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)

2
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Ethics and Professionalism
Ethical Issues in Health Informatics
Lecture d
Ethical Issues
in 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
3
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Ethics and Professionalism
Ethical Issues in Health Informatics
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)
4
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Ethics and Professionalism
Ethical Issues in Health Informatics
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
5
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Ethics and Professionalism
Ethical Issues in Health Informatics
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

6
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Ethics and Professionalism
Ethical Issues in Health Informatics
Lecture d
Conflicts of Interest:
When Duties and Motives Clash
8.10 Figure: Conflicts of interest (CC BY-NC-SA 3.0, 2012).

7
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Ethics and Professionalism
Ethical Issues in Health Informatics
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
8
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Ethics and Professionalism
Ethical Issues in Health Informatics
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
9
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Ethics and Professionalism
Ethical Issues in Health Informatics
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
10
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Ethics and Professionalism
Ethical Issues in Health Informatics
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
11
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Ethics and Professionalism
Ethical Issues in Health Informatics
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

12
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Ethics and Professionalism
Ethical Issues in Health Informatics
Lecture d
Duties Owed to Patients:
The Basics Apply
8.11 Figure: Duties to patients (CC BY-NC-SA 3.0, 2012).

13
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Ethics and Professionalism
Ethical Issues in Health Informatics
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
14
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Ethics and Professionalism
Ethical Issues in Health Informatics
Lecture d
Duties Owed to Patients
(continued)
15
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Ethics and Professionalism
Ethical Issues in Health Informatics
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
16
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Ethics and Professionalism
Ethical Issues in Health Informatics
Lecture d
Duties Owed to
Healthcare 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
17
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Ethics and Professionalism
Ethical Issues in Health Informatics
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)
18
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Ethics and Professionalism
Ethical Issues in Health Informatics
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


19
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Ethics and Professionalism
Ethical Issues in Health Informatics
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
20
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Ethics and Professionalism
Ethical Issues in Health Informatics
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

21
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Ethics and Professionalism
Ethical Issues in Health Informatics
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
22
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Ethics and Professionalism
Ethical Issues in Health Informatics
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).
23
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Ethics and Professionalism
Ethical Issues in Health Informatics
Lecture d