy Bacus

Composition: S4Carlisle Publishing Services Cover Design: Kristin E. Parker Rights & Media Research Coordinator: Mary Flatley Media Development Editor: Shannon Sheehan Cover Image: © kentoh/Shutterstock Printing and Binding: Edwards Brothers Malloy Cover Printing: Edwards Brothers Malloy

Library of Congress Cataloging-in-Publication Data Ethical challenges in the management of health information     Ethical health informatics : challenges and opportunities / [edited by] Laurinda Beebe Harman and Frances H. Cornelius. -Third edition.        p. ; cm.   Preceded by: Ethical challenges in the management of health information / [edited by ] Laurinda Beebe Harman. 2nd edition. 2006.   Includes bibliographical references and index.   ISBN 978-1-284-05370-8 (paper.)   I. Harman, Laurinda B., editor. II. Cornelius, Frances H, editor. III. Title.   [DNLM: 1.  Medical Informatics--ethics. 2.  Health Information Management--ethics.  W 26.5]   R118.2   174'.2--dc23                                                             2015017068 6048 Printed in the United States of America 19 18 17 16 15 10 9 8 7 6 5 4 3 2 1

9781284053708_FMxx_i-xxxviii.indd 2

17/11/15 4:11 pm

We dedicate this book to Our parents and first ethical teachers Paul William and Gloria Virginia Scott Sugg Frank and Gabriela Haider Our caring and compassionate ethical husbands Gilbert Lee Hoffer John Lynn Cornelius Our Families Dorette Eirene Welk and Charleen Rene Szabo Gabriele Haider, Ryan A. Cornelius, and Janis E. Cornelius

Our colleagues and students who have informed our professional practice and challenged us to achieve excellence

9781284053708_FMxx_i-xxxviii.indd 3

17/11/15 4:11 pm

9781284053708_FMxx_i-xxxviii.indd 4

17/11/15 4:11 pm

© kentoh/Shutterstock

Contents

Contributors Foreword Preface Acknowledgments

xxvii xxxi xxxiii xxxvii

SECTION I

Professional Ethics

1

Chapter 1

Professional Values and the Code of Ethics

3

Laurinda B. Harman, PhD, RHIA, FAHIMA Virginia L. Mullen, RHIA Frances H. Cornelius, PhD, MSN, RN-BC, CNE Learning Objectives Introduction Ethical Dilemmas for the HIM Professional Coding and Financial Reimbursement Accreditation and Regulation Vendors and Software Applications Sensitive Information Research The Health Information System: Then and Now The Healthcare System Healthcare Documentation Access to Information Release of Information Coding and Reimbursement Technology Role of the HIM Professional HIM Profession and Ethical Pledge Professional Codes of Ethics AHIMA Code of Ethics Preamble

3 3 4 4 4 5 5 5 5 5 6 6 7 8 8 8 11 12 12 12

v

9781284053708_FMxx_i-xxxviii.indd 5

17/11/15 4:11 pm

vi

Contents Patients and the Healthcare Team 15 Employer 16 Public Interest 17 Professional Associations and Peers 17 Accountability to the AHIMA Code of Ethics 18 Policy and Procedure 19 Ethical Tools 19 Consequences of Unethical Behavior 19 American Nurses Association Code of Ethics 20 Principles of Medical Ethics for Physicians 21 Shared Professional Values 22 Interprofessional Collaboration Competencies 22 Values for Interprofessional Practice 22 Building an Ethical Health Information System 24 Conclusion 27 Key Terms 28 Chapter Summary 28 References 29 Appendix 1-A: 1957 Code of Ethics for the Practice of Medical Record Science

32

Appendix 1-B: 1998 American Health Information Management Association Code of Ethics 33 Preamble 33 Appendix 1-C: 2011 American Health Information Management Association Code of Ethics 34 Preamble 34 Purpose of the American Health Information Management Association Code of Ethics 34 34 The Code of Ethics and How to Interpret the Code of Ethics 34 Principles and Guidelines The Use of the Code 39 Code of Ethics 2011 Ethical Principles 40 Resources 40

9781284053708_FMxx_i-xxxviii.indd 6

Appendix 1-D: Common Values of Health Care Regulators Values of Health Care Professionals

41 41

Appendix 1-E: Ethical Challenges Chapter Abstracts Professional Ethics Chapter 1: Professional Values and the Code of Ethics Chapter 2: Ethical Decision-Making Guidelines and Tools Chapter 3: Privacy and Confidentiality Uses of Information Chapter 4: Data Analytics Chapter 5: Compliance, Fraud, and Abuse Chapter 6: Coding Chapter 7: Quality Management Chapter 8: Research and Decision Support Chapter 9: Public Health Chapter 10: Longitudinal Coordinated Care Chapter 11: Clinical Care: End of Life

42 42 42 42 42 43 43 43 43 44 44 44 44 45

20/11/15 12:12 AM

Contents



Electronic Health Information Chapter 12: Electronic Health Records Chapter 13: Information Security Chapter 14: Information Technology and Biomedical Instrumentation Chapter 15: Information Governance and Management Chapter 16: Integrated Delivery Systems Chapter 17: Digital Health: Health Information Technology and Information Exchange Sensitive Health Information Chapter 18: Genetic Information Chapter 19: Adoption Chapter 20: Substance Abuse, Behavioral Health, and Sexual Information Consumer and Professional Informatics Chapter 21: Digital Health Technologies for Consumers, Patients, and Caregivers Chapter 22: Management and Leadership Chapter 23: Entrepreneurship Chapter 24: Vendor Management Chapter 25: Advocacy Chapter 26: Future Challenges and Opportunities

Chapter 2

Ethical Decision-Making Guidelines and Tools

vii 45 45 45 46 46 47 47 48 48 48 48 49 49 49 49 49 50 50

51

Jacqueline J. Glover, PhD Learning Objectives 51 Introduction 51 Scenario 2-A: Decision Making for an Adolescent 51 What Is an Ethical Issue? 52 Why Do Ethical Issues Need to Be Addressed? 52 But You Can’t Teach Ethics, Can You? 53 The Process of Ethical Decision Making 53 Justification in Ethical Reasoning: How Do You Know What Is Best? 57 Classic Ethical Theories 57 Utilitarianism 58 Deontological Theory 58 Applying Multiple Theories 58 Current Ethical Approaches 59 Analysis of Principles 59 Analysis of Rights 59 Ethics of Care 60 Virtue-Based Ethics 60 The Bioethicist’s Toolbox 60 Moral Distress 62 Scenario 2-B: Access by Adolescents to Patient Portals 62 Ethics Resources 63 Conclusion 63 Key Terms 63 Chapter Summary 63 References 64 Blank Ethical Decision-Making Matrix

9781284053708_FMxx_i-xxxviii.indd 7

66

17/11/15 4:11 pm

viii

Contents Ethical Decision-Making Matrices 67 Scenario 2-A: Decision Making for an Adolescent 67 Scenario 2-B: Access by Adolescents to Patient Portals 70

Chapter 3

Privacy and Confidentiality

75

Laurie A. Rinehart-Thompson, JD, RHIA, CHP, FAHIMA Laurinda B. Harman, PhD, RHIA, FAHIMA Learning Objectives 75 Introduction 75 Scenario 3-A: Family and Friends: Should I Tell? 75 Scenario 3-B: Share Information on Facebook? 76 Protecting Health Information 77 Privacy and Confidentiality 78 Release of Information 78 The HIPAA Privacy Rule 79 79 History of Privacy Laws 79 HIPAA Privacy Rule Framework Requirements for Patient Authorization 80 Use and Disclosure 81 Patient Authorization Required 81 82 Patient Authorization Not Required Blanket Authorizations 83 Breaches 83 Patient Concerns 84 Medical Identity Theft 84 85 Electronic Health Records and Mobile Devices Social Media 85 Professional Concerns 86 Ethical Challenges 86 Conclusion 87 Key Terms 87 Chapter Summary 88 References 88 Ethical Decision-Making Matrices Scenario 3-A: Family and Friends: Should I Tell? Scenario 3-B: Share Information on Facebook?

