Ethical Challenges in the Management of Health Information

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ISBN: 9780763747329 | 0763747327
Cover: Hardcover
Copyright: 3/1/2006

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Published in conjunction with the American Health Information Management Association (AHIMA), this new edition addresses HIPAA and contains new chapters on research, advocacy and specialty sites to include dialysis, correctional, dental, mental health, long-term care, home hospice and rehabilitation. HIM professionals who work on behalf of patients to protect privacy and healthcare providers who treat patients and patient care advocacy groups will find this book to be a unique and invaluable resource.

Contributors

xvii

Foreword

xxi

Preface

xxiii

Acknowledgments

xxix

PART I---Professional Ethics

Professional Values and the Code of Ethics

(30)

Laurinda B. Harman

Virginia L. Mullen

Learning Objectives

(1)

Abstract

(1)

Ethical Dilemmas for the HIM Professional

(1)

The Health Information System: Then and Now

(3)

Role of the HIM Professional

(1)

Professional Code of Ethics

(1)

Professional Values

(5)

Building an Ethical Health Information System

(1)

The Intersection of HIM and Ethics

(1)

Key Terms

(1)

Summary

(2)

Appendix 1-A: 1957 Code of Ethics for the Practice of Medical Record Science

(1)

Appendix 1-B: 1977 American Medical Record Association Bylaws and Code of Ethics

(2)

Appendix 1-C: 1988 American Medical Record Association Code of Ethics and Bylaws

(1)

Appendix 1-D: 1998 American Health Information Management Association Code of Ethics and Bylaws

(2)

Appendix 1-E: 2004 American Health Information Management Association Code of Ethics

(8)

Ethical Decision-Making Guidelines and Tools

(18)

Jacqueline J. Glover

Learning Objectives

(1)

Abstract

(1)

Scenario 2-A: Documentation and DRG Assignment

(1)

What is an Ethical Issue?

(1)

Why is it Important to Identify and Address Ethical Issues?

(1)

But You Can't Teach Ethics, Can You?

(1)

The Process of Ethical Decision-Making

(3)

Justification in Ethical Reasoning: How Do You Know What is Best?

(4)

Moral Distress

(1)

Scenario 2-B: Retrospective Documentation to Increase Reimbursement

(1)

Ethics Resources

(1)

Conclusion

(1)

Key Terms

(1)

Chapter Summary

(2)

Ethical Decision-Making Matrices

Scenario 2-A: Documentation and DRG Assignment

(2)

Scenario 2-B: Retrospective Documentation to Increase Reimbursement

(2)

Appendix 2-A: Blank Ethical Decision-Making Matrix

(1)

Privacy and Confidentiality

(16)

Laurie A. Rinehart-Thompson

Laurinda B. Harman

Learning Objectives

(1)

Abstract

(1)

Scenario 3-A: Family and Friends: Should I Tell?

(1)

Privacy and Confidentiality

(1)

Release of Information

(1)

The HIPAA Privacy Rule

(5)

Blanket Authorizations

(1)

Patient Concerns

(1)

Professional Concerns

(1)

Ethical Challenges

(1)

Conclusion

(1)

Key Terms

(1)

Chapter Summary

(1)

Ethical Decision-Making Matrix

Scenario 3-A: Family and Friends: Should I Tell?

(3)

PART II---Uses of Health Information

(210)

Compliance, Fraud, and Abuse

(28)

Laurie A. Rinehart-Thompson

Learning Objectives

(1)

Abstract

(1)

Scenario 4-A: Documentation Does Not Justify Billed Procedure

(1)

Traditional Regulations that Guide HIM Professionals

(5)

More Recent Regulations That Guide HIM Professionals

(1)

HIPAA Administrative Simplification Standards

(2)

Roles for HIM Professionals

(1)

Compliance Programs to Prevent Fraudulent Behaviors

(2)

Dilemmas in Practice

(1)

Scenario 4-B: Accepting Money for Information

(1)

Fraudulent Documentation Practices

(1)

Scenario 4-C: Retrospective Documentation to Avoid Suspension

(1)

Retrospective Medical Record Analysis

(1)

Scenario 4-D: Coder Assigns Code Without Physician's Documentation

(1)

Coding Turnaround Time

(1)

Conclusion

(1)

Key Terms

(1)

