journal club
This blog is a journal club sharing environment. Member of the class are identifying articles and posting a brief commentary
posted by UTArlington_N5308 at 8:46 AM
We are journal club where students enrolled in UT Arlington's NURS 5308, Nursing Informatics identify, read, and write a brief commentary regarding an article having ethical or social issues associated with technology, specifically Nursing Informatics. The best thing about this is the insights we share.
posted by UTArlington_N5308 at 8:46 AM
35 Comments:
Hello
Hello I am really learning how to do this
JD
okay now let's see if i get it now
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Curtin, L. (2005, October). Ethics in nursing administration. Ethics in informatics: the intersection of nursing, ethics, and information technology. Nursing Administration Quarterly, 29(4), 349-352. Retrieved November 5, 2008, from CINAHL Plus with Full Text database.
This is an excellent article that provides a general overview of the ethics of privacy within an increasingly more advanced medical technological world. It brings awareness to the fact that this technology allows for individuals to find out information with less effort and distribute it quickly if desired. Due to this, the consequence of error is more intense when technology is involved. The information contained in technological databases contains highly personal and sensitive patient information that could be used for financial gain and form biased opinions. Inappropriate power can technically be given to anyone with access to a computer, with hacking as prevalent as it is. This article is general enough that I believe it can be used clinically as well as administratively.
My question is, do you think adequate laws and law enforcement are being put in place to prevent this type of information stealing?
In response to the legal question regarding safe keeping of information, I think laws are in place, but it is such a huge domain that policing the access and retrievel is too large of an undertaking for any law enforcement agency. You can google just about anyone's name these days and find information about them..
I believe there are lwas to keep this information confidential, but it is hard to enforce. Most of the personal information has limited access, but as Laina said, there are ways around it. Also, people who have access can misuse the information.
Maddox, P. (2003) Ethics and the brave new world of e-health. Online Journal of Issues in Nursing, 8(1), 8. Retrieved November 10, 2008, from CINAHL database.
This article explains the increase in use of technology shows promise to improve health but raises new ethical questions. People are using the Internet more and more to make healthcare choices including choosing providers, treatment options, making appointments, and choosing specialists. Some patient populations lack computer access which may deny an entire group access to certain healthcare aspects. If the wave of the future is to go completely to using computers, will the underserved groups suffer more? Some healthcare systems have medical records including diagnosis and treatment options on-line. There are many health-related sites which people use to look up illnesses or conditions. If access to these services is only available at work or other public areas, is ths compromising confidentiality? Rules have been established to limit access to medical records, but does this truly keep the information confidential? There has been a code of ethics developed to keep information confidential on the Internet. The principles of this code of ethics are candor, honesty, quality, informed consent, privacy, professionalism, responsible partnering, and accountability. The article explains that nurses must be the patient advocate with the new technology by following this code of ethics. This article can be administrative because it links to maintaining confidentiallity and monitoring use of patient records. It is also clinical because the hands on nurse has the most opportunity to explain to the patient and plays a big role in confidentiallity.
Great blog happy to be a part of it! The article I read and hope others can read I found on Medline by Hickman, S., Sabatino, C.P., Moss, A.H., & Nester, J.W. (2008). The POLST (Physician Orders for Life-Sustaining Treatment) Paradigm to Imprive End-of-Life Care: Potential State Legal Barriers to Implementation. This article was published in the Journal of Law. Medicine and Ethics. I found this article relevent not only as a emergency health care provider but as a consumer. This semester I have been dealing with the very heartfelt issue of putting my mother into the hospice system. This article discusses a standardized system that utilizes forms, and electronic records to ensure that patients DNR wishes are abided by. The POLST paradigm has been recognized as a valuable innovation for improving end-of life care because it includes a systemic approach for ensuring patients treatment preferences by having a system to converting them into medical orders. The article has a detail list of states who utilize this technology. It also has a copy of a teleform that can be e-mailed from one facility to another with the patient's end of life wishes. Being a provider and having to keep a patient on a ventilator because a EMS team didn't have access to DNR paperwork, then having to keep a patient "alive" until the paperwork is found is a common heart breaking occurance for many emergency/ICU providers. It goes against the ethical tenets of what we are taught to be advocates for our patients. If you have ever had to tell a relative, "I am sorry we have to keep him on life support until the paper work is found". Then they respond "He has a DNR but we just can't find it now".... it's heartbreaking. This new paradigm may prevent this ordeal from happening. I know with a mother in hospice, I will be using this knowledge to make sure that my mothers wishes are carried out.
