Regulatory Issues in Health Information

QUESTION

Scenario: You are the HIM Director in an acute care hospital setting. Your facility has purchased an electronic health record (EHR) system, and pressure is mounting to deploy this system as soon as possible by the chief information officer (CIO) and chief of the medical staff (CMS). However, during a testing period, you and your team discover that the EHR system does not comply with applicable federal privacy and security standards. It is your recommendation to stop the deployment until these issues can be resolved; however, the CIO and CMS disagree.

Using the AHIMA Code of Ethics (found in the Sayles and Gordon textbook or via link: https://library.ahima.org/doc?oid=105098 (https://library.ahima.org/doc?oid=105098) ) outline your response as the HIM Director’s perspective to each of the steps as if you were writing the memorandum to the CIO and CMS. Consider the following steps in your response from legal, liability, and ethical perspectives.

1. Clearly define the issue.
2. Determine the facts of the situation.
3. Determine who the stakeholders are, the HIM values at stake, and the obligations and interests of each stakeholder.
4. Determine what options are available and evaluate them. 5. Decide what should be done.
5. Justify the decision made by identifying reasons that support the decision. 7. Implement the decision.
6. Evaluate the outcome of the decision.
7. Examine how to prevent the issue from recurring

Prepare a memorandum analyzing the key issues in this case and stating a recommendation. Feel free to use the Ethics Memo Template (https://lms.devry.edu/lms/content/1650/64573/HIT220/Ethics%20Memo%20Template.docx) , also found in the Ethics folder under Files, to help guide your memo. Be sure to address all steps and to fill in the memo header sections (To; From; Subject; etc.).

Deliverables: Your memorandum should be a short paper submitted in Microsoft Word, addressing each step above from legal, liability, and ethical perspectives. The document should be double-spaced, in 12-point Times New Roman font, with one-inch margins, and sources properly cited. For additional expectations, please review rubric below.

Ethics Memo Template

General Hospital Interoffice Memorandum

to:	Recipient Name
from:	Your Name
subject:	Enter Subject
date:	Enter Date
CC:	cc Name

Paragraph 1: Define the issues and facts of the situation (steps 1 and 2).

Paragraph 2: Identify the stakeholders and their obligations and interests.  Determine the values at stake (step 3).

Paragraph 3: Identify and evaluate available options (step 4).

Paragraph 4: Recommend what should be done and justify your reasoning (steps 5 and 6).

Paragraph 5: Discuss how to implement your decision and how to evaluate the outcome (steps 7 and 8).

Paragraph 6: Consider ways to prevent this issue from reoccurring (step 9).

ANSWER

GENERAL HOSPITAL

INTEROFFICE MEMORANDUM

TO: NAME OF RECIPIENT

FROM: YOUR NAME

SUBJECT: RECOMMENDATION TO STOP DEPLOYMENT OF THE EHR SYSTEM

DATE: 25^TH OCTOBER, 2022

CC: CIO & CMS

I am writing to you regarding the newly proposed deployment of the electronic health record that will aid various functions within the hospital. Upon close evaluation during the testing period, we have discovered some shortcomings that can be due for consideration before settling on the deployment of this system. Therefore, this is to recommend that the deployment be halted until the deficiencies are resolved.

As a healthcare organization, it is essential to uphold the privacy of the patients and every stakeholder within the organization. While studies like Bowman (2013) agree that the electronic health record system has substantial benefits, they also agree that there are serious unintended consequences stemming from the implementation and use of this system within a healthcare setting. Bowman (2013) explains that the EHR system jeopardizes the integrity of information fed into it, thus causing errors and threatening patient safety and the overall quality of healthcare. Moreover, the system can lead to fraud and abuse, which has profound legal implications for the organization as a whole (Sittig et al., 2016).

Considering we are part of a healthcare system that needs the efforts of all stakeholders, we need to consider their interests and obligations closely. With regard to the projected system, patients are the largest shareholders who can feel threatened when the privacy of the EHR system is compromised. Their obligations include providing information for easy and progressive care, and their compromise will make some patients hold back their trust in the hospital. Healthcare practitioners like nurses and caregivers are also important stakeholders whose main obligation is to provide quality healthcare. Given that a breach of the system is likely to compromise privacy and the quality of care, deployment needs to be halted, as it is detrimental to efficiency in providing care. Moreover, the board as a stakeholder can face financial losses if the system is deployed, minus reviewing the concerns. The hospital and its stakeholders have an obligation to implement a system that makes care efficient for both the care provider and the patients. Otherwise, values like integrity, privacy, and confidentiality will be at stake if the system is implemented without addressing the problems.

The EHR software is an opportunity made available to healthcare facilities. However, a poor design will impact every shareholder directly or indirectly. Therefore, available options like designing standard systems and looking for competitive differentiation can be explored. The aim is to ensure that the software to be implemented has the best security measures and that there is a shared responsibility between vendors and healthcare organizations such as ours to ensure the system’s safety.

As a straight-up recommendation, it is essential for you as the policymakers, us as the healthcare providers, and EHR vendors to work collaboratively and ensure the EHR systems are preventing rather than causing medical errors, leading to quality patient care. Therefore, we need to re-scrutinize the system and take a period of time to ensure it is safe for use.

Lastly, I request time for my team to explore the specific characteristics of the system that are likely to increase or decrease the rate at which errors occur in the system, identify what characteristics will be safe for the EHR system, and determine what usability principles and best practices can be implemented before full deployment.

Otherwise, the issue of privacy concerns over a system should not reoccur if we take time to eliminate all possibilities of a breach of the values of healthcare like privacy. Nonetheless, it would be unethical to assume the threats that are likely to be posed by risky software such as EHR and proceed with deployment. I am confident that the points noted herein will be considered and that the system’s deployment will be halted as we await scrutiny of the available measures to counter its shortcomings.

References

Bowman, S. (2013). Impact of Electronic Health Record Systems on Information Integrity: Quality and Safety Implications. Perspectives in Health Information Management, 10(Fall), 1c. https://pubmed.ncbi.nlm.nih.gov/24159271

Sittig, D. F., Wright, A., Ash., Singh, H. (2016). New Unintended Adverse Consequences of Electronic Health Records. Yearbook of Medical Informatics, 25(1) 7-12.

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