DQ: Discuss one ethical and one legal issue related to the use of EHRs that directly impact advanced registered nursing practice

DQ Discuss one ethical and one legal issue related to the use of EHRs that directly impact advanced registered nursing practice

Health Insurance Portability and Accountability Act (HIPAA) and protected health information are applicable to electronic health records (EHR). The patient has a right to privacy in regard to all their health care information (U.S. Department of Health & Human Services Office for Civil Rights, n.d.). This information must only be shared with authorized personnel who provide direct care to the patient. EHRs use data encryption and security measures to protect this data. The user has a password to access the system. If patient portals are in use, the patient can access using PINs or passwords. All information contained in an EHR is to be used for the purposes of patient care or data aggregation to improve patient outcomes (U.S. Department of Health & Human Services Office for Civil Rights, n.d.). It is the legal obligation of a facility or provider to notify patients of any data breaches and the Secretary of Health and Human Services.

EHR documentation as an advanced practice nurse can be time-consuming. This can impact the partnership between nursing and patient. The patient must be able to develop a rapport with the nurse in order for cooperation and collaboration towards the patient achieving healthful outcomes(McBride et al., 2018). The advanced practice nurse who follows a clinical decision support system because it is required when contraindicated in a specific patient population creates a legal situation where they cause harm to the patient. An example is a patient with a history of heart failure who presents to the emergency room with a diagnosis of possible sepsis through a CDSS symptom recognition pattern. The patient in fact had an exacerbation of CHF based on history and further assessment (McBride et al., 2018). The EHR will continue to identify sepsis and gear orders towards sepsis management. Following these order sets would be detrimental to the patient’s health. It is important for nurse educators to understand and teach these concepts to students.

HIPAA violations result in fines or time in prison or both. I would maintain patient privacy by not speaking in public areas about PHI. This means creating a private area to speak to patients and families without others having the ability to overhear. The EHR must be locked when I am not in attendance. Family members must provide the PIN or code necessary to get any information in person or via phone. The patient must clearly state who he/she wants to have his/her information shared with unless there is a legal document giving an individual power of attorney for health care.

Referenes

McBride, S., Tietze, M., Robichaux, C., Stokes, L., & Weber, E. (2018). Identifying and addressing ethical issues with use of electronic health records. Online Journal of Issue in Nursing, 23(1). https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Identifying-and-Addressing-Ethical-Issues-EHR.html#McBride7

U.S. Department of Health & Human Services Office for Civil Rights. (n.d.). Privacy, security, and electronic health records. https://www.hhs.gov/sites/default/files/ocr/privacy/hipaa/understanding/consumers/privacy-security-electronic-records.pdf.

RESPOND HERE (150 WORDS, 2 REFERENCES)

This is insightful, Camille; the application or electronic health record system is associated with different legal and ethical practices that

DQ Discuss one ethical and one legal issue related to the use of EHRs that directly impact advanced registered nursing practice

ought to be observed. As a result, Health Insurance Portability and Accountability Act (HIPAA) and protected health information are applicable to the EHR. The main objective of the EHR system is to enhance the management of patient’s data. As a result, there is always the need for healthcare professionals or users to adhere to the privacy policies or confidentiality of information (McBride et al., 2018). Enhancing the confidentiality of information is one of the ethical concerns often observed by healthcare professionals when using an EHR system. The confidentiality of information can be achieved through integrating effective mechanisms to enhance the security of data (Iyengar et al., 2018). Putting security measures such as passwords is one of the main methods that can be used to enhance the confidentiality of information. Also, encryption processes can be undertaken to prevent unauthorized access of patient’s data by third parties or strangers. Additionally, adherence to the HIPAA policies is critical in ensuring the maintenance of data security.

References

Iyengar, A., Kundu, A., & Pallis, G. (2018). Healthcare informatics and privacy. IEEE Internet Computing, 22(2), 29-31. https://ieeexplore.ieee.org/abstract/document/8345561

Re: Topic 7 DQ 2

The Health Insurance Portability and Accountability Act (HIPAA) requires that patient health information is protected and secure at all times. The regulations that are in place by HIPAA have an effect on healthcare institutions willingness to share data with other institutions (DeNisco & Baker, 2016). The Electronic Medical Record (EMR) is different from an Electronic Health Record (HER) because the information it contains is intended to be shared. While both the EMR and her contain protected health information (PHI), an EHRs purpose is to be shared among physicians and hospitals when needed. Unfortunately, sharing this PHI becomes a challenge. Hospitals in particular, “face a “catch-22” situation in responding to the conflicting mandates of developing electronic health records that information sharing across institutions versus ensuring absolute protection and security of patients’ individual health information” (Sarrico & Hauenstein, 2011).