Hickman, S.E., Sabatino, C.P., Moss, A.H., & Nester, J.W.(2008). The POLST (Physician Orders for Life-Sustaining Treatment) Paradigm to Improve End-of-Life Care: Potential State Legal Barriers to Implementation. Journal of Law, Medicine & Ethics. Retrieved from Medline.
Here is the citation. For my article and note, K
Kathi, I liked the information you provided about your article. I see that happen a lot about the DNR and it is heartbeaking to see pt's have to suffer as well as family members. Thank you for sharing.
Ashley
The article I read by Simpson (2005) discusses potential dilemmas that may emerge alongside new technology. The author discusses ethics versus regulation, where regulations are the laws in place to protect information but ethics is how people interrupt those laws. The author goes on to write about how harm can be inflicted by misuse of electronic medical records. An interesting story in the article was how a patient came in for a transplant and had found their match on a website called MatchingDonors.com. The hospital had to decide that though this surgery was legal, was it ethical since the match formed from the internet. We are likely to see more cases like this one and I am afraid that could get into a "black market" type situation, very dangerous.
As we rely more on information technology in healthcare, I fear it will become harder to protect patients private information. Organizations will have to put safe guards in place to prevent the misuse of medical information. Laina gave a good example of how her chart was viewed by coworkers and the information was made public. It is our obligation not to do this to our patients or coworkers and it is our organizations responsibility to handle the people that not using the medical records appropriately. I look forward to seeing everyone else's blogs. Hope I am posting in the right spot.
Ashley
Simpson, R. L. (2005). Nursing informatics. e-Ethics: new dilemmas emerge alongside technologies [Electronic version]. Nursing Administration Quarterly, 29(2), 179-182.
I do think that proper laws and precautions are being put in place to prevent sensitive information from getting into the wrong hands. Not only in healthcare is this a problem, identity theaft is also on the radar of law enforcement and informatic security. This is the reason we have passwords and pass codes to prevent sensitive information from getting into the wrong hands. With all the security in the world there are still breeches of the system.
Kathi, has computers become more in demand there price has gone down. People of any socioeconomic background can have access to computers; at libraries and other places for free. I also worry about patients using the internet to gain information on health related topics. Patients are more informed now more than ever and this is good and also bad. Patients that are well informed are not always getting the full scope of the information obtained and a lead to believe that insignificant things are significant. On the issue of ethics we can only hope that our healthcare information is safe.
Cosco, T., Knopp, A. & Milke, D. (October, 2007). Investigative first steps: Appropriate identification and ethical review of research and quality improvement. Online Journal of Nursing Informatics (OJNI), 11, (3) [Online]. Available at http://ojni.org/11_3/cosco.htm
This article was very informative and discussed the importance of differentiating between research and quality improvement data when reviewing studies . This is crucial in the interpretation of results in order to appropriately review any studies. Because data may be obtained from patient health care records, it is vital that the nurses utilize the correct channels to obtain ethics approval for the use of patients/PHI in studies. The article's main focus was on how to differentiate research and quality improvement and the reason this was essential. While this information is important, I did not find this article too stimulating!
Milton, C.L. (2007). Information and human freedom: Nursing implications and ethical decision-making in the 21st century. Nursing Science Quarterly, 20(1), 33-36.
This is an educational article that discusses some of the ethical implications and challenges in nursing. Specifically, Milton states that nurses should be guided by nursing theories, principles, and concepts. Further, she states that information used in electronic records is being analyzed for other purposes, such as to control costs in the healthcare setting and for insurance companies to use to determine if someone is going to be covered or not. Milton then explains that the patient record should become more patient focused and concentrate on the specific needs of the patient instead of the needs of the hospital. Nurses should also be ethical in handling confidential information. Lastly, Milton discusses how electronic record keeping is not based off of evidence based practice, which is something nurses of the future must consider.