89 89 91

SECTION II

Uses of Information

93

Chapter 4

Data Analytics

95

Billie Anderson, PhD J. Michael Hardin, PhD Learning Objectives Introduction The Role of Data Analytics in Health Care Medical Data and the Data Collection Process Structured and Unstructured Data Current State of Medical Data Collection

9781284053708_FMxx_i-xxxviii.indd 8

95 95 95 97 97 99

20/11/15 12:13 AM

Contents



ix

Paper-Based Medical Records 99 Hybrid Medical Records 100 Electronic Medical Records 101 Ethical Dilemmas Associated with Big Data and Data Analytics 102 Scenario 4-A: Readmission Predictive Model Project, Part 1: Right Skills? 103 Scenario 4-B: Readmission Predictive Model Project, Part 2: Impact of Bad Data 104 Value of Model Assumptions 105 Data Altruism 106 Big Data Analysis Techniques Used to Analyze Medical Data 108 Big Data Analysis 108 Traditional Data Analysis 109 Predictive Analytics 109 Supervised and Unsupervised Analyses 109 Conclusion 112 Key Terms 112 Chapter Summary 112 References 113 Ethical Decision-Making Matrices Scenario 4-A: Readmission Predictive Model Project, Part 1: Right Skills? Scenario 4-B: Readmission Predictive Model Project, Part 2: Impact of Bad Data

Chapter 5

Compliance, Fraud, and Abuse

115 115 117

119

Laurie A. Rinehart-Thompson, JD, RHIA, CHP, FAHIMA Learning Objectives 119 Introduction 119 Scenario 5-A: Documentation Does Not Justify Billed Procedure 119 Regulations that Guide HIM Professionals 121 False Claims Act 121 Qui Tam Statutes 122 Voluntary Disclosure Protocol 123 Anti-kickback Statute 124 Anti-referral Statutes: Stark I and II 124 “Safe Harbors” and Stark Exceptions 125 Mail and Wire Fraud 125 HIPAA Regulations 125 HIPAA Administrative Simplification Standards 126 Security Standards 126 Privacy Standards 126 Enforcement Programs 127 False Claims Penalties 127 Roles for HIM Professionals 127 Compliance Programs to Prevent Fraudulent Behaviors 128 Dilemmas in Practice 129 Scenario 5-B: Accepting Money for Information 130 Fraudulent Documentation Practices 130 Scenario 5-C: Retrospective Documentation to Avoid Suspension 130 Retrospective Medical Record Analysis 132

9781284053708_FMxx_i-xxxviii.indd 9

17/11/15 4:11 pm

x

Contents Scenario 5-D: Coder Assigns Code Without Physician Documentation 132 Coding Turnaround Time 133 Conclusion 133 Key Terms 133 Chapter Summary 134 References 135 Ethical Decision-Making Matrices Scenario 5-A: Documentation Does Not Justify Billed Procedure Scenario 5-B: Accepting Money for Information Scenario 5-C: Retrospective Documentation to Avoid Suspension Scenario 5-D: Coder Assigns Code Without Physician Documentation

Chapter 6

Coding

136 136 138 140 142

145

Linda Holtzman, MHA, RHIA, CCS, CCS-P, CPC, COC Rosalind Holtzman, RN, BA, BSN Learning Objectives 145 Introduction 145 Scenario 6-A: Blood Loss Anemia 145 Coding Systems 146 The Function of Coding 147 Legal Foundation and Framework for Ethical Coding 148 Aortography 148 Scenario 6-B: Thoracic Aortogram 148 Coding and Payment Elements 149 Fraud and Abuse 149 Ethical Foundations and Ethical Standards 150 AHIMA Code of Ethics 151 AHIMA Standards of Ethical Coding 151 Coding and Payment Elements 152 Sources for Coding Direction 154 Mandated Sources 154 Coding Sources 154 Credible Sources 154 Main Ethical Challenges 155 Scenario 6-C: Revise the Analysis? 155 Upcoding 156 Unbundling 157 Evading Medical Necessity Requirements 158 Making a Decision and Making Your Case 159 Conclusion 162 Key Terms 162 Chapter Summary 162 References 163 Appendix 6-A: American Health Information Management Association  Code of Ethics 164 Preamble 164 Purpose of the American Health Information Management Association Code of Ethics 164

9781284053708_FMxx_i-xxxviii.indd 10

17/11/15 4:11 pm

Contents



xi

The Code of Ethics and How to Interpret the Code of Ethics 165 Principles and Guidelines 165 The Use of the Code 169 Code of Ethics 2011 Ethical Principles 170 Resources 170 Appendix 6-B: American Health Information Management Association  Standards of Ethical Coding 171 Introduction 171 Standards of Ethical Coding 171 Resources 172 How to Interpret the Standards of Ethical Coding 172 Ethical Decision-Making Matrices 177 Scenario 6-A: Blood Loss Anemia 177 Scenario 6-B: Thoracic Aortogram 179 Scenario 6-C: Revise the Analysis? 181

Chapter 7

Quality Management

183

Patrice L. Spath, MA, RHIT Fameka B. Leonard, RN, MSN Learning Objectives 183 Introduction 183 Scenario 7-A: Inaccurate Publicly Reported Performance Data 183 183 Quality Management Milestones that Created QM Ethical Questions 185 Transitions Bring Ethical Challenges 187 Scenario 7-B: Audit Results Indicate Inappropriate Health Care 187 Ethical Issues Facing QM Professionals 187 188 Scenario 7-C: Reporting Hospital-Acquired Conditions 189 Ethical Standards Affecting QM Activities Quality and Professional Ethics 189 Code of Ethics 190 Organizational Values 191 Scenario 7-D: Disclosure of an Unanticipated Outcome 191 Personal Convictions 192 Moral Courage 193 Scenario 7-E: Failure to Check Physician’s Licensure Status 193 Making Ethical Decisions 193 QM Situations Raising Ethical Questions 194 Enabling Ethical Conduct 195 Role of the Profession 195 196 Role of the Employer Conclusion 196 Key Terms 197 Chapter Summary 197 References 197 Ethical Decision-Making Matrices Scenario 7-A: Inaccurate Performance Data Reported to the Public Scenario 7-B: Audit Results Indicate Inappropriate Health Care Scenario 7-C: Reporting Hospital-Acquired Conditions

9781284053708_FMxx_i-xxxviii.indd 11

200 200 202 204

20/11/15 12:13 AM

xii

Contents Scenario 7-D: Disclosure of an Unanticipated Outcome Scenario 7-E: Failure to Check Physician’s Licensure Status

Chapter 8

Research and Decision Support

206 208

211

Susan White, PhD, RHIA, CHDA J. Michael Hardin, PhD Learning Objectives 211 Introduction 211 Scenario 8-A: Designing a Survey to Bias the Results 212 Scenario 8-B: The Impact of Sample Selection Bias 212 Roles of the RS and DSS 213 Ethical Responsibilities of the RS and DSS 215 Ensuring Data Integrity and Confidentiality 215 Data Acquisition and Integrity 217 Privacy and Confidentiality 218 Data from External Sources 219 Data Reporting 219 Data Access 220 Human Subject Research 221 Internal Review Board 221 Research Versus Clinical Record 224 Medical Record Data in Retrospective Studies 225 Maintaining and Enhancing Professional Competence 226 Conclusion 226 Key Terms 226 Chapter Summary 226 References 227 Ethical Decision-Making Matrices Scenario 8-A: Designing a Survey to Bias the Results Scenario 8-B: The Impact of Sample Selection Bias

Chapter 9

Public Health and Informatics

229 229 231

233

Babette J. Neuberger, JD, MPH Eric S. Swirsky, JD, MA Learning Objectives 233 Introduction 233 Scenario 9-A: Gun Control and Reporting Mental Health Status 233 Public Health Information: An Overview 236 The Evolution of Public Health and Government Access to Private Medical Information 237 State Use of Protected Heath Information: Sexually Transmitted Disease Contact Tracing and Partner Notification 242 Ethical Challenges in Public Health 245 When the Public’s Right to Know Conflicts with the Individual’s Right to Privacy 245 An Antecedent Issue: The Duty to Decide 246 Making a Reasoned Decision 247 Autonomy 247

