Conflicting Moral Priorities Resulting from Cultural and/or Religious Diversity

How does one decide on which moral norms should prevail in the clinical setting?

I actually found that this topic was very interesting.  Right from Chapter 1, Beauchamp and Childress (2009) state that "particular moralities…contain moral norms that are not shared by all cultures, groups and individuals" (p. 5).   To me this means that at times some may feel it is necessary to introduce their particular norms into the clinical setting, as held by their particular beliefs or culture.  This reminds me of a surgery that I underwent a few years back.  Without going into too many details, the condition was a result of certain life activities that I had been involved in.  One of the nurses took it upon herself to relay her Christian beliefs to me and to basically tell me how I needed to change my life based on her particular moral beliefs.  At the time, and because I was under duress, I did not pay much attention to her, but now I see that what she was doing had no place in the clinical setting.  You see, even though her beliefs where relevant to her, this could have caused tension between the medical facility and myself.  Richard Sloan wrote an article in the LA Times and expressed this sentiment; "we all are free to practice our religion as we see fit, as long as we do not interfere with the well-being of others by imposing our religious views on them."  He went on to say "Freedom of religion is a cherished value in American society. So is the right to be free of religious domination by others. 

So the question is which moral norms should this nurse have chosen?  Well certainly, her particular moral norms should have no place in the clinical setting.  I believe that in this setting, because of the influx of such a wide diversity of persons coming and going, all professionals should adhere to the common morality and if a particular morality is chosen it should be professional moralities that define the guidelines for health care professionals.

Beauchamp and Childress (2009) lay out 10 examples of moral character traits when it comes to the common morality.  These are non-malevolence, honesty, integrity, conscientiousness, trustworthiness, fidelity, gratitude, truthfulness, lovingness and kindness.  These are the types of traits that should be displayed first and foremost in the clinical setting.  When it comes to professional ethics, eHow.com contributor Stephanie Mitchell puts it this way, "Codes of ethics come into play when simply knowing the difference between right and wrong is not enough, and such situations arise around patients' rights, patients' dignity, equitable access to treatment and the development of new medical technologies. Medical codes of ethics help ensure that healthcare professionals make the best possible choices when faced with difficult decisions."

Beauchamp, T. L., & Childress, J. F.  (2009).  Principles of Biomedical Ethics (7th ed.).  New York, NY: Oxford University Press.

Mitchell, S. (n.d.).  The Purpose of Professional Ethics in Healthcare.  eHow.com.  Retrieved from http://www.ehow.com/info_8404364_purpose-professional-ethics-healthcare.html

Sloan, R. P.  (2008 August 23).  When religion and healthcare collide.  LA Times.  Retrieved from http://www.latimes.com/la-oe-sloan23-2008aug23,0,4637656.story

Clinical Ancillary Applications Benefits and Limitations to Integration

Being new to healthcare, I had no clue what ancillary services were.  Your Dictionary, Medical (n.d.) defines these services as being "Relating to or being auxiliary or secondary."  So since these are secondary and supplementary to the primary medical functions, why would it be advantageous for them to have their own computer systems dedicated to their functions?  What benefits are there to using systems of this nature and what are the limitations?

First off let us discuss why these services should be automated and computerized and also what is the current state of technology in regards to clinical ancillary.  As part of an abstract for a paper, Michael Minear and Jeff Sutherland (2003) wrote the following:

Digital computers have been successfully incorporated into specialized clinical instruments to offer advanced digital devices such as fetal monitors, heart monitors, and imaging equipment. But these devices are often not fully integrated with clinical management and operational systems. Beyond ancillary department applications, the result of almost 30 years of trying to automate the clinical processes in health care is large investments in both computer systems and paper medical records that have resulted in paper-based, computer-assisted processes of care.  This expensive combination of partial clinical automation and archaic paper-based support processes is a major obstacle to improvements in care delivery and management. (Minear & Sutherland, 2003)

So as you can see not having these processes computerized is causing a disadvantage to patient care process, delivery and management.  For example of how the current systems are set up in some places, let us look at the operating room (OR).  The OR is an example of leading edge technology advances, but in many cases, in many HCOs, the ancillary systems are not integrated with each other or into the core systems (Minear & Sutherland, 2003).  One of the benefits of having computerized, integrated ancillary systems is having all of the "players" related to the patient care delivery process working as a synchronized unit (Minear & Sutherland, 2003).  If this is not the case then it is hard to stay on track, stay informed and the process will suffer.  

