LESSON 14

ETHICS, PRIVACY, AND SECURITY

 LEARNING GUIDE TIME LEARNING
Lesson 14: Ethics, Privacy, and Security ALLOTMENT RESOURCES

Intended Learning Outcomes 1.5 hours Lesson Content:

14.1. explain the ethics in health informatics; and Lesson 14
14.2. review the privacy, confidentiality, and security
measures in hospitals.

Self-Directed Activity 2.0 hours

Visit a local hospital and inquire about the privacy,
confidentiality, and security measures that it practices in
the workplace. Include cases of violations of Data
Privacy Act of 2012. Submit a narrative report of your
inquiry.

Baseline Concept Understanding 30 minutes

Learning Outcomes Assessment 30 minutes
ETHICS IN HEALTH INFORMATICS
Ethical principles
1. A program should undergo appropriate evaluation prior to use in clinical practice.
It should perform efficiently at an acceptable financial and timeframe cost.
2. Adequate training and instruction should be completed before proceeding to the
implementation.
3. A qualified health professional should be assigned to handle concerns regarding
uses, licenses, and other concerns. The software system’s applications should
not replace functions as decision-making.
GENERAL ETHICS

General ethics guide the reasoning and decision-making of all people and
organization involved in health care.

Two ethical principles a health professional

1. Autonomy
2. Beneficence and Non-maleficence
Informatics Ethics

Informatics ethics is about the ethical behavior expected from an individual

assigned to handle information.
Informatics Ethics

Informatics ethics is about the ethical behavior expected from an individual

assigned to handle information.
 Seven principles of information ethics

Principle of
Principle of Principle of
Information- Principles of Principles of Principles of Principle of
Legitimate Least Intrusive
Privacy and Openness Security Access Accountability
Infringement Alternative
Disposition
PRIVACY, CONFIDENTIALITY, SECURITY

Levels of Security in Hospital Information System

Safeguard are solutions and tools which may be utilized to implement security
policies at different levels of health organization such as administrative,
physical, and technical.
 Table 14.1 Administrative, Physical, and Technical Safeguards for HIS

• Regular risk assessment of the health IT environment

• Continuous assessment of the effectiveness of safeguards for electronic health information
• Detailed processes and procedures for viewing and administering electronic health
Administrative
information
Safeguards
• Training for the users of health IT to appropriately protect electronic health information
• Reporting security breaches (e.g., to those entities required by law or contract) and
continued health IT operations

• Placing office alarm systems

Physical • Locking offices and areas that contain computing equipment that store electronic health
information
Safeguards
• Having security guards that make regular rounds in the vicinity

• Configuration of computing equipment to ensure security (e.g., virus checking, firewalls)

• Using certified applications and technologies that store or exchange electronic health
information
• Setting up access controls to health IT and electronic health information (e.g., authorized
Technical computer accounts)
Safeguards • Encryption of electronic health information
• Regular audit of the health IT operations
• Having backup capabilities (e.g., regular backups of electronic health information to
another computer file server)
 The National Research Council (1997) emphasizes that technological security
tools are essential components of modern distributed health care information
systems, and that they serve five key functions:
1. Availability
2. Accountability
3. Perimeter identification
4. Controlling access
5. Comprehensibility and control
 Table 14.2 Key Steps in Laboratory Information Flow for a Hospital Patient
STEP DESCRIPTION

Patient record (e.g. ID Number, name, sex, age, location) must be created in the LIS before tests can be ordered. LIS
Register Patient usually receives these data from a hospital registration system when a patient is admitted.

The attending physician orders the tests for the patient and the procedure is requested as part of the laboratory’s morning
Order Tests blood collection rounds. These orders are entered into the CIS and they are sent to the LIS electronically.

The LIS prints a list of all patients who have to be drawn which also includes the appropriate number of sample barcode
labels for each patient order. Each barcode contains the patient ID, sample contained, and laboratory workstation which is
Collect Sample used to sort the tube once it reaches the laboratory. An increasingly popular approach is for caregivers or nurses to collect
blood samples. Sample barcode labels can be printed (on demand) at the nursing station on an LIS printer or portable
bedside printer prior to collection.

Once the samples arrive in the laboratory, the status is updated in the LIS from “collected” to “received.” This is done by
Receive Sample scanning each sample container’s barcode ID into the LIS. Once the status becomes “received,” the LIS then transmits the
test order to the analyzer that will perform the test.

The sample is loaded onto the analyser, and the bar code is then read. No work list is needed because the analyser knows
which tests to perform from the order provided by the LIS. However, when tests are performed manually, the technologist
Run Sample prints a work list from the LIS. The work list should contain the names of the patients and the tests ordered on each and
next to each test is a space to record the result.

The analyzer then produces the results and sends the same to the LIS. The results is only viewable to the assigned
Review Results technologists until it is released for general viewing. The LIS can be programmed to flag certain results—for example,
critical values—so the technologist can easily identify what needs to be repeated or further evaluated.

The technologist is responsible for the release of the results. Unflagged results are reviewed and released at the same
time. The LIS can be programmed to automatically review and release normal results or results that fall within a certain
Release Results range. This approach reduces the number of tests that a technologist has to review. The results are automatically
transmitted to the CIS upon release.

Report Results The physician can now view the results on the CIS screen. Reports can be printed when needed.
 Table 14.3 Administrative, Physical, and Technical Safeguards for LIS

• Continuous training for the users of the LIS

• Periodic review of standards used to identify results that should be flagged
• Review of the authorization and supervision policies
Administrative
• Strict implementation of the rules and regulations for the testing procedures
Safeguards
• Release and dissemination of guidelines on proper disposal of laboratory specimen
• Enforcement of strict policies on the proper use of laboratory workstations
• Requiring appropriate disciplinary measures as needed

• Ensuring the periodic maintenance of laboratory equipment

• Having biometrics or other security protocol for laboratory access
Physical
• Maintenance of controlled temperature both for equipment and specimen
Safeguards
• Use of contingency operations plan
• Use of appropriate personal laboratory safety equipment

• Presence of automated identity confirmation procedures for users requesting access

Technical • Regular updating of passwords

Safeguards • Requiring different authorizations based on user level
• Capability of the unit to automatically log-off after long periods of inactivity
PHILIPPINE DATA PRIVACY ACT OF 2012

The Data Privacy Act of 2012 provides that consent must be documented and given
prior to the collection of all forms of personal data; and the collection must be declared,
specified, and used for legitimate purpose.
The subject must be notified about the purpose and extent of data processing, with
details specifying the need for automated processing, profiling, direct marketing, or sharing.
Violations of the Data Privacy Act
• Unauthorized processing
• Processing for unauthorized purposes
• Negligent access
• Improper disposal
• Unauthorized access or intentional breach
• Concealment of breach involving sensitive personal information
• Unauthorized disclosure; and
• Malicious disclosure.
Republic Act No. 1073, Ch. 8, Sec. 33

Any combination or series of acts shall make a person subject to imprisonment ranging
from three to six years, and a fine of not less than one million pesos (PhP 1,000,000.00) but
more than five million (PhP 5,000,000.00).
 KEY POINTS TO REMEMBER
 Health informatics ethics is the application of the principles of ethics to the domain of
health informatics. There are three main aspects of health informatics ethics: general
ethics, informatics, and software.
 General ethics covers autonomy, beneficence and non-maleficence.
 Informatics refers to privacy, openness, security, access, infringement, least intrusion
and accountability.
 Software developers should consider the best interest of the society in general, the
institution and its employees, and profession.
 Administrative, Physical and technical safeguards are placed to regularly monitor
effectiveness and assess the health IT environment.