9781284053708_FMxx_i-xxxviii.indd 12

17/11/15 4:11 pm

Contents



xiii

Nonmaleficence 248 Beneficence 249 Justice 250 Utility 251 Globalization and Attendant Ethical Challenges 253 Opportunities and Ethical Challenges of Social Media 255 The HIM Professional’s Role and Responsibility as an Advocate 258 A Reciprocal Duty Owed to Society 258 Superior Knowledge 259 An Unambiguous Duty to Protect Patient Privacy 259 Resources for Advocacy 259 Scenario 9-B: Conflicting Personal and Public Duties 260 Making a Reasoned Decision 261 Analyzing the Ethical Conflict 261 Conclusion 262 Key Terms 262 Chapter Summary 262 References 263 Ethical Decision-Making Matrices Scenario 9-A: Gun Control and Reporting Mental Health Status Scenario 9-B: Conflicting Personal and Public Duties

Chapter 10

Longitudinal Coordinated Care

266 266 268

271

Ida Critelli Schick, PhD, LFACHE Learning Objectives 271 Introduction 271 The Ever-Changing Healthcare Scene 271 Two Significant Initiatives 271 Healthy People Initiative 271 Healthcare Improvement Initiative 272 Key Stakeholders in Health Care 272 Population Health 273 The Focus on Patient-Centered Care 274 Changes in the Medical Care System 275 Formation of Accountable Care Organizations 275 Critical Cultural Changes in ACOs 275 Health Care in Transition 276 Patient-Centered Medical Homes 276 Longitudinal Care 278 Complex Care Management 282 Exploring the Ethical Dimensions of PCMH and Longitudinal Care 285 Ethical Principles 285 Respect for Autonomy 285 Application of Respect for Autonomy: Enhancing and Expanding Informed Consent in PCMH and Longitudinal Care 285 Beneficence (Do Good) and Nonmaleficence (Do No Harm) 286 Justice 287 A Decision-Making Methodology in Ethics 287 Ethical Challenges and Issues 287

9781284053708_FMxx_i-xxxviii.indd 13

17/11/15 4:11 pm

xiv

Contents Challenges for Boards and Administrators 288 Scenario 10-A: Competing Stakeholder Agendas in a Community ACO 288 Longitudinal Care Coordination 289 Scenario 10-B: Patient Transfer 289 Conclusion 290 Key Terms 290 Chapter Summary 290 References 291 Ethical Decision-Making Matrices Scenario 10-A: Competing Stakeholder Agendas in a Community ACO Scenario 10-B: Patient Transfer

Chapter 11

Clinical Care: End-of-Life

293 293 295

297

Deepak Mandi, MD Michael A. Silverman, MD, MPH James F. Tischler, MD Adam G. Golden, MD, MBA Learning Objectives 297 Introduction 297 Scenario 11-A: Bad News 297 Autonomy and Beneficence 298 Are Physicians Getting the Right Message Out to Patients? 298 Physician Bias and Equity: A Systems Issue 299 Scenario 11-B: Treatment Choices 299 Information Across a Healthcare Continuum 300 Treatment Goals and Beneficence 300 Scenario 11-C: Advance Care Planning 301 Advance Care Planning: An Opportunity 301 The Meaning of Terminal 302 Scenario 11-D: Palliative Care 302 Managing Pain 303 Palliative Care 303 Emerging Issues 303 Physician-Assisted Suicide 303 Euthanasia 304 Is Withholding or Withdrawing Life-Sustaining Treatment Euthanasia? 304 Conclusion 304 Key Terms 304 Chapter Summary 304 References 305 Ethical Decision-Making Matrices Scenario 11-A: Bad News Scenario 11-B: Treatment Choices Scenario 11-C: Advance Care Planning Scenario 11-D: Palliative Care

9781284053708_FMxx_i-xxxviii.indd 14

307 307 309 311 313

17/11/15 4:11 pm

Contents



xv

SECTION III

Electronic Health Information

315

Chapter 12

Electronic Health Records

317

Mary Alice Hanken, PhD, CHPS, RHIA Gretchen Murphy, MEd, RHIA, FAHIMA Learning Objectives 317 Introduction 317 Scenario 12-A: Patient Record Integrity and Access 317 EHR Systems: Functions and Expected Features 318 EHR Definitions 319 EHR Benefits and Functionality 320 Health Data Uses 321 EHR Systems in the Twenty-First Century 323 EHR Technology and Ethical Issues 325 Patient Privacy 325 Data Quality 327 Patient Interest 327 Organizational Values 328 Making Ethical Decisions 328 Ethical Issues in Implementation 328 Patient Record Integrity and Access 328 Additional Ethical Issues in Implementation Planning 329 Clinical Care Process 329 Data Correction and Editing Process 330 System Problems 330 Health Information Access Capabilities 331 Scenario 12-B: Parent Access to Child’s Health Information 331 Expanded Use of Health Information 331 Infrastructure Strengths and Weaknesses 332 New Opportunities for Vendors and Healthcare Organizations 332 Scenario 12-C: Differences When Linking EHR Systems 333 User Access 336 Security Practices 336 Data Quality/Integrity 337 Confidentiality Agreements 337 Notifying Patients About Information Practices 338 Audit Trails and Email 338 Conclusion 338 Key Terms 338 Chapter Summary 338 References 339 Ethical Decision-Making Matrices Scenario 12-A: Patient Record Integrity and Access Scenario 12-B: Parent Access to Child’s Health Information Scenario 12-C: Differences When Linking EHR Systems

9781284053708_FMxx_i-xxxviii.indd 15

341 341 343 345

17/11/15 4:11 pm

xvi

Contents

Chapter 13

Information Security

347

Karen Czirr, MS, RHIA, CHP Emily West, RHIA Learning Objectives 347 Introduction 347 Scenario 13-A: A Curious Human Resource Employee 348 The Healthcare Information Revolution 349 The Role of the CIO 350 Access and Information Security 351 Privacy, Confidentiality, Disclosure, and Need to Know 351 Privacy-Related Security 352 Confidentiality, Integrity, Availability 353 Sanctions 353 Establishing a Security Baseline 353 Policies and Procedures 353 Need to Know and Data Sharing 354 Access Control 356 Unique User Identification 356 Scenario 13-B: Failure to Log Out of the System 358 Audit Trails 358 Workstation Use and Security 359 The Internet, Email, and E-Health 359 Conducting a Risk Analysis 360 Identifying Vulnerabilities 360 Scenario 13-C: Storing Data on a Laptop Computer 360 Interoperability 361 Patient Notification and Informed Consent 362 Conclusion 362 Key Terms 362 Chapter Summary 363 References 363 Ethical Decision-Making Matrices Scenario 13-A: A Curious Human Resource Employee Scenario 13-B: Failure to Log Out of the System Scenario 13-C: Storing Data on a Laptop Computer

Chapter 14

Information Technology and Biomedical Instrumentation

365 365 367 369

371

Susan H. Fenton, PhD, RHIA, FAHIMA Frances H. Cornelius, PhD, MSN, RN-BC, CNE Learning Objectives 371 Introduction 371 Biomedical Instrumentation and Interoperability 372 Scenario 14-A: Lack of Interoperability 373 Medical Device Interoperability Defined 374 The Need for Interoperability 375 Codes of Ethics 376

9781284053708_FMxx_i-xxxviii.indd 16

17/11/15 4:11 pm

Contents



xvii

Ethical Issues for Interface Development 377 Interface Development and Biomedical Device Integration 378 Functional Medical Device Interoperability 379 Scenario 14-B: Data Interface Decisions 379 Consultant’s Perspective 379 Information Gathering 379 Key Considerations 380 Benefits of Functional Device Interoperability 381 Prioritizing Device Integration 381 A Collaborative Approach to Decision Making 382 Scenario 14-C: Data Interface Quality 383 Conclusion 384 Key Terms 384 Chapter Summary 384 References 385 Ethical Decision-Making Matrices Scenario 14-A: Lack of Interoperability Scenario 14-B: Data Interface Decisions Scenario 14-C: Data Interface Quality

