Professor Susan Hahn Reizner
Textbook: No textbook. Extensive readings were from the primary literature and Internet Resources.
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As in Medical Informatics 404, much of the material covered in this class was far outside my previous experience, and, in addition, some of it was disturbing and challenging to my self-image as a physician. After 30 years of 80 hour work weeks and sleep deprived call nights, I viewed myself as a dedicated highly trained professional with my patients’ best interests at heart. Yet at times during the course some of the readings portrayed doctors as Luddites, wasteful cost augmenters or, worse yet, perpetrators of fraud and abuse, all of which seemed at variance with my own personal experience. I decided that the legal, social, and ethical aspects of medical informatics were going to be an inseparable part of my future career and that I should try to look at every issue as objectively as possible and learn all that I could. Professor Hahn Reizner and my classmates helped me with this by providing some of the most vibrant, intelligent, articulate Discussion Boards of any course in the program. |
Our study of the legal, ethical, and social issues in medical informatics encompassed a broad variety of topics. We began with papers detailing the development of basic consensus ethical principles related to medical care and applying those principles to daily activities in the healthcare system and to the analysis of costs, performance, and outcomes in healthcare delivery in the United States. We looked at the roles and authority
of different branches of government in formulating the requirements which define protected health information and regulate the systems which manage it. We examined both the HIPAA privacy rules and the regulations and laws governing data privacy and security breaches in some depth. We studied the role played by medical informatics in supporting patient portals, social media, and portable devices especially as regards harnessing the potential of these modalities to increase patient education and involvement while still keeping the data secure. We learned about the ways HIT can be used to commit fraud and abuse (up-coding, medical identity theft) and the ways HIT can be used to prevent fraud and abuse (predictive modeling, data mining). Other topics addressed in the course included intellectual property issues, legal challenges related to clinical decision support systems, the pros and cons of the current CMS incentives for the “Meaningful Use” of electronic health records, and the critical role of HIT in tracking the quality and financial metrics which make Accountable Care Organizations possible.
of different branches of government in formulating the requirements which define protected health information and regulate the systems which manage it. We examined both the HIPAA privacy rules and the regulations and laws governing data privacy and security breaches in some depth. We studied the role played by medical informatics in supporting patient portals, social media, and portable devices especially as regards harnessing the potential of these modalities to increase patient education and involvement while still keeping the data secure. We learned about the ways HIT can be used to commit fraud and abuse (up-coding, medical identity theft) and the ways HIT can be used to prevent fraud and abuse (predictive modeling, data mining). Other topics addressed in the course included intellectual property issues, legal challenges related to clinical decision support systems, the pros and cons of the current CMS incentives for the “Meaningful Use” of electronic health records, and the critical role of HIT in tracking the quality and financial metrics which make Accountable Care Organizations possible.
The major course project, written in three phases (charter, statement of work, and final proposal), was an individual research paper proposing “an HIT application to solve a pressing issue in healthcare,” selected from Challenge.gov, a website where federal agencies promote innovation by posting challenges and offering prizes that stimulate the public to submit novel solutions to difficult problems. One of the problems in the Startup America Policy Challenge section of the site involved “how to knock down barriers to innovation in healthcare IT.” I reviewed data suggesting that the rush by healthcare organizations to implement electronic health records (EHR’s) and receive federal meaningful use incentive funds has overwhelmed EHR vendors’ normal innovation and development cycles, forcing clinicians to use poorly designed information technology which disrupts physician workflow, increases physician fatigue and error rates, and decreases clinical productivity. The poor usability of current generation EHR’s constitutes a major barrier to physician adoption of the technology. I proposed a low cost, customizable application for evaluating, rating, and comparing the usability of office and hospital EHR products from different vendors. The goals were to identify and correct EHR usability design weaknesses that can lead to user errors and threats to patient safety, accumulate reproducible quantitative data to guide vendors’ understanding of how to improve user centered design, and stimulate the development of more logical, powerful, intuitive EHR’s which support clinician workflows, increase clinician efficiency and productivity, and thereby improve patient care safety and quality. Links to the three sections of the project are attached.