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The Scenario and Its Ethical and Legal Issues
The present case study considers the issue of the lack of an appropriate tracking mechanism of certain reporting processes at a tertiary-care hospital. In particular, an audit has shown that it is impossible to determine the whether the reporting of the instances of child abuse, cancer, and communicable diseases takes place or not. The director of health information services is expected to evaluate the situation and offer a solution.
Healthcare providers are required by the law to report certain events, including child abuse and certain diseases (Janati, Hosseiny, Gouya, Moradi, & Ghaderi, 2015; Pietrantonio et al., 2013), since they can be viewed as public health concerns (Barraza, Collmer, Meza & Penunuri, 2015).
There is no direct conflict between the requirement to report the information and the privacy of the patients because public health concerns are taken into account in the Health Insurance Portability and Accountability Act (1996). The solutions for typical and ambiguous cases of the disclosure can be guided by the explanations and decision-making tools provided by the Office for Civil Rights (2017).
It can be suggested that the audit does not reveal a blatant violation of the mentioned requirements since it cannot determine the lack of reporting, but the fact that the reporting process cannot be tracked implies that violations could have occurred. Moreover, the lack of tracking mechanisms indicates that the process cannot be evaluated and improved; in case violations or other issues occur, they might not be determined and resolved, which demonstrates the neglect of legal requirements and public health concerns. Therefore, both ethical and legal issues are present, and the problem needs to be solved.
Resolving the Problem
Inadequate reporting infrastructure often plagues hospitals all over the world (Janati et al., 2015), and an appropriate tracking system is required to support a functional reporting policy. To develop such tracking systems, it is necessary to review the existing one (if it is present) and establish the needs and opportunities of the hospital in this respect. For example, the scenario mentions difficulties with the documentation of the events of reporting, which might be caused by the lack of appropriate training or guidelines on documentation.
If any of these issues is found, it needs to be specifically addressed: the guidelines can be reviewed, and the training can be carried out, for example, with the help of the tools of the Office for Civil Rights (2017). To sum up, an investigation is needed to determine specific problems and produce appropriate solutions, which should culminate in the development and implementation of a customized tracking system.
Future Challenges and Measures to Avoid Repeating the Issue
Some of the issues that the hospital might encounter in the future include the adoption of new technologies or the development of new legal requirements, including local ones (Barraza et al., 2015; Cornelius, Harman, & Mullen, 2015), both of which may require the revision of the existing reporting process. However, both these challenges can also be viewed as opportunities: upon meaningful adoption, the former is bound to facilitate the work of the staff, and the latter is likely to improve the hospitals ability to protect the privacy of the patients and respond to public health concerns.
In any case, the revised, functional reporting system with appropriate tracking mechanisms is likely to produce a sufficient amount of feedback to ensure its continuous evaluation, which is required for the timely determination of weaknesses and issues and their resolution. As a result, I suggest that the ambiguity of the future changes, which might be the biggest predicament of health information professionals, can be resolved through the relevant, customized monitoring of internal and external systems.
References
Barraza, L., Collmer, V., Meza, N., & Penunuri, K. (2015). The legal implications of HIPAA privacy and public health reporting for correctional facilities. Journal of Correctional Health Care, 21(3), 213-221.
Cornelius, F., Harman, L., & Mullen, V. (2015). Future challenges and opportunities. In L. Harman & F. Cornelius (Eds.), Ethical Health Informatics (pp. 693-725). Burlington, MA: Jones & Bartlett Learning.
Health Insurance Portability and Accountability Act, Pub. L. No. 104-191, § 264, 110 Stat. 2030.
Janati, A., Hosseiny, M., Gouya, M. M., Moradi, G., & Ghaderi, E. (2015). Communicable Disease Reporting Systems in the World: A Systematic Review Article. Iranian journal of public health, 44(11), 1453-1465.
Office for Civil Rights. (2017). A decision tool: Overview.
Pietrantonio, A., Wright, E., Gibson, K., Alldred, T., Jacobson, D., & Niec, A. (2013). Mandatory reporting of child abuse and neglect: Crafting a positive process for health professionals and caregivers. Child Abuse & Neglect, 37(2-3), 102-109.
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