Another advantage of ancillary applications is creation of a knowledge base.  Minear and Sutherland (2003) said that, "Knowledge-enabled software is inherently flexible and delivers much more sophisticated support to clinicians."  Another advantage is the enforcement of standards throughout the organization (Minear & Sutherland, 2003).

One limitation is the "major amount of work to rewrite and test a new system that has no guarantee of satisfying all the needs of the ancillary services (Andrews, n.d.)."  Another is the coordination of so many dissimilar projects.  Other limitations are difference data definitions for storage, formal processes to integration taken over by committees and formulating a process for management of the data.

As you can see there are benefits (correlation and standardization of care and knowledge) with clinical ancillary applications.  There are also limitations especially when it comes to integrating these into a core system.  It is up to the HCO to determine if the benefits outweigh the limitations, and this can be based on many difference factors.

References:

Andrews, R. D.  (n.d.).  Integration of Ancillary Data for improved Clinical Use: A Prototype within the VA's DHCP.  Downloaded from http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=20&ved=0CHUQFjAJOAo&url=http%3A%2F%2Fpubmedcentralcanada.ca%2Fpmcc%2Farticles%2FPMC2245652%2Fpdf%2Fprocascamc00017-0608.pdf&ei=cLkEUfyHBMzdqAHj2oCIDg&usg=AFQjCNFcLdttxcfqEXbHyP44u8A_HFVV-g&sig2=au_3UNpsjJzUZdksizXJog&bvm=bv.41524429,d.aWM

Minear, M. N. & Sutherland, J.  (2003 June).  Medical Informatics-A Catalyst for Operating Room Transformation.  Seminars in Laparoscopic Surgery, 10(2), pgs. 71 - 78.  DOI: 10.1177/107155170301000203

Your Dictionary, Medical.  (n.d.).  ancillary medical definition.  Retrieved from http://medical.yourdictionary.com/ancillary

Dreaming of the (Medical Information Technology) Future

Have you watched Star Trek lately?  What is the future of healthcare?  Will it be "trekkie" in a few hundred years.  Mobile devices that scan you and send the information back to the central computer for AI to make decisions?  Hologram doctors?  Whats in store?  We can only dream!!

What's the Big Deal About Big Data?

My career has allowed me to learn quite a few things.  I have worked with software, testing it to ensure it met the requirement needs of clients. I have worked at a small cell phone company, trying to create a small and primitive data warehouse.  Now I work assisting in gaining adherence to ITIL methods for the entire government of a country.  These have all been great positions, but I have to say my first job out of college was by far my favourite.

At AIG, I was able to work with some very brilliant minds on the executive team, engage on some fraud reporting and saw my reports used throughout the United States.  I had a great manager, and awesome co-workers   However, by far the best part was working with data, reporting and writing SQL.  I loved it.  If you go back into my past a little further, you would see me asking my professor, after my class was finished for the semester, could I retain access to the database so that I could practice SQL more (can you say NERD!).

Nowadays my use of SQL is very limited and I miss it.  I miss reporting, seeing trends in data, and creating tools that guide decision making that can change the outcomes of the business and how everything interacts to create success.  So you should not be surprised that this term I have been hearing brings about a level of excitement for me.  It is Big Data.

OK, so I am sure you have heard of big data.  Maybe you know exactly what it is.  I am hoping to shed some light on this for people that have heard what it is, but have not had the time to look into it further.  Also I would like to convey why it will be important to healthcare.

What is Big Data?

When I was at AIG we had a data warehouse that had, most likely, millions and millions of records.  It was massive.  Big data is even bigger than that.  According to Wikipedia, big data is data sets so large that using standard database tools or data processing becomes very difficult.  The reason data is growing so much is because it is “increasingly being gathered by ubiquitous information-sensing mobile devices, aerial sensory technologies (remote sensing), software logs, cameras, microphones, radio-frequency identification readers, and wireless sensor networks."  Wikipedia goes on to say that, "The world's technological per-capita capacity to store information has roughly doubled every 40 months since the 1980s; as of 2012, every day 2.5 quintillion (2.5×1018) bytes of data is created."

Wow, that is big!

This data is being used for data analytics, business intelligence and effective decision making.  Cliff Saran of ComputerWeekly.com alludes to a fact.  The bigger your data, the larger the gap grows in competitiveness that lies between you and your competitors.

