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Safeguarding Health Information and Systems

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Safeguarding Health Information and Systems

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A new concept for some organizations is to allow nurses to bring in their own devices known as bring your own devices (BYOD) to use at work. What are some of the security issues you might encounter if this were allowed? How would you address these issues? How is this issue addressed in your practice setting? 

Lecture

Welcome to Week 7!

This week will be a review of current issues in health information technology (HIT) and informatics, and implications for the nurse leader. Some of these issues are fairly obvious while others are less obvious.

Introduction

This week, as we look at current issues and trends related to health information technology (HIT) and informatics, the foundation of knowledge model continues to provide structure and guidance for us in several ways. First, we must acquire knowledge of the ethical issues associated with HIT use. We process that information and knowledge, generate new knowledge, and share what we have learned with others, and hopefully, leave with a new view of why we need to support the adoption and appropriate use of HIT.

When patient information is accessed, the first thought when discussing security issues, which are also ethical questions, whether it was used appropriately. Before we examine these larger issues, we need to review of the ANA Code of Ethics.

Review of Ethical Principles, Theory, and Approaches

The American Nurses Association (2015) provides specific guidance for ethical decision making via its Code of Ethics for Nurses with Interpretive Statements. While the document is not specific to HIT and informatics, it still provides a valuable framework that can be used when working with HIT, particularly the nurse’s role with the following:

  • Respect for human dignity
  • Respect for individual right to self-determinism
  • Primary commitment to the patient (defined as individual, family, group, or community)
  • Advocacy for the patient
  • Participation in the creation, maintenance, and improvement of healthcare environments
  • Advancing the profession
  • Collaboration with others to meet health needs
  • Shaping social policy

Ethical Issues With HIT and Nursing Informatics

Much of the healthcare literature addresses the potential of HIT, the need to prepare the 2020 workforce capable of working in a highly technological environment, and benefits accrued to date. Much less is written on the totality of ethical issues. A partial list of issues having an ethical component includes the following:

  • inappropriate access to PHI without a need to know;
  • failure to address threats to privacy and personal health information;
  • a lack of regard to data integrity such as may be seen when there are discrepancies in record information that are noted but no corrective action is taken;
  • a failure on the part of nurses to adopt technology or use it adeptly;
  • a failure on the part of nurses to actively participate in the selection, use, and/or evaluation of technology that has the potential to improve healthcare;
  • a failure on the part of nurses to recall that the patient is their primary focus;
  • a failure on the part of nurses to engage in policy discussions that impact healthcare delivery;
  • a failure on the part of nurses to recognize and use technology to advance the profession; and
  • a failure to keep informed of emerging developments and issues.

The first three items listed above have been discussed previously under threats to information, which they are. According to Healthit.gov (2014) Protecting Your Health Information, the privacy and security of patient health information is a top priority for patients and their families, health care providers and professionals, and the government. This was also previously discussed under HIPAA. It also requires that “key persons and organizations that handle health information to have policies and security safeguards in place to protect your health information — whether it is stored on paper or electronically.” (Healthit.gov, 2014, p. 1)

Each of these three items became ethical issues because they may actually result in patient harm—whether that might be to reputation or physical safety. Noting discrepancies in record information without corrective action is irresponsible. Nurses need to demonstrate accountability for data integrity or risk that it may be compromised (Procter, Hayward, Heyes, Owen, & 2013). Failure to adopt technology or not using it well or as designed can also jeopardize patient safety. Failure to adopt technology might be seen with a nurse who continues to use written notes when automated documentation is the expectation. This deviation might be quicker and easier initially for the individual nurse, but it creates a fragmented patient record, increasing the likelihood that important information will be lost, and because it is unstructured data, it is invisible for data analysis.

Another example of not using technology as intended can be seen with the nurse who does not scan the patient’s ID bracelet for positive patient identification before medication administration, instead using a cut-and-paste feature or keying in information,both of which bypass built-in safeguards.

Proctor, Hayward, Heyes, and Owen (2013) noted that, as the largest group of caregivers, nurses at all levels have an obligation to interpret data held by their organizations to plan, deliver, and evaluate services to support patient-centered care and to actively participate in setting the technology agenda, including how patient information is collected, stored, and used. In the same vein, Sensmeier (2011) noted that nurses have an integral role not only to the proper collection of Meaningful Use criteria, but also in defining further criteria, which will collect information that will better determine and support population-health needs and services. But, perhaps the biggest ethical challenge comes when nurses fail to embrace their roles in shaping health policy and social change. Nurses need to be aware of the facts related to features of HIT legislation,particularly the Patient Protection and Affordable Care Act (ACA). ACA was intended to improve care and reduce disparities and help reform healthcare. Lachman (2012) noted distributive justice as the major ethical principal underlying health-reform initiatives.

Emerging technology will introduce new issues and dilemmas. In addition to the use of EHRs, there is a growing use of social media to market provider services and provide support. Many organizations struggle with questions surrounding proper use of social media. Genomics, or personalized medicine targeted to one’s specific genetic make-up, is an area within our grasp but still not widely known. And, technological advancements and miniaturization are quickly making nanotechnology an area that we will need to address. Nanotechnology is science, engineering, and technology that is conducted at the level of the nanoscale (nano.gov, n.d.). For reference purposes, a nanometer is equal to one billionth of a meter.

According to Healthit.gov (2018) Protecting Your Health Information

the privacy and security of patient   health information is a top priority for patients and their families, health care providers and professionals, and the government. This was also previously discussed under HIPAA. It also requires that “key persons and organizations that handle health information to have policies and security safeguards in place to protect your health information — whether it is stored on paper or electronically.” (Healthit.gov, 2018, p. 1)

Implications for the Masters Prepared Nurse

In order for nurses to influence policy and HIT projects, they must be alert to professional ethics, use information technology effectively, be well-informed, advance skills and knowledge and help educate others. Nurses need to embrace technology, as the shift in roles with higher expectations for advanced leadership levels and skills due to increased automation of data capture becomes more. Knowledge management and decision making will also become much more multifaceted. As nurse leaders, the masters prepared nurse needs to consider the greater good for patients that can occur with the use of well-designed, well-used, and enhanced with advanced skills. The true ethical dilemma for nurse leaders is to fail to rise to the challenge.

Safeguarding Health Information and Systems

Summary

The American Nurses Association (2015) provides guidance for ethical decision making via its Code of Ethics for Nurses with Interpretive Statements.

Ethical issues related to HIT and nursing informatics range from failure to embrace technology, to not using technology well, to failure to consider the benefits of HIT for consumers.

Nurses have an obligation to participate in designing HIT and helping to establish HIT policy and achieve healthcare reform.

References

American Nurses Association. (2015). Short definitions of ethical principles and theories Familiar words, what do they mean? Retrieved fromhttp://nursingworld.org/MainMenuCategories/EthicsStandards/Resources/Ethics-Definitions.pdf

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf

Healthit.gov. (2018). Protecting Your Health Information: Health IT Privacy and Security of your Health Information. Retrieved from: https://www.healthit.gov/topic/protecting-your-privacy-security

Lachman, B. D. (2012). Ethical challenges in the era of health care reform. MEDSURG Nursing, 21(4), 245-50.

Nano.gov.(n.d.). What is nanotechnology? Retrieved from http://www.nano.gov/nanotech-101/what/definition

Procter, P., Haward, R., Heyes, B., & Owen, A. (2013). Encouraging nurses to take the lead on the information agenda. Nursing Management, 19(9), 26-28.

Sensmeier, J. (2011). Transformation through IT. Nursing Management, 42(7), 34-39. doi: 10.1097/01.NUMA.0000398674.84499.ce

Sorrell, J. M. (2012). Ethics: The Patient Protection and Affordable Care Act: Ethical perspectives in 21st century health care. OJIN: The Online Journal of Issues in Nursing, 18(1). doi: 10.3912/OJIN.Vol18No02EthCol01

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