An ethical issue related to HIPAA and the sharing of information through EHRs is sharing information in emergency situations. There are times in the ER when information is crucial for the care of critically ill patients. Is it ethically right to access and share information about patients during emergency situations if it means saving a life?

A legal issue related to the use of EHRs is when the breach of PHI occurs. Keeping PHI secure is imperative for patients, but unfortunately breaches do occur. Healthcare professionals must be held accountable for their access into EHRs at all times. One restriction which some healthcare systems use is “placing restritctions on which application and module within that application a user can access, despite the user’s having established his or her ID at login” (Sarrico & Hauenstein, 2011). It is also important for internal audits to take place as well to monitor the security of PHI. Of course there are always steps that the healthcare industry can enforce to maintain security of PHI. Regulators in the industry should specify standards and definitions regarding what constitutes a violation, create evels of severity, and devise a hierarchy of warnings and fines that are based on standards (Sarrico & Hauenstein, 2011). As far as healthcare providers, they should tighten internal compliance procedures, conduct extensive and regular training of all employees, train the employees of provider-partners, obtain signed privacy agreements with all employees and conduct regular audits to ensure compliance (Sarrico & Hauenstein, 2011). All of these are suggested and can be implemented in daily practice to maintain proper security of information.

References

DeNisco, S.M., & Barker, A.M. (2016). Advanced practice nursing: essential knowledge for the profession. Burlington, MA: Jones & Bartlett Learning.

Sarrico, C., & Hauenstein, J. (2011). Can EHRs get along with HIPAA security requirements? Hfm (Healthcare Financial Management), 65(2), 86-90.

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RESPOND HERE (150 WORDS, 2 REFERENCES)

This is insightful; La Shiona, the Health Insurance Portability and Accountability Act (HIPAA) requires that patient health information is protected and secure at all times. HIPAA regulations should be observed by all healthcare systems to ensure that patient data and information are protected (Mailewa et al., 2017). With the increased use of technology in the management of patient data, there are many security issues that must be addressed to ensure quality health outcomes. The application of an electronic health record system is necessary for the healthcare system; however, there is always the need for healthcare professionals to adhere to the legal and ethical issues surrounding the use of the EHR system (McBride et al., 2018). The legal issue surrounding the use of EHR systems can be observed when PHI rules are violated. On the other hand, some ethical issues surrounding the use of the EHR system include confidentiality of information or the security of data. There is always the need for healthcare professionals to adhere to the ethical and legal issues when using the EHR system.

References

Mailewa Dissanayaka, A., Shetty, R. R., Kothari, S., Mengel, S., Gittner, L., & Vadapalli, R. (2017, December). A review of MongoDB and singularity container security in regards to hipaa regulations. In Companion Proceedings of the10th International Conference on Utility and Cloud Computing (pp. 91-97). https://dl.acm.org/doi/abs/10.1145/3147234.3148133

McBride, S., Tietze, M., Robichaux, C., Stokes, L., & Weber, E. (2018). Identifying and addressing ethical issues with use of electronic health records. Online J Issues Nurs, 23(1). http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Identifying-and-Addressing-Ethical-Issues-EHR.html

Re: Topic 7 DQ 2

Electronic health records (EHRs) and electronic medical records (EMRs) have become an essential part of healthcare. Patients expect the information they share with clinicians is protected; with the increased use of EHRs and EMRs, the advanced registered nurse must take caution to protect the privacy and confidentiality of their patients.

The Health Insurance Portability and Accountability Act (HIPPA) was set in place in 1996, to protect individually identifiable health information. There are five rules that determine what types of information are subject to HIPPA, who may access protected information, and enforcement measures; these include, security rule, transactions rule, identifiers rule, privacy rule, and enforcement rule (McMullen, 2014). Patients have the right to access and obtain a copy of their healthcare information either through a patient portal or in writing.

HIPPA requires safeguards be put in place by healthcare providers and organizations to guarantee confidentiality, integrity, and availability of protected health information (PHI). PHI includes individually identifiable health information such as demographic data, medical history, lab results, and other data used to identify a patient or provide health care services (Alder, 2021).

Ethical and legal concerns can become an issue when using EHRs. Ethical and legal issues can include protecting patient privacy and confidentiality, copy and pasting notes, ignoring clinical decision support alerts, and documenting (late entries, changes, incomplete or omitting data). These issues can result in the advanced registered nurse facing malpractice litigation and/or licensing issues from the Board of Nursing (Balestra, 2017).

PHI should only be accessed by authorized individuals. The authorized individual needs to be aware that they will be liable for the use and misuse of information they view. Not protecting patient data, even if unintentional, when using EHRs can result in HIPPA violations. Consequences of compromising patient information can include, fines, employee termination, loss of Medicare payments, sanctions, and criminal charges. Criminal charges can range from up to 12 months of imprisonment for “no knowledge of violation”, up to five years for intentional deception to access PHI and up to ten years for “malicious intent” (RSI Security, 2020).

