Medical Information Systems Ethics E-Book

Jérôme Béranger

• Herausgeber: John Wiley & Sons
• Kategorie: Wissenschaft und neue Technologien
• Sprache: Englisch

Seitenzahl: 465

Veröffentlichungsjahr: 2015

Beschreibung

The exponential digitization of medical data has led to a transformation of the practice of medicine. This change notably raises a new complexity of issues surrounding health IT. The proper use of these communication tools, such as telemedicine, e-health, m-health the big medical data, should improve the quality of monitoring and care of patients for an information system to "human face".

Faced with these challenges, the author analyses in an ethical angle the patient-physician relationship, sharing, transmission and storage of medical information, setting pins to an ethic for the digitization of medical information. Drawing on good practice recommendations closely associated with values, this model is developing tools for reflection and present the keys to understanding the decision-making issues that reflect both the technological constraints and the complex nature of human reality in medicine .

Leseprobe

Table of Contents

Cover

Title

Copyright

Introduction

I.1. Questions on which our study is based

I.2. Objectives and contributions of this book

I.3. Toward medical ethics

1: The Emergence of Medical Information in the Face of Personal and Societal Ethical Challenges

1.1. An information-consuming society

1.2. e-Health, m-health, the Quantified Self and Big Data

1.3. Medical secrecy in the face of the computerization of healthcare data

1.4. Cultural evolution of mentalities surrounding legitimacy of information

1.5. Processing of personal data in law

2: Ethical Modeling: From the Design to the Use of an Information System

2.1. Info-ethics: data on practical wisdom

2.2. Identification of method used to develop the ethical analysis model

2.3. Development of the ethical analysis space

2.4. Presentation of the ethical model

3: Uses of This Ethical Model

3.1. Implementing the ethical model

3.2. Presentation of the study’s questionnaires

3.3. Necessary environmental changes for healthcare information systems: recommendations and actions

3.4. Creating an ethical charter on the “ideal” computational tool for a healthcare establishment

4: Ethics-Oriented Personalized Medicine

4.1. The evolution of society toward an ethical ideal based on information

4.2. The doctor–patient–IS triangulation

4.3. Ethical use of an information system in healthcare

4.4. Ethics-oriented personalized medicine

4.5. Tool for the establishment and constant improvement of information systems for ethical practice in hospitals

Conclusions

Appendix 1: Classification of the Justifications in terms of the Different Real-world Environmental Parameters and Fundamental Ethical Principles pertaining to the Major Objectives of an IS in Healthcare

Appendix 2: Questionnaire 1: Designed to Analyze the Perception of Actors in Oncology about the Primary Objectives of an IS in Healthcare

Appendix 3: Questionnaire 1′: Designed to Analyze Healthcare Users’ Perceptions of the Main Objectives of an IS in Healthcare

Appendix 4: Questionnaire 2: Designed to Study the Realization and Characteristics of the IS Tool, to be used by the Designer of the IS and to the “Internal” Users

Appendix 5: Questionnaire 3: Designed to Analyze the Methods and Tools Put in Place to Enable the IS to Work

Appendix 6: Environmental Parameters of the Knowledge Pyramid

Bibliography

Index

End User License Agreement

Guide

Cover

Table of Contents

Begin Reading

List of Tables

2: Ethical Modeling: From the Design to the Use of an Information System

Table 2.1. Support on which analysis questionnaires are based

Table 2.2. Model of ethical analysis

Table 2.3. Interactions between the dimensions of ethical modeling

Table 2.4. Environmental parameters of the infosphere

Table 2.5. Structuring of pyramid of knowledge

3: Uses of This Ethical Model

Table 3.1. Justifications of the purposes, fundamental principles and underlying social values to the main aims of a healthcare information system

Table 3.2. Justifications of the limitations, fundamental principles and underlying social values of the main aims of a healthcare information system

Table 3.3. Distribution of the justification in the ethical cube of acceptable contingency

Table 3.4. Proportion of real environmental parameters within the fundamental ethical principles