Chapter 15

Information Governance and Management

387 387 389 391

393

Linda L. Kloss, MA, RHIA, FAHIMA Learning Objectives 393 Introduction 393 Scenario 15-A: Stewardship Literacy for Community Health Improvement 394 Governance of Health Information 395 Defining Information Governance 395 Defining Data and Other Dimensions of Governance 396 Governance as Ethical Stewardship 397 Healthcare Organizations and Stewardship 399 Scenario 15-B: Managing Patient Identification as Master Data 400 Organizing for Governance 402 Scenario 15-C: Big Data Analytics and Stewardship 403 Contemporary Health Information Management 404 Enterprise Information Management Domains 405 Organizing for EIM 406 Scenario 15-D: EHR Integrity Management 407 Conclusion 408 Key Terms 408 Chapter Summary 408 References 409 Ethical Decision-Making Matrices 410 Scenario 15-A: Stewardship Literacy for Community Health Improvement 410 Scenario 15-B: Managing Patient Identification as Master Data 412 Scenario 15-C: Big Data Analytics and Stewardship 414 Scenario 15-D: EHR Integrity Management 416

9781284053708_FMxx_i-xxxviii.indd 17

17/11/15 4:11 pm

xviii

Contents

Chapter 16

Integrated Delivery Systems

419

Brenda Olson, MEd, RHIA, CHP Karen Gallagher Grant, RHIA, CHP Learning Objectives 419 Introduction 419 Scenario 16-A: Scheduling Clerk Has Access to All Clinical Information 419 Privacy and Security Issues 422 Models for the Integrated Delivery System 425 Data Quality Issues 426 Scenario 16-B: Vulnerabilities in the Electronic Health Record 426 Management of Patient Identity Management Systems 428 Scenario 16-C: Inconsistencies in the Patient Identity Management System 429 Required Skills for HIM Professionals 430 Conclusion 430 Key Terms 431 Chapter Summary 431 References 431 Appendix 16-A: Sample Access Policy Ethical Decision-Making Matrices Scenario 16-A: Scheduling Clerk Has Access to All Clinical Information Scenario 16-B: Vulnerabilities in the Electronic Health Record Scenario 16-C: Inconsistencies in the Patient Identity Management System

Chapter 17

Digital Health: Information Technology and Information Exchange

433 435 435 437 439

441

Meryl Bloomrosen, MBA, MBI, RHIA, FAHIMA Learning Objectives 441 Introduction 441 Goals and Objectives 442 Health Information Technology and Health Information Exchange 443 Health Information Exchange 443 Data and Information Governance 444 Evolving Roles, Responsibilities, and Challenges 445 Background and History of Public- and Private-Sector Activities 445 Public Sector 445 Private Sector 452 Mobile Health 454 Ethical Challenges 454 Scenario 17-A: Health Informatics and Information Management (HIIM) Professionals’ Role 456 Conclusion 457 Key Terms 458 Chapter Summary 458 References and Resources 459 Ethical Decision-Making Matrices Scenario 17-A: Health Informatics and Information Management (HIIM) Professionals’ Role

9781284053708_FMxx_i-xxxviii.indd 18

464 464

17/11/15 4:11 pm

Contents



xix

SECTION IV

Management of Sensitive Health Information

467

Chapter 18

Genetic Information

469

Sharon F. Terry, MA Learning Objectives 469 Introduction 469 Scenario 18-A: Genetic Privacy 469 Genetic and Genomic Information 470 Genetic Information in the Clinical Context 471 Translational Science’s Implications for the Management of Genomic Information 471 Privacy and Confidentiality of Genetic Information 472 Research Setting 474 Legislation Regarding Genetic Information 475 Genetic Information Nondiscrimination Act (GINA) 475 State Legislative Protections Related to Genetics 476 Ethical and Social Issues Related to Genetics 476 Access to Genetic Services and Health Disparities 477 Whole Genome and Exome Sequencing 478 Right to Know, Not to Know, and Incidental Findings 478 Conclusion 479 Key Terms 479 Chapter Summary 480 References 481 Appendix 18-A: Legislative Acts Relevant to Genetic Testing Ethical Decision-Making Matrices Scenario 18-A: Genetic Privacy

Chapter 19

Adoption Information

484 485 485

487

Martha L. Jones, PhD, LSW Learning Objectives 487 Introduction 487 Scenario 19-A: Seeking Information Many Years Later 487 Historical and Emerging Ethical Issues 489 Adoption and Assisted Reproductive Technology (ART) 492 Ethical Issues for HIM Professionals 494 Adoptive Parents Seek Information on Their Adopted Child 494 Scenario 19-B: An Adoptee Seeks Information on Her Biological Family 495 Scenario 19-C: A Birth Mother Seeks Information on Her Biological Son 496 Future Issues 498 Conclusion 500 Key Terms 500 Chapter Summary 500 References 501 Ethical Decision-Making Matrices Scenario 19-A: Seeking Information Many Years Later Scenario 19-B: An Adoptee Seeks Information on Her Biological Family Scenario 19-C: A Birth Mother Seeks Information on Her Biological Son

9781284053708_FMxx_i-xxxviii.indd 19

502 502 504 506

17/11/15 4:11 pm

xx

Contents

Chapter 20

Substance Abuse, Behavioral Health, and Sexual Information

509

Laurie A. Rinehart-Thompson, JD, RHIA, CHP, FAHIMA Sharon J. Randolph, JD, RHIA Learning Objectives 509 Introduction 509 Scenario 20-A: The Arrest Warrant: Is This Person in Your Facility? 510 Substance Abuse Treatment, Health Information, and the Law 511 Ethical Challenges in Behavioral Health and Substance Abuse Treatment 511 Law Enforcement Requests ­Patient-Identifying Information 513 Scenario 20-B: Safety of a Citizen Versus Privacy of a Patient 514 Law Enforcement Requests Patient Information for Public Safety Reasons 515 Scenario 20-C: Patient Confesses to a Psychiatrist 516 A Behavioral Health Patient Confesses to a Staff Member That He Has Committed a Crime 517 Scenario 20-D: Patient Confesses to the Nurse’s Aide 517 Protecting Information About a Patient’s Admission to a Behavioral Health Unit of a General Hospital 518 Scenario 20-E: Verifying Admission Can Violate Privacy 519 Requests for Information on Sexually Transmitted Diseases (STDs) 520 Scenario 20-F: A Prisoner Who May Have AIDS 520 Requests About Employees and Children 521 Scenario 20-G: Workers’ Compensation Case 521 Employees 522 Children 522 Scenario 20-H: Children’s Protective Services 522 Conclusion 523 Key Terms 524 Chapter Summary 524 References 525 Ethical Decision-Making Matrices Scenario 20-A: The Arrest Warrant: Is This Person in Your Facility? Scenario 20-B: Safety of a Citizen Versus Privacy of a Patient Scenario 20-C: Patient Confesses to a Psychiatrist Scenario 20-D: Patient Confesses to the Nurse’s Aide Scenario 20-E: Verifying Admission Can Violate Privacy Scenario 20-F: A Prisoner Who May Have AIDS Scenario 20-G: Workers’ Compensation Case Scenario 20-H: Children’s Protective Services

526 526 528 530 532 534 536 538 540

SECTION V

Consumer and Professional Informatics

543

Chapter 21

Digital Health Technologies for Consumers, Patients, and Caregivers

545

Cynthia Baur, PhD Mary Jo Deering, PhD Learning Objectives

9781284053708_FMxx_i-xxxviii.indd 20

545

17/11/15 4:11 pm

Contents



xxi

Introduction 545 Scenario 21-A: Plain Language and Health Information Privacy Policies 545 The HIM Professional and Consumer, Patient, and Caregiver Digital Health Technologies 547 Consumer, Patient, and Caregiver Digital Health Technologies 548 Benefits and Risks of Digital Health Technologies 550 Special Considerations for Privacy and Security Management in Digital Health Technologies 551 Patient Portals and Their Special Significance for HIM Professionals 552 Data Access 552 Receiving Patient-Generated Information 552 Secure Messaging 552 Interactive Tools 552 Links to Authoritative Information 552 National Policy Related to Digital Health Technology for Consumers, Patients, and Caregivers 553 Information Access and the HIM Professional 554 Ethical Issues Related to Consumer, Patient, and Caregiver Digital Technology Access 555 Scenario 21-B: Ensuring Privacy Protections for Digital Health Technologies 556 Emerging Issues 558 Conclusion 559 Key Terms 560 Chapter Summary 560 References 560 Ethical Decision-Making Matrices 563 Scenario 21-A: Plain Language and Health Information Privacy Policies 563 Scenario 21-B: Ensuring Privacy Protections for Digital Health Technologies 565