Chapter Summary

(3)

Ethical Decision-Making Matrices

Scenario 4-A: Documentation Does Not Justify Billed Procedure

(2)

Scenario 4-B: Accepting Money for Information

(2)

Scenario 4-C: Retrospective Documentation to Avoid Suspension

(2)

Scenario 4-D: Coder Assigns Code Without Physician's Documentation

(3)

Clinical Code Selection and Use

(42)

Lou Ann Schraffenberger

Rita A. Scichilone

Learning Objectives

(1)

Abstract

(1)

Scenario 5-A: Coding an Inappropriate Level of Service

(3)

HIPAA and Billing Activities

101

(1)

Ethical Approaches to Coding Situations

102

(2)

Applying the AHIMA Standards of Ethical Coding

104

(5)

Ethical Dilemmas for the Coding Professional

109

(1)

Scenario 5-B: Discovering Misrepresentation in Physician Documentation

109

(1)

Scenario 5-C: Miscoding to Avoid Conflicts

110

(4)

Scenario 5-D: Discovering of Miscoding by Other Staff Members

114

(1)

Scenario 5-E: Lacking the Tools to do One's Job

115

(1)

Scenario 5-F: Being Required by the Employer to Engage in Negligent Coding Practices

116

(2)

Scenario 5-G: Supporting Application Software that Facilitates Questionable Results

118

(2)

Professional Practice Solutions

120

(2)

The Future of Coding

122

(1)

Key Terms

122

(1)

Chapter Summary

122

(2)

Ethical Decision-Making Matrices

Scenario 5-A: Coding an Inappropriate Level of Service

124

(2)

Scenario 5-B: Discovering Misrepresentation in Physician Documentation

126

(2)

Scenario 5-C: Miscoding to Avoid Conflicts

128

(2)

Scenario 5-D: Discovering of Miscoding by Other Staff Members

130

(2)

Scenario 5-E: Lacking the Tools to Do One's Job

132

(2)

Scenario 5-F: Being Required by the Employer to Engage in Negligent Coding Practices

134

(2)

Scenario 5-G: Supporting Application Software that Facilitates Questionable Results

136

(3)

Quality Review

139

(36)

Patrice L. Spath

Learning Objectives

139

(1)

Abstract

139

(1)

Quality Management

140

(2)

Scenario 6-A: Inaccurate Performance Data

142

(1)

QM Ethical Issues Facing HIM Professionals

142

(1)

Scenario 6-B: Home Health Care and Central-Line Infections

143

(1)

Ethical Standards Affecting QM Activities

144

(2)

Scenario 6-C: Failure to Check Physician's Licensure Status

146

(1)

Scenario 6-D: Hiding Incomplete Medical Records

147

(1)

Making Ethical Decisions

148

(1)

Scenario 6-E: Audit Results Indicate Inappropriate Health Care

149

(1)

QM Situations that Raise Ethical Questions

149

(2)

Enabling Ethical Conduct

151

(1)

Conclusion

152

(1)

Key Terms

153

(1)

Chapter Summary

153

(3)

Scenarios---Survey Results and Ethical Decision-Making Matrices

Scenario 6-A: Inaccurate Performance Data

156

(2)

Scenario 6-B: Home Health Care and Central-line Infections

158

(4)

Scenario 6-C: Failure to Check Physician's Licensure Status

162

(4)

Scenario 6-D: Hiding Incomplete Medical Records

166

(4)

Scenario 6-E: Audit Results Indicate Inappropriate Health Care

170

(5)

Research and Decision Support

175

(24)

Merida L. Johns

J. Michael Hardin

Learning Objectives

175

(1)

Abstract

175

(1)

Scenario 7-A: Designing a Survey to Bias the Results

176

(1)

Roles of the RS and DSS

177

(4)

Ethical Responsibilities of the RS and DSS

181

(14)

Conclusion

195

(1)

Key Terms

195

(1)

Chapter Summary

195

(3)

Ethical Decision-Making Matrix

Scenario 7-A: Designing a Survey to Bias the Results

198

(1)

Public Health

199

(32)

Babette J. Neuberger

Learning Objectives

199

(1)

Abstract

199

(1)

Scenario 8-A: Reporting HIV Status

200

(1)

Public Health: An Overview

201

(9)

