Information Technology, Ethics and Integrity

Today I learned about and visited IT expert John Halamka’s new blog – “Life as a Healthcare CIO.” It is a very interesting site, and while it is not about ethics per se, readers with a serious interest in the practical aspects of how organizations can strengthen their ethical climate will find it useful.

In teaching about organizational ethics I often quote the aphorism: “if the CEO is not Chief Ethics Officer, developing an ethics program will probably be a waste of time.” For ethics activities to succeed CEOs don’t have to lead them – but their strong support is vital. After reading Halamka’s blog I have a new aphorism: “if the CIO is not Chief Integrity Officer…”

Two of Halamka’s first three postings have major ethical implications. His discussion of his own change of attitude on flexible work arrangements and telecommuting shows deep respect for the well-being of workers as well as for their productivity. His view is – if technologically enabled flexibility sustains (or better, improves) productivity and increases staff satisfaction, let’s try it. And the last two sentences of his posting about “the top 10 things a CIO can do to enhance security” sound like an ethically concerned clinician, not a technological geek:

“Compliance with HIPAA is a key motivator to implement good security, but most important is retaining the trust of our patients. We are the stewards of their data and our security systems are the last defense against breaches of confidentiality.”

Halamka’s blog got me thinking about my own experience with IT in the group practice I have been part of for 32 years. I don’t do anything fancy, but the electronic medical record lets me integrate what I do with patients with clinicians who are at a distance from us. I have sat at the terminal with a patient just beginning to acknowledge an alcohol problem and collaboratively composed a clinical note that would go to his primary care physician. We bargained. I yielded on “alcoholism” and agreed to “alcohol problem.” For my patient that was a step forward. The electronic substrate facilitated collaboration, communication, and acknowledgment of the alcohol problem. And secure email allows for richer exchange with patients in ways that can serve their convenience and mine.

It is increasingly true that IT functions as the nervous system of health organizations. It shapes our capacity to communicate with patients and colleagues. At its best IT enables wide communication combined with privacy protections. It can enhance or impede the quality of clinician-patient relationships.

Those of us who work with organizations on the ethical quality of their environments have learned how important it is for ethics and compliance to work together. Halamka shows us how IT must also be part of that equation.