Chapter 22

Management and Leadership

567

Cathy A. Flite, MEd, RHIA, FAHIMA Merida L. Johns, PhD, RHIA Learning Objectives Introduction Scenario 22-A: Lateness and Absenteeism Moral Development and Moral Awareness Stages of Moral Development Ethic of Caring Moral Awareness Scenario 22-B: Concerns in Telecommuting Scenario 22-C: Failure to Document Poor Work Performance for a Friendly Employee Moral Muteness Orientation of New Employees Scenario 22-D: Avoiding the Employee Who Will Be Fired Ethical Organizational Leadership: Beyond a Mission Statement and Code of Ethics Ethical Frameworks for Diversity Management The Ethical Leader: Doing the Right Thing

9781284053708_FMxx_i-xxxviii.indd 21

567 567 567 569 570 573 574 574 576 578 578 580 581 582 583

17/11/15 4:11 pm

xxii

Contents Conclusion 584 Key Terms 584 Chapter Summary 585 References 585 Ethical Decision-Making Matrices Scenario 22-A.1: Lateness and Absenteeism—Fire the Employee Scenario 22-A.2: Lateness and Absenteeism—Don’t Fire the Employee Scenario 22-B: Concerns in Telecommuting Scenario 22-C: Failure to Document Poor Work Performance for a Friendly Employee Scenario 22-D: Avoiding the Employee Who Will Be Fired

Chapter 23

Entrepreneurship

587 587 589 591 593 595

597

Marie Gardenier, MBA, RHIA, CHPS Keith Olenik, MA, RHIA, CHP Learning Objectives 597 Introduction 597 Scenario 23-A: Competing Constituencies 597 Entrepreneurship in Health Information Management 599 Defining the Entrepreneur 600 Entrepreneur versus Intrapreneur 601 Function-Based Issues for the Consultant 602 Rights of the Independent Contractor 602 The Expert Role 603 Delivering a Difficult Message 604 Advice Not Taken 604 Conflicts of Interest 605 The Collaborative Role 605 Scapegoating 606 Special Opportunities for the Consultant to Act as Moral Voice 607 Relationship-Based Issues for the Independent Contractor 607 Social Isolation 608 Business Ethics: Concepts and Principles 609 Contracts 610 Advertising 611 The Profit Motive 612 Corporate Responsibility 613 The Case for Ethics in Business 613 The Intersection of Ethics and HIM Entrepreneurship 614 Scenario 23-B: Negotiating Contracts 616 Negotiating Contracts 616 Scenario 23-C: Unrealistic Client Expectations 617 Scenario 23-D: Discovering Sensitive Information About a Client, Competitor, or Colleague 618 Learning Sensitive Information About a Client, Competitor, or Colleague 619 Managing Client Relationships 620 Conclusion 621 Key Terms 621 Chapter Summary 621

9781284053708_FMxx_i-xxxviii.indd 22

17/11/15 4:11 pm

Contents



xxiii

References 622 Ethical Decision-Making Matrices 623 Scenario 23-A: Competing Constituencies 623 Scenario 23-B: Negotiating Contracts 625 Scenario 23-C: Unrealistic Client Expectations 627 Scenario 23-D: Discovering Sensitive Information About a Client, Competitor, or Colleague 629

Chapter 24

Vendor Management

631

Keith Olenik, MA, RHIA, CHP Learning Objectives 631 Introduction 631 Scenario 24-A: Vendor Request 631 Vendor Relations 632 Sales Ethics 632 Scenario 24-B: Vendors as Friends 633 Scenario 24-C: Gifts 634 Prevention of Ethical Problems 636 Scenario 24-D: Preferred Vendors 636 Requests for Proposals 637 Introduction 637 Directions 637 Standard Text 638 Statement of Work 638 Social Responsibility 639 Ethical Considerations for the RFP Process 639 Scenario 24-E: Negotiating 639 Negotiation 640 Enhancement of Vendor Relationships 642 Ethical Behavior 642 Scenario 24-F: Unethical Behavior 643 Conclusion 644 Key Terms 644 Chapter Summary 645 References 645

Chapter 25

Appendix 24-A: Sample Gifts Policy

647

Appendix 24-B: Sample Conflict of Interest Policy Ethical Decision-Making Matrices Scenario 24-A: Vendor Request Scenario 24-B: Vendors as Friends Scenario 24-C: Gifts Scenario 24-D: Preferred Vendors Scenario 24-E: Negotiating Scenario 24-F: Unethical Behavior

649 654 654 655 656 657 659 660

Advocacy

661

Susan Helbig, MA, RHIA Learning Objectives

9781284053708_FMxx_i-xxxviii.indd 23

661

17/11/15 4:11 pm

xxiv

Contents Introduction 661 Scenario 25-A: Violating the Privacy of a Prominent Citizen 661 Advocacy: The Choice of Ethics in Action 662 Advocating for Patients 663 Patient Rights 664 Supporting Patients Who Advocate 664 Health Information: Individual Patient and Collective Patient Stories 665 Advocating for Peers 667 Scenario 25-B: Compassion in Action for an Alcoholic Peer 667 Advocating for Staff 669 Scenario 25-C: Cockroaches in the HIM Department 669 Scenario 25-D: Unfair Treatment of Part-Time Workers 670 Advocating for the Healthcare Organization 672 Scenario 25-E: Small Print on a Consent Form 672 Scenario 25-F: The Data Warehouse Wants to Sell Patient Information 673 Advocating for the Larger Community and Society 674 Advocating for One’s Self 675 Conclusion 675 Key Terms 675 Chapter Summary 676 References 676 Appendix 25-A: Example of Organizational Engagement in Societal Advocacy

677

Appendix 25-B: Precepts of Effective HIM Advocacy Ethical Decision-Making Matrices Scenario 25-A: Violating the Privacy of a Prominent Citizen Scenario 25-B: Compassion in Action for an Alcoholic Peer Scenario 25-C: Cockroaches in the HIM Department Scenario 25-D: Unfair Treatment of Part-Time Workers Scenario 25-E: Small Print on a Consent Form Scenario 25-F: The Data Warehouse Wants to Sell Patient Information

678 679 679 681 683 685 687 689

SECTION VI

Looking to the Future

691

Chapter 26

Future Challenges and Opportunities

693

Frances H. Cornelius, PhD, MSN, RN-BC, CNE Laurinda B. Harman, PhD, RHIA, FAHIMA Virginia L. Mullen, RHIA Learning Objectives 693 Introduction 693 Uses of Information 694 Clinical Care 694 Substance Abuse, Behavioral Health, and Sexual Information 694 Longitudinal Coordinated Care 695 End of Life 695 Family Decisions 695 Adoption 695 Genetics 695

9781284053708_FMxx_i-xxxviii.indd 24

17/11/15 4:11 pm



Contents

xxv

Data Analysis 696 Quality Management 696 Research and Decision Support 696 Data Analytics 697 Information Governance and Management 697 Public Health 697 Professional Roles 698 Management and Leadership 698 Entrepreneurship and Intrapreneurship 698 Vendor Management 698 Advocacy 699 Emerging Trends 699 Technology Explosion 699 Digital Health: Health Information Technology and Information Exchange 702 Digital Health Technologies for Consumers, Patients, and Caregivers 702 Electronic Health Records 703 Integrated Delivery Systems 703 Biomedical Instrumentation and Interoperability 703 Growth for Healthcare Expenditures 704 Growth for HIT 705 Challenges 707 Clinical and Legal 707 Privacy and Confidentiality 707 Coding, Fraud, and Abuse 707 Legal System Changes 708 Technology 708 Information Security 708 Cyberintelligence and Cybersecurity 709 Security Breaches 709 Interoperability, Terminology, and Standards 711 Big Data/Data Analytics 712 Surveillance 713 Cloud Computing 713 Opportunities 714 Interdisciplinary Education 715 Interdisciplinary Collaboration 716 Ethics as Standard of Practice 718 Conclusion 719 Key Terms 719 Chapter Summary 720 References 722

Glossary 725 Index 741

9781284053708_FMxx_i-xxxviii.indd 25

17/11/15 4:11 pm

9781284053708_FMxx_i-xxxviii.indd 26

17/11/15 4:11 pm

© kentoh/Shutterstock

Contributors

Billie Anderson, PhD Associate Professor of Business Data Analytics Department of Marketing College of Business Ferris State University Big Rapids, Michigan

College of Nursing and Health Professions Drexel University Philadelphia, Pennsylvania

