Ethics in nursing informatics

Informatics is changing nursing today and in the future. One very important issue is ethics and patient confidentiality.

When paper records were used health providers sealed them away in file cabinets and prohibited others from seeing them. State laws which governed the use and disclosure of this information left many gaps which became very evident when computers arrived. As a result of this patient information has sometimes been shared innappropiately. According to Thede in 'Informatics and Nursing' the protection of patient data has three parts. They are privacy, confidentiality and security. Privacy allows the patient to choose who they will share their private information with. They will select which information shared with their health provider will become known to others. Confidentiality refers to the people who have access to the patints health information and how they protect it. Finally security deals with protecting data from errors such as input or system errors.

Protecting a patients privacy is every healthcare worker's professional responsibility. It is important that we safeguard the information that patients share with us. When a patient is interviewed the environment should be such that the interview can not be overheard by anyone. It is also important to ask all family members or anyone who accompanies the patient, even husband or wife, to leave the room. Also care shouls be taken when charting this imformation in the computer. The computer screen should not be visible to anyone except the person doing the charting.

Confidentiality according to Thede, is a constant balancing act. When paper records were used anyone with a white lab coat that said "Dr X" could pick up the chart and read it. Also when patients were trnsferred to different units the chart would be placed under a corner of the patients stretcher which allowed anyone to grab the chart and read it. Computer records have brought the issue of confidentiality to the forefront. It is easier for health proffesionals to access health information now because when you gain access to the system and more than one record at a time can be viewed which wasn't easy with paper recors. This access is achieved with a login process that authenticates that the person using the system is allowed access. The most secure method of authentication is biometrics. This is the use of physiological characteristics such as fingerprints, retinal or iris scans, or even a voice print that is presumably unique to a specific person. The second most secure system is the card or key entry system accompanied by a password. The least secure system is the user ID and password because usually the user ID is the first initial and a last name which are fairly easy to guess. The password usually is a little more difficult to guess. Most systems force the user to change their password every certain amount of time and don't allow the use of the same password to make it more secure. We need to recognize that it is someones life information we are dealing with and we need to safeguard it like we would with a treasure. When we leave our patients room we should make sure we log off and not leave anything showing on the computer because family members and visitors in the room can view this information.

Data security has three aspects. The first deals with the accuracy of the data, the second deals with protection of the data from unathorized eyes inside or outside the agency, and the third with internal or external damage to the data. Accuracy of the original data is the responsibility of the user. The user should make sure that they don't change the information. The user should also protect the information from prying eyes, never give out your password to anyone. Data should also be protected from getting lost. Back ups of data must be routinely created and stored off site in a secure place. Also a disaster recovery plan should be devised and tested.

Finally we should always remember the Health Insurance Portability and Accountability Act passed by congress in 1996 which was made to protect the patients privacy in every way possible in healthcare today. It is our responsibility as health care professionals to protect the patients privacy whether it is in paper or in the great world of informatics.

References
Informatics and Nursing opportunities and challenges
Lippincott 5th Edition by Linda Q. Thede