With these advantages, come some challenges.  The biggest, ironically, is the size of the data.  Saran says that "big data will cause traditional practices to fail, no matter how aggressively information managers address dimensions beyond volume."  Another challenge is trying to understand how to use unstructured formats, such as text and video (McDonnell, 2011).  According to McDonnell, some other challenges include storage of this data and getting the most important data to the right people at the right time.  And of course there are going to be immense challenges when it comes to security and privacy.

Big Data in Healthcare

Is big data important to healthcare?  Irfan Khan (2012) says that if we estimate that each of our cells contains 1.5 GB of data, each one of us is walking around with approximately 150 zettabytes of data.  Thanks 150 billion terabytes.  So, it seems, big data is already in health care.  We just need to capture this data. By capturing this data there is a great potential for improved healthcare "including personalization of care, defining patient populations with a greater level of granularity, analysing unstructured data, mining claims data for insights that can improve wellness and patient compliance, advancing medical research, and helping governmental agencies detect fraud, identify best care delivery practices, and improve bio-surveillance (Terry, 2012)."

Big data has big possibilities, including better healthcare outcomes.  It also has big challenges, such as storage, privacy and how to work with new and unstructured data, to name a few.  The benefits outweigh the challenges, however.  mHealth, EHR and all of the technologies related to health informatics will continue to grow big data.  The big question is, are you ready?

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Khan, I.  (2012 November 15).  Where's the big data in healthcare IT? Look in the mirror.  Retrieved from http://www.itworld.com/big-data/315298/where-s-big-data-healthcare-it-look-mirror

McDonnell, S.  (2011 June 21).  Big Data Challenges and Opportunities.  Retrieved from http://spotfire.tibco.com/blog/?p=6793

Saran, C. (n.d.).  What is big data and how can it be used to gain competitive advantage?  Retrieved from http://www.computerweekly.com/feature/What-is-big-data-and-how-can-it-be-used-to-gain-competitive-advantage

Terry, K.  (2012 October 15). Health IT Execs Urged To Promote Big Data.  Retrieved from  http://www.informationweek.com/healthcare/clinical-systems/health-it-execs-urged-to-promote-big-dat/240009034

Wikipedia.  (2012 December 23).  Big Data.  Retrieved from http://en.wikipedia.org/wiki/Big_data

Is cloud computing safe for healthcare?

So I am learning today one of the pitfalls of this new [old] technology called Cloud computing.  AWS, the cloud service from Amazon, has gone down.  How did I notice?  It took Netfilx down with it, meaning I am missing out on my Star Trek marathon I had planned for Christmas Eve.  So this has me thinking.  How can we trust cloud computing?  Can we trust it with healthcare, where there are so many life or death decisions made everyday?  What ways can be implemented to ensure uptime if using cloud computing in healthcare?  Any thoughts?

Link: Netflix Down!!

mHealth's Emergence

Not too long ago I thought I had the best technology in the world.  Someone could call my number and this little gadget on my hip would beep.  I could then call them back.  As I look back at those days in nostalgia, I also think that this was also the latest in "mobile health" technology.  In an emergency a doctor could be reached at any time and respond to the needs of his or her patients.  Now days if we need to contact our doctor the latest emerging trend is mobile health or mHealth.  Messages, images, prescriptions, notes and all sorts of medical information are now traded on mobile phones and tablets.  mHealth is posed to change the way we interact with our providers, view our medical history and try to "self-diagnose" ourselves.  But this is not all that mHealth is bringing us.  We can also track our weight, create workout programs and monitor how we eat.  Diabetics can have their blood sugar automatically sent to their doctors, who in turn can create health plans to keep these people on track.

This all sounds like it is going to make life easier for all of us, right.  Well for certain groups of people these advancements are far from easy.  These people are the politicians and regulatory groups that must enforce safe and secure transfer of data.  People selling applications must also sell the products in a harsh economical environment, and find a way to convince consumers that it is worth paying for some of these pieces of software.  There are also researchers who must conduct studies to see how these technologies will fit in an ever-changing social environment.  And last but not least, the people that must build the infrastructure to support this massive flow of information.  Lets take a look at some of these complexities and see how mHealth will move forward.

