Ethics and Privacy in Nutrition Informatics

For guidance about ethics, health care often relies on the principles of respect for autonomy, nonmaleficence, beneficence, and justice.¹ Respecting autonomy means allowing individuals control over their lives. Nonmaleficence requires refraining from harming patients, while beneficence entails providing beneficial care. (Beneficence also includes preventing harm – as opposed to refraining from harm, which is nonmaleficence.) Justice seeks a fair distribution of resources and responsibilities.Clinicians and institutions using EMR systems must ensure patient health information.

confidentiality and protect patient privacy. With computer systems this seems a difficult task because records are easily shared with more people: physicians, nurses, other clinicians, clerks, coders, managers, information technology staff, insurance personnel, the government, patients, vendor staff, and even patients themselves. Health information exists not only in an institution’s electronic medical records but is also made available through health information exchanges, personal health records, and patient portals.

Reference:

//www.ncbi.nlm.nih.gov/pmc/articles/PMC6376961/

IMPLICATIONS OF ETHICS AND PRIVACY IN NUTRITION INFORMATICS

The major U.S. federal law governing health data privacy is the Privacy Rule created under the Health Insurance Portability and Accountability Act (HIPAA)—there are also state-specific privacy laws, and the federal Common Rule, which protects research subjects. Health Insurance Portability and Accountability Act (HIPAA) regulations mandate the privacy and confidentiality of protected health information and apply to covered entities. Covered entities are defined as “health plans, health care clearinghouses, and health care providers who electronically transmit any health information in connection with transactions for which [the US Department of Health and Human Services] has adopted standards.” . Regardless of practice setting, all RDNs and NDTRs must abide by the Code of Ethics for the Profession, which states: “Respect patient/ client’s autonomy. Safeguard patient/ client confidentiality according to current regulations and laws. . A business associate agreement or business associate contract is a contract that binds the service provider to all of the provisions of HIPAA, which protects patient privacy and confidentiality for all data transferred via video conference to the third party. Any devices used to store or transmit patient data should be encrypted so that in the case that the device is lost the data will not be vulnerable. The volume of medical knowledge has far exceeded human capacity, and requires informatics solutions to navigate and apply. The doubling time of medical knowledge in 1950 was estimated at 50 years. By 2020, the doubling time of medical knowledge is expected to shrink to just 73 days.

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//doi.org/10.1016/j.jand.2019.06.004

J Acad Nutr Diet. 2019;119(8):1375-1382

Clinicians and institutions using Electronic Medical Records (EMR) (1) systems must ensure patient health information confidentiality and protect patient )privacy. With computer systems, this seems a difficult task because records are easily shared with more people: physicians, nurses, other clinicians, clerks, coders, managers, information technology staff, insurance personnel, the government, patients, vendor staff, and even patients themselves. Health information exists not only in an institution’s electronic medical records but is also made available through health information exchanges, personal health records, and patient portals.

Those working in health care have a moral (and legal) obligation to protect information confidentiality and patient privacy. Electronic records and associated systems are thus monitored and secured to prevent privacy breaches. The moral basis of such an obligation is in respecting patient autonomy (keeping patients in control of their health information), and refraining from harming and preventing harm to patients (nonmaleficence and beneficence), as might occur, for example, through disclosure of embarrassing information. Patients who feel their health information will be kept confidential will more likely share it willingly with providers, which is important for optimal care. 

Yet despite the existence of the HIPAA (Health Insurance Portability and Accountability Act) regulations and institutional monitoring of records, snooping, hacking, public breaches, and healthcare identity thefts occur (2,3). Clinicians already chafe at what they see as overly strict and burdensome security requirements such as having to constantly log in after a short auto-logout, change passwords at regular time intervals (and meet technical requirements for password acceptability, making them difficult to recall, and be unable to reuse previous passwords), remember multiple user names and passwords for different systems, be unable to store chart notes on computers that leave the facility, establish VPN (Virtual Private Network) connections to access hospital records from home, and authenticate/justify one’s role before accessing particular patient records. Information technology staff need to work with clinicians and seek their input in security techniques, otherwise, they risk clinicians trying to bypass security measures out of frustration.

