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Reid Cushman, PhD University of Miami Ethics Programs UM-Miller School of Medicine

Ethics, Health Information Technology, and Primary Care Baptist Health South Florida 11 th Annual Primary Focus Symposium. Reid Cushman, PhD University of Miami Ethics Programs UM-Miller School of Medicine Departments of Medicine and Health Informatics rcushman@med.miami.edu. Objectives.

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Reid Cushman, PhD University of Miami Ethics Programs UM-Miller School of Medicine

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  1. Ethics, Health Information Technology, and Primary CareBaptist Health South Florida11th Annual Primary Focus Symposium Reid Cushman, PhD University of Miami Ethics Programs UM-Miller School of Medicine Departments of Medicine and Health Informatics rcushman@med.miami.edu

  2. Objectives • Describe how basic principles of biomedical ethics are applied to deployments of health information technologies. • Identify and discuss the particular challenges and opportunities of advanced information technologies in primary care settings.

  3. What does “moral philosophy” offer that’s relevant for decisions about today’s information technologies? Rubens, “The Four Philosophers” c. 1611 (source: Wikimedia) ENIAC cycling units c. 1946 (source: Penn Library Exhibitions) IBM Watson supercomputer c. 2011 (source: Wikimedia)

  4. Fair Information Practice Principles • Notice/Awareness • Choice/Consent • Access/Participation • Integrity/Security • Enforcement/Redress • Self-Regulation • Private Remedies • Government Enforcement • Source: Federal Trade Commission

  5. HIPAA Privacy/Security “Rights” • Notice of Privacy Practices • Access to and Copying of Records • Correction/Amendment of Errors • Accounting of Disclosures • Additional Limits, Confidentiality • Assurance of Reasonable and Appropriate Security Practices • Complaint and Investigation Process

  6. Recent/upcoming HIPAA changes • “Breach” notifications • Electronic access to records • Expanded disclosure accounting • Expanded restriction request rights • More restrictions on resale, uses for marketing, fundraising, research (?) • Extension of requirements to BAs • Audits (random) • New penalty structure

  7. November 8, 2011

  8. “A feeble execution is but another phrase for a bad execution; and a government ill executed, whatever may be its theory, must be, in practice, a bad government.” Alexander Hamilton, Federalist No. 70, 1788

  9. How does all this translate into “challenges and opportunities” for deployments of information technologies in primary care settings? Medical tablet computer c. 2012 (source: SUNY-Stony Brook) Bank vault door c. 2009 (source: Wikipedia.org) Medical files c. 2012 (source: WBUR.org)

  10. Source: OECD Health Data 2011

  11. U.S. population profile: 1990, 2000, 2025, 2050, 2100 1990 2050 2100 2000 2025 Source: U.S. Census Bureau, National Population Projection Pyramids (2011)

  12. Counties in top two quintiles for diabetes and obesity Counties in the bottom two quintiles for diabetes and obesity County-Level Estimates of Obesity (percentage) Source: CDC, Diabetes and Obesity, 2009 Age-Adjusted by County

  13. Three levels of Prevention Primary prevention Secondary prevention Tertiary prevention Susceptible population Asymptomatic population Symptomatic population Reduced disease incidence Reduced prevalence / consequence Reduced complications / disability • Source: adapted from B J Turnock, ch. 1, Public Health: What It Is and How it Works (5th ed., 2012)

  14. Three levels of Prevention • Treatment and acute care • Chronic care • Complications management • Maintenance and rehabilitation • Screening • Case finding • Early intervention • Control risk co-factors – lifestyle and medication • Promotion of healthy behaviors and healthy environments • Universal and targeted approaches to control of risk factors

  15. Image source: NIH Bio-data-repository

  16. “Despite strong evidence that clinical preventive services (CPS) reduce morbidity and mortality, CPS performance has not improved in adult primary care. In addition to implementing electronic health records (EHRs), key factors for improving CPS include providing actionable information at the point of care, technical support staff, and quality-improvement assistance. These resources are not typically available in small practices.” Shih SC et al, “Health information systems in small practices. Improving the delivery of clinical preventive services” Am J Prev Med (2011 Dec,41(6)) Buying a system is only the beginning, and many ways the cheapest part. Successful implemen-tation requires changing practices.

  17. “I, for one, welcome our new computer overlords.” Ken Jennings, Jeopardy, 16 January 2011

  18. “I’m a doctor, not a mechanic” Dr. ‘Bones’ McCoy Star Trek (various), 1966-1989 “I’m a doctor, not a counterinsurgent.” Emergency Holographic Doctor Stark Trek: Voyager, 1995-2001

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