Politics, Regulations and Your Mobile Freedom

Ponemon Institute, a research organization that conducts studies on privacy, data protection and information security policies, found that 94% of healthcare organizations have had at least one data breach in the past two years (SIW Editorial Staff, 2012).  This number is scary.  The most common types of breaches include lost equipment, employee errors, third-party error, criminal attack and technology glitches (SIW Editorial Staff, 2012).  Now with the rise of mHealth, there is a new avenue for private data to be leaked to people who should not have access.  Yes we are entering a world of more mobile access, but this access comes with a price.  This price is the potential for data to be stolen, lost or mishandled.  Eric Wicklund (2012), editor at mHIMSS, learned from Peter Tippett of Verizon Enterprise Solutions that "healthcare is 'dead last' among industries in using cloud computing and IT" and that "part of the reason for that is regulatory overhang."  Technology is advancing and healthcare is just entering the game.  There are many regulations and laws to be created to make sure data is safe as it flies over the airways.  Also with Bring Your Own Device (BYOD) it is becoming difficult for CIOs to find a happy medium between company policy and the law (Comstock, 2012). 

mHealth Faces the Economy

The economy may be a barrier to mHealth adoption, especially in developing nations.  Dan Jellinek (2012), states that one barrier is lack of investment funds because of the worldwide economic crisis.  Another is the misalignment of funding incentives (Jellinek, 2012).  He advises that governments around the world take these into account when planning infrastructure and policy (Jellinek, 2012). 

How mHealth will affect the Socio-Economic Climate

There is no doubt that this emerging technology will make an impact on how healthcare is delivered.  Studies are already being done on how far the impact will be.  The Boston Consulting Group (BCG) was commissioned to study these impacts.  These impacts will be especially felt in emerging economies.  BCG found that mHealth will provide the solutions needed in these economies and do it quickly (BCG, 2012).  They also found that mHealth will free up health resources by reducing paperwork, reducing human error, avoid duplication and reduce administrative burdens by 20 - 30 percent (BCG, 2012).  This will go a long way in countries that face short budgets and start to save and improve lives all over the globe.  Another example of the socio-economic effect is how mHealth will improve mother and child health.  Voice of America (2012) (VOA) gives the scenario of a pregnant woman whose mobile device sends messages timed to her pregnancy that tells her what to do and when to do certain things.  It will even alert her when to get special treatment, or prevention care (VOA, 2012). 

Building a Foundation

When using the technology to facilitate mHealth, there are a few challenges that need to be considered when building the infrastructure on which all platforms will live.  One consideration is the quality of connection and performance of the end device, according to Jenny Laurello (2011).  There must be a high quality of connections (Laurello, 2011).  Unfortunately in most cases connects on mobile devices are not as consistent as a desktop device (Laurello, 2011).  One way around this is to create a wireless network at the organization that can accommodate the increased load of all the mobile devices (Laurello, 2011). 

As you can see mHealth will make a great impact on healthcare of the future.  There are few barriers such as lack of oversight and regulation that can lead to data breaches, and key parts of the infrastructure must be upgraded, especially wireless technology like Wi-Fi.  There is also the lack of investment in a world recovering from a global economic catastrophe.  If these barriers can be over come the socio-economic affect will be saved and improved lives across the world and because of this the future of mHealth looks bright.

References:

Boston Consulting Group.  (2012 April).  The Socio-Economic Impact of Mobile Health.  Retrieved from http://telenor.com/wp-content/uploads/2012/05/BCG-Telenor-Mobile-Health-Report-May-20121.pdf

Comstock, J.  (2012 December 06).  BYOD, HIPAA are rock and hard place for CIOs.  mobihealthnews.  Retrieved from http://mobihealthnews.com/19385/byod-hipaa-are-rock-and-hard-place-for-cios/

Jellinek, D.  (2012).  A changing world.  Vodafone mHealth Solutions.  Downloaded from http://mhealth.vodafone.com/health_debate/insights_guides/politics_economics/index.jsp

Laurello, J.  (2011 June 28).  Network and infrastructure considerations for mHealth and mobile devices.  Retrieved from http://www.circadence.com/news/current/Network-and-infrastructure-considerations-for-mHealth-and-mobile-devices

SIW Editorial Staff.  (2012 December 10).  Study: Healthcare Data Breaches A Growing Concern.  SECURITYINFOWATCH.COM.  Retrieved from http://www.securityinfowatch.com/news/10840149/study-healthcare-data-breaches-a-growing-concern

Voice of America.  (2012 December 05).  Using a Mobile Phone to Improve Mother and Child Health.  Retrieved from http://learningenglish.voanews.com/content/wireless-phone-pregnancy-mama-baby-medical-mobile/1559325.html

Wicklung, E.  (2012 December 04).  Verizon's Tippett says mHealth data transfer and security must be invisible and seamless.  mHIMSS.  Retrieved from http://www.mhimss.org/news/verizons-tippett-says-mhealth-data-transfer-and-security-must-be-invisible-and-seamless

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