Ethical Considerations of the Use of Informatics in Nursing and Health Care - Term Paper Example

Ethical Issues in Healthcare Informatics Abstract Informatics is extensively used in the sphere of healthcare. Healthcare informatics has a range of benefits for the nursing practice and education. The biggest achievement of healthcare informatics in relation to nursing was the development of nursing information systems. This made it possible for physicians to enhance the quality of care through accumulation of medical facts about patients. Today nursing information systems are used for building up clinical wisdom, when nurses are provided with the necessary background data upon which their decisions will be based and with advice on how to decide, and compiling electronic databases, which allows them to operate patient data in an effective manner. Besides, informatics has been widely used in nursing education process. Future nurses improve their reading, writing, and communication skills through blogs writing, participation in discussions, and writing journal entries. The ethical considerations of the use of informatics in nursing and health care are above all related to data security and data quality issues. Overall, informatics has brought numerous benefits to the field of nursing and nursing education, yet more should be done to resolve ethical dilemmas. Introduction Computers have greatly altered the way we do various things. Health care is not an exception. Within the sphere of health care, informatics is widely used. This paper examines benefits the benefits of health care informatics for nursing practice and education. It also focuses on ethical considerations of the use of informatics in nursing and health care. Benefits of Health Care Informatics for Nursing Recognition of information as the leading health resource has led to development of health care informatics (Conrick, 2006, p.12). From the available sources, health care informatics or health informatics may be defined as application, in a systematic manner, of information and computer science as well as technology to the practice of health care, related research, and learning. Similarly, health informatics may be referred to IT application to the sphere of health care and in health care professions for the purposes of producing various tools and procedures which would help medical staff diagnose and treat customers in a more efficient and accurate way (“The History of Health Informatics”, 2013). Historically, benefits of computers for health care were recognized early in the 20th century, practically application of computers to health care did not became possible until 1950s, when informatics took off in the States. Early computers were mostly used for office purposes as large calculating machines. It is believed that the stage for further developments of health care informatics was set by Robert Ledley, an inventor of the body CT scanner, who used informatics in his dental projects carried out in collaboration with the National Bureau of Standards. After the invention of the LISP and MUMPS languages of programming in the 1960s, computers started to be seen as a means of creation of medical databases, diagnostic systems, and other programs related to health. Throughout the 1970s the potential of informatics for improving data storage and overall quality of patient care was realized (Conrick, 2006, p.12). The cost-saving benefit of using computers in financial and management areas of health care was stated. At the same time, MYCIN was developed for the purposes of helping physicians find the bacteria that caused several infections, as well as recommend medication and dosage for treatment. Besides, it aimed at treating blood clotting problems. INTERNIST-1 was developed at around that time. It was conceived as a system that could be used for supplying medical information to non-medics. The major advancement of 1980s was the development of nursing information systems. This enabled physicians to document a few aspects of records for their patients, which included vital signs, medical orders, discharge planning, and patient notes. Owing to these developments, nursing informatics was founded as a specialty. It led to advancement of nursing information systems. Within these changes and owing to the development of the microcomputer, the U.S. Veterans Administration actively used MUMPS to create patients’ personal health records. These days it utilizes the CPRS program (abbreviation for Computerized Patient Record System). This allows having a graphic interface which presents a long-term history of a patient’s health. It features a special notification system that notifies users about important clinical events for a particular patient and reminds to give correct treatments on time. Today the biggest use of health informatics and nursing informatics in particular, has been in the field of electronic medical records. According to the experts from the University of Illinois at Chicago, it will remain “the most significant application of health informatics in the foreseeable future” (“The History of Health Informatics”). Aspirations behind the widespread use of electronic medical records are it will lower the overall healthcare costs and enhance patient care in the United States. That is why the U.S. Department of Health enforces the plan to ensure extensive application of electronic records in health care by 2014. As for the nursing informatics, its major aim is knowledge generation for nurses (McGonigle & Mastrian, 2011, p.96). The foundational concepts are those of data, knowledge, information, and wisdom. According to the American Nurses Association, nursing informatics or NI may well be defined as “a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice.NI supports consumers, patients, nurses, and other providers in their decision-making in all roles and settings. This support is accomplished through the use of information structures, information processes and information technology” (ANA, 2008 in McGonigle & Mastrian, 2011, p.96) The advancement of Nursing Informatics gas brought in two major specialized of registered nurses within the field: informatics nurses and informatics nurse specialists. Informatics nurses are those RNs who accomplish some continuing education course or complete an on-the-job training. As for informatics nurse specialists these are MS or PhD awarded nurses as well as nurses with a post-MS certificate in either nursing informatics or a related area. The key specialty areas within nursing informatics are clinical informatics, public-health informatics, consumer-health informatics, and educational informatics (Ozbolt, Nahm, & Wilson, 2003). The benefits of nursing informatics for quality nursing practice are evident. Specifically, the greatest benefit for nurses is that nursing informatics helps to build clinical wisdom and critical thinking skills. These are crucial for adequate decision-making. Namely, nurses make decisions