The Problems and Key Contributors
Overall, the situation can be described as a critical bottleneck that was affected by the inability of the stakeholders to reach an agreement. Therefore, it can be stated that the safety of patients with HIV was under pressure and there was no way to resolve this without a reasonable trade-off. Another issue that can be identified is the anxiety that might have grown in the patients with HIV that would be forced to register by means of the main computer. This problem was promoted by the decision to organize the system in a way that would only allow record the patient’s data in a non-private environment. This can be perceived as an unethical decision that was only supported by the minimization of the costs of the system.
Therefore, it is critical to address the problem of a relevant and effective trade-off. On a bigger scale, the efficiency of the information system within any given healthcare facility is important, but there is no way it should interfere with privacy concerns. It can be stated that there is no possibility for the executives to reach an adequate agreement that will justly resolve both the issue of privacy and the issue of the total implementation costs. Privacy concerns should never be inferior to the ultimate performance of the system, especially when it comes to patients with HIV (or any other ethically-marked illness).
Within the framework of this case study, ABCCHD is expected to encounter a number of complications connected to the expenditures connected to the security of the information system installed at the facility. The costs are projected to go over the top due to the fact that additional security measures require more monetary resources. As it was stated by one of the stakeholders, the efficiency of the system is also important, so this hints at the fact that they are more interested in performance. On the other hand, ABCCHD expose themselves to an increase in patient anxiety because they will not be able to register their data as they used to do it before.
Even though the trade-off between patient privacy and performance of the information system is not possible, the cost of the former still can be determined. In order to do that, we should take into account the time that will be spent on any given patient with HIV in case if they will have to update their records publicly. Therefore, the installation of a new information system that features an updated security mechanism should be included in the total costs of the enhancement (Murphy, 2015). Despite the performance of the system, we have to put patient safety at the forefront so as to spend more resources throughout the stage of installation but claim them back later by means of minimizing the nurse-patient interaction time.
The key players that are involved in the decision-making process are the hospital executives, ABCCHD developers, and the Board of Directors of Info-Health. These relationships are mitigated by patient privacy and the costs of the ultimate decision regarding the development of a new information system for the hospital. Within the framework of the current case study, it can be concluded that the current situation will impact Info-Health due to the fact that they will have to pay close attention to the development process so as not to miss out any critical points. The hospital will have to allocate extra monetary resources so as to cover the required expenses (Magnuson & Fu, 2014). Considering the situation at hand, the patients will win big and receive health care of a much higher quality while feeling (and being) protected.
One of the evident ways, in this case, is to spend extra resources on ensuring that the ethical issue of recording sensitive data within an unsafe environment is mitigated by the deployment of additional security measures. Consequently, this will positively affect the attitudes of patients with HIV toward health care practices at the given hospital. On the other hand, the hospital may decide not to spend any money on improving security. This will majorly contribute to the development of psychological issues and create indirect pressure on the group of interest.
The biggest contributor to the issue is the unwillingness of the stakeholders to reach an agreement. On a bigger scale, it can be seen that the third party (patients) does not win at all. The ethical side of this problem also makes patients inferior to the decisions that are made at a higher level. Overall, the dilemma cannot be resolved by means of any trade-offs and should be addressed from the patients’ side.
Short-term Warranted Actions
The trade-off between cost and privacy should be evaluated against several basic criteria. First of all, it is pivotal to take into account the number of patients with HIV whose records are stored at the hospital. The higher the number, the more chances that the trade-off has to be resolved in favor of the patients. Second, the management has to evaluate the available resources and make an informed decision on whether to spend additional resources on the development of a new information system or not (Hoyt & Yoshihashi, 2016). In perspective, this may be rather helpful to the other stakeholders as well because they will be able to assess the hospital’s possibilities and options.
The majority of the prior actions negatively influenced the situation on a number of different levels. This happened because an unbiased trade-off became unavailable. The stakeholders tried to preserve their interests instead of addressing the patients’ fundamental requirements. The alternatives that were suggested by the parties involved are adequate, but they will never allow any of them to reach an informed, unprejudiced decision. Considering the existing situation, it can be concluded that the ethical issue will not be resolved throughout a short period of time.
The very first thing that has to be done in order to repair the situation and adhere to the ethical guidelines is the creation of an additional security level. The latter will be added to the existing information system so as to ensure the patients’ safety. If we address this problem as soon as possible, we will be able to save big on software and hardware expenditures. The more the hospital extends the discussion, the fewer chances the stakeholders have to reach an agreement that will be beneficial for all the parties. At all times, patient health should be kept in mind.