Table 3.5. Advantages and disadvantages of single- or multi-developer approaches

Table 3.6. Recommendations for the structural and technological domain

Table 3.7. Recommendations for the strategic and methodological domain

Table 3.8. Recommendations for the organizational and legislative domain

Table 3.9. Recommendations for the relational and cultural domain

Table 3.10. Ethical charter on the aims surrounding the creation, implementation and use of a healthcare information system

4: Ethics-Oriented Personalized Medicine

Table 4.1. Components characterizing the environment surrounding knowledge

Table 4.2. Structure of knowledge pyramid

Table 4.3. Strategic deployment: giving meaning and goals

Table 4.4. Structure and composition of the three dashboards

Table 4.5. Representation of the strategic dashboard – visualization. For a color version of the table, see www.iste.co.uk/beranger/ethics.com

Table 4.6. Representation of the “tactical” dashboard – intervention. For a color version of the table, see www.iste.co.uk/beranger/ethics.com

Table 4.7. Representation of operational dashboard – control. For a color version of the table, see www.iste.co.uk/beranger/ethics.com

Table 4.8. Intrahospital coordination and strategic planning

Appendix 1: Classification of the Justifications in terms of the Different Real-world Environmental Parameters and Fundamental Ethical Principles pertaining to the Major Objectives of an IS in Healthcare

Table A1.1. Justifications of the purposes of the major objectives of an IS in healthcare in terms of the real-world environmental parameters

Table A1.2. Justifications of the limitations of the major objectives of an IS in healthcare in terms of the real-world environmental parameters

Appendix 2: Questionnaire 1: Designed to Analyze the Perception of Actors in Oncology about the Primary Objectives of an IS in Healthcare

Table A2.1. Questionnaire 1, designed to analyze the perception of actors in oncology about the primary objectives of an IS in healthcare

Appendix 3: Questionnaire 1′: Designed to Analyze Healthcare Users’ Perceptions of the Main Objectives of an IS in Healthcare

Table A3.1. Questionnaire 1′, designed to analyze healthcare users’ perceptions of the main objectives of an IS in healthcare

Appendix 4: Questionnaire 2: Designed to Study the Realization and Characteristics of the IS Tool, to be used by the Designer of the IS and to the “Internal” Users

Table A4.1. Questionnaire 2, designed to study the realization and characteristics of the IS tool, to be used by the designer of the IS and the “internal” users

Appendix 5: Questionnaire 3: Designed to Analyze the Methods and Tools Put in Place to Enable the IS to Work

Table A5.1. Questionnaire 3, designed to analyze the methods and tools put in place to enable the IS to work

Appendix 6: Environmental Parameters of the Knowledge Pyramid

Table A6.1. Environmental parameters of info-ethics

Table A6.2. Environmental parameters of the computosphere

List of Illustrations

2: Ethical Modeling: From the Design to the Use of an Information System

Figure 2.1. Structural analogy between genetics and information

Figure 2.2. Information systems and knowledge

Figure 2.3. Developed information systems and knowledge

Figure 2.4. Construction of an ethical event

Figure 2.5. Ethical space

Figure 2.6. Informative plan

Figure 2.7. Ethical analysis space

Figure 2.8. Ethical cube of an accepted contingency

Figure 2.9. Conversion of data into practical wisdom in an ethical analysis space in the infosphere

Figure 2.10. Nonaka’s model of organizational learning

Figure 2.11. Ethical modeling of information system in the doctor–patient relationship. For a color version of the figure, see www.iste.co.uk/beranger/ethics.com

Figure 2.12. Ethical modeling of information system in the doctor–patient relationship

Figure 2.13. Transformation from alpha to omega via the neo-Platonic systemic ethical prism

Figure 2.14. Flow of quantity of information from A to Ω

Figure 2.15. Process of creation of practical wisdom via organizational intelligence