which interventions to make from their perspectives. While decision-making is understood as the process of selection among a variety of alternatives, the quality of the choice depends on the nurse’s unique characteristics. At the same time right decisions are made on the basis of effective critical thinking and adequate application of knowledge. All this makes up clinical wisdom. The latter is defined as “the ability of a nurse to add experience and intuition to a situation involving the care of a person” (Benner, Hooper-Kyriadkidis, & Stannard, 1999 in McGonigle & Mastrian, 2011, p.105). Nursing informatics background helps to develop clinical wisdom, i.e. effective skills of evaluation of information on the basis of the data contained in a health information system and adapting them “to improve the workflow of a clinical nurse” (McGonigle & Mastrian, 2011, p.105). Importantly, nursing informatics involves the use of decision-support systems designed as computer applications utilized to support human decision-making process. Decision-making is supported by computer recommendations that take for of alerts or suggestions. At the same time, expert systems, which are automated decision-making systems, allow applying knowledge of several human experts when no human intervention takes place. As for nursing education, information technology brings a lot of benefits, too. One of the latest educational tools based on information technology is blogs. Margaret Maag, the author of “Potential use of ‘blogs’ in nursing education” concludes that “creation and publication of blogs by students from the healthcare profession can enhance their written and oral communication skills.” This is achieved through students getting encouraged by the opportunity to write and publish texts on the Web. Besides, they get involved in reading what other people write in response to their writings. As for the kinds of blogs, these may be: reflective journals describing students’ interactions with patients and medical staff; electronic portfolios; parts of group discussions/debates on nursing issues and case studies; blogs for knowledge management and class coordination (Maag, 2005) All in all, benefits of health informatics for nursing practice are numerous. They allow creating personal health records databases and operating them effectively; they prevent dramatic errors through decision-making support systems and alerts; they facilitate the improvement of nursing working environment with data, available information, and knowledge being efficiently managed so as to ensure all nursing decisions are guided by wisdom. Ethical Issues in Nursing Informatics Probably the biggest ethical concern is the extensive adoption of Electronic Health Record System. While the latter may represent evident beneficence through increasing access to health care, improving the overall quality of health, and decrease costs, certain ethical principles are violated. According to Layman (2008) the use of the system creates certain ethical conflicts. Autonomy (or individual’s right for non-interference) gets jeopardized once a customer’s data on health are shared without his/her consent. Fidelity gest violated when millions records of patients health conditions get exposed though error or theft. Justice breach occurs when people, on the basis of their socio-economic status or age, are deprived of equal health information access (Layman, 2008). Ethical considerations related its use in terms of data security, confidentiality, and privacy are the subject of concern by both medical practitioners and patients. Carel in his “Ethics of Electronic Health Records” observes that fear of privacy breach prevents many people from honest sharing of information about their health condition, leads them to altering diagnoses or avoiding clinical help. This may be explained by the fact these people are afraid the potential employer will reject them after he sees their heath record (Carel, 2010). As for security, errors may occur in systems that will disclose patients’ data. Besides, the involvement of representatives of health personnel in entering, storing and using data is itself a great disclosure and “lost and misplaced files” (Conrick, 2006, p.323). In addition, storing data on a central database, which is typically off the hospital, exposes it to breaches of security. Legally, the concerns related to electronic storage of patient data have been basically resolved. In 1996, the Health Insurance Portability and Accountability Act was signed to prevent providers from sharing clinical information with other bodies without customer concern. At the same time, the involvement of some big corporations that are not usually associated with the sphere of health care raises clear ethical concerns. Patients are unsure their records stored in web-accessible databases will be secure enough if protected only by one password. On the one hand, the accounts may be easily breached by hackers, on the other hand – Google and Microsoft may use electronic health records to target advertising through automated systems (Stair, Reynolds, and Reynolds, 2008, p. 117). Among other ethical issue associated with keeping electronic records is that of data quality. It is supposed that data that is about to be uploaded into the system be managed without error and characterized by “accuracy, currency, quality, and completeness” (Conrick, 2006, p. 323). Conclusion On a balanced view, health informatics offers a number of benefits for nursing practice and education. Given the ethical concerned are properly addressed, both health care practitioners and patients may garner benefits from electronic health record systems and computer applications. Education of nurses, too, gets more effective with the use of latest technologies and educational tools. References Carel, J. (2010) The ethics of electronic health records. Yale Journal of Medicine & Law: An Undergraduate Publication, VII (1). Retrieved from http://www.yalemedlaw.com/2010/10/the-ethics-of-electronic-health-records/. Conrick, M. (2006) Health informatics. Cengage Learning Australia. Layman, E. (2008) Ethical issues and the electronic health record. Health Care Manag (Frederick). Apr-Jun; 27(2), 165-76. Maag, M. (2005) The potential use of "blogs" in nursing education. CIN: Computers, Informatics, Nursing, January/February 2005, 23 (1), 16-24. McGonigle, D. and Mastriam, K. (2011) Nursing informatics and the foundation of knowledge. Jones & Bartlett Publishers. Ozbolt, J., Nahm, E., and Wilson, M. (2003) How about a career in nursing informatics? American Nurse Today, 2 (9), pp. 34-36. Retrieved from http://www.americannursetoday.com/assets/0/434/436/440/5492/5494/5540/5542/040897ed-4278-4f83-ac66-e015676e38d7.pdf. Stair, R., Reynolds, J. & Reynolds, J. (2008) Fundamentals of Information Systems. Cengage Learning. “The History of Health Informatics” (n.d.) Retrieved from http://healthinformaticsdegree.uic.edu/history-of-health-informatics/. Read More