Ethical Challenges in Public Health

210

(6)

Scenario 8-B: When Duty to One's Employer Conflicts with a Duty Owed to the Public

216

(3)

The HIM Professional's Role and Responsibility as an Advocate

219

(2)

Emerging Issues: Bioterrorism and Global Infections

221

(1)

Scenario 8-C: The Terrorism Preparedness Act

222

(1)

Conclusion

223

(1)

Key Terms

223

(1)

Chapter Summary

224

(2)

Ethical Decision-Making Matrices

Scenario 8-A: Reporting HIV Status

226

(2)

Scenario 8-B: When Duty to One's Employer Conflicts with a Duty Owed to the Public

228

(3)

Managed Care: Lessons of Integration

231

(26)

Ida Critelli Schick

Learning Objectives

231

(1)

Abstract

231

(1)

Scenario 9-A: Complexity of Choosing a Managed Care Plan

232

(1)

What is Managed Care?

233

(1)

Growth of Managed Care

234

(1)

Managed Care Strategies

235

(5)

The Role of Information and HIM Professionals in a Managed Care Environment

240

(1)

Ethical Dilemmas for HIM Professionals

241

(2)

Scenario 9-B: Provision of Information by Physician Practices

243

(2)

Scenario 9-C: HIM Professionals in Provider Organizations

245

(1)

Policies for Which the HIM Professional Can Advocate

246

(1)

Conclusion

247

(1)

Key Terms

247

(1)

Chapter Summary

247

(3)

Ethical Decision-Making Matrices

Scenario 9-A: Complexity of Choosing a Managed Care Plan

250

(2)

Scenario 9-B: Provision of Information by Physician Practices

252

(2)

Scenario 9-C: HIM Professionals in Provider Organizations

254

(3)

Clinical Care: End of Life

257

(20)

James F. Tischler

Learning Objectives

257

(1)

Abstract

257

(1)

Scenario 10-A: Bad News

258

(1)

Aging, Frailty, and Information Ethics

258

(1)

Evolution of Autonomy

259

(1)

Cultural Influences on Autonomy

259

(1)

Physician Bias and Equity: A Systems Issue

259

(1)

Scenario 10-B: Treatment Choices

260

(1)

Information Across a Healthcare Continuum

261

(1)

Treatment Goals and Beneficence

261

(1)

Scenario 10-C: Advance Care Planning

262

(1)

Advance Care Planning: An Opportunity

263

(1)

The Meaning of Terminal

263

(1)

Advance Care Planning and Law

264

(1)

Scenario 10-D: Palliative Care

264

(1)

Managing Pain

265

(1)

Ethics Committees

265

(1)

Palliative Care

265

(1)

Emerging Issues

266

(1)

Key Terms

266

(1)

Chapter Summary

266

(2)

Ethical Decision-Making Matrices

Scenario 10-A: Bad News

268

(2)

Scenario 10-B: Treatment Choices

270

(2)

Scenario 10-C: Advance Care Planning

272

(2)

Scenario 10-D: Palliative Care

274

(3)

Part III---Computerized Health Information

277

(144)

Electronic Health Records

279

(28)

Mary Alice Hanken

Gretchen Murphy

Learning Objectives

279

(1)

Abstract

279

(1)

Scenario 11-A: Patient Record Integrity and System Security

280

(1)

EHR Systems: Functions and Expected Features

281

(4)

EHR Systems in the Twenty-First Century

285

(1)

EHR Technology and Ethical Issues

286

(7)

Scenario 11-B: Differences when Linking EHR Systems

293

(6)

Conclusion

299

(1)

Key Terms

299

(1)

Chapter Summary

299

(3)

Ethical Decision-Making Matrices

Scenario 11-A: Patient Record Integrity and System Security

302

(2)

Scenario 11-B: Differences when Linking EHR Systems

304

(3)

Information Security

307

(22)

Karen Czirr

Karen A. Rosendale

Emily West

Learning Objectives

307

(1)

Abstract

307

(1)

Scenario 12-A: A Curious Human Resource Employee

308

(1)

The Healthcare Information Revolution

308

(2)

The Role of the ISO

310

(1)

Concepts in Information Security

310

(1)

Privacy-Related Security

310

(2)

Establishing a Security Baseline

312

(3)