Cynthia Baur, PhD Senior Advisor for Health Literacy and Senior Official for the Plain Writing Act Office of the Associate Director for Communication Centers for Disease Control and Prevention Atlanta, Georgia Meryl Bloomrosen, MBA, MBI, RHIA, FAHIMA Senior Vice President Policy, Advocacy and Research Asthma and Allergy Foundation of America Landover, Maryland

Karen C. Czirr, MS, RHIA, CHP Health Information Technology Program Coordinator Department of Allied Health Gateway Community & Technical College Covington, Kentucky Mary Jo Deering, PhD President Deering Health Associates Bethesda, Maryland Susan H. Fenton, PhD, RHIA, FAHIMA Associate Dean for Academic Affairs Principal Investigator, Gulf Coast Regional Extension Center UTHealth School of Biomedical Informatics Houston, Texas

Melanie S. Brodnik, PhD, RHIA, FAHIMA Associate Professor Emeritus Health Information Management and Systems School of Health and Rehabilitation Sciences The Ohio State University Columbus, Ohio Frances H. Cornelius, PhD, MSN, RN-BC, CNE Professor and Chair MSN Advanced Practice Role Department & Complementary and Integrative Health Programs Coordinator of Clinical Nursing Informatics Education

Cathy A. Flite, MEd, RHIA, FAHIMA Assistant Professor and Interim Chair Department of Health Services Administration & Policy College of Public Health Temple University Philadelphia, Pennsylvania Marie Gardenier, RHIA, CHPS, PMP Enterprise EHR Program Manager Einstein Healthcare Network Philadelphia, Pennsylvania

xxvii

9781284053708_FMxx_i-xxxviii.indd 27

17/11/15 4:11 pm

xxviii Contributors Jacqueline J. Glover, PhD Professor Department of Pediatrics Center for Bioethics and Humanities University of Colorado Anschutz Medical Campus Fulginiti Pavilion for Bioethics and Humanities Aurora, Colorado Adam G. Golden, MD, MBA Associate Professor Department of Internal Medicine University of Central Florida College of Medicine Associate Chief of Staff, Geriatrics & Extended Care Orlando VA Medical Center Orlando, Florida Karen Gallagher Grant, RHIA, CHP Chief Operating Officer Medical Record Associates, LLC Quincy, Massachusetts Mary Alice Hanken, PhD, RHIA, CHPS Senior Lecturer Health Informatics and Health Information Management Master's and Baccalaureate Programs in Health Services Department School of Public Health University of Washington Seattle, Washington Quality Manager Sound Mental Health Seattle, Washington J. Michael Hardin, PhD Provost and Vice President for Academic Affairs Samford University Birmingham, Alabama Laurinda B. Harman, PhD, RHIA, FAHIMA Associate Professor Emeritus Department of Health Information Management College of Public Health Temple University Philadelphia, Pennsylvania

9781284053708_FMxx_i-xxxviii.indd 28

Susan Helbig, MA, RHIA Affiliate Faculty Health Informatics and Health Information Management Programs School of Public Health University of Washington Seattle, Washington Linda Holtzman, MHA, RHIA, CCS, CCS-P, CPC, COC President Clarity Coding Marlton, New Jersey Rosalind A. Holtzman, RN, BSN, BA Senior Consultant Clarity Coding Marlton, New Jersey Merida L. Johns, PhD, RHIA Founder and President The Monarch Center for Women's Leadership Development Woodstock, Illinois Martha L. Jones, PhD, LSW President Common Sense Adoption Services Camp Hill, Pennsylvania Linda L. Kloss, MA, RHIA, FAHIMA Founder and President Kloss Strategic Advisors, Ltd. Sister Bay, Wisconsin Fameka Leonard, RN, MSN Administrative Director, Quality Management Department of Quality & Patient Safety University of Alabama Hospital Birmingham, Alabama Deepak Mandi, MD Chief of Staff VA West Palm Beach Medical Center West Palm Beach, Florida Virginia L. Mullen, RHIA Retired Executive Director, Patient Safety and Reliability Loma Linda University Medical Center Loma Linda, California

17/11/15 4:11 pm

Contributors

Gretchen Murphy, MEd, RHIA, FAHIMA Director and Senior Lecturer Master of Health Informatics and Health Information Management Programs Health Services Department School of Public Health University of Washington Seattle, Washington Babette J. Neuberger, JD, MPH Clinical Associate Professor and Associate Dean for Academic Affairs School of Public Health University of Illinois at Chicago Chicago, Ilinios Keith Olenik, MA, RHIA, CHP Principal The Olenik Consulting Group, LLC Chicago, Ilinios Brenda S. Olson, MEd, CHP, RHIA Vice President for Health Information Management/Privacy Officer Great Plains Health Alliance, Inc. Phillipsburg, Kansas Sharon J. Randolph, JD, RHIA Manager, Transition Management Clinical Revenue Integrity Confer Health Solutions Frisco, Texas Laurie A. Rinehart-Thompson, JD, RHIA, CHP, FAHIMA Associate Professor and Interim Director Health Information Management and Systems School of Health and Rehabilitation Sciences The Ohio State University Columbus, Ohio Ida Critelli Schick, PhD, MS, LFACHE Professor Emeritus Retired Chair of the Department of Health Services Administration and Director of the MHSA Program Department of Health Services Administration College of Social Sciences, Health and Education Xavier University Cincinnati, Ohio

9781284053708_FMxx_i-xxxviii.indd 29

xxix

Michael A. Silverman MD, MPH, CMD Service Chief Geriatrics and Extended Care and Hospice VA Medical Center West Palm Beach, Florida Patrice L. Spath, MA, RHIT Healthcare Quality Specialist Brown-Spath & Associates Forest Grove, Oregon Adjunct Assistant Professor Department of Health Services Administration University of Alabama, Birmingham Birmingham, Alabama Eric S. Swirsky, JD, MA Clinical Assistant Professor Department of Biomedical and Health Information Sciences College of Applied Health Sciences University of Illinois at Chicago Chicago, Illinios Sharon F. Terry, MA President and CEO Genetic Alliance Washington, DC James F. Tischler, MD Physician Clinical Reviewer National Imaging Associates West Chester, Pennsylvania Emily L. West, RHIA Director Health Information Services Doylestown Hospital Doylestown, Pennsylvania Susan E. White, PhD, RHIA, CHDA Associate Professor, Clinical Health and Rehabilitation Sciences Health Information Management and Systems Division School of Health and Rehabilitation Sciences The Ohio State University Columbus, Ohio

17/11/15 4:11 pm

9781284053708_FMxx_i-xxxviii.indd 30

17/11/15 4:11 pm

© kentoh/Shutterstock

Foreword

Ethical Health Informatics: Challenges and Opportunities presents an informed discourse on many issues arising from the proliferation of information technology and biotechnology in the delivery and funding of health care in the United States. Ten years have passed since the second publication of this book, and in that timeframe the social and ethical concerns confronting society have expanded. Mapping of the human genome, homeland security, terrorism, bioterrorism, natural disasters, patient safety, medication errors, medical identity theft, hacking of data systems, and accessibility of health care for all have resulted in an increased reliance on information technology to process the massive amounts of data generated by these concerns. However, information technology appears to be both the answer and a potential problem for many ethical challenges concerning the privacy, confidentiality, security, and safety of patient and provider and government electronic information systems. The societal changes taking place as a result of the above concerns are especially relevant to those individuals who generate healthcare data (doctors, nurses, health practitioners) and those individuals who manage information and technology (health information management and informatics professionals). Today’s challenges require vigilance concerning the right and wrong uses of patient information and appropriate and inappropriate access to it from a much broader perspective than in the past. This requires

professionals to assume the ethical responsibility not only to manage, but to protect patient-related data and information resources in whatever form it is contained (paper or electronic), and at whatever site it may be maintained. These challenges have been eloquently brought to light in the third edition. The book has been expanded to include updated chapters in the areas of professional ethics, uses of information, electronic health records, sensitive information, and consumer and professional informatics. Five new chapters have been added on important topics related to data analytics, information governance, longitudinal health care, information technology and biomedical instrumentation, and future trends and roles healthcare professionals may encounter in the ethical handling of healthcare data and information. An excellent cadre of authors has been brought together to provide an overview and assessment of the ethical issues raised by the increased demands for tertiary and secondary data and information. The authors provide indepth theoretical and practical discussions on a variety of ethical issues. They address theories and models of ethical practice, along with ethical case scenarios related to selected practice venues. Overall, there are 80 case scenarios to consider along with an eight-step decisionmaking matrix. The matrix is a wonderful learning tool because it guides the reader in understanding the complexity of problem solving and ethical decision making.

xxxi

9781284053708_FMxx_i-xxxviii.indd 31

17/11/15 4:11 pm

xxxii Foreword The book is an excellent resource for healthcare professionals in a variety of disciplines, such as clinical medicine, administration, public health, health information management, informatics, and ethics. This book provides standards of conduct and ethical practice, thus introducing the student to the basic ethical principles and values of whatever discipline they represent. For faculty, the book serves as a foundation for debate and discussion that will help weave the ethical fiber of tomorrow’s practitioners throughout the educational program. For the practitioner, it offers a confirmation of the standards of conduct and ethical uniformity of practice that supports the practitioner’s resolve to address ethical issues in a proactive, effective manner. The practicality of the book makes it attractive to all who are drawn into the professional responsibility of generating, using, or managing health information in an ethical manner.