Ethically thinking, there are a few questions that may arise when one thinks of using EMR and privacy. Several ethical issues arise about the development and use of decision-support technologies. If such a technology is available and might help prevent patient harm or improve patient outcomes, is the provider morally obligated to use it? Since the provider is the ultimate decision-maker, what if the provider relies on decision-support recommendations that prove incorrect? Is the provider morally (or legally) at fault? Does the vendor bear any moral responsibility for incorrect recommendations or faulty software? What if the problem is not faulty information in the system, but rather a poorly designed display that misleads or is easily misinterpreted by the provider? The ethical issue for health care professionals is about what guidance to give patients about the use of sites dispensing information, advice, or medications. Steering patients away from all such sites seems unrealistic. Recommending specific reputable sites may be more helpful, but obviously, self-diagnosis from web information is no substitute for seeing a provider. Some hospitals and practices themselves make health information available on the web in an attempt to provide a reliable source of information for patients. Cautioning patients about online prescription purchases from questionable sites would also seem important. Again, though, sometimes here we see a tension between following the obligation to respect patient autonomy and preventing harm to patients (beneficence).

(1)  Layman E. Health informatics, ethical issues. Health Care Manager. 2003;22(1):2–15. [PubMed] [Google Scholar]

(2) Sittig DF, Singh H. Legal, ethical, and financial dilemmas in electronic health record adoption and use. Pediatrics. 2011;127(4):e1042–e1047. [PMC free article] [PubMed] [Google Scholar]

//www.ncbi.nlm.nih.gov/pmc/articles/PMC6170081/#b3-ms112_p0053 ‌" target="_blank" rel="noopener">Phillips, W. (2015). Ethical controversies about proper health informatics practices. Missouri Medicine, 112(1), 53–57. //www.ncbi.nlm.nih.gov/pmc/articles/PMC6170081/#b3-ms112_p0053 ‌

Big data can improve healthcare quality and efficiency by enabling more powerful evaluations and promoting care improvement. It can measure hospital quality, develop scientific hypotheses, compare interventions' effectiveness, and monitor drug and device safety using tools like the Centers for Medicare and Medicaid Services Hospital Inpatient Quality Reporting program.

A new collection of quickly evolving tools employs artificial intelligence approaches to discover patterns in large amounts of health data, which may subsequently be utilized to generate predictions and suggestions in care. Image analysis is the most well-known of these technologies, which is beginning to enter clinical practice.
AI algorithms could also give therapeutic recommendations. Finally, and rather controversially, AI algorithms may be used to assist with resource allocation decisions. All of these applications necessitate massive amounts of data from health care: how patients were treated, how they responded, and data on the patients themselves, such as genetic data, family history, health behavior, and vital signs. Algorithms cannot be taught or assessed on their performance without these data.

Sources: //www.ncbi.nlm.nih.gov/pmc/articles/PMC6376961/

Health informatics is the study of health care information and communication, both of which have been profoundly influenced in recent years by health care providers’ and patients' use of computers and the internet. Electronic medical records (EMRs), electronic health records (EHRs) and computerized provider order entry (CPOE) are currently used in many practices. Patients frequently search the internet for health information. However, some use of computers in health care are contentious and create ethical considerations, particularly when patient safety and outcomes are at stake.

Health care frequently relies on the concepts of autonomy, nonmaleficence, beneficence, and justice for ethical direction. Respecting autonomy entails giving people authority over their life. Nonmaleficence means not causing harm to patients, and beneficence entails delivering beneficial care. (Beneficence also entails preventing injury, as opposed to nonmaleficence, which is refraining from harm.) Justice seeks an equitable allocation of resources and duties.

These principles apply to health informatics practice. We observe a repeating theme of difficulties between the norms of autonomy, beneficence, and nonmaleficence in the debate over the ethics of such computer use in health care.

EMR systems, for example, can help patients by enhancing access, quality, coordination, and cost. If the optimal use of EMR, EHR and CPOE systems produces significant patient benefit, health care providers appear to have a moral imperative to employ them. However, some health care providers find such systems to be inconvenient, and patients may view professional usage of such devices during medical visits to be intrusive. Furthermore, if practitioners use such tools in actual practice, they may participate in potentially harmful documentation procedures. That would put into question whether the employment of such systems is a moral obligation, or simply that such systems, if utilized, must be used in a morally acceptable manner. Tensions between ethical values also exist in the domain of patient usage of the internet and social media. We must protect patients' autonomy in using these technologies while also limiting potential patient harm from erroneous information and illegal prescription pharmaceutical purchases.

Reference:

//www.ncbi.nlm.nih.gov/pmc/articles/PMC6170081/

Working in the health care poses a moral as well as legal obligation on the medical staff to protect information and privacy of patients. The moral basis of such an obligation is in respecting patient autonomy in keeping patients in control of their health information, and refraining from harming and preventing harm to patients, for example, through disclosure of any embarrassing or private information. Further, Patients who feel their health information keep confidential will more likely share it with providers that ensures an optimal care. Moreover, with computer systems it is find to be difficult task for records which are easily shared with more people such as physicians, nurses, clinicians, clerks, coders, managers, information technology staff, insurance personnel, the government, patients, vendor staff, and patients themselves. Therefore, Electronic records and associated systems must be monitored and secured with extra care to prevent privacy breaches.