Scenario 12-B: Failure to Log Off of the System

315

(3)

Scenario 12-C: Storing Data on a Laptop Computer

318

(1)

Key Terms

319

(1)

Chapter Summary

319

(3)

Ethical Decision-Making Matrices

Scenario 12-A: A Curious Human Resource Employee

322

(2)

Scenario 12-B: Failure to Log Off of the System

324

(2)

Scenario 12-C: Storing Data on a Laptop Computer

326

(3)

Software Development and Implementation

329

(12)

Susan H. Fenton

Learning Objectives

329

(1)

Abstract

329

(1)

Scenario 13-A: Planning the EHR: Competing Interests

330

(1)

Consultant's Approach

330

(1)

Information Gathering

331

(4)

Conclusion

335

(1)

Key Terms

335

(1)

Chapter Summary

336

(2)

Ethical Decision-Making Matrix

Scenario 13-A: Planning the EHR: Competing Interests

338

(3)

Data Resource Management

341

(22)

Frances Wickham Lee

Andrea W. White

Karen A. Wager

Learning Objectives

341

(1)

Abstract

341

(1)

Data Resource Management in Health Care

341

(1)

Impact of HIPAA Regulations on Data Resource Management

342

(1)

Data Resource Management Tools

342

(4)

Scenario 14-A: The Physicians Resist a New Password Policy

346

(1)

Ethical Dilemmas for Data Resource Managers

347

(2)

Scenario 14-B: Threat to Integrity of the CDR

349

(1)

Scenario 14-C: Research Access to Admission/Discharge/Registration Data

350

(3)

Conclusion

353

(1)

Key Terms

353

(1)

Chapter Summary

353

(3)

Ethical Decision-Making Matrices

Scenario 14-A: The Physicians Resist a New Password Policy

356

(2)

Scenario 14-B: Threat to Integrity of the CDR

358

(2)

Scenario 14-C: Research Access to Admission/Discharge/Registration Data

360

(3)

Integrated Delivery Systems

363

(18)

Brenda Olson

Karen Gallagher Grant

Learning Objectives

363

(1)

Abstract

363

(1)

Scenario 15-A: Scheduling Clerk Has Access to All Clinical Information

364

(1)

Privacy and Security Issues

365

(3)

Data Quality Issues

368

(4)

Scenario 15-B: Inconsistencies in the MPI

372

(1)

Required Skills for HIM Professionals

373

(1)

Conclusion

373

(1)

Key Terms

373

(1)

Chapter Summary

374

(2)

Ethical Decision-Making Matrices

Scenario 15-A: Scheduling Clerk Has Access to All Clinical Information

376

(2)

Scenario 15-B: Inconsistencies in the MPI

378

(3)

E-Health for Consumers, Patients, and Caregivers

381

(22)

Cynthia Baur

Mary Jo Deering

Learning Objectives

381

(1)

Abstract

381

(1)

Scenario 16-A: Equity and Privacy

382

(4)

E-Health and the Changing Healthcare System

386

(2)

E-Health and National Policy

388

(1)

E-Health and the HIM Professional

389

(1)

Some E-Health Ethical Issues

390

(1)

Scenario 16-B: Ensuring Online Quality and Privacy Protections

391

(2)

Emerging Issues

393

(1)

Conclusion

394

(1)

Key Terms

395

(1)

Chapter Summary

395

(2)

Appendix 16-A: Examples of Guidelines, Policies, and Codes of Conduct for Health Websites

397

(6)

Ethical Decision-Making Matrices

Scenario 16-A: Equity and Privacy

398

(2)

Scenario 16-B: Ensuring Online Quality and Privacy Protections

400

(3)

E-HIM: Information Technology and Information Exchange

403

(18)

Meryl Bloomrosen

Learning Objectives

403

(1)

Abstract

403

(1)

Introduction

404

(7)

Scenario 17-A: The HIM Professionals' Role in eHIM

411

(1)

Conclusion

412

(1)

Key Terms

413

(1)

Chapter Summary

414

(7)

PART IV Management of Sensitive Health Information

421

(76)

Genetic Information

423

(16)

Barbara P. Fuller

Kathy L. Hudson

Learning Objectives

423

(1)

Abstract

423

(1)

Scenario 18-A: Genetic Privacy

424

(1)

The Issue of Genetic Information

424

(2)

The Relationship Between Genetic Information and Generic Medical Information

426

(1)

What Do We Mean by Privacy of Medical Information?

