journal week 5

Review Scenario 21-B (pages 556 to 557) and the corresponding Ethical  Decision-Making Matrices (pages 115 to 118) found in Chapter 21 of the  course text,

Ethical Health Informatics: Challenges and Opportunities

.

In two to three pages, determine appropriate policy changes that  should be adopted, while keeping in mind sound business intelligence  strategies.

Review Scenario 21-B (pages 556 to 557) and the corresponding Ethical Decision-Making Matrices
(pages 115 to 118) found in Chapter 21 of the course text, Ethical Health Informatics: Challenges and
Opportunities.
“Scenario 21-B Ensuring Privacy Protections for Digital Health Technologies
Vivian uses several digital health technologies to track her health: her providers have patient portals
where she can view, download, and transmit her data; she has a fitness app that tracks her physical
activity; she has an app that monitors her sleep; and she has a personal health record where she
aggregates information from these and other sources. She regularly transfers new data from her portal
records and her two apps to her personal health record, as well as entering data from visits to health
professionals who are not clinicians (e.g., her nutrition coach) and other observations about her health.
Vivian finds digital tracking and record keeping convenient, especially when she needs to look up
information or visit a new healthcare provider or other health professional. She assumes that she
“owns” her own health information—that she has the final say about which information goes into her
records, who has access to which parts of the information, and what they can do with the information.
When she registered with the provider portals, she read their privacy notices, which said they followed
HIPAA and would not sell information about her that it collects, but that it would share information with
unnamed business partners, who also must follow HIPAA. She was reassured by the explicit statement
from her fitness tracker site that it would not share her information unless legally necessary or with her
specific consent. Although the personal health record or sleep monitor companies did not have such
explicit statements about her control over her information, she assumed that they would keep it private.
She thought that at most they might pull everyone’s information into an anonymous pool to show
trends. She was surprised and angered when she received both email and regular mail promotions for
sleep and nutrition programs that she had not heard of. She deduced that both her sleep monitor
vendor and PHR vendor must be selling her identifiable data, including email and mailing addresses.”
“Scenario 21-B Ensuring Privacy Protections for Digital Health Technologies
Vivian uses several digital health technologies to track her health: her providers have patient portals
where she can view, download, and transmit her data; she has a fitness app that tracks her physical
activity; she has an app that monitors her sleep; and she has a personal health record where she
aggregates information from these and other sources. She regularly transfers new data from her portal
records and her two apps to her personal health record, as well as entering data from visits to health
professionals who are not clinicians (e.g., her nutrition coach) and other observations about her health.
Vivian finds digital tracking and record keeping convenient, especially when she needs to look up
information or visit a new healthcare provider or other health professional. She assumes that she
“owns” her own health information—that she has the final say about which information goes into her
records, who has access to which parts of the information, and what they can do with the information.
When she registered with the provider portals, she read their privacy notices, which said they followed
HIPAA and would not sell information about her that it collects, but that it would share information with
unnamed business partners, who also must follow HIPAA. She was reassured by the explicit statement
from her fitness tracker site that it would not share her information unless legally necessary or with her
specific consent. Although the personal health record or sleep monitor companies did not have such
explicit statements about her control over her information, she assumed that they would keep it private.
She thought that at most they might pull everyone’s information into an anonymous pool to show
trends. She was surprised and angered when she received both email and regular mail promotions for
sleep and nutrition programs that she had not heard of. She deduced that both her sleep monitor
vendor and PHR vendor must be selling her identifiable data, including email and mailing addresses.”
“Martin, an HIM professional who has just been hired by the PHR vendor, has a similar reaction as Vivian
to the vendor’s privacy and information-sharing policies. Although he is working on content
development—in particular, electronic forms for the collection of consumer health information, rather
than on privacy and security issues—he notices and is disturbed by the privacy policy posted on the