Reference- 

Phillips W. (2015). Ethical controversies about proper health informatics practices. Missouri medicine, 112(1), 53–57.

Ethics and privacy play crucial roles in the field of Nutrition Informatics which involves the use of technology to collect, analyse and disseminate nutrition-related information.
Nutrition data often contains sensitive and personal information about individuals and respecting privacy ensures that they have control over their personal information and helps prevent unauthorized access, misuse or potential harm resulting from the disclosure of sensitive data.
Many practices now use Electronic Medical Records (EMRs) and Computerised Provider Order Entry (CPOE). Patients often surf the web seeking health information. But some users of computers in health care are controversial and raise ethical concerns especially when patient safety and outcomes are at stake.
Ethics in nutrition informatics encompasses a set of principles and guidelines that govern the responsible use, handling and dissemination of nutrition-related information.
For guidance about ethics health care often relies on the principles of respect for autonomy, nonmaleficence, beneficence and justice. For example, EMR systems can benefit patients by improving care access, quality, coordination and cost.
Electronic records and associated systems are thus monitored and secured to prevent privacy breaches.
Big data has become the ubiquitous watch word of medical innovation which outlines the legal and ethical challenges it brings to patient privacy.
Adhering to ethical principles and privacy regulations in nutrition informatics is essential to build trust among individuals, ensure data security and promote responsible use of data.
Reference: //www.ncbi.nlm.nih.gov/pmc/articles/PMC6170081/

Information technology has transformed daily life, business, entertainment, and health care.

The study of health informatics focuses on information and communication in the healthcare industry, both of which have been significantly impacted by the rise in clinical and patient usage of computers and the internet. Electronic medical records (EMRs) and computerised provider order entry (CPOE) are now widely used in healthcare settings.

Patients frequently search the internet for medical information. However, some applications of computers in healthcare are debatable and give rise to ethical questions, particularly when patient outcomes and safety are at risk.

Ethics is a lens through which we detect issues and a lever by which we formulate and motivate optimal practises.

Ethics should always come first, both to serve as a guide and to lessen the possibility of health-system policies that condone or even encourage unethical behaviour.

The ethical use, processing, and transmission of information about nutrition is governed by a set of rules and guidelines known as nutrition informatics ethics.Health care frequently looks to the ethical precepts of respect for autonomy, nonmaleficence, beneficence, and justice for direction. EMR systems, for instance, are monitored and safeguarded.

Thus, to promote interpersonal trust, guarantee data security, and encourage responsible data use, it is crucial that nutrition informatics adhere to ethical standards and privacy laws.

References

1. //www.ncbi.nlm.nih.gov/pmc/articles/PMC6170081/

2. //www.ncbi.nlm.nih.gov/pmc/articles/PMC7442522/

Implications of Ethics and Privacy in Nutrition Informatics:

Protecting secret information in the digital age is more complicated than preserving hard-copy records in a secured office. Data held in computer systems are vulnerable to hacking and hardware failure and must be safeguarded and backed up to ensure that critical data of a patient's care are not lost. With suitable safeguarding and backup procedures in place, the benefits of electronic records outweigh the hazards. Practitioners that offer telehealth counseling through video conference should work with a third-party provider who will sign a business associate agreement. A business associate agreement or contract commits the service provider to all HIPAA provisions that preserve patient privacy and confidentiality for all data provided via video conference to the third party. Users of free services such as Facetime and Skype do not have business associate agreements in place, making them insecure methods of offering telehealth services. It is excellent practice to use a secure web portal for sending and receiving messages from patients and clients while sending electronic messages. Even if a practitioner uses a secure e-mail server, the recipient may not utilize a secure service, putting personal information at risk. Any devices used to store or transmit patient data should be encrypted so that the data is not compromised if the device is lost. There are free encryption programs available for Windows, Mac, and Linux.

One of HIPAA's most essential tactics for safeguarding patients' privacy while allowing data exchange is deidentifying their data by eliminating a set of 18 specified identifiers such as names and email addresses. However, de-identified data may become re-identifiable through data triangulation from other data sets. Furthermore, HIPAA regulates specific people and their activities rather than the data itself. For example, once patients request their own health data—which HIPAA gives them the right to do and some concerted efforts encourage patients to do—if the patients give those data to another individual, HIPAA does not restrict the use or disclosure of those data (unless the recipient is another covered entity or a business associate).

Some options that guarantee privacy while lowering the cost of innovation should be pursued. In other cases, rather than using identified data, researchers could employ strategies including pseudonymized data or differential privacy. Privacy audits can assure appropriate use, while security requirements should keep unