Module 5: Ethical Considerations

As I carefully consider the relationship between information (such as that found on the AHQR website), reimbursement and HIT, I realize this trio is a three-legged stool and without any of the three spindles, the stool would suffer from instability. Health information technology is the backbone of the AHQR site: making possible information exchanges on quality, patient safety / medical errors, research, and standards of care. The government is taking full advantage of the information age, providing a wellspring of information for both professional and lay consumers. But the question arises: where should the line be drawn between opacity and transparency in regards to health / patient / provider information?

In the powerful photo editing program called Photoshop, there is a tool whereby the range of color can be manipulated with a slider from either 0 to 100% transparency.  Finding the right balance is dependent upon many issues such as artist preference, style of the art, and end-user preference. Such it is with the accessability of information in today's highly-technological-instant-information-web-2.0 age. The ethical dilemmas regarding transparent information sharing are of paramount concern.

As the guests on the Diane Ream show discussed, activated patients are a great strength. Now the real challenge is to muscle up discernment strength. I loved the analogy of comparing web consumers to that of first year medical students. Both med students and many people reading scientific / medical information have the cognitive ability to understand it. However, what both groups lack are the ability to make not only educated inferences, but intuitive inferences based on experiential evidence, and the ability to fold in prior experiences, low likelihoods of disease and other nuances gained only over time.

Based upon the topics found on the AHQR, it is clear that the government is moving towards increased accessibility: making information such as quality data and standards of care available to the public. This is necessary if pay-for-performance (P4P) programs are going to implemented. Thinking about the government trying to become more accessible makes me chuckle. This flies in the face of the nature of government both past and present. In fact, isn't the phrase government transparency an oxymoron? Well, ok...that is just my editorializing.

Which brings me to the next ethical consideration:  confidentiality. There is a great movement afoot to increase data sharing, not only such as seen on the AHQR website, but also in the arena of patient to patient sharing. Again, development of HIT lies at the epicenter. The challenge will be to come up with ways to allow data sharing while still protecting sensitive data. Technology is way out ahead magnetically pulling us to move healthcare delivery towards using web housecalls, telemedicine, twitter, e-consults, and emails. The technology exists to use all of these, but as usual, practice and payment lags behind. Therein lies the challenge to utilize the technology, and convert patient experience into measurable, usable data while maintaining confidential integrity. 

And finally, rampant spread of information sharing and increased use of HIT subsequently increases the risk of plagiarism. Both users and producers must sport accountability in avoiding the misuse and misproduction of information.