9781284053708_FMxx_i-xxxviii.indd 32

As the healthcare industry continues to adjust to the requirements of the Affordable Healthcare Act (Obamacare), new delivery modes, cost containment, electronic health record systems, the sharing of information between systems, and the use of data for business and clinical analytics, there will be a need to address the ethical handling of healthcare data and information. I am pleased that Ethical Health Informatics: ­Challenges and Opportunities provides the reader with an awareness and solid foundation for understanding the principles and values so important for the ethical practice of managing healthcare data and information. Melanie S. Brodnik, PhD, RHIA, FAHIMA Associate Professor Emeritus Health Information Management & Systems The Ohio State University Columbus, Ohio

17/11/15 4:11 pm

© kentoh/Shutterstock

Preface

There are two characteristics of this book that make it unique: the content which focuses on the intersection of health informatics and ethics and the use of a decision-making matrix to analyze issues surrounding the appropriate use of health information. The textbook describes the ethical challenges and opportunities that arise from the growing use of data and information in healthcare. Legal and legislative aspects surrounding the ethics of managing data and information are interwoven throughout the book which serves as a resource for teachers, students and practitioners. This textbook is written to reflect a commitment to interdisciplinary collaboration because many of the ethical issues discussed are not limited to just one healthcare discipline. Overall, the textbook is designed to assist health informatics and information management professionals as well as physicians, nurses, social workers, public health professionals, healthcare administrators, health care professionals, such as, physical, occupational and respiratory therapists, and other related disciplines. This textbook will assist professionals who establish standards for ethical competency and those who want to improve their ethical decision-making skills. The preface will answer the following questions. ■ ■ ■



■ ■

What is the decision-making matrix and why is it important? How can teachers use this book? What is the unique value of this book?

Who are the authors? The authors include faculty, deans, healthcare professionals from universities and governmental agencies and consultants with degrees and credentials across the continuum of healthcare and health informatics. Each author has identified ethical issues reflective of their experience with the topic along with one or more scenarios to illustrate the issue under discussion.

How are the chapters organized? This book is divided into six sections: Professional Ethics; Uses of Information; Electronic Health Information; Management of Sensitive Health Information; Consumer and Professional Informatics; and Looking to the Future. Chapters from the 2nd edition were updated and five new chapters were written for this edition, as noted below.

Who are the authors? How are the chapters organized? What students will benefit from reading this book?

I. Professional Ethics 1. Professional Values and the Code of Ethics 2. Ethical Decision-Making Guidelines and Tools 3. Privacy and Confidentiality

xxxiii

9781284053708_FMxx_i-xxxviii.indd 33

17/11/15 4:11 pm

xxxiv Preface II. Uses of Information 4. Data Analytics (NEW ) Examines the challenges presented by the vast amount of data available, based on advances in technology. Data analysts must consciously attend to the ethical considerations associated with the management of big data. 5. Compliance, Fraud, and Abuse 6. Coding 7. Quality Management 8. Research and Decision Support 9. Public Health and Informatics 10. Longitudinal Coordinated Care (NEW ) Describes the implications of a significant change in health care as the patient becomes a member of the care team across the continuum of the healthcare system. Patient-centered medical homes, longitudinal care and complex care management are explored. 11. Clinical Care: End of Life. III. Electronic Health Information 12. Electronic Health Records 13. Information Security 14. Information Technology and Biomedical Instrumentation (NEW ) Describes the burgeoning growth of information technology and the increasing adoption of biomedical instrumentation. 15. Information Governance and Management (NEW ) Clarifies how effective stewardship (responsible handling of information) and governance (ground rules for execution of the information) advances ethical information management. 16. Integrated Delivery Systems 17. Digital Health: Health Information Technology and Information Exchange IV. Sensitive Information 18. Genetic Information 19. Adoption Information 20. Substance Abuse, Behavioral Health and Sexual Information

9781284053708_FMxx_i-xxxviii.indd 34

V. Consumer and Professional Informatics 21. Digital Health Technologies for Consumers, Patients and Caregivers 22. Management and Leadership 23. Entrepreneurship 24. Vendor Management 25. Advocacy VI. Looking to the Future 26. Future Challenges and Opportunities (NEW ) Focuses on potential future professional roles and emerging trends, driven by the explosion of information technology in the healthcare and health information systems and examines how we can educate ourselves and future generations to be prepared to meet these challenges and respond to the opportunities.

What students will benefit from reading this book? Students enrolled in associate, baccalaureate, masters and doctoral programs in many healthcare related disciplines, including health informatics, health information management, medicine, nursing, healthcare professions, public health, healthcare administration, business and information technology.

What is the decision-making matrix and why is it important? Ethical issues do not allow the luxury of the right answer based exclusively on laws, standards, or rules. To facilitate ethical decisionmaking, a matrix has been developed to help readers evaluate and resolve problems based on an understanding of values, professional obligations and multidisciplinary perspectives. The matrix facilitates a more expansive view of a problem and the options for making an ethical decision. Jacqueline Glover’s chapter, Ethical DecisionMaking Guidelines and Tools, includes an ethical

17/11/15 4:11 pm

Preface xxxv



SCENARIO  What is the problem to be solved? Steps

Information

1. What is the question? 2. What is my “gut” reaction?

What is your first reaction to this case on an emotional level? What assumptions are you making? What biases do you have?

3. What are the facts?

KNOWN

4. What are the values?

Patient:

Examine the shared and competing values, obligations, and interests of the many stakeholders in order to fully understand the complexity of the ethical problem(s).

Family:

STAKEHOLDERS Patient, family, HIM professional(s), healthcare professional(s), administrators, society, and others appropriate to the issue.

TO BE GATHERED

HIM Professional(s): Healthcare professional(s): Administrators: Society: Others, as appropriate:

5. What are my options? 6. What should I do? 7. What justifies my choice?

JUSTIFIED

NOT JUSTIFIED

8. How can I prevent this problem?

decision-making process, which is presented in the matrix. The textbook includes 80 scenarios which have been analyzed using this matrix. The ethical decision-making matrix is a tool to help you organize complex ethical problems; however, there is no simple fill-in-the-box approach to ethical decision making. The objective is to follow each step of the process and not move from the question directly to what should be done or how to prevent it next time. If you skip steps, you will not fully understand all of the values and options for action. Also, the matrix provided for each scenario is not the only way to examine the problem. You can make an equally compelling ethical argument for a different

9781284053708_FMxx_i-xxxviii.indd 35

decision—just be sure to follow all the steps of the matrix.

