Ethics and Professionalism in Health Care

The Culture of Health Care Ethics and Professionalism Lecture d This material (Comp 2 Unit 8) was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015. This material was updated in 2016 by Bellevue College under Award Number 90WT0002. This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/.

Ethics and Professionalism Learning Objectives Discuss foundational concepts in medical ethics and professionalism (Lecture a). Examine 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). 3

Ethical Issues in Health Informatics Sources of ethical standards in health informatics Professionalism Representing credentials Privacy, confidentiality, and security Respect for patients and coworkers Responding to unethical practices 4

Sources of Ethical Standards 8.10 Figure: Sources of ethical standards (CC-BY image by Vivian Todhunter & CAST). 5

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 6

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 7

Conflicts of Interest: When Duties and Motives Clash 8.11 Figure: Conflicts of interest (CC BY-NC-SA 3.0, 2012). 8

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 9

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 AHIMA Code of Ethics, 2011 10

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 11

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 12

Respect for Patients, Employers, and Coworkers 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 AHIMA Code of Ethics, 2011 13

Duties Owed to Patients 8.12 Figure: Duties to patients (CC BY-NC-SA 3.0, 2012). 14

Duties Owed to Patients Continued 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 Nonmaleficence: 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 IMIA Code of Ethics, 2011 15

Duties Owed to Patients Continued 2 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, 2011 16

Duties Owed to Employers 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 IMIA Code of Ethics, 2011 17

Duties Owed to Health Care Professionals Provide informatics services necessary for health care 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 IMIA Code of Ethics, 2011 18

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 19

Whistleblowing Duty to report can conflict with feelings of loyalty May result in retaliation Snubs by coworkers Loss of promotions or raises Physical assault Laws may protect whistleblowers 20

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 Health informatics professionals have four ethical duties: Represent credentials accurately Protect patient privacy, including confidentiality and security Respect patients and coworkers Respond to unethical practices by others 21

Ethics and Professionalism Summary Professionalism requires that people act in accordance with the standards of their profession Health care professionals must meet both ethical and legal standards Informed consent, end-of-life issues, conflicts of interest, health care disparities, and conscientious objection are among the many difficult ethical issues faced by health care professionals Codes of ethics provide guidance for health informatics professionals 22

Ethics and Professionalism References Lecture d References American Health Information Management Association (AHIMA). (2011). AHIIMA code of ethics. Retrieved from http://library.ahima.org/xpedio/groups/public/documents/ahima/ bok1_024277.hcsp?dDocName=bok1_024277 American Medical Informatics Association. (2007). Biomedical informatics core competencies. Retrieved from http://www.amia.org/biomedical-informatics-core-competencies Ethics Resource Center. (2010). Blowing the whistle on workplace misconduct. Retrieved from http://www.whistleblowers.org/storage/documents/DoddFrank/ercwhistleblowerwp.pdf Goodman, K. W., Adams, S., Berner, E. S., et al. (2013). AMIA s code of professional and ethical conduct. Journal of the American Medical Informatics Association, 20(1), 141 143. HealthIT.gov. (2014). About ONC. Retrieved from http://www.healthit.gov/newsroom/about-onc Hurdle, J. F., Adams, S., Brokel, J., et al. (2007). A code of professional ethical conduct for AMIA. Journal of the American Medical Information Association, 14(4), 391 393. Institute of Medicine. (2012). Health IT and patient safety: Building safer systems for better care. Retrieved from http://www.nap.edu/catalog.php?record_id=13269 International Medical Informatics Association. (2011). The IMIA code of ethics for health information professionals. Retrieved from http://www.imia-medinfo.org/new2/node/39 and http://www.imia- medinfo.org/new2/pubdocs/Ethics_Eng.pdf 23

Ethics and Professionalism References Lecture d Continued Kulikowski, C. A., Shortliffe, E. H., Currie, et al. (2012). AMIA Board white paper: Definition of biomedical informatics and specification of core competencies for graduate education in the discipline. Journal of the American Medical Informatics Association, 19(6), 931 938. Lo, B., & Field, M. J. (2009). Conflict of interest in medical research, education, and practice. National Academies Press. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK22942 Loewenstein, G., Sah, S., & Cain, D. M. (2012). The unintended consequences of conflict of interest disclosure. JAMA, 307(7), 669 670. Mannion, R., & Davies, H. T. (2015). Cultures of silence and cultures of voice: The role of whistleblowing in healthcare organisations. International Journal of Health Policy and Management, 4(8), 503. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4529038 Masters, K. (2014). Health informatics ethics. In R. E. Hoyt & A. Yoshihashi (Eds.), Health informatics: Practical guide for healthcare and information technology (6th ed.), pp.195 215, S.I.: Informatics Education. Samuel H. W., Zaiane, O. R., & Sobsey, D. (2010). Towards a definition of health informatics ethics. Retrieved from https://webdocs.cs.ualberta.ca/~zaiane/postscript/ACMIHI2010.pdf 24

Ethics and Professionalism References Lecture d Continued 2 Samuel, H. W., & Za ane, O. R. (2014). A repository of codes of ethics and technical standards in health informatics. Online Journal of Public Health Informatics, 6(2), e189. Tables, Charts, Figures 8.10 Figure: Sources of ethical standards (CC BY CAST & Vivian Todhunter). 8.11 Figure: Conflicts of interest (CC BY-NC-SA 3.0, 2012). 8.12 Figure: Duties to patients (CC BY-NC-SA 3.0, 2012). 25

The Culture of Health Care Ethics and Professionalism Lecture d This material was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015. This material was updated in 2016 by Bellevue College under Award Number 90WT0002. 26