Understanding Ethics: Individual, Professional

Ethics Defined

• Ethics is a system or code of conduct and morals
• Ethics is advocated by an individual or group
• Ethics is the study of acceptable conduct and moral judgement
• Individual ethics are based on concepts of right and wrong
• Individual ethics are not determined by strict rules or rigid guidelines
• Individual ethics are relatively stable but can change

Professional Ethic

• Professional ethic consists of accepted criteria that differentiate a profession from trades
• Professional ethic includes efforts and behaviors deemed valuable and worthy by society
• Ethics addresses the "rightness and wrongness" of actions compared to natural reason
• Societal behavior is defined by laws, rules, regulations, and ordinances
• Professional behavior is defined by professional Standards of Conduct and Scope of Practice
• Society expects professions to self-regulate

Societal Behaviour

• Societal behavior is governed by laws and morals
• Laws can be limiting and are not comprehensive
• Laws require enforcement and authority
• Laws can be politically motivated and applied unequally
• Morals are generally accepted customs of right living, conduct, and individual practice

Professional Behavior

• Professions, through members, create their own statements of acceptable and unacceptable behavior
• Professional behavior is defined by Standards of Conduct and Scope of Practice
• Norms for professional conduct are to be established
• Individuals are responsible for knowing the ethical and professional standards of their chosen career

ARRT Code of Ethics

• The American Registry of Radiologic Technologists (ARRT) has a code of Ethics
• The ARRT Code of Ethics has two parts
• Part A addresses behaviors a professional should aspire to achieve
• Part B contains mandatory rules of acceptable professional conduct
• Medical imaging professionals required to know the Code of Ethics
• Ethical codes reflect societal trends and values so, codes are typically static and slow to change

Rules of Ethics

• The Rules of Ethics form the second part of the Standards of Ethics
• The Rules of Ethics sets the mandatory standard for all Registered Technologists and candidates
• The Rules of Ethics promotes protection, safety, and comfort for all patients
• Registered Technologists must notify the ARRT of ethics violations, licensing issues, charges, and convictions within 30 days
• Key points for Rules of Ethics include: Fraud, deceptive practices, subversion and unprofessional conduct
• Scope of Practice, Fitness to Practice, Improper Management of Patients Records
• Violation of State or Federal Law or Regulatory Rule, and Duty to Report also are key points

Ethical Dilemma

• Professional decisions in radiologic and imaging sciences involve human values
• Unethical behavior can be defined as an ethical outrage
• Ethical dilemmas arise when the correct choice is unclear and personal values conflict

Ethical Analysis

• Ethical analysis involves: Identification of a problem, developing alternative solutions, selecting the best solution, and defending that selection

Basic Ethical Principles

• Basic Ethical Principles include: Beneficence, Nonmaleficence, Justice, Autonomy, Veracity, Fidelity

Beneficence and Non-Maleficence

• Beneficence: primary factor is to do good to patients
• Code of ethics defines Beneficence as “acts in best interest of the patient."
• Non-maleficence means to do no harm, and never do anything to harm the patient

Justice and Autonomy

• Justice involves giving the patient fair and equal treatment regardless of race, color, creed, or income
• Autonomy means freedom of choice, including the right to refuse treatment; the patient decides if they want to be treated

Veracity and Fidelity

• Veracity involves being truthful and not lying to the patient
• Fidelity involves being careful of acts that do not observe covenants or promises
• An example of fidelity would be avoiding bribery with a child and failing to follow through
• You should be faithful to the patient’s needs and try to meet reasonable expectations

Professional Relationships

• Professional relationships are important towards: patients, physicians, other health professionals

Avoiding Ethical Conflicts

• It is vital to understand that some situations are unavoidable
• One must clearly understand the right thing to do and the wrong thing to do
• It is essential to choose the right thing to do
• One should research professional standards of conduct and ethical principles as a guide if unsure

Importance of Studying Ethics

• Ethical questions can affect the activities in which a radiologist technologists engage
• Studying ethics leads to a better understanding of daily problems in the profession
• Studying ethics helps individuals understand themselves in relation to duty

Conclusion: Ethics

• Ethics is a combination of societal laws and values
• Professional ethics are specific to an occupation, defined by members at many levels
• Ethical dilemmas naturally occur and require thorough analysis -Radiologic sciences professionals must possess a sense of the role human values play in resolving ethical dilemmas in their dealings with patients and interactions with physicians