427

(1)

Research Records

427

(1)

The Misuse of Genetic Information and Discrimination

428

(1)

Federal Legislative Protections

429

(1)

State Legislative Protections

430

(1)

Legislation on Research Record Privacy

431

(2)

Ethical Issues for the HIM Professional

433

(1)

Conclusion

433

(1)

Key Terms

434

(1)

Chapter Summary

434

(2)

Ethical Decision-Making Matrix

Scenario 18-A: Genetic Privacy

436

(3)

Adoption Information

439

(24)

Martha L. Jones

Learning Objectives

439

(1)

Abstract

439

(1)

Scenario 19-A: Seeking Information Many Years Later

440

(2)

Adoption: Historical and Emerging Ethical Issues

442

(3)

Who's Who in Adoption: Some Explanations of Terminology

445

(2)

Ethical Issues for HIM Professionals

447

(1)

Scenario 19-B: An Adoptee Seeks Information on Her Biological Family

448

(2)

Scenario 19-C: A Birth Mother Seeks Information on Her Biological Son

450

(1)

Future Issues

451

(3)

Key Terms

454

(1)

Chapter Summary

454

(2)

Ethical Decision-Making Matrices

Scenario 19-A: Seeking Information Many Years Later

456

(2)

Scenario 19-B: An Adoptee Seeks Information on Her Biological Family

458

(2)

Scenario 19-C: A Birth Mother Seeks Information on Her Biological Son

460

(3)

Drug, Alcohol, Sexual, and Behavioral Information

463

(34)

Sharon J. Randolph

Laurie A. Rinehart-Thompson

Learning Objectives

463

(1)

Abstract

463

(1)

Scenario 20-A: The Arrest Warrant: is This Person in Your Facility?

464

(1)

Substance Abuse Treatment, Health Information, and the Law

464

(1)

Ethical Challenges in Behavioral Health and Substance Abuse Treatment

465

(4)

Scenario 20-B: Safety of a Citizen versus Privacy of a Patient

469

(1)

Scenario 20-C: Patient Confesses to a Psychiatrist

470

(2)

Scenario 20-D: Patient Confesses to the Nurse's Aide

472

(1)

Scenario 20-E: Verifying Admission Can Violate Privacy

473

(2)

Scenario 20-F: A Prisoner Who May Have AIDS

475

(1)

Scenario 20-G: Workers' Compensation Case

476

(1)

Scenario 20-H: Children's Protective Services

477

(1)

Conclusion

478

(1)

Key Terms

478

(1)

Chapter Summary

479

(1)

Ethical Decision-Making Matrices

Scenario 20-A: The Arrest Warrant: Is This Person in Your Facility?

480

(2)

Scenario 20-B: Safety of a Citizen versus Privacy of a Patient

482

(2)

Scenario 20-C: Patient Confesses to a Psychiatrist

484

(2)

Scenario 20-D: Patient Confesses to the Nurse's Aide

486

(2)

Scenario 20-E: Verifying Admission Can Violate Privacy

488

(2)

Scenario 20-F: A Prisoner Who May Have AIDS

490

(2)

Scenario 20-G: Workers' Compensation Case

492

(2)

Scenario 20-H: Children's Protective Services

494

(3)

PART V Roles

497

(128)

Management

499

(30)

Cathy Flite

Sharon Laquer

Learning Objectives

499

(1)

Abstract

499

(1)

Scenario 21-A: Lateness and Absenteeism

500

(1)

Moral Development and Awareness

500

(7)

Scenario 21-B: National Convention Misadventures

507

(1)

Orientation of New Employees

508

(2)

Scenario 21-C: Avoiding the Employee Who Will Be Fired

510

(1)

The Code of Ethics is Not Enough

511

(1)

When Leadership Fails

511

(2)

Scenario 21-D: Failure to Document Poor Work Performance for a Friendly Employee

513

(1)

Moral Muteness

514

(1)

Conclusion

514

(1)

Key Terms

515

(1)

Chapter Summary

516

(2)

Ethical Decision-Making Matrices

Scenario 21-A-1 and A-2: Lateness and Absenteeism

518

(4)

