Computer-assisted software transcription of qualitative interviews

John Alcock and Ron Iphofen examine a method to assist with interview transcription using free, open source computer software and digital recordings, and consider some underlying practical, ethical and philosophical issues.

Using electronic patient records in mental health care to capture housing and homelessness information of psychiatric consumers

Homelessness among people with psychiatric illness is at an all time high. Many explanations for this phenomenon exist, including the incidence of discharge from inpatient hospital directly into the streets or shelter system. With little known about this unseen social issue afflicting many mental health consumers, this manuscript provides recommendations for using electronic patient records (EPR) as a conduit to capture housing and homelessness related information. With the increased use of EPRs in the Canadian health care system, the research and clinical benefits of this technology have only recently begun to be realized in mental health care.

EHR in the perspective of security, integrity and ethics

Success stories of modern applications in healthcare and welfare, like the electronic health record, are always linked to end user awareness, confidence, and acceptance. Reports and surveys have given proof of these dependencies. Knowing about existing and emerging concerns and weaknesses right in advance allows to taking actions on an ethical, social, and societal level. This paper gives a review of specific observations regarding security, privacy, authentication, integrity and ethical aspects when operating an electronic health record (EHR) system in a hospital, an open care department and in a wider community of the health care sector. A reference is given to existing and emerging international standards related to the aforementioned aspects.

Data protection rights and preserving confidentiality

The last two articles considered the right of others under Data Protection legislation to access a patient's records and the right to access medical reports for employment or insurance purposes. This article considers the duty of confidentiality and the provisions of the Data Protection Act 1998, which protect the confidentiality of health records.

HIPAA--Implications for research

Privacy, anonymity, and informed consent are the hallmarks of current research conduct. How do the Health Insurance Portability and Accountability Act regulations regarding individually identified health information and protected health information affect research? The purpose of this article is to discuss ways that the Health Insurance Portability and Accountability Act is influencing the conduct of research, including the implications for institutional review boards, recruitment of subjects, obtaining consent, access to data, de-identification of data, authorization to disclose data, and the processing, transmission, and storage of collected data.

[Ethical and regulatory requirements for conducting clinical trials: patient information and patient informed consent]

Written informed consent must be obtained from legally competent subjects, after having been duly informed verbally and in writing, before participation in a clinical trial with pharmaceutical products or medical devices. For persons or minors incapable of giving their informed legal consent, the written consent of the subject's legal representative is mandatory. The subject's presumed or expressed wish must be considered.

The bioethics of preterm labour

Until recently, bioethics (ethics related to biology or, more specifically, in the context of preterm labour, medical ethics) was considered mainly to relate to the active treatment or investigation of patients. Collection of data, excised specimens or even whole organs was considered to be relatively uncontentious as it did not impinge directly upon the health of the individual concerned. However, in the UK in particular, the practice of collecting data, tissues or even whole organs has recently come under the spotlight of public scrutiny, particularly following the Alder Hey Enquiry. Coincidentally with a decline in public confidence in the probity of authority, medical scientists increasingly have to justify the accumulation of data about individuals.

Patient confidentiality, clinical data and NHS research--a researcher's guide

More stringent research governance in the NHS has led to an increased focus on the importance of patient confidentiality. But relatively low levels of knowledge of the Data Protection Act and common law duty of confidentiality among some researchers and research managers cause difficulties in getting research projects off the ground. The authors outline the main issues surrounding research, data protection and patient confidentiality, and provide guidance for researchers, clinicians and managers on how to conduct research appropriately.

HIPAA???Clinical and Ethical Considerations for Nurses

Congress enacted the Health Insurance Portability and Accountability Act (HIPAA) to protect patients' basic rights to privacy and their control over the disclosure of their personal health information. Advances in and the more widespread use of communication technology were increasing the public's concerns over the ease with which their health information could be transmitted, how protected that information was during such transmissions, and their lack of approval for the use of that information by known and unknown third parties. This article, the first of two papers focusing on HIPAA, discusses HIPAA from the clinical perspective and focuses primarily on the HIPAA Privacy Rule. Under what circumstances can a covered entity disclose protected health information? What are the ethical issues inherent in HIPAA? What does HIPAA require of covered entities? What are the implications of HIPAA for professional nurses? The goal of HIPAA is to ensure the protection of confidential health information through having appropriate security systems to guard against unintentional disclosure of that information.

Email consultations in health care: 2--acceptability and safe application

Electronic communication promises to revolutionise the delivery of health care. In the second of two articles considering the potential for email consultations, Car and Sheikh summarise the evidence about public and professional attitudes to them and discuss how to ensure their safe use

Ethical issues in HealthConnect's shared electronic health record system

Many countries are in the process of implementing systems of shared electronic health records. This article explores some of the ethical concerns raised by Australia's proposed HealthConnect system which aims to create electronic event summaries of health information. Three areas of ethical concern relating to confidentiality, consent and the involvement of the private sector are examined. It is argued that unless the HealthConnect system is firmly grounded in policy based on ethical considerations, patients may not want to "opt in" to it.

An ethics framework for nursing education on the Internet

An ethics framework for the use of the Internet for nursing education, consultation, research, and practice is proposed. The proposed framework, discussed in terms of structure, process, and outcome, would guide policy for confidentiality, privacy issues, professionalism, ownership of intellectual property, accountability, and control of access. A goal would be to encourage creative problem solving without constant reference to authority.

Ethical issues in public health informatics: implications for system design when sharing geographic information

Public health programs today constitute a multi-professional inter-organizational environment, where both health service and other organizations are involved. Developing information systems, including the IT security measures needed to suit this complex context, is a challenge. To ensure that all involved organizations work together towards a common goal, i.e., promotion of health, an intuitive strategy would be to share information freely in these programs. However, in practice it is seldom possible to realize this ideal scenario. One reason may be that ethical issues are often ignored in the system development process. This investigation uses case study methods to explore ethical obstacles originating in the shared use of geographic health information in public health programs and how this affects the design of information systems. Concerns involving confidentiality caused by geographically referenced health information and influences of professional and organizational codes are discussed. The experience presented shows that disregard of ethical issues can result in a prolonged development process for public health information systems. Finally, a theoretical model of design issues based on the case study results is presented.

Patient privacy: how far is too far?

With few exceptions, personal privacy has long been an ethical right and legal mandate. Clinicians, policy makers, and consumers are challenged to find a balance between allowing consumers to be protected and allowing clinicians to meet patient care needs. This article examines the current debate pertaining to new Medical Privacy Guidelines that were issued in April 2001. The ethical principle of patient confidentiality, including the right to personal privacy, is reviewed along with its relationship to computer-generated wound care tracking programs that transcend practice settings. Options for Health Insurance Portability and Accountability Act (HIPAA) compliance are presented.

Draft secure medical database standard

Medical database security is a particularly important issue for all Healthcare establishments. Medical information systems are intended to support a wide range of pertinent health issues today, for example: assure the quality of care, support effective management of the health services institutions, monitor and contain the cost of care, implement technology into care without violating social values, ensure the equity and availability of care, preserve humanity despite the proliferation of technology etc.. In this context, medical database security aims primarily to support: high availability, accuracy and consistency of the stored data, the medical professional secrecy and confidentiality, and the protection of the privacy of the patient. These properties, though of technical nature, basically require that the system is actually helpful for medical care and not harmful to patients. These later properties require in turn not only that fundamental ethical principles are not violated by employing database systems, but instead, are effectively enforced by technical means. This document reviews the existing and emerging work on the security of medical database systems. It presents in detail the related problems and requirements related to medical database security. It addresses the problems of medical database security policies, secure design methodologies and implementation techniques. It also describes the current legal framework and regulatory requirements for medical database security. The issue of medical database security guidelines is also examined in detailed. The current national and international efforts in the area are studied. It also gives an overview of the research work in the area. The document also presents in detail the most complete to our knowledge set of security guidelines for the development and operation of medical database systems.

The protection of individuals by protecting medical data in EHRs

The paper discusses the changes in the delivery of Healthcare and the ways in which individuals need to be protected by protecting their Electronic Health Records. A Code of Ethics is needed for health Information Professionals, Data Protection and Security issues need to be taken more seriously. Health Informatics needs to address the issues of safety in the delivery of Healthcare so that it provides solutions to healthcare safety problems rather than increasing the problems to be addressed.