My question is in order to make the electronic record fully patient centered, then there will be a loss in the quality of care they receive. I really disagree with Milton when she stated that persons should be able to choose what is to be documented on their private medical records, for in the situation of a psychotic patient, is it ethical to respect such a request? I don't think that the line between patient requests and patient needs should be blurry just for the sake of patient satisfaction. If a patient is looking for quality healthcare, then they should expect that some of the information that they may not want permanent in their legal record is going to be present in order to provide the best treatment. If we don't get the full clinical picture, how can we as nurses provide the best care?
I agree with bsterl1972 who commented that they worry about patients using the Internet to gain information on health related topics for this can be both good and bad. I do think that patients need to use the Internet nowadays. It is impossible for a patient to remember everything they are taught in the hospital and the Internet is a great reference. However, many patients do not understand what they are reading and take it into the wrong context completely or focus on just one small issue that they think is extremely pertinent. Working in the NICU, I see a lot of parents who may think of themselves as well-informed, but need more education to correct their misbeliefs. Ethically, it is important to provide as much education as we can in the hospital and provide the patient with trusted references on the Internet so that quality information is being given. WIthout doing so, the patient is not going to have the best outcome after discharge.
Layman, E. (2003). Health informatics: ethical issues. Health Care Manager, 22(1), 2-15.
Layman discusses ethical issues and informatics using the principles of beneficence, autonomy, justice and fidelity. The author states that informatics contributes to beneficence in the sense that all of the technology working together can help bridge gaps in information and improve the quality of the healthcare record. The author states there is also a loss of autonomy for patients with an electronic health record. Layman feels that looking at a record on the computer will have healthcare workers seeing a "chart" and not the patient. Layman also discusses implications for healthcare managers and fidelity. Fear of a confidentiality breach is great and therefore there must be consequences for those who break the confidentiality.
It seems as though almost everyone's common theme with these articles is confidentiality. Perhaps we need stricter laws for a breach in confidentiality. At my work, it seems people are threatened with their job, maybe adding a financial penalty and chance of prison time would deter people more. I feel that we have made leaps and bounds with the development of the EHR, but on the same hand I feel that we are still so far behind. Until patient's medical records can be viewed at any hospital or by any EMS worker, we are going to continue to run into the problems Kathi has referred to about DNRs. I hear patients complain all the time about how their doctor has their information in their computer - why doesn't this transfer to the hospital's computer system? I know it's not as easy as it seems, but just think of the time, money, and lives we could save with a "world-wide" EHR...
I like agree with Lindsey saying a theme is confidentiality. This has always been a problem in healthcare, with faxing information and release of information over the phone. HIPPA laws are in place but I know that people do not enforce them. I am sure that many of you have had this conversation on the phone, where you won't give information and the family member says well that other nurse was telling me everything. It is hard to police this and it puts each nurse in a vulnerable position. We must protect our patients and ourselves.
After Hurricane Katrina, EMR became more in the light. During this semester the facility where I work changed from paper to computer charting. This has been an interesting process to experience. (I am learning lots of computer tricks this semester!!) I feel that I have to pay attention to who is around when I am on the computer, as I do not want visitors to be reading over my shoulder if they are not on the release of information sheet and don't need to know. I am interested to see the safeguards that will come about related to technology in healthcare. Good blogging everyone!
Ashley
Layman, E.J. (2008). Ethical issues and the electronic health record. The Health Care Manager, 27(2), 165-176. Retrieved November 12, 2008, from CINAHL database.
This was an interesting article that addressed the ethical issues with electronic health records that confront health care personnels. The issues of privacy and autonomy was addressed which is jeopardized when patients' health data are shared or linked without the patients' knowledge and/or permission. Patients at times, conseal important critical information about their health status, due to distrust and lack of confidence in the security of the electronic system, which consequently jeopardizes appropriate treatment.
Rothstein, M., & Talbott, M. (2006). Compelled disclosure of health information: Protecting against the greatest potential threat to privacy. JAMA, 295(24), 2882-2885. Retrieved November 1, 2008 from EBSCO.
