211383 Implementing Electronic Health Records for Public Health Practitioners & the Public: Ethical Challenges

Tuesday, November 10, 2009: 10:45 AM

Kirk C. Allison, PhD, MS , Program in Human Rights and Health, University of Minnesota, Minneapolis, MN
While some ethical concerns are common to clinical and public health electronic records as expressed in privacy requirements for personal health information (HIPAA), additional ethical and practical challenges intersect in the HIIT implementation of EHRs for public health practitioners and the public. Several may be clarified through addressing specific questions: 1) What ethical framework is selected and why for forming HIIT policy concerning public health EHRs? 2) What is the role of public consultation (involving the public at large) and public values in cocreating policy for EHR implementation beyond clinical EHRs? 3) What ethical and practical challenges for implementation arise due to differing scopes, interests, and legal prescriptions for public health data compared to clinical data embodied in EHRs (e.g., compulsory vs. voluntary submissions, state to state variation, data sunsets, etc.)? 4) What interagency firewall issues must be addressed regarding genetic or other data (e.g. between public health and state and federal bureaus of criminal investigation)? 5) What (intra-agency) access controls for identifiable and disidentified data are required in research and other contexts and what ethical challenges do such present HIIT professionals as data gatekeepers? 6) Are context-specific ethical boundaries considered routine design parameters in HIIT/EHR system design and implementation? 7) What equity considerations do HIIT infrastructure and public health EHR implementations highlight or embody in resource discrepant contexts (urban/rural, developed/developing world)? 8) What are HIIT-specific vulnerable population risks in EHR implementation and how will an HIIT-specific lens on these influence the recursive regulatory process? What institutional support is provided HIIT practitioners to develop (and defend) critical vigilance in issues such as these? Such highlight the ethical import of HIIT disciplines.

Learning Objectives:
* Identify how the selection of an ethical framework impacts the use of EHRs and their implementation. * Explain the ethical importance of public consultation and co-creation of policy in the context of this emergent technology. * Compare electronic health records in public health vs. clinical contexts (scope, compulsion, consent) and the ethical implications of this difference. * Identify ethical challenges for HIIT professionals as architects, maintainers, and gatekeepers of EHR information including privacy, confidentiality, interests of vulnerable populations, and researchers. * Recognize and incorporate context-specific ethical boundaries as a design parameter in EHR system design and implementation. * Analyze the equity implications of public health EHR implementation in resource discrepant contexts (urban/rural, developed/developing world)

Keywords: Health Information Systems, Ethics

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Immediate past chair of Ethics SPIG; Presented last year in HIIT forum on ethics and HIIT * Informatics background (UG) * Director, Program in Human Rights and Health, University of Minnesota School of Public Health * Research interest: Emergent technology policy forecasting
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.