How can teachers use this book? Ethical decision-making cannot be based on the perspective of one individual. The content in the chapters and the process for analyzing the scenarios, using the matrix, requires team discussions. This textbook can be utilized acrossthe-curriculum, in conjunction with all of the courses in the professional program. For example, when teaching quality management, faculty can have students read the information on quality management from books, periodicals,

17/11/15 4:11 pm

xxxvi Preface websites and other resources and have the students read the chapter on quality management in this book. Students can be taught the professional content and then discuss the ethical implications of the decisions that must be made. Ethics can be interwoven into all courses so that it can become a standard of practice. This approach can be used for many courses to reinforce and integrate ethical considerations in content areas such as data analytics, clinical decision-making, electronic health record systems (EHRS), information security and management and leadership, to name a few of the courses in professional academic programs. Ethical scenarios can be coordinated with other case studies and learning activities to help students understand how ethics is interwoven in all areas of practice and they can build competencies in the process of exploring the ethical dimensions of professional practice. This textbook can be used in professional courses as noted above and/or in a ­discipline-specific or multidisciplinary ethics course. Small group discussions: Most ethics classes combine lecture/didactic with small group discussions. Ethical decisions are analyzed and discussed, using ethical tools and critical thinking. If there are students from multiple academic programs, mix the students up into various groups so that multiple perspectives (personal and professional) can be heard. Understanding the diversity of obligations, values and obligations are essential in the ethical decision-­making process. If it is a multidisciplinary course, faculty members from several disciplines can lead the small group discussions. Faculty may also want to reach out to alumni and other practitioners in the area to lead these small group discussions. Small group or homework assignments: Have the students create the decision-making matrix making equally compelling counterarguments or a decision that is different than what is

9781284053708_FMxx_i-xxxviii.indd 36

presented in the chapter. For example, if the matrix indicates that information should not be shared on Facebook, the students can decide to make a different decision—as long as they use the 8-step matrix to evaluate the problem and decide what to do.

What is the unique value of this book? All who work within healthcare and information systems must utilize and combine their technical, professional, and ethical expertise. The management of health information increasingly requires decisions that cannot be made only by applying rules, regulations, accreditation standards or legal mandates. Everyone working in roles that support healthcare and health information will need to make ethical decisions. Students and professionals should consistently expand ethical decision-making skills. Understanding the language and tools of ethics, the values embedded in the various professions and applying knowledge in support of ethical decisions is a rewarding endeavor. If someone learns the ethical language and principles and how to use the decision-­m aking matrix, the identification and defense of multiple perspectives and options for ethical ­decision-making is possible. The chapters in this book should generate many energized discussions. Ethical decisionmaking requires courage. Read the chapters, discuss the content in groups and celebrate the joy and power of ethical decision-making. Laurinda B. Harman PhD, RHIA, FAHIMA Temple University Frances H. Cornelius PhD, MSN, RN-BC, CNE Drexel University

17/11/15 4:11 pm

© kentoh/Shutterstock

Acknowledgments

I want to especially thank Gilbert Lee Hoffer, my precious husband. We share the values of gratitude for the gifts of life, the importance of joy and celebration with family and friends, and most important, laughter and love. Two courageous, compassionate, and intelligent teachers guided my learning about health information and ethics. Louise Huttsell taught me to be passionate about medical records, to always remember the sacredness of the information and to be competent when analyzing, presenting, or releasing health information. Jackie Glover taught me the importance of ethics in my personal and professional life. She is my friend and mentor. I had the opportunity to work with excellent authors who had the courage to describe the ethical issues for their area of expertise. I was honored to work with these authors, and I thank them for their scholarly and innovative contributions. In addition to my parents and sisters, I couldn’t sustain life without the support of my brother-in-law, Francis Joseph Welk, and my nephews and their families—Paul Joseph, Courtney, and Ryan; John David, Karen, Sebastian, Sara, and Lilith; Jeffrey Scott, Kim, Brady, and Ethan and Gil’s children and their partners,

Aaron and Deborah, Ada, Sophia and Kim. Their love and hugs energize my soul. Friends and their families celebrate life with me: Sandy and John Bailey; Melanie and Martyn Brodnik; Theresa Duff, Dawn Ferguson; Barbara and Ed Fuller; Merida and Russell Johns; Barbara and Gerald Hrycko; Anita, Lea and Mia Jensen; Gwen Kennedy; Alfred and Elana Michenzi; Lisa, Vince and Elisabeth Morton; Bernard Slosberg and Mary Chor; Jane Wietsma and Scott Gudgeon; Sally Williams; parishioners at St. Paul’s; Thanksgiving holiday friends and many relatives in the Sugg, Scott and Hoffer families. My colleagues and friends Melanie Brodnik, Cathy Flite, Lisa Morton, and Virginia Mullen are always there for guidance Charlie and Edie Seashore have left this life and are my spiritual mentors. Charlie taught me to “think purple!” Mike Brown, my publisher, was always available for my questions, and I absolutely trust his advice. He has been my publisher for all three editions of Ethical Challenges, and he encouraged me to edit this third edition, even though I was “retired.” Nicholas Alakel, Rebekah Linga, and Joyce Ippolito guided the words on the page and the production of the book. Laurinda Beebe Harman

xxxvii

9781284053708_FMxx_i-xxxviii.indd 37

17/11/15 4:11 pm

xxxviii  Acknowledgments We are all students and teachers. Today’s dynamic environment requires that of us all. The very nature of contemporary society and the information explosion necessitates that we continually adjust our understanding of the world around us. I wish to take a moment to acknowledge those teachers, mentors, colleagues and students who have contributed to my ethical growth and development and served as the foundational bricks and mortar to help me construct and reinforce my moral fortitude. Without your influence and support, this book would not have been possible. For me, this book presents an in-depth exploration of important ethical challenges encountered in healthcare and asks some tough, thought provoking questions. Thought provoking questions can spark us think in new and exciting ways. Dr. Elizebeth Smythe (2004) articulates the value of stimulating focused thinking in the following quote: The very nature of being human means that we cannot not-think. Every person sitting in the classroom will be thinking about something (what others are wearing, how long till lunch, what happened

9781284053708_FMxx_i-xxxviii.indd 38

yesterday). Thoughts will always run around our minds, infuse our emotions, and provoke our bodies. We seek thoughts and thoughts seek us. There will be excitement, concern, bewilderment and clarity, perhaps all in the same experience. The charge is not to ‘make thinking happen’ for that is beyond our abilities. The teacher, however, has the chance to capture the focus of the think and invest the thinking time in a quest worthy of thought. Thinking can infuse everything with fresh passion, with bold questions, with radical insights. And it can be as simple as stopping to listen, as simple as asking the right question at the right time (p. 331). You have instilled in me the courage to ask those difficult questions and encourage others to do the same. Thank you. Frances H. Cornelius Smythe, E. A. (2004) Thinking, Nurse Education Today, Volume 24, Issue 4, May 2004, Pages 326–332. doi:10.1016/j.nedt.2004.02.008

17/11/15 4:11 pm

Loading...

Front Matter - Jones & Bartlett Learning

THIRD EDITION Ethical Health Informatics Challenges and Opportunities Laurinda Beebe Harman, PhD, RHIA, FAHIMA Associate Professor Emeritus Departm...

1MB Sizes 4 Downloads 15 Views

Recommend Documents

Jones & Bartlett Learning Blog
Mary Elizabeth O'Brien's Spirituality in Nursing: Standing on Holy Ground, Sixth Edition Receives a 5-Star Review ... In

Medication Administration - Jones & Bartlett Learning
administration error. Medication error. Oral. Subcutaneous. Sublingual. Transdermal. Transmucosal. CHAPTER OBJECTIVES. A

Descriptive Statistics - Jones & Bartlett Learning
Explain the purpose of descriptive statistics. • Compute measures of central tendency. • Compute measures of variabi

Chapter 4 - Jones & Bartlett Learning
every gene in an organism is already sequenced, then what is the point of genetic mapping? The answer is that a gene's s

electrical training - Jones & Bartlett Learning
electronic, printable PDF format. All you need is a computer and the free version of Adobe Reader ..... methods used in

Statistical Significance - Jones & Bartlett Learning
P < 0.05 and distinguish between the statistical significance of a result and its importance in clinical application. 25

criminal justice - Jones & Bartlett Learning
Interactive Glossary. • Crossword Puzzles. • Practice Quizzes. • Web Links. 5 Wall Street | Burlington, MA | 01803

Pulmonary Ventilation - Jones & Bartlett Learning
By studying this chapter, you should be able to do the following: 1. Identify the basic structures of the ... piration a

Fire Suppression - Jones & Bartlett Learning
fire. ( p 701–702). Fire Suppression. Knowledge Objectives. After studying this chapter, you will be able to: □. Des

Nutrition Research - Jones & Bartlett Learning
This is the first nutrition research text that starts with the basics and is comprehensive in approach, making it ideal