Hipaa and Ethics Case Study

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Case Study

Using the scenario provided , please complete the case study based on your knowledge of ethics, HIPPA, HITECH and other standards that apply to technology in nursing practice. I have also attached some materials to help and some sites you can look at to help with the case study.

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Grading rubric

Identifies at least 2 HIPAA Violations (10 pts each) 20 pts

Completes flow chart with 2 outcomes for the case (10 pts each) 20 pts

Identifies leadership behaviors essential to the case 5 pts

Includes worksheet, utilizes provided handout, provides. 5 pts

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HIPAA and Ethics Worksheet A nurse practitioner in the ED was treating an elderly woman for shortness of breath began to look for the cause of her worsening condition. She ordered a drug screen, on which she tested positive for cocaine. Her family, including her adult children, were present in the ED with her. The NP asked the patient about the findings in the exam room and the patient told her that she had no idea how cocaine could be in her system, which made the NP concerned she might be a victim of abuse. One of the nurses involved in her care Googled her and discovered that she had a previous police record for cocaine possession. The nurse emailed the NP the information about the patient. The nurse also called social services and the family overheard her discussing this patient on the phone in a public area. 1. Identify 2 HIPAA violation in the case. (10 pts each, 20 total) 2. Provide two possible outcomes in terms of the ethical dilemmas. (10 pts each, 20 total) 3. What leadership behaviors are essential to this case? (5 pts) Nurs Admin Q Vol. 29, No. 4, pp. 349–352 c 2005 Lippincott Williams & Wilkins, Inc.  Ethics in Nursing Administration Ethics in Informatics The Intersection of Nursing, Ethics, and Information Technology Leah L. Curtin, ScD (H), RN, FAAN T HE ethical questions posed by technology are fundamentally human questions—almost all of which have to do with how humans choose to use, or to abuse, the powers of technology. Let us take, for example, the much discussed, and now highly regulated, issue of information technologies and privacy. People have been snooping into other people’s business—and other people have been trying to stop them—since the dawn of time. I can almost see a neolithic voyeur peeking around the huge pillars of Stonehenge to get a better look! What does technology add? You can find out more with less effort, and spread it farther and faster than anyone ever dreamed was possible. This, in turn, vastly increases the impact of illicitly gathered information. Stealing—information, money, even a person’s identity—has always been wrong. It is still wrong. What does technology add? It adds greatly to the abilities of the unscrupulous to bilk the unwary. From the University of Cincinnati College of Nursing and Health, Ohio. Dr Curtin is also the Editor-in-Chief of Journal of Clinical Systems Management and senior partner in Metier Consultants. Corresponding author: Leah L. Curtin, ScD (H), RN, FAAN, University of Cincinnati College of Nursing and Health, Cincinnati, OH (e-mail: curtincal@one.net). Accuracy in record keeping has always been important, but rarely has the impact of erroneous record keeping had the impact it has today. And because we are talking about healthcare—pain, life, suffering, and death— the stakes are quite high. “Indeed, medical informatics is rich with ethical issues . . . privacy and confidentiality, risks of bias and discrimination, the danger of scientific and clinical hubris, the erosion of cherished relationships, and the degradation of precious skills.”1 This article explores, however inadequately, the intersection of 3 vast areas of inquiry: ethics, computing, and healthcare. While each is a separate area of inquiry, they all intersect in medical informatics— and while there are, indeed, experts in each field, rarely will there be one person proficient in all 3 fields of inquiry.1 On the one hand, the sheer power technology places in the hands of healthcare professionals enlarges the ethical problems they encounter, and on the other hand, it decreases vastly the patient’s vulnerability by allowing the patient to access vast quantities of information about his or her condition. Provided, of course, that the information is accurate. Technologically improved tools not only compress time but also dramatically increase the impact of error—or of carelessness, foolishness, recklessness, and, for that matter, malevolence. But they also enable 349 350 NURSING ADMINISTRATION QUARTERLY/OCTOBER–DECEMBER 2005 anyone with access to learn far more, far faster than ever before. A FEW BRIEF DEFINITIONS . . . For the sake of both brevity and clarity, ethics can be defined as a discipline in which one attempts to identify, organize, analyze, and justify human acts by applying certain principles to determine what is the right thing to do in a given situation.2 A “human act” is a choice, and a choice always involves a value judgment.3 The concept of choice necessarily involves freedom (the ability to make a choice) and with it the responsibility for the results of that action. Values, simply