Figure 2.16. Technico-ethical regulation of data

3: Uses of This Ethical Model

Figure 3.1. Geometric representations integrated within the sketch of the Vitruvian Man. For a color version of the figure, see www.iste.co.uk/beranger/ethics.zip

Figure 3.2. Implementation structure of an information system

Figure 3.3. Forces that characterize organization

4: Ethics-Oriented Personalized Medicine

Figure 4.1. Evolution of an information society using NICT

Figure 4.2. Analysis of the knowledge pyramid via ethical modeling

Figure 4.3. Triangulation of the doctor–patient–IS relationship

Figure 4.4. Maxwell’s three-dimensional model

Figure 4.5. Use of dashboards in the hospital organogram

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“Whatever, in the course of my practice, I may see or hear (even when not invited), whatever I may happen to obtain knowledge of, if it be not proper to repeat it, I will keep sacred and secret within my own breast.”

Hippocratic Oath

“I hope the principles here laid down will afford some light either to this or some truer method of philosophy.”

Isaac Newton

Medical Information Systems Ethics

Jérôme Béranger

Series EditorBruno Salgues

First published 2015 in Great Britain and the United States by ISTE Ltd and John Wiley & Sons, Inc.

Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act 1988, this publication may only be reproduced, stored or transmitted, in any form or by any means, with the prior permission in writing of the publishers, or in the case of reprographic reproduction in accordance with the terms and licenses issued by the CLA. Enquiries concerning reproduction outside these terms should be sent to the publishers at the undermentioned address:

ISTE Ltd27-37 St George’s RoadLondon SW19 4EUUK

www.iste.co.uk

John Wiley & Sons, Inc. 111 River StreetHoboken, NJ 07030USA

www.wiley.com

© ISTE Ltd 2015The rights of Jérôme Béranger to be identified as the author of this work have been asserted by him in accordance with the Copyright, Designs and Patents Act 1988.

Library of Congress Control Number: 2015942609

British Library Cataloguing-in-Publication DataA CIP record for this book is available from the British LibraryISBN 978-1-84821-859-8

Introduction

The past several years have been a turbulent time for the French healthcare system. With an institutional environment in the midst of dramatic change, patient care is in a perpetual state of transformation under the effects of factors such as evolving healthcare needs and emergence of new technologies playing an increasingly large role in cost-saving policy.

Collectively, hospital establishments represent assets that are important as much for our healthcare system as for the social role they play. However, they are currently facing significant concerns such as demographic challenges; evolving management tasks, which notably include the hyper-specialization of certain techniques; changing financial regulations with the introduction of fee-for-service practices; quality of services and reception; continuity of the care process; human and organizational management; and obligation to inform, all against a background of budgetary restriction.

This period has been conducive to value conflicts, divergences of opinion and opposing points of view, and even clashes, notably mainly concerning the development of healthcare expenditure control policies, with care opposing cost, providers opposing economists or managers, and the right to individual healthcare opposing the obligation of solidarity and efficiency. In the resulting ethical debates, tensions have appeared between the morals of conviction and the morals of individual and collective responsibility, and between clinical medicine and public healthcare, contributing to strategic and organizational dysfunction in the healthcare sector.

To all this, we can add revolutionary developments in information technology, with new communication devices such as the Internet, e-health, m-health, medical big data, and the complexity of internal and external transmission, notably in hospitals, due to the existence of medical information carrier systems (hospital information system (HIS), radiology information system, personal medical file (PMF), confidential physician cancer reporting, telemedicine, intranet networks, etc.). Currently, “data intelligence” appears to be the strategic response for the management of the use and deviance of the latter. Consequently, exploitation of big data is a sensitive subject, as it directly touches the private life of everyone. The number of situations in which difficult problems of strategic choice are faced in matters of personal data management grows larger every day. The increasing digitalization of digital data, the ever-growing capacity to store digital data and the resulting accumulation of information of every type have given rise to certain fears and uncertainties due to their multiple (and complex) usages, their impacts on highly diverse populations, which are difficult to measure, and the fact that information is sometimes impossible to control.