Ethical Issues in Health Information Management

Ethical Issues in Health Information Management

• Core ethical problems in health information management include: privacy and confidentiality, compliance, fraud and abuse, clinical code selection and use, quality review, research and decision support, public health, managed care, clinical care, electronic health information systems, management of sensitive information, roles of managers, entrepreneurs and advocates, and business relationships with vendors.
• Historical problems in research and ethics highlight the importance of diligence in future research endeavors.
• Ethical principles and professional values guide health information management professionals in addressing ethical problems.
• The AHIMA Code of Ethics guides behaviors such as protecting privacy, advancing HIM knowledge and practice, advocating for others, and refusing to participate in or conceal unethical behaviors.
• An ethical decision-making process can be used to resolve complex ethical problems
• Ethics involves reasoned discourse among decision-makers.
• Ethical discussions provide a framework for resolving conflicts between competing values.
• Ethics is a formal process of intentionally and critically analyzing the basis of one's moral judgments.

Ethical Principles and Professional Values

• Autonomy requires the HIM professional to ensure patients make decisions regarding access to their health information.
• Beneficence requires the HIM professional to ensure information is released only to individuals who need it to benefit the patient.
• Nonmaleficence requires the HIM professional to ensure information is not released to individuals who are not authorized to access it and could potentially harm the patient.

Professional Code of Ethics

• The first Code of Ethics for the Practice of Medical Record Science was passed in 1957 by the American Association of Medical Record Librarians.
• The first code of ethics combined ethical principles with professional values to support HIM professional decision-making.
• The Code of Ethics has been revised several times since 1957.
• Upon being awarded the RHIA credential, the HIM professional agrees to follow the principles and values outlined in the AHIMA Code of Ethics.
• The HIM professional is responsible for protecting patient privacy, even if federal or state laws do not require it.

Professional Values and Obligations

• HIM professionals are obligated to protect patient privacy and confidential information.
• Core health information issues include what information should be collected, how it should be handled, who should have access, and under what conditions it should be disclosed.
• Ethical obligations are essential to the professional's responsibility, regardless of employment site or information management method.
• Ethical and professional values are based on obligations to the patient, healthcare team, employer, public, peers, and professional associations.
• Themes and values identified in the AHIMA Code of Ethics include:
  • Obligations to the Patient and the Healthcare Team
  • Obligations to the Employer
  • Obligations to the Public
  • Obligations to Peers and Professional Associations.

Obligations to the Patient and the Healthcare Team

• HIM professionals are obligated to protect all sensitive information related to the patient, including clinical, behavioral, and financial information.
• Analysis of the medical record for accuracy can help identify falsification of information.
• HIM professionals should participate in research studies aimed at identifying medical identity theft.
• Risk assessments should be conducted to address the increasing threat of identity theft in the electronic health record (EHR) environment.
• HIM professionals should work to design systems that assess employee integrity and accountability.
• HIM professionals should ensure healthcare teams understand the importance of respecting patient information.
• HIM professionals should ensure colleagues understand and value the AHIMA Code of Ethics.

Ethical Issues Related to Documentation and Privacy

• Due to the increasing use of electronic health records, many different individuals document in patient health records and many more individuals have access to the data.
• HIM professionals play a critical role in developing policies and procedures to ensure the integrity of patient information, including appropriate and authorized access.
• HIM professionals should ensure compliance with federal and state laws as well as accrediting and licensing agency requirements.
• HIM professionals can design and deliver educational sessions for healthcare teams to educate them on documentation and access rules and regulations.
• Unacceptable documentation practices include backdating records or changing documentation to reflect known outcomes of care.

Ethical Issues Related to Release of Information

• The primary ethical problems related to release of information include violations of the need-to-know principle, misuse of blanket authorizations, and violations of privacy as a result of secondary release of information procedures.
• HIM professionals should adhere to the need-to-know principle when releasing information, carefully examining requests and verifying information.
• Misuse of blanket authorizations can occur when patients sign authorizations without understanding the implications, allowing requesters access to information for extended periods.
• The direct linkage between coding and payment has led to increased pressure on HIM professionals to transmit inaccurate information, raising ethical and legal concerns.
• Problems include pressure to code inappropriate levels of service, discovering misrepresentation in physician documentation, miscoding to avoid conflict, discovering miscoding by other staff, lacking coding tools and education, and being required to engage in negligent coding practices.
• Failure to comply with complex coding rules for reimbursement can lead to compliance and fraud and abuse problems for HIM professionals.

Ethical Issues Related to Quality Management, Decision Support, Public Health, Managed Care, and Clinical Care

• The rising cost of healthcare, limited resources, and concerns with patient safety contribute to ethical problems faced by quality management professionals.
• Common quality outcome problems include inaccurate performance data being shared with the public, negative care outcomes, failure to check physician licensure status, incomplete health records concealed from accreditation surveys, and patterns of inappropriate healthcare.
• The pressures to conceal information discovered through quality reporting systems create ethical dilemmas, particularly when patient safety is at risk.
• HIM professionals are increasingly involved in public health systems.
• The government's obligation to protect public health sometimes competes with the need to protect patient privacy, such as in the case of reporting HIV status.
• State and local mandated reporting requirements exist for certain conditions, including infectious and communicable diseases.

Additional Considerations

• The increasing accessibility and sensitivity of patient information in the EHR makes it crucial to protect this data.
• HIM professionals must remain diligent in upholding ethical principles and values to ensure the integrity and ethical use of patient information within healthcare systems.