The Culture of Healthcare Ethics and Professionalism Lecture d This material (Comp2_Unit8d) was...

The Culture of Healthcare

Ethics and Professionalism

Lecture d

This material (Comp2_Unit8d) was developed by Oregon Health and Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number

IU24OC000015.

Ethics and Professionalism Learning Objectives

• Provide an orientation to ideas about medical ethics and professionalism (Lecture a)

• Explore the relationships among ethical ideals, professionalism, and legal duties (Lecture a, b)

• Apply the general principles of ethics and professionalism to specific topics (Lecture c, d)

• Examine ethical issues in health informatics (Lecture d)

2Health IT Workforce Curriculum Version 3.0/Spring 2012

Ethics and Professionalism Ethical Issues in Health Informatics

Lecture d

Ethical Issuesin Health Informatics

• Sources of ethical standards in health informatics

• Professionalism• Representing credentials• Privacy, confidentiality, and security • Respect for patients and co-workers• Responding to unethical practices



Lecture d

Sources of Ethical and Professional Standards in Health Informatics

• Codes of ethics– American Health Information Management Association (AHIMA) – American Medical Informatics Association (AMIA)– International Medical Informatics Association (IMIA)

• Federal and state governments– Agency for Healthcare Research and Quality (AHRQ) National

Resource Center for Health Information Technology– Office of the National Coordinator for Health IT (ONC)



Lecture d

Ethics and Law Interact

• Privacy and security rules in the Health Insurance Portability and Accountability Act (HIPAA)

• Health Information Technology for Economic and Clinical Health Act (HITECH)

• Lawsuits and case law about failure to meet minimum professional standards



Lecture d

Professionalism

• Behavior in accordance with generally accepted ideas of appropriate conduct within a specific profession

• In health informatics, it includes:– Knowledge of ethical requirements and ideals– Maintenance of professional skills



Lecture d

Conflicts of Interest:When Duties and Motives Clash

8.10 Figure: Conflicts of interest (CC BY-NC-SA 3.0, 2012).



Lecture d

Example of a Conflict of Interest

• Patients get medical appointments in order of listing in database

• Close friend is far down, asks to be moved up– Primary duty: treat all patients fairly – Secondary motivation: friendship

• Conflicts of interest cannot always be avoided– If not, they should be disclosed to supervisor

or other appropriate person



Lecture d

Represent Credentials Accurately

• Report professional qualifications accurately, including: – Abilities– Training– Certification– Relevant professional experience

• Correct any inaccuracies regarding credentials• Report only continuing education units actually

earned, and correct any inaccuracies



Lecture d

Privacy

• “A health information management professional shall: advocate, uphold, and defend the individual's right to privacy and the doctrine of confidentiality in the use and disclosure of information” — AHIMA Code of Ethics

• “All persons have a fundamental right to privacy, and hence to control over the collection, storage, access, use, communication, manipulation and disposition of data about themselves” — IMIA Code of Ethics



Lecture d

Privacy = Confidentiality + Security

• Confidentiality = do not improperly disclose information

• Security = safeguard patient information from improper access by others

• Privacy includes:– Advocating for laws respecting patient privacy– Promoting these values among colleagues



Lecture d

Respect for Patients,Employers, and Co-workers

(AHIMA Code of Ethics. 2011)

Respect the inherent dignity and worth of every person•Treat each person in a respectful fashion, being mindful of individual differences and cultural and ethnic diversity•Promote the value of self-determination for each individual•Value all kinds and classes of people equitably, deal effectively with all races, cultures, disabilities, ages and genders•Ensure all voices are listened to and respected



Lecture d

Duties Owed to Patients:The Basics Apply

8.11 Figure: Duties to patients (CC BY-NC-SA 3.0, 2012).



Lecture d

Duties Owed to Patients:The Basics Apply (continued)

(IMIA Code of Ethics, 2011)

• Autonomy: “All persons have a fundamental right to self-determination”

• Justice: “All persons are equal as persons and have a right to be treated accordingly”

• Beneficence: “All persons have a duty to advance the good of others where the nature of this good is in keeping with the fundamental and ethically defensible values of the affected party”

• Non-maleficence: “All persons have a duty to prevent harm to other persons insofar as it lies within their power to do so without undue harm to themselves”



Lecture d

Duties Owed to Patients (continued)



Lecture d

• Recognize that patients have a right to know about the existence of electronic records and how they will be used

• Ensure that patient data is maintained in a safe, reliable manner

• Never use patients’ data for outside purposes• Treat the data of all patients with equal respect

