Posted: April 3rd, 2015

Ethics of Nursing Informatics

Currently, health care has embraced use of computers in its operations. Computers are used mainly to speed up processes and procedures, ease communication and access, monitoring and evaluation of patient data. However, outgrowing concerns have arisen about the use of computers in storing and monitoring patients’ electronic health records (EHRs). The concerns are mainly based on the confidentiality or privacy of patients’ information. Several incidences of unauthorized and inappropriate access of patients’ health records mostly celebrities have been witnessed in the health care. In this paper we are evaluating two such incidences

First and foremost, both cases involve abuse of confidentiality about patients’ information. Therefore they are relevant to Health Insurance Portability and Accountability Act (HIPAA). Amongst all the roles of HIPAA, protecting the security and confidentiality of patient’s health records takes the central position (Ziel, 2009). In regards to confidentiality, HIPAA recommends that authorization for any disclosure or use of patients’ health records more so those unrelated to health operations, treatment and payment. In both the two cases, the nurses’ incentive of getting patients information was illegal and prohibited by HIPAA since they were not authorized. In the first case, the nurse invaded the privacy of his/her neighbor. On the other case, the nurse attempted to retrieve a celebrity’s EHRs for illegal business deals.

Prior to the above incidences, questions arise regarding who has or who does not have permission to access EHRs. To begin with, EHR refers to stored patients data that is in digital form and shared privately by authorized users only. The users include all medical practitioners and even sometimes patients or their guardians. In respect to this case, both nurses were not authorized to obtain the patient’s data. Only those with authority are allowed to view and open patients’ electronic health records. Also, as earlier mentioned medical practitioners undertaking their respective duties are given the privilege but this is extended only to the patients they are handling (Terry , 2012).

Thereby, there are limitations to medical practitioners while using the EHR system in their respective working places. The one and most significant limitation to use of EHRs is insufficient knowledge relating to EHR system. Majority of nurses have little knowledge and skills pertaining to computer literacy. A study by Campbell and McDowell (2011) showed that majority of the nurses had little knowledge concerning computer literacy. Most often, many had fewer skills limited to emailing, data entry and so forth. In addition to this, the levels of computer literacy correlated with the age. Older nurse were much disadvantaged as opposed to the young nurses. Surprisingly, most of the health care systems were comprised of many older registered nurses as compared to the young ones (Campbell, and McDowell, 2011). With the change of the EHRs structure over time more complications have arisen. The earlier HER system differentiated between the elements, that is, time oriented, problem oriented and source oriented of its structure. Today, the HER system incorporates all the elements together. In time oriented structure, electronic health records follow a chronological order whereas in problem oriented, information is updated for each and every patient assigned. At the same time each problem is evaluated depending on the information collected. Lastly, in the source oriented structure information is presented on the basis of method of collection like x-ray reports and blood tests (Campbell, and McDowell, 2011).

Furthermore, to enhance the security and confidentiality of patient’s EHRs medical practitioners must exhibit informatics ethics. This has benefits and shortcomings to the patients based on the nature of informatics ethics possessed by the nurse; either good or bad. In regards to good ethics, patients and/or their guardians have confidence about the safety of their health records particularly those with lengthy medical records. In short there exists a good nurse to patient relationship (Goodman, 2010). Patients will feel free to share thoroughly information regarding to their health. Nurses with good ethics will preserve patients’ privacy rights, that is, to whom or under what situation should their identifiable health records be disclosed. Additionally, patients should be allowed to access as well as supplement their own health records. This is much of much significance in enhancing correction of erroneous health records and addressing their discrepancies. On the contrary, medical practitioners with poor informatics ethics are a threat to security and privacy of patients’ health records. They would disclose patients’ identifiable health records without their informed consent to suit their self interests. Therefore, patients limit sharing of the information at the expense of their own health. Next, medical practitioners with good informatics ethics enhance good decision making in both themselves and their respective patients. A good clinical decision is directly proportional to good information. Use of electronic health record systems in health care makes patients health records more readily available and reliable. Availability of such information is relevant in facilitating good decisions (Paneth-Pollak, Schillinger, Borrelli, Handel, Pathela, and Blank, 2010). Both the nurse and the patient may have different opinion concerning which information is relevant and useful in the health care. This requires mutual agreement and clarification from both parties. Similarly, nurses with poor informatics   effective decision making and in most cases they do not involve patients in decision making.