company’s website.
Questions
What ethical issues are raised by digital health technologies’ ambiguous position in relation to privacy
regulations?
The lack of regulatory requirements places HIM professionals who work for companies not covered by
HIPAA in the position of having to implement practices such as the sale of personally identifiable
information (PII) that they recognize as problematic. These HIM professionals may also have to make
judgment calls, weighing their companies’ practices against their professional standards.
What policy changes might Martin consider to be necessary? How might he advocate for them?
Martin might propose that the company stop selling PII, and publicly make this pledge to its customers,
in both its marketing material and notice of privacy practices. Martin could point to examples of leading
companies who are benefiting from positive publicity about their decisions not to sell data. He could
also point to the model privacy notice for PHRs, published by the Office of the National Coordinator for
Health IT, as a way to earn customers’ trust and loyalty.”
“Ethical Decision-Making Matrices
SCENARIO 4-A Readmission Predictive Model Project, Part 1: Right Skills?
Steps
Information
1. What is the question?
Should Dan be asked to develop the readmission predictive model?
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
Hospital administration is taking proactive measures to avoid penalties associated with hospital
readmission.
Hospital administration wants to implement model immediately.
DSS is off-site working on a major project.
Dan is eager to work on request and has some technical capabilities but is not formally trained in data
analytics.
TO BE GATHERED
Why was someone who was not formally trained in data analytics allowed to produce the final
predictive model?
Whose responsibility is it to identify work/project priorities?
What is the scope of practice for the HIM professional? Was he practicing out of scope? Who was aware
of this?
Is it appropriate and ethical for a non-formally statistically trained HIM specialist to build the model
under DSS supervision? Are there standards of practice associate with this? Is there precedent?
4. What are the values?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).STAKEHOLDERSPatient, family, HIM professional(s), healthcare professional(s),
administrators, society, and others appropriate to the issue.
Patient: Trust; patients trust their primary doctor to provide them with all the services they will need
when they leave the hospital to fully recover.Family: Trust; family members trust the healthcare
providers will provide their family member with all the services they will need when they leave the
hospital to fully recover and also provide caregiver support services as needed.RS/DSS: Ensure data
accuracy and validity to guide organizational decision making.HIM professional(s): Security, integrity,
accuracy, and reliability (ensure development of an alerting system is effective, but does not violate
ethics); wants to be responsive to administration’s requests; multiple demands and lack of prioritization
of requests can result in conflicting obligations related to quantity versus quality.Healthcare
professional(s): Protect welfare of patients without compromising confidentiality or data integrity; avoid
harm to patients; respect patient autonomy.HIT professional(s): Ensure that patients, physicians,
insurers, public agencies, and healthcare facilities have the right information to make critical decisions;
ensure security and accurate information and results of the data analysis to guide organizational
decision making.Administrators: Meet fiduciary and stewardship responsibilities to manage hospital
system operations to ensure cost reductions, improve patient safety, improve patient outcomes, and
reduce hospital readmissions; access to trusted information and results of the data analysis to guide
organizational decision making.Society: Reduce healthcare costs; quality and equitable health care for
all.
5. What are my options?
Build the predictive model as requested.
Wait until the DSS is available to work on the predictive model.
6. What should I do?
Wait until the DSS is available to work on the predictive model.
7. What justifies my choice?
JUSTIFIED
Dan does not possess the skills to build the predictive model.
NOT JUSTIFIED
Loss of professional integrity.
Violate professional standards.
Endanger patient health.
8. How can I prevent this problem?
Put in place more rigorous guidelines not allowing individuals to perform data analytic techniques
without the proper formal statistical education. Administration/management should identify human
resources needs proactively to ensure adequate professional staffing to meet organizations needs for
timely information.
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 decision—just be sure to follow all the steps of the
matrix.
SCENARIO 4-B Readmission Predictive Model Project, Part 2: Impact of Bad Data
Steps
Information
1. What is the question?
Should the readmission predictive model have been deployed?
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