Health Informatics and Health Information Management

• Health informatics and information management must be defined
• Responsibilities of a health information professional should be listed
• Steps to resolve errors in patient identity management should be explained
• Key components of a patient health record must be listed
• The revenue cycle management process should be outlined
• Coding as it relates to radiologic and imaging science procedures, and the reimbursement impact for healthcare facilities must be identified

HIPAA

• HIPAA (Health Insurance Portability and Accountability Act) privacy and security requirements in a radiologic and imaging science setting needs explaination
• Interoperability and health information exchange must be explained
• Health information systems (HIS), radiology information systems (RIS), PACS, and AI should to be understood

Health Information Management (HIM)

• Health Information Management requires all health care providers maintain all patient care information for each individual patient
• Health records concentrate all patient care information in a single record
• HIM promotes effective communication and ensures continuity of care

Health Information Department Functions

• Health Information Departments support the current and continuing care of patients
• Health Information Departments support the institution's administrative processes
• Health Information Departments maintain records for patient billing and accounting processes
• Health Information Departments support medical education programs and health services research
• Health Information Departments maintain records for utilization, risk, and quality management programs
• Health Information Departments ensure patient privacy, security issues, and compliance with legal requirements
• Health Information Departments perform services related to patient records

HIPAA 1996

• HIPAA ensures a patients have a right to access their personal health information
• 21st Century Cures Act makes it mandatory for health systems to provide patients with notes, reports, images, etc. through patient portal applications
• Patient portals facilitate patient involvement in their health care
• Secure on-line websites permit patients convenient round-the-clock access to personal health information and medical records

HIPAA

• The purpose of HIPAA is to protect health information privacy, ensure timely access, and to secure electronic health records (EHR)

HIS/RIS/PACS

• Health information systems (HIS) manage healthcare data and allows sharing of protected health information (PHI) across the healthcare industry
• Information provided by HIS is very vital to the radiology information system (RIS)
• Radiology Information System (RIS) manages imaging orders, scheduling and billing, and is a method for patient management, tracking, and reporting
• RIS communicates with picture archiving and communication systems (PACS)

HIS/RIS/PACS continued

• Picture archiving and communication system (PACS) is a networked group of computers, servers and archives to manage digital images
• Cloud-based PACS are required for medical imaging modalities

The Joint Commission

• The Joint Commission (TJC) accredits and certifies healthcare orgs and other programs in the US, also sets maintenance and documentation standards within health records
• According to TJC, medical records must identify the patient, support the diagnosis, justify the treatment, document the course/results, and promote continuity of care
• According to Medicare the medical record must justify admission and hospitalization, support the diagnosis, and describe the patient’s progress and response to care

Health Record Content

• All departments involved in a patient’s care must document that care in the health record
• Documentation should be done by radiologists and radiographers when a patient receives diagnostic or therapeutic radiologic services

AI Terminology and Concepts

• Machine Learning: Algorithms are trained on data to make predictions without explicit programming
• Neural Networks: Computational models, inspired by the human brain, for pattern recognition
• Deep Learning: Machine learning subset using neural networks with many layers
• Natural Language Processing (NLP): Enables machines to understand and respond to human language

Applications in Healthcare

• AI is used in: diagnostic tools for early disease detection, personalized treatment plans, and accelerating drug discovery
• Data is the backbone of AI development, and high-quality, diverse data improve AI model accuracy and reliability
• Structured data sets includes: databases such as tables
• Unstructured data sets includes: text and images

AI in Medical Imaging

• AI improves diagnostic accuracy and speeds image processing
• AI enhancements are used in applications such as X-rays, CT scans, MRIs
• Techniques used are: Image Segmentation, Classification, Reconstruction

Ethics, Legality, Liability

• Issues surrounding algorithm bias require fairness and transparency
• Data privacy that protects patient information must be respected
• Accountability and legal frameworks for AI-driven errors are essential