put, are matters of such importance that a person is willing to suffer, sacrifice, or even die—or perhaps go on living—for them. To at least some extent, all choices are value choices. What then distinguishes an ethical choice from any other choice? Ethical choices share certain characteristics: (1) they always involve fundamental value conflicts; (2) because the choice involves fundamental values (matters of utmost importance) rather than facts (provable truth), scientific inquiry may influence the choice, but cannot provide answers; and (3) because these choices involve the placing of one value above another, and because by definition values are of the utmost importance, any decision reached will have profound, multiple, and often unanticipated impact on many areas of human concern. Because medical and healthcare professionals are almost always involved with choices that affect significant, personal choices of other human beings (patients/clients), the foundation, form, and balance of values within that relationship are of great importance.4 Professionals, by and large, are educated in an elitist tradition that assumes the professional is the expert, and it is the professional who knows and weighs the options and makes and implements the decisions. Burgeoning technology, multiple options, and diffusion of knowledge have rendered this command ethic obsolete. Trouble is, few professionals are prepared to make the transition to a more humble provision of assistance in decision making—the communication of support and guidance rather than authority and control. That being said, however, in some instances, professionals are surrendering both technical and moral authority to patients, perceiving themselves quite simply as tradesmen selling a service. And that, too, is wrong. Are professionals moral agents, or are they merely instruments of the desires of others? Ethics in the health professions is a discipline in transition, for professionals in transition, in a society in transition. We have yet to develop an ideal model of adult patient/ professional relationship—one that optimizes the contributions each partner in this relationship has to offer, and emphasizes mutual guidance, support, and shared decision making. We are just beginning to sort out who ought to be making decisions about what4(p300) Into this volatile mixture, we now add medical informatics—with all the promise and peril it offers. Medical informatics has been emerging as a discipline in its own right over the past quarter century. During that evolution, there have been a number of notable attempts along the way to define the field in scientific, formal yet succinct terms, and in many cases each has built on its predecessors. However, for the purposes of this article, we shall use the American Nurses Association’s definition of nursing informatics as “the specialty that integrates nursing science, computer science, and information science in identifying, collecting, processing and managing data and information to support nursing practice, administration, education, research and the expansion of nursing knowledge.”∗ ∗ For more information, visit the American Nurses Association’s Web site, http://www.ana.org, and type “informatics” into the search field. Ethics in Informatics DEFINING THE FIELD OF COMPUTER ETHICS From the 1940s through the 1960s, there was no discipline known as computer ethics. In the mid-1970s, Maner coined the term computer ethics and defined it as a field in which one examines “ethical problems aggravated, transformed or created by computer technology.”5 In her book, Computer Ethics, Johnson defined the field as one that studies the way in which computers “pose new versions of standard moral problems and moral dilemmas, exacerbating the old problems, and forcing us to apply ordinary moral norms in uncharted realms.”6 Like Maner before her, Johnson recommended the “applied ethics” approach, but she did not believe that computers create wholly new moral problems. Moor defined computer ethics as a field concerned with “policy vacuums” and “conceptual muddles” regarding the social and ethical use of information technology.7 Moor holds that computer technology is genuinely revolutionary because it is logically malleable. According to Moor, the computer revolution is occurring in 2 stages. The first stage was that of technological introduction, and the second stage—one that the industrialized world has only recently entered—is that of technological permeation in which technology gets integrated into everyday human activities. In the 1990s, Donald Gotterbarn became a strong advocate for viewing computer ethics as a branch of professional ethics, and of developing standards of practice and codes of conduct for computing professionals. As a result, Gotterbarn and others have been involved in a number of related activities, such as coauthoring the third version of the American Computing Machines (ACM) Code of Ethics and Professional Conduct∗ and working to establish ∗ The Board of ACM adopted this Code in 1992, and it is binding on all ACM members. For a full rendition of this Code, augmented by the extremely helpful guidelines included, please visit ACM’s Web site at www.acm.org/ constitution/code.html. 351 licensing standards for software engineers.8,9 The code, consisting of 24 