Therefore, it is important for the advanced registered nurse to take measures to protect patient privacy and confidentiality. Some of these measures include the following:

Never share our password with anyone else and change it frequently.
Review your organizations confidentiality and EHR use policy.
Avoid sending sensitive patient information via email or text unless you are certain the intended receiver will be the only one to access information.
Avoid communicating any information that can identify individual patients, including any of the 18 personal identifiers in HIPPA’s Privacy rules, unless it is required.
When disclosing patient information to anyone other than the patient, make sure the recipient’s identity is confirmed or use a predetermined password, and obtain the patient’s consent prior to disclosing information.
Get informed consent to use patient information for audit and management purposes (McMullen et al., 2014).

References

Alder, S. (2021). What is protected health information? HIPPA Journal https://www.hipaajournal.com/what-is-protected-health-information/

Balestra, M. (2017). Electronic health records: Patient care and ethical and legal implications for nurse practitioners. The Journal for Nurse Practitioners, 13(2), 105-111. https://doi.org/10.1016/j.nurpra.2016.09.010

McMullen, P.C., Howie, W.O., Philipsen, N., Bryant, V.C., Setlow, P.D., Calhoun, M., & Green, Z.D. (2014). Electronic medical records and electronic health records: Overview for nurse practitioners. The Journal for Nurse Practitioners, 10(9), 660-665.:https://doi.org/10.1016/j.nurpra.2014.07.013

RSI Security. (2020, Nov. 12). Top five consequences of HIPPA violations. https://blog.rsisecurity.com/top-five-consequences-of-hipaa-violations/

As many have expressed, EHRs are a major part of the healthcare industry. Many providers, hospitals, clinics, and urgent cares utilize a EHR system. One ethical concern of an EHR system is the risk of confidentiality. While used appropriately, the EHR system is a benefit to both the patient and the provider, but one ethical concern is the risk of hackers or non-participating staff having access to confidential information. In the past, I worked in Labor and Delivery. This area can have a lot of private information such as someone is currently in labor, test results, concerns with baby, etc. I have seen the repercussions of someone accessing private information, telling a family member, and the staff’s family member came up to the hospital hoping to see the patient. The family member of the staff was unwanted in the hospital setting and the patient was upset their private information was spread. Additionally, this situation could also be a legal concern. The patient has a right to privacy and private information should not be spread to others without consent. Another legal concern is nurses entering false information to bypass the EHR system. Many nurses learn workarounds to get the desired effect. The concern is when false information is placed in a patient’s chart. This follows the patient and may be the reason for a denial in the future (McBride et al., 2018).

As an advanced practice nurse, I feel education is one of the most important aspects in this role. It is important for advanced practice nurses to educate the staff on safety protocols such as making sure their computer is locked when they are away, keeping their passwords private, and keeping up to date on safety protocols. Also, it is important for nurses to educate their patients on the potential of access to information and ways to protect their information. While technology continues to be a great benefit to the healthcare industry, it does come with multiple concerns.

Reference

McBride, S., Tietze, M., Robichaux, C., Stokes, L., & Weber, E. (2018). Identifying and addressing ethical issues with use of electronic health records. The Online Journal of Issues in Nursing, 23(1).

Ransomware is an “extortion software that can lock your computer and then demand a ransom for its release” which can cause catastrophic problems concerning patient health information (PHI) (Kaspersky, 2023). When healthcare organizations fall victim to ransomware, patient information such as medical history, treatments, results, and identifiable data can be stolen and lost completely. In Swasey’s article, “Insufficient Healthcare Cybersecurity invites ransomware attacks and the sale of PHI on the dark web,” she discusses the potential risks of ransomware on the healthcare system, and the reasons why there are pitfalls in hospitals and clinics cybersecurity.

Swasey also discusses possible small solutions such as better education with IT and others working with security with PHI to reduce the ransomware risks. Implementing “training procedures, more proactive planning, increased budget commitments can greatly reduce the number of successful attacks. As the focus is shifted to cybersecurity, healthcare entities will be able to learn from past mistakes to better prepare for the future” (Swasey, 2020). The loss of PHI to ransomware goes beyond just the data loss, it can delay affected patients’ treatment, diagnoses, and prescriptions with inaccessible or manipulated data. These incidents also threaten the patients trust towards the healthcare system.

The recovery after the attack is substantial in both finances and time consuming efforts for the restoration of the data and reestablishing security infrastructure. To prevent this risk, hospitals and clinics need to have proper cypersecurity measures and regularly evaluate and perform backups. When hospitals prioritize the safety of PHI, they ensure the trust of their patients, and the safety and security of sensitive information