The authors explain that with the call by President Bush in 2004 for an interconnected EHR, the process has begun to develop the Nationwide Health Information Network (NHIN). They contend that currently the only protection to privacy lies in the fragmentation of the paper patient record. Once the EHR is all inclusive, then any third party requesting the EHR would have access to the entire contents of the EHR without the need for all of the contents. THerefore, the authors are urging that the EHR development take into consideration the potential for privacy and confidentiality loss of medical records.
Hello, I am posting again, after realizing that I have duplicated an article that someone else has used already.
Anderson, James (2003). The role of ethics in information technology
decisions: a case-based approach to biomedical informatics education. International Journal of Medical Informatics (73), 145—150.
This was an interesting article that outlined major issues raised by the use of information technology. Specific
cases are used as examples of dilemmas that are posed by the introduction of information
technologyin healthcare. One issue that was addressed in the article, was the issue of privacy violations and confidentiality. The question was posed regarding if certain portions of patient's information should be restricted from the patient's record, if you are not directly involved in care of the patient, such as mental illness, STDs, or substance abuse. I personally think that this is something that should be considered and is not a bad idea. I know that at my hospital, alot of restrictions are made for the Labor and Delivery area, and access to the electronic record is off-limits to personnel not involved with the patient, but this is only for the L&D area. I think that this would be a good idea, universally throughout the hospital.
Newbell, B. (2008, July). The last word. The paper chase. Family Practice Management, 15(7), 50-50. Retrieved November 12, 2008, from CINAHL Plus with Full Text database.
This article is about a Dr. that opened his practice years ago and started with paperless charting. The Question the Dr. now poses is why are they so much paper in his office. Through evaluation of the papers around him, he came to the conclusion that the papers are other things relating to the electronic chart. He then asks why we are still struggling with paper; the healthcare industry should have been paperless years ago. I wander what a paperless office is really looks like. For years the healthcare industry has been working towards a complete paperless charting system, but many things have hindered the process, like the patient’s right to have their information protected and IT safety is a major problem. Another hindrance to paperless charting is cost of the technology and training of staff. This article is social because it addresses information technology use and question why the healthcare industry has not totally got on board with IT. This article is also administrative because it gave insight to what administration think about when making the decision to go paperless. What do you guys think about total paperless charting is it possible? and How can we ensure the patient information is protected?
I see so many commonalities in my own thinking and the issues addressed in Brenda's article regarding totally paperless charting. So many facilities chart their "paperless" charting, but yet there is paper everywhere. I do not believe we will ever be paperless. I almost tend to believe the the confidentiality issues with electronic charting may be too much to tackle, and some facilites will revert away from electronic charting. Having the experience of having to copy an electronic chart to transfer a patient to a different facility, I have been able to also see how difficult the electronic chart is to read when printed on paper. The system we use looks completely different when printed out. It is a mass of information that would be very labor intensive to look through for important information.
Privacy, confidentiality, and Electronic medical records.
Barrows, R., & Clayton, P. (1996, March). Privacy, confidentiality, and electronic medical records. Journal Of The American Medical Informatics Association: JAMIA, 3(2), 139-148. Retrieved November 19, 2008, from MEDLINE database.
kathy A.
This article talks about the fact that EMR are very accessible and is a convenient way to share medical records with other healthcare users/facilities. The concerns is that as hospitals implement the use of EMR, there is no cohesive security policy to manage the access and use of that information. Policy should shape technology and not the other way around (barrows, Clayton 1996). The security issues ranges from computer acess to staff education on what is and is not accessible.
Hello all
Milton, C., L. (2007). Information and human freedom: Nursing implications and ethical decision-making in the 21st century.Nursing Science Quarterly 20(1), 33-36.
This author discussed the manner in which information is handled and processed being important to healthcare. Milton (2007) stated that the prupose of electronic health information is to improve health practices. The code of ethics of american nurse association addressed the concern that nurses have with the privacy, confidentiality and competing loyalities to both the patient and hospital policies. Nurse must remain ethical in handling confidential information. Sometimes conflict arises when nurses questioned what is documented in patient records,and who should have access to them. It is still nurses responsibility to facilitate the do no harm to others. According to author, this may present increasing challenges in the 21st century as conumers may request, accept, or reject medical services offered. Milton (2007) suggested that nurses must examine their practice with regards to the values and beliefs set forth in nursing's theories.