Hospital administration is taking proactive measures to avoid penalties associated with hospital
readmission.
Hospital administration wants to implement model immediately.
Administrators have to respond to CMS inquiry immediately.
DSS is off-site working on a major project.
Dan is eager to work on request and has some technical capabilities but is not formally trained in data
analytics.
TO BE GATHERED
Why was someone who was not formally trained in data analytics allowed to produce the final
predictive model?
Whose responsibility is it to identify work/project priorities?
Why were the assumptions of the model not verified by the HIM professional that built the model, even
after the DSS stated that the assumptions should be checked?
Whose responsibility was it to follow up? Should the DSS have tested the model upon return from the
off-site project?
What is the scope of practice for the HIM professional? Was he practicing out of scope? Who was aware
of this?
Is it appropriate and ethical for a non-formally statistically trained HIM specialist to build the model
under DSS supervision? Are there standards of practice associate with this? Is there precedent?
4. What are the values?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).STAKEHOLDERSPatient, family, HIM professional(s), healthcare professional(s),
administrators, society, and others appropriate to the issue.
Patient: Trust (patients trust their primary doctor to provide them with all the services they will need
when they leave the hospital to fully recover).Family: Trust (family members trust the healthcare
providers will provide their family member with all the services they will need when they leave the
hospital to fully recover and also provide caregiver support services as needed).RS/DSS: Ensure data
accuracy and validity to guide organizational decision making.HIM Professional(s): Security, integrity,
accuracy, and reliability (ensure development of an alerting system is effective, but does not violate
ethics); wants to be responsive to administration’s requests; multiple demands and lack of prioritization
of requests can result in conflicting obligations related to quantity versus quality.Healthcare
Professional(s): Protect welfare of patients without compromising confidentiality or data integrity; avoid
harm to patients; respect patient autonomy.HIT Professional(s): Ensure that patients, physicians,
insurers, public agencies, and healthcare facilities have the right information to make critical decisions;
ensure security and accuracy accurate information and results of the data analysis to guide
organizational decision making.Administrators: Meet fiduciary and stewardship responsibilities to
manage hospital system operations to ensure cost reductions, improved patient safety, improved
patient outcomes, reduced hospital readmissions; need access to trusted information and results of the
data analysis to guide organizational decision making.Society: Reduce healthcare costs; quality and
equitable health care for all.
5. What are my options?
Acknowledge that all patients have been affected by not receiving an accurate readmission risk score.
Make primary providers fully aware that the warning system is incorrect, and follow up with all patients
until the alerting system is properly addressed.
Put in place more stringent policies regarding which individuals can build the final predictive models for
data analysis purposes.
Only allow professionals who have been formally trained in statistics to perform any type of data
analytics.
6. What should I do?
Carry out the disclosure to the primary providers so that they can reach out to all their patients who
have recently been discharged and determine if they need any follow-up care.
7. What justifies my choice?
JUSTIFIED
Notify providers that received the alerts that there is a problem with the alerting system.
Be truthful in the information regarding the data analysis problem.
NOT JUSTIFIED
Not making providers aware that there is an issue with the medical alerting system and continuing on
with medical care as if nothing has happened.
Competing demands on time, limited resources (e.g., staff, expertise), and information needs are
realities within the contemporary healthcare arena but do not justify bypassing standard procedures
and protocols.
8. How can I prevent this problem?
Read more and learn about the importance of using big data and data analysis techniques to improve
patient care.
Put in place more rigorous guidelines not allowing individuals to perform data analytic techniques
without the proper formal statistical education.
Administration/management must become proficient with prioritization. Furthermore, analysts should
not be put into a position of determining which project comes first; such responsibility lies with
leadership.
Senior management must collectively take a step back, determine which projects have the highest value
(as well as which can wait), and then commit to seeing the highest-value projects through to
completion—even if new opportunities or dilemmas appear on the horizon.
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 decision—just be sure to follow all the steps of the
matrix.”