imperatives formulated as statements of personal responsibility, identifies the elements of each commitment. It contains many, but not all, issues professionals are likely to face, outlines fundamental ethical considerations, and addresses additional, more specific considerations of professional conduct. The code and its supplemented guidelines are intended to serve as a basis for ethical decision making in the conduct of professional work. Secondarily, they may serve as a basis for judging the merit of a formal complaint pertaining to violation of professional ethical standards. INTERSECTION POINTS Health services involve some of the most substantial information about matters that are unquestionably personal and highly significant to all, and to each who receives healthcare at some point in his or her life—and that is just about all of us. Its collection, accuracy, and distribution is essential to both continuity in our personal healthcare and research into health and illness in populations. The information contained in these databases also offers enormous opportunities for prejudice and financial gain. Applied ethics is an area of inquiry that developed over the millennia, primarily to protect people from those who hold power. It deals primarily with helping people decide what is the right thing to do in a given situation, based on general concepts of good and bad—and on the values of individuals and the societies in which they live, breathe and have their being. Often, what people believe to be “right” ends up translated into laws designed to protect the “right,” which is what happened in this case (note the privacy safeguards built into the Health Information Portability and Accountability Act). The information revolution places unprecedented power in the hands of anyone with access to a computer—many of whom are ill-prepared to assume the responsibilities of 352 NURSING ADMINISTRATION QUARTERLY/OCTOBER–DECEMBER 2005 such power. Hacking, malicious destruction (computer viruses), identity theft, sale of private information amply attest to both the power of the medium and the puerile (and occasionally villainous) uses to which it is fartoo-often put. And whole new areas of law and law enforcement are quickly developing. The mathematicians, engineers, and scientists who developed the hardware and software—the very “engines”of the computer revolution—are rapidly forging a new profession, one dedicated to personal development and public protection (thus, the standards and ethics). Healthcare informatics, by its very nature, intersects all 3—healthcare, ethics, and informatics—and its practitioners must, for the public’s good, be bound by additional ethical, moral, and legal responsibilities. REFERENCES 1. Kenneth G. Ethics, Computing and Medicine. Melbourne, Australia: Cambridge University Press; 1999:2. 2. Carl W. Morals and Ethics. Glenview, Ill: Scott, Foresman Co.; 1975:317. 3. Bronowski J. The Identity of Man. Garden City, NY: The Natural History Press; 1965:23. 4. Edmund P. The Health Care Professional as Friend and Healer. Washington, DC: Georgetown University Press; 2000:32. 5. Walter M. Unique ethical problems in information technology. The London Times. June 9, 1995:137– 152. In: Bynum and Rogerson, eds. “Cyberspace: The Ethical Frontier,” Times Higher Education Supplement. 6. Johnson DG. Computer ethics in the 21st century. Spinello RA, Herman TT, eds. Readings in CyberEthics. Jones & Bartlett; 2001. A keynote address at the ETHICOMP99 Conference, Rome, Italy, October 1999. 7. Moor JH. Towards a theory of privacy in the information age. Comput Soc. 1997;27(3):27–32. 8. Donald G, Miller K, Rogerson S. Software engineering code of ethics. Inf Soc. 1997;40(11):110–118. 9. Ronald A, Johnson D, Gotterbarn D, Perrolle J. Using the New ACM Code of Ethics in Decision Making. Commun ACM. 1993;36:98–107. 530509 research-article2014 JDMXXX10.1177/8756479314530509Journal of Diagnostic Medical SonographyBagley et al. Original Article Health Care Students Who Frequently Use Facebook Are Unaware of the Risks for Violating HIPAA Standards: A Pilot Study Journal of Diagnostic Medical Sonography 2014, Vol. 30(3) 114­–120 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/8756479314530509 jdms.sagepub.com Jennifer E. Bagley, MPH, RDMS, RVT1, Dora DiGiacinto, MEd, RDMS, RDCS1, Jaclyn Lawyer, BSMIRS, RDCS1, and Michael P. Anderson, PhD1 Abstract Social networking creates easy opportunities to violate HIPAA (Health Insurance Portability and Accountability Act). The purpose of this study is to determine if students who frequently update their Facebook statuses have the ability to identify certain Facebook postings as HIPAA violations. An anonymous survey was distributed to students on a university campus of a health sciences center, containing questions related to how often Facebook was used or accessed, how often students updated their Facebook statuses, and whether they could identify if specific online postings constituted HIPAA violations. Students’ HIPAA scenario responses were compared to their frequency of Facebook status updates, and students who frequently updated their information were more likely to incorrectly identify a HIPAA violation—namely, photos of patients posted to Facebook, even those devoid of identifying information. No other HIPAA violation scenarios