Geneva
Milton, C., L. (2007). Information and human freedom: Nursing implications and ethical decision-making in the 21st century.Nursing Science Quarterly 20(1), 33-36.
This author discussed the manner in which information is handled and processed being important to healthcare. Milton (2007) stated that the prupose of electronic health information is to improve health practices. The code of ethics of american nurse association addressed the concern that nurses have with the privacy, confidentiality and competing loyalities to both the patient and hospital policies. Nurse must remain ethical in handling confidential information. Sometimes conflict arises when nurses questioned what is documented in patient records,and who should have access to them. It is still nurses responsibility to facilitate the do no harm to others. According to author, this may present increasing challenges in the 21st century as conumers may request, accept, or reject medical services offered. Milton (2007) suggested that nurses must examine their practice with regards to the values and beliefs set forth in nursing's theories.
Geneva
Layman, E. (2003). Health informatics: ethical issues. Health Care Manager. 22: 2-15.
Layman (2003) states that informatics promises beneficence to patients, but we also need to take in to consideration how informatics creates a conflict with autonomy, fidelity, and justice.
Autonomy- Patient has a right to determine one's on course. Patients can be replaced by the information held in a EMR, rather than gathering information from the individual. The loss of autonomy is when the patient's information is utilized without their consent.
Fidelity- we have the duty to maintain confidentiality. Unfortunately we are human and do make errors. Breach of personal information as occurred by inadvertent and purposeful means.
Justice- the example about justice is where some states have made Medicaid services data available on the internet.
Informatics is a great technology, but as with everything, we need to make sure we are aware of protecting our patients.
BCB
I really can not figure out how to post a new comment that is not a reply. Please help so that I can post my article!
Ward-McNight, R.(2008). Information technology improves nursing care. ASBN: Update 12(3).
The author points out that all health care professionals and patients have notoriously complained about how much time nurses spend charting and out of the patient's room. She sites that nurses spend 50% of their time charting and usually only 15% of their time providing direct patient care. Much of this charting (on paper) was/is redundant- copying one piece of information from one place to another rather than actually charting new and relevant data. She states that with all information becoming available on a computer the redundancy is decreased and patient centered and care implementation centered charting is achieved. This frees up time from charting to provide direct patient care, thus increasing patient safety and satisfaction.
HOW DO YOU POST YOUR OWN ARTICLE???? I can leave a comment as myself, but I do not see anything to publish my own article about ethics in informatics. I need some help!!!!
Well since I cannot seem to figure out how to post a new "thread" for my article...I will do it here (I tried 2 different browsers thinking maybe chrome was blocking it).
Pyne, M., & Schlichting, N. (2007). In box. Practical ethics: time to start blogging?. H&HN: Hospitals & Health Networks, 81(9), 24. Retrieved from CINAHL Plus with Full Text database.
This was a short sidebar of an article but I felt that it posed an interesting question with some real solutions. Pyne and Schlichting ask what would you do if your hospital CEO started blogging? One hospital CEO felt that you can "never over communicate" while the other stated she would work with a multidisciplinary approach to blogging about health care. I like the second approach. We are taught to use many other disciplines to help us to care for our patients. It seems fitting that a healthcare blog would do the same thing. I do feel that blogging, the Internet, and even smartphones will become more and more prominent in healthcare. But you do have to consider the ethical issues. Is is ethical to talk about specific patients? HIPPA laws say NO! A healthcare professional run medical blog that leaves out specific would violate any ethical issues as long as the contributors are careful about what they include. Smaller hospitals and communities would have to be very careful...everyone knows everything anyway so simply changes names may not work!
Just something to think about!
Hello,
This is my first time posting on a blog
Interesting writing . Apropos , if someone needs to fill out a Multi-Family Lease , We used a fillable version here http://goo.gl/HOJJG8.
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