Regulation and Workflow Integration

• Importance of Al integration requires careful planning and regulation

Standards Needed

• Data quality, algorithm transparency, and system interoperability are needed

Standards for Inpatient Records

• Standards for inpatient records include: Patient identification data, Medical history
• Relevant family and social histories, and inventory by body system, Report of relevant physical exam, Diagnostic and therapeutic orders
• Clinical observations, including results of therapy, Reports of diagnostic and therapeutic procedures and tests, as well as their results
• Evidence of appropriate informed consent when consent is not obtainable, the reason should be entered in the record
• Conclusions at termination of hospitalization or evaluation of treatment, including any pertinent instructions for follow-up care

Informed Consent

• Informed Consent means the patient has been informed of the procedure or operation, risks, and consequences
• Authorization for treatment is general permission given at the time of admission to the hospital, giving the hospital permission to treat or allow treatments in the patient's best interest Authorization covers routine hospital services, general diagnostic procedures, and medical treatment

Health Records Used in Radiology

• Heath records such as a radiology order before imaging, patient demographic information, specific procedure requested, and the ordering physician should be identified
• Authentication required i.e. Description of what is seen on radiograph and its implications for the patient
• Documentation includes: therapeutic radiology, dose of x-ray or radioactive material administered, date and time, special reports documenting evaluation or treatment should be placed in permanent record
• Treatments require a physician order
• Patient Portals are secure online website which gives access to health information and medical records

Medical Record Information

• Medical Record Information is to include: final diagnosis and prognosis, psychological needs summary, physical exam report, treatment plan, progress notes
• It is to include: patient ID and demographics, medical history, diagnostic and therapeutic orders, clinical observations, consultation reports, surgical and invasive procedures
• Final diagnoses, discharge summaries, postmortem results, records of donations and implants, conclusions at termination of stay, discharge info given to patient, family are all to be included

Health Record Reimbursement

• ICD-10-CM (International Classification of Diseases, 10th edition, Clinical Modification) is used for diagnostic coding
• CPT (Current Procedural Terminology, 4th edition) codes procedure for outpatient encounters/services
• Accurate coding is critical to reimbursement and financial health

Recording Data

• Records must be permanent, ink or digital records
• Electronic records must be verifiable

Considerations When Recording Data

• Essential to remember that without proper documentation, it is assumed an event did not take place

Legal Aspects of Records

• Health records are legal documents
• Radiographers may give depositions or testify about health records or radiographs
• To correct an error, the author should draw a single line through it, write "ERROR," and then record the correct information, the individual should date and authenticate the entry
• The original record never leaves court
• Informing patients of exam results is the physician’s responsibility
• HIPAA outlines confidentiality requirements

Medical Record Recording

• For medical record recording: be legible, write in ink, use correct spelling, be accurate, and keep information concise
• Include the date and time, record information as it occurs, keep all information confidential, and sign with name and title
• Do not: write in pencil, block out entries, include critical comments, leave blank spaces, use improper abbreviations, or record data for someone else

Data Regarding Patients

• Do not divulge information concerning the patient or use initials when signing your name

Incident Report

• Incident Reports contains information relevant to unusual patient incidents and occurrences
• Incidents are classified as sentinel events and must be completed following an event

Performance Improvement

• Performance Improvement monitors and evaluates the quality of care in a healthcare facility, also known as Quality Assurance or Quality Assessment

Areas of Assessment

• Include: Utilization, risk management, infection control, surgical case review, medication usage, health/blood usage review, pharmacy, case management, hospital committees and radiation safety

Ownership of Medical Records

• Caregivers or facilities own medical records
• Patients have those information unless prohibited by law

Releasing patient information

• Consents to release patient information must be written, including to whom the information is released, the patient’s name, address, and birth date; the extent of the information to be released; the date; and the signature of the patient or legal representative

E-mail and Fax considerations

• For e-mail or fax, all transmissions must be accompanied by confidentiality
• Sender should contact receiver before and after sending

Maintaining records

• Films/digital records must be kept in a secure area with limited public access
• Copies of the written interpretation should be kept with the image files/films and patient’s medical records
• Medical records and image files/films can be stored offsite if economically feasible and security is maintained

Conclusion

• A health information management department is a key hospital department
• The health record communicates information pertaining to patient care
• Proper medical coding is essential to the financial viability of the institution -The health record is the legal document that attests to the care -In electronic media, confidentiality of the health record is crucial and required, with penalties for noncompliance