demonstrated an association with frequencies of use or status updates. Further research needs to be conducted to see what traits or behaviors put students at risk for violating HIPAA through social networking sites. Keywords Health Insurance Portability and Accountability Act, HIPAA, violation, social media, professionalism, online professionalism Facebook has evolved from a social media site for high school and college students to a globally used and recognized social networking forum that includes more than 1 billion people.1 Facebook has created a forum in which individuals, businesses, schools, and other professions are able to connect with one another, share information, and express opinions across a wide network of users. The literature is unclear how personal use overlaps with professional use or if individuals identify the difference. The information that health care workers post online not only affects others’ opinions of them and the reputations of their employers but also creates the potential to violate patients’ privacy and trust. As a result, the medical field is beginning to define best practices for maintaining both a professional and a personal online persona. The goal of this study is to determine if students who frequently versus infrequently update their Facebook status information can correctly identify updates that are in violation of laws per the Health Insurance Portability and Accountability Act (HIPAA). Problems With Social Media in the Health Care Setting Pew Internet Research2 released a survey in 2010 that explained how American adults interact on social networking sites. The Pew sample found that 92% of the 975 respondents participating in social networking sites have a Facebook account and that 52% of these individuals stated that they interact on Facebook on a daily basis. The survey noted that Facebook users are more likely to comment on others’ Facebook posts, statuses, and photos than 1 The University of Oklahoma Health Sciences Center, Tulsa, OK, USA Corresponding Author: Dora DiGiacinto, MEd, RDMS, RDCS, Associate Professor, Department of Medical Imaging and Radiation Sciences, College of Allied Health, The University of Oklahoma Health Sciences Center, 1200 North Stonewall, Oklahoma City, OK 73126, USA. Email: Dora-digiacinto@ouhsc.edu Bagley et al. to update their own Facebook statuses on a daily basis. Women are more likely than men to interact on Facebook, and the younger the user is, the more likely that he or she will comment on others’ posts at least once per day. The survey also demonstrated how social networking platforms have changed social interactions. The average American adult feels more connected to other people when interacting on Facebook and claims to have closer social circles in which to confide and discuss daily events. Thompson et al3 conducted a study in 2008 to assess 501 medical students’ and 312 residents’ use of Facebook and their professionalism (or lack thereof) present in their digital profiles. The researchers found that 44.5% of participants had Facebook accounts and that the further students progress in school, the less active they became on the site. Only 12.8% of the residents had Facebook accounts, while 64.3% of medical students each had one. The study demonstrated that only 37.5% of medical students and residents had private Facebook profiles, while the remaining students left their Facebook profiles public and did not implement any additional privacy settings. MacDonald et al4 conducted a study that examined the use of social networking sites and content posted, as well as the use of privacy settings by doctors who graduated from a university in New Zealand between 2006 and 2007. Their retrospective study assessed 338 newly graduated physician Facebook profiles for availability of content to other Facebook users who belonged to the same network. They found that 65% of newly graduated doctors had Facebook accounts, that 66% of the these doctors frequently accessed their Facebook profiles, and that 63% of the profiles had activated privacy settings. A number of users provided their personal age, friends, and associated groups, including groups with obscene names containing profanity or degrading to the medical profession. The mean number of photographs displayed per Facebook account was 85.8, and approximately half the photos portrayed unhealthy, unprofessional, or obs ...
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HIPAA and Ethics Worksheet
A nurse practitioner in the ED was treating an elderly woman for shortness of breath
began to look for the cause of her worsening condition. She ordered a drug screen, on which she
tested positive for cocaine. Her family, including her adult children, were present in the ED with
her. The NP asked the patient about the findings in the exam room, and the patient told her that
she had no idea how cocaine could be in her system, which made the NP concerned she might be
a victim of abuse. One of the nurses involved in her care Googled her and discovered that she
had a previous police record for cocaine possession. The nurse emailed the NP the information
about the patient. The nurse also called social services, and the family overheard her discussing
this patient on the phone in a public area.
1. ...

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