— AMIA Code of Ethics

Duties Owed to Employers(IMIA Code of Ethics, 2011)

• Competence, diligence, integrity, and loyalty• Best data security measures • Highest possible qualitative standards of data

collection, storage, retrieval, processing, accessing, communication, and utilization

• Appropriate systems for evaluating the technical, legal, and ethical acceptability of the data



Lecture d

Duties Owed toHealthcare Professionals

(IMIA Code of Ethics, 2011)

• Provide informatics services necessary for healthcare professionals to carry out their obligations

• Provide timely and secure access to relevant electronic records

• Ensure the usability, integrity, and highest possible technical quality of the records



Lecture d

Responding to Unethical Practices

• “Health informatics professionals will refrain from impugning the reputation of colleagues but will report to the appropriate authority any unprofessional conduct by a colleague”(IMIA Code of Ethics, 2011)

• “A health information professional shall take adequate measures to discourage, prevent, expose, and correct the unethical conduct of colleagues” (AHIMA Code of Ethics, 2011)



Lecture d

Whistleblowing

• Duty to report can conflict with feelings of loyalty• May result in retaliation

– Snubs by co-workers– Loss of promotions or raises– Physical assault

• Laws may protect whistleblowers



Lecture d

Ethics and Professionalism Summary – Lecture d

• Health informatics professionals have general standards of ethical behavior and professionalism

• Major sources of standards come from codes of ethics written by health informatics professional societies

• There are four ethical duties of health informatics professionals:– Represent credentials accurately– Protect patient privacy, including confidentiality and

security– Respect patients and co-workers– Respond to unethical practices by others



Lecture d

Ethics and Professionalism Summary

• Professionalism requires that people act in accordance with the standards of their profession

• Healthcare professionals must meet both ethical and legal standards

• Informed consent, end-of-life issues, conflicts of interest, healthcare disparities, and conscientious objection are among the many difficult ethical issues faced by healthcare professionals

• Codes of ethics provide guidance for health informatics professionals



Lecture d

Ethics and Professionalism References – Lecture d

• American Health Information Management Association [Internet]. Undated [cited 2011 Dec 29]. American Health Information Management Association Code of Ethics [1 page]. Available from: http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_024277.hcsp?dDocName=bok1_024277.

• American Medical Informatics Association [Internet]. Undated draft [cited 2011 Dec 29]. Biomedical informatics core competencies [1 page]. Available from: http://www.amia.org/biomedical-informatics-core-competencies.

• Ethics Resource Center [Internet]. December 2010 [cited 2011 Dec 30]. Blowing the whistle on workplace misconduct [16 pages]. Available from: http://www.ethics.org/files/u5/WhistleblowerWP.pdf .

• Hurdle JF, Adams S, Brokel J, et al. A code of professional ethical conduct for AMIA . J Am Med Inform Assoc. 2007;14(4):391-393.

• Institute of Medicine [Internet]. 2009 [cited 2011 Dec 29]. Conflict of Interest in Medical Research, Education, and Practice [436 pages]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK22942.

• Institute of Medicine [Internet]. Prepublication [cited 2011 Dec 30]. Health IT and Patient Safety: Building Safer Systems for Better Care [197 pages]. Available from: http://www.nap.edu/catalog.php?record_id=13269.

• International Medical Informatics Association [Internet]. Undated [cited 2011 Dec 29]. The IMIA Code of Ethics for Health Information Professionals [10 pages]. Available from: http://www.imia-medinfo.org/new2/node/39



Lecture d

Ethics and Professionalism References – Lecture d (continued)

• Office of the National Coordinator for Health Information Technology, U.S. Department of Health and Human Services [Internet]. October 2011 [cited 2011 Dec 29]. About ONC [1 page]. Available from: http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__onc/1200.

• Samuel HW, Zaiane OR, Sobsey D. Towards a definition of health informatics ethics. In: Proceedings of the First ACM International Health Informatics Symposium. New York: Association for Computing Machinery, 2010. Available from: http://hwsamuel.com/wp-content/uploads/acmihi2010.pdf.

Charts, Tables, Figures• 8.10 Figure: Conflicts of interest (CC BY-NC-SA 3.0, 2012).• 8.11 Figure: Duties to patients (CC BY-NC-SA 3.0, 2012).



Lecture d

The Culture of Healthcare Ethics and Professionalism Lecture d This material (Comp2_Unit8d) was...

Documents

Transcript of The Culture of Healthcare Ethics and Professionalism Lecture d This material (Comp2_Unit8d) was...