Obviously, another aspect that has to be addressed is the performance of the system. Nonetheless, it should be repaired only after patient security is improved. The current situation hints at the fact that if we do not resolve the situation as soon as possible all the parties will be left behind – the stakeholders will lose a ton of money, and the patients will be exposed to the critical drawbacks of the existing information system and become dissatisfied with the overall quality of health care that is provided by the hospital (Harman & Cornelius, 2015). As it was mentioned above, a trade-off is not an option here, but the situation can be mitigated by a timely response.
On a short-term scale, the drawbacks can be mitigated by means of creating a list of patients that belong to the risk group. The access will be granted to a limited number of hospital employees that are not associated in any way with other stakeholders. The key goal here is not to disclose the information before bigger adjustments to the information system are made. We have to address the problem of patient safety from a number of perspectives so as to implement a long-term decision later. At this moment, the only option that is available to the hospital management is to grant access to the sensitive information only to a limited number of hospital workers.
Other warranted short-term actions may include leaving a note on the records of patients with HIV and treating the latter separately from other clients of the hospital. The first can be explained by the importance of treating these patients with extra cautiousness. The rationale for the second option is the specifics of the patients’ illness. They can be treated separately in order to protect them from becoming too anxious because of the sensitive information that can be accessed by other people. Overall, the proposed short-term solutions can be applied within the health care environment right away. The key advantage of these proposals is that they do not intend to interfere with the existing workflow and simply adjust it to the ethical side of the question.
Long-term Resolution
When we address the long-term resolution, we have to review three alternatives that can be proven useful within the framework of the evaluated case study. First, the hospital can implement a separate system so as to introduce there all the information concerning the patients with HIV. The core idea behind this system is that it will be a stand-alone application. In this case, it is advised to process the information at a separate front desk so as to detach HIV patients from other patient groups.
The advantage of this approach consists in the fact that the patients will feel safer and change their attitude toward client-provider relationships (Goodman, 2016). The disadvantage is that this option will not be available without separate software and hardware. In perspective, this alternative is expected to raise the costs of health care because a new person will be necessary to operate that computer.
The second alternative is to implement a new subsystem within the existing main system and introduce new privacy options. By doing this, the hospital will be able to maintain the security of the patients’ records. If the hospital decides to implement this, they will have to make sure that additional software is in place so as to ensure that privacy is maintained and security is warranted. In this case, a separate front desk is still necessary to register the patients with HIV.
The biggest advantage of this option is that supplementary hardware is not required and the hospital will not have to spend the majority of their monetary resources on the information system. At the same time, the disadvantage is that the system may be breached and all the sensitive info will be retrieved by either wrongdoers or those individuals who were not intended to have access to it.
The third alternative is to deploy the new registration system directly in the existing system. The only difference is that it will have to be a built-in feature that cannot be separated from the information system. The registration of all patients will occur at the same desk. All the privacy features will be included by default. The biggest advantage of this approach is that it does not require extra operational expenditures and can be implemented on the spot. The disadvantage, at the same time, is that all the patients will be served at the same place and the patients with HIV may become anxious and develop numerous covert fears that may have an adverse impact on their overall condition.
The five-year solution can be perceived as a way to translate the short-term activities into a long-term resolution. The current situation can be efficiently addressed only when all the ethical implications are considered. The five-year solution will be focused on developing an extra system that will be used to record the data regarding HIV patients. This will be done in order to align the deployment of the information system with the ethical norms of health care.
Positive long-term outcomes can be achieved only when the system is patient-centered. Therefore, all the future incentives should revolve around making the patients’ lives easier instead of concentrating on monetary profits and increased hardware/ software performance.
References
Goodman, K. (2016). Ethics, medicine, and information technology: Intelligent machines and the transformation of health care. New York, NY: Cambridge University Press.
Harman, L. B., & Cornelius, F. H. (2015). Ethical health informatics: Challenges and opportunities. Burlington, MA: Jones & Bartlett Learning.
Hoyt, R. E., & Yoshihashi, A. (2016). Health informatics: Practical guide for healthcare and information technology professionals: sixth edition supplement. Raleigh, NC: Lulu.
Magnuson, J. A., & Fu, P. C. (2014). Public health informatics and information systems. London, UK: Springer.
Murphy, S. P. (2015). Healthcare information security and privacy. New York, NY: McGraw-Hill Education.