5 Chapter 6: Ethical Issues in Health Informatics

Introduction

Health informatics professionals face a variety of ethical issues similar to those encountered in broader healthcare professions. This chapter focuses on four key ethical responsibilities: accurate representation of credentials, protection of privacy and confidentiality, respectful behavior toward patients and coworkers, and response to unethical practices. It also examines the sources of professional standards and the complex interplay between ethics, professionalism, and the law.

Sources of Ethical and Professional Standards

Codes of ethics from organizations like AHIMA, AMIA, and IMIA, as well as government guidance from ONC and AHRQ, provide foundational standards. These bodies shape the expectations for ethical behavior in the field.

[Insert Table 1: Comparison of AHIMA, AMIA, and IMIA Ethical Guidelines]

Interaction of Ethics and Law

Laws such as HIPAA and HITECH reinforce ethical obligations around patient data privacy and security. However, ethical duties can extend beyond legal requirements, and sometimes conflict with them.

[Insert Figure 1: Diagram of Overlapping Areas Between Ethics, Professionalism, and Health Informatics Law]

Professionalism in Health Informatics

Professionalism includes understanding and following ethical codes, maintaining skill levels, and avoiding conflicts of interest. It requires a commitment to appropriate behavior and self-regulation in the rapidly evolving field of digital health.

[Insert Figure 2: Professionalism Cycle – Knowledge, Conduct, Maintenance of Skills]

Conflicts of Interest

Professionals must recognize when personal motivations, such as friendships or financial interests, conflict with ethical obligations. These should be disclosed to a supervisor when avoidance is not possible.

For example, if a friend asks for a favor that violates a scheduling protocol or data policy, the ethical responsibility is to treat all patients fairly and disclose the conflict if needed.

[Insert Figure 3: Example Scenario – Scheduling Conflict of Interest]

Representing Credentials Accurately

Health informatics professionals are ethically obligated to accurately report their training, abilities, and experience, and to correct any misrepresentations in resumes or continuing education records.

Misrepresentation can compromise patient safety, employer trust, and public confidence in the profession.

[Insert Table 2: Examples of Acceptable vs. Unethical Credential Reporting Practices]

Privacy, Confidentiality, and Security

Ethical principles emphasize protecting patients’ rights to privacy by ensuring confidentiality and implementing proper data security. Professionals must advocate for privacy-respecting laws and promote those values within their organizations.

Privacy = Confidentiality (not disclosing data) + Security (protecting against unauthorized access).

[Insert Figure 4: Venn Diagram Showing Relationship Between Privacy, Confidentiality, and Security]

Respect for Individuals

AHIMA’s Code of Ethics stresses equitable treatment and respect for all individuals, considering cultural, racial, gender, and ability differences. Respect extends to patients, coworkers, and employers alike.

This includes ensuring everyone’s voice is heard, recognizing diversity, and treating others with dignity.

[Insert Figure 5: Infographic on Respectful Workplace Behavior and Cultural Competence]

Core Ethical Principles

Informatics professionals follow the same four principles as other healthcare professionals:

Autonomy: Support patient self-determination

Beneficence: Promote the well-being of others

Non-maleficence: Avoid causing harm

Justice: Treat all individuals fairly

These guide decisions around patient data use and interaction.

[Insert Table 3: Four Core Ethical Principles – Definitions and Informatics Examples]

Duties to Patients, Employers, and Coworkers

Professionals must maintain data integrity, avoid misuse of information, and support healthcare providers with timely, secure access to records. They are also responsible for maintaining loyalty, diligence, and competence in their roles.

To patients: ensure confidentiality and accurate recordkeeping

To employers: apply best security and data handling practices

To healthcare colleagues: ensure usability and accessibility of systems

[Insert Figure 6: Matrix of Duties by Stakeholder Group – Patients, Employers, Providers]

Responding to Unethical Practices

Professionals must take action when encountering unethical behavior, including discouraging and reporting such conduct, despite potential retaliation risks. Laws may offer whistleblower protections, though applying them can be complex.

Professionals are encouraged to report misconduct through internal procedures first and consult ethics committees or supervisors.

[Insert Figure 7: Flowchart – Steps for Responding to Unethical Conduct]

[Insert Table 4: Whistleblower Protections by U.S. Law – HIPAA, OSHA, False Claims Act]

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Adapted from Oregon Health & Science University, funded by the U.S. Department of Health and Human Services