Scenario 21-B: National Convention Misadventures

522

(2)

Scenario 21-C: Avoiding the Employee Who Will Be Fired

524

(2)

Scenario 21-D: Failure to Document Poor Work Performance for a Friendly Employee

526

(3)

Entrepreneurship

529

(38)

Marie Gardenier

Learning Objectives

529

(1)

Abstract

529

(1)

Scenario 22-A: Competing Constituencies

530

(2)

Entrepreneurship in Health Information Management

532

(2)

Entrepreneur versus Intraprenuer

534

(1)

Business Ethics: Concepts and Principles

535

(5)

The Intersection of Ethics and HIM Entrepreneurship

540

(9)

Scenario 22-B: Negotiating Contracts

549

(1)

Scenario 22-C: Unrealistic Client Expectations

550

(2)

Scenario 22-D: Discovering Sensitive Information about a Client, Competitor, or Colleague

552

(3)

Conclusion

555

(1)

Key Terms

556

(1)

Chapter Summary

556

(1)

Ethical Decision-Making Matrices

Scenario 22-A: Competing Constituencies

556

(4)

Scenario 22-B: Negotiating Contracts

560

(2)

Scenario 22-C: Unrealistic Client Expectations

562

(2)

Scenario 22-D: Discovering Sensitive Information about a Client, Competitor, or Colleague

564

(3)

Vendor Management

567

(28)

Keith Olenik

Learning Objectives

567

(1)

Abstract

567

(1)

Scenario 23-A: Vendor Request

568

(1)

Vendor Relations

568

(2)

Scenario 23-B: Vendors as Friends

570

(1)

Scenario 23-C: Gifts

570

(2)

Scenario 23-D: Preferred Vendors

572

(1)

Request for Proposals

573

(3)

Scenario 23-E: Negotiating

576

(1)

Negotiation

577

(2)

Enhancement of Vendor Relationships

579

(1)

Ethical Behavior

579

(1)

Conclusion

580

(1)

Key Terms

580

(1)

Chapter Summary

580

(2)

Appendix 23-A: Sample Gifts Policy

582

(2)

Ethical Decision-Making Matrices

Scenario 23-A: Vendor Request

584

(2)

Scenario 23-B: Vendors as Friends

586

(2)

Scenario 23-C: Gifts

588

(2)

Scenario 23-D: Preferred Vendors

590

(2)

Scenario 23-E: Negotiating

592

(3)

Advocacy

595

(30)

Susan Helbig

Learning Objectives

595

(1)

Abstract

595

(1)

Scenario 24-A: Violating Privacy of a Prominent Citizen

596

(1)

Advocacy: The Choice of Ethics in Action

596

(1)

Advocating for Patients

596

(4)

Scenario 24-B: Compassion in Action for an Alcoholic Peer

600

(1)

Advocating for Peers

600

(2)

Scenario 24-C: Cockroaches in the HIM Department

602

(1)

Advocating for Staff

602

(1)

Scenario 24-D: Unfair Treatment of Part-time Workers

603

(1)

Scenario 24-E: Small Print on a Consent Form

604

(1)

Advocating for the Healthcare Organization

605

(1)

Scenario 24-F: The Data Warehouse Wants to Sell Patient Information

606

(1)

Advocating for the Larger Community and Society

606

(1)

Advocating for One's Self

607

(1)

Conclusion

607

(1)

Key Terms

608

(1)

Chapter Summary

608

(2)

Appendix 24-A: Example of Organizational Engagement in Societal Advocacy

610

(1)

Appendix 24-B: Precepts of Effective HIM Advocacy

611

(1)

Ethical Decision-Making Matrices

Scenario 24-A: Violating Privacy of a Prominent Citizen

612

(2)

Scenario 24-B: Compassion in Action for an Alcoholic Peer

614

(2)

Scenario 24-C: Cockroaches in the HIM Department

616

(2)

Scenario 24-D: Unfair Treatment of Part-time Workers

618

(2)

Scenario 24-E: Small Print on a Consent Form

620

(2)

Scenario 24-F: The Data Warehouse Wants to Sell Patient Information

622

(3)

Glossary

625

(14)

Index

639

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Ethical Challenges in the Management of Health Information

Summary

Table of Contents

Supplemental Materials