Policy-Ethics-Informatics

The U. S. Department of Health & Human Services Agency for Healthcare Research and Quality is a complex site full of articles, comparisons, tables of recommendations, and links to reputable organizations in healthcare. As I surveyed the site, I was surprised at what a high level the materials seemed to be as compared with other consumer sites previously visited. Because it is a government operated site, there is data related to grant money available and detailed cost analysis of health procedures that only providers could possibly understand (Agency for Healthcare Research and Quality, 2009). The research portion of this website contained articles that providers might be interested in reading, but I wonder how many actually go to the site to read the results. After listening to Deane Rehm's Public Radio Broadcasting panel discussion where she stated that only about 20% of physicians use the Internet sources for healthcare (Hanberg, 2009), it would seem reasonable to assume that the majority of physicians do not frequent this site.



Viewing this website as a consumer, there appeared to be two main elements of value, health promotion and hospital comparison. In order to promote health, there were charts detailing what tests are recommended, but how often the tests ought to be obtained was unclear. There were links to other entities such as the CDC (Center for Disease Control) which could prove helpful; for example, this link to the CDC better explained when to get certain immunizations. The second item of value to consumers was the ability to compare hospital services with one to another in selected counties or states. Most likely hospitals review these statistics to make sure they hold a secure ranking and reputation (Agency for Healthcare Research & Quality, 2009). These posted statistical comparisons could pose a threat to hospitals that do not perform well.



Authenticity is of concern because hospitals submit their own data which raises questions about accuracy. In Leah Curtin's article, she explained Moor's two stages of computer technology with the first being "introduction" and the second being "permeation" where we are clearly just beginning as healthcare providers. Moor is quoted describing computer ethics as "policy vacuums" (Curtin, 2005), which agreed with what Deane Rehm's panelist Eric Corbetts said, "We are in the early days of medical use...with reimbursement issues and privacy issues" (Hanberg, 2009). During this same podcast interview, Don Depner seemed pleased that consumers are being "empowered" and he related systems that provide privacy such as the use of Health Vault for storing private information. He echoed the need for public policy development (Hanberg, 2009). Ethics and the utilization of the Internet pose many questions yet to be resolved for healthcare provision. Though resources are abundant, authenticity and privacy are vital considerations.



During the same podcast, Jonathan Winer talked about how expensive systems are for providers to establish but that informatics systems would increase the ability to flag problems where patient follow up is imperative. Later in the podcast one of the three panelist mentioned that doctors are not accustomed to active patients and state that systems are only as smart as the people who build them (Hanberg, 2009). There seemed to be a resistance in providers trusting materials found on the Internet and clearly there must be a shift in the expectation that physicians' knowledge could be shared or in any way equaled. Physician reimbursement is an issue when using Internet and email type involvement with patients (Hanberg, 2009).



In summary, my concerns are that electronic patient information needs to be secure and shared only by permission with new providers. Providers in turn must be educated on obtaining accurate medical information from clinical decision support tools and location and access of authentic consumer health information electronically. Finally, policy needs to be written that keeps up with the changing modalities of healthcare delivery so that we can provide the best quality, efficiently, and at a reasonable cost.







Agency for Healthcare Research and Quality, (2009). Retrieved November 7, 2009 from: www.ahrq.gov/



Curtin, L.L. (2005). Ethics in informatics: the intersection of nursing, ethics, and information technology. Nursing Administration Quarterly, 29(4), 349-352.



Hangerg, A. (2009). Ethics & informatics, Allen Hanberg's Album Podcast, "E-Health" Diane Rehm retrieved November 7, 2009.