Referenced and Presented in alphabetical order (by author sir-name) in the American Medical Association (AMA) format.
Every day we see some new advancement in technology and its rapid integration into our everyday live, most usually to our benefit and convenience. In the healthcare system, technology has not just become a convenience, but now a necessity. It’s wide range of benefits have solidified it as a foundation in modern medical practice, Be it in storing/accessing/sending medical records, tele-medicine, decision support, etc., the adoption of increasingly advanced HIT has shown to increase the likelihood of a positive medical outcome almost all of the time1. What I find incredibly interesting is the integration of Clinical decision support systems into the medical field. Per Ethical Health Informatics, CDS is like a toolset (smart interface / predictive device) that provides patients and clinicians alerts and care reminders, helping mitigate errors in missed appointments, misperscriptions, and other mistakes 2. This alone is extremely beneficial to everyone, given the complexity and business of today’s world.But this is only a baseline for the CDS system’s benefits to the healthcare system. As artificial intelligence rapidly becomes more and more advanced, the roles of CDS may become riskier are more critical. Through the use of predictive analysis (machine learning / deep learning) the medical field will and can use CDS systems for prognosis/diagnosis to more rapidly provide the correct care and options for patients3.
Remote monitoring allows for medical providers to access patient information at almost any time. This is extremely convenient and important in providing care to patients that may be critically ill. But to do so, there are considerations that have to be taken into account. Firstly, is the patient’s autonomy. As we’ve learning, providing a patient with the recognition of their own decision-making capabilities is the cornerstone of healthcare ethics. While a healthcare provider may recommend for a patient to provide remote monitoring, the patient’s wishes should be respected first.
- Kruse CS, Beane A. Health Information Technology Continues to Show Positive Effect on Medical Outcomes: Systematic Review. Journal of Medical Internet Research. 2018;20(2). doi:10.2196/jmir.8793
- Laurinda Beebe Harman and Frances Cornelius. Ethical challenges in the management of health information, 3rd edition. Burlington, MA: Jones & Bartlett Learning. 2017.
- Kumar ES, Jayadev PS. Deep Learning for Clinical Decision Support Systems: A Review from the Panorama of Smart Healthcare. Studies in Big Data Deep Learning Techniques for Biomedical and Health Informatics. 2019:79-99. doi:10.1007/978-3-030-33966-1_5.
Health information technology (HIT) is at this point an essential part of the healthcare system. It delivers information to the appropriate professional in a timely manor leading to the better care of patients. This technology facilitates the communication between professionals, improves medication safety by monitoring tracking and reporting on the patient, and promotes the quality of care that is delivered to the patient.3 One of the ways in which the HIT is improving the quality of care of patients is by alerting medical staff when problems arise and track the problem in real time.3 The HIT is necessary for modern medical professionals to be able to deliver the best care.
With the advent of the novel corona virus, it seems that all attention is being placed on it. Let’s continue that trend by taking a look at the ethical implications of the decisions made by the Israeli government to use surveillance technology to determine disease outbreak.
Remote monitoring is the use of digital technologies to collect medical and other health information from individuals in one location.1 The Israeli government has recently started to use their government surveillance system to track infected people and possible infected people. People that have been presumed to be infected received a text message telling them to stay in quarantine for two weeks.2 The technological power of the Israeli government is unknown and the methods in which the health data was collected is unknown. An educated guess can be made that the surveillance system uses the gps data or cell phone tower data that is collected from cellular devices. This data was collected without the consent of the people that were being monitored however the circumstances of a crisis was used to justify the action.2 This action taken from a government does not respect the patients autonomy, however the value of beneficence may be upheld by containing the outbreak as best they can. This also is problematic with the respect for the rights of these humans if there exists rights to privacy in the Israeli society. The effects of a global health pandemic has created a large ethical conundrum.
1. About Telehealth. Thumbnail. https://www.cchpca.org/about/about-telehealth/remote-patient-monitoring-rpm. Accessed March 28, 2020.
2. Estrin D. Israel Begins Tracking And Texting Those Possibly Exposed To The Coronavirus. NPR. https://www.npr.org/2020/03/19/818327945/israel-begins-tracking-and-texting-those-possibly-exposed-to-the-coronavirus. Published March 19, 2020. Accessed March 28, 2020.
3. Patient Safety and Health Information Technology. ACOG. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2015/01/patient-safety-and-health-information-technology. Accessed March 28, 2020.
Health information technology is defined by Ashley Brooks as “the area of healthcare that oversees the technology systems healthcare providers use to manage patient data.”1 As we’ve learned throughout the course, one major technology categorized under HIT is electronic medical records. Brooks continues to explain that e-prescriptions and other tech tools help patients meet health goals.1 The cross between healthcare and technology has given patients more control over their data such as through apps and other computer programs. It has also created more precise EHRs for patients and tracks them through different healthcare facilities. As stated on the HHS website, “Health IT use within the health care industry will improve the quality of health care, prevent medical errors, reduce health care costs, increase administrative efficiencies, decrease paperwork, and expand access to affordable health care.”2 Utilizing health information technology will free up more time for doctors by saving them from paperwork and creating more accurate records for patients to help treat them as best and as quickly as possible.
The CCHPCA defines remote patient monitoring as “the digital technologies that collect medical and other forms of health data from individuals in one location and electronically transmit that information securely to health care providers in a different location for assessment and recommendations.”3 Remote patient monitoring has many benefits such as tracking data for patients who have been released to their home and reducing the ammount of readmissions and the number of hospitalization. However, as with the use of technology in any situation, comes the flood of ethical concerns. The article Citizen Generated Data states “data from monitoring devices cannot tell the observer anything about the personâ€™s mental or emotional state, or the context in which the data was recorded.”4 A patient cannot be reduced to their data. Without a face-to-face confrontation, a doctor cannot determine anything other than what data a patient gives them. For example, if a doctor sees how a patient is acting or how they look, they may ask other questions about their mental state that would not have been prompted without a proper confrontation.
1) Brooks A. What Is Health Information Technology? Exploring the Cutting Edge of Our Healthcare System. Rasmussen College. https://www.rasmussen.edu/degrees/health-sciences/blog/what-is-health-information-technology/. Published June 10, 2019. Accessed March 28, 2020.
2) HHS Office of the Secretary,Office for Civil Rights, and Ocr., https://www.hhs.gov/hipaa/for-professionals/special-topics/health-information-technology/index.html (Links to an external site.)
3) About Telehealth. Thumbnail. https://www.cchpca.org/about/about-telehealth/remote-patient-monitoring-rpm. Accessed March 28, 2020.
4) Citizen generated data: the ethics of remote patient monitoring. PHG Foundation. https://www.phgfoundation.org/briefing/ethics-of-remote-patient-monitoring. Accessed March 28, 2020.
After reviewing studies evaluating health IT in healthcare across yearly time spans, the benefits of adopting HIT are only improving. The benefits include the following:1,2,3
- Direct access to health records
- Patient safety
- Improved efficacy and quality of patient care
- Reduction of paperwork, unnecessary tests and procedures
- Reduces harmful medication errors
- Cost effective
- Safer way of disclosing sensitive health information
- Improves patient engagement in their own health care
An ethical consideration involved in the application of remote monitoring may include “reductionism”, which is reducing a patient to down to data. By overly relying on just patient data, the monitoring platforms neglect to evaluate a patient’s mental and emotional state during the time the data was collected. Face to face interactions between doctors and patients allow for more interpersonal relationships to form and therefore making the patient feel more comfortable about discussing their well-being and health. This is an essential consideration that could affect patient health.4
1. AHRQ. Costs and Benefits of Health Information Technology: Evidence Report/Technology Assessment. Retrieved from https://www.ahrq.gov/downloads/pub/evidence/pdf/hitsyscosts/hitsys.pdf. Published April 2006.
2. HealthIT. Benefits of Health IT. https://www.healthit.gov/topic/health-it-basics/benefits-health-it. Published September 15, 2017.
3. Buntin MB, Blumenthal, Jha, et al. The Benefits Of Health Information Technology: A Review Of The Recent Literature Shows Predominantly Positive Results. Health Affairs. https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2011.0178. Published March 1, 2011.
4. PHG. Citizen generated data: the ethics of remote patient monitoring. Retrieved from https://www.phgfoundation.org/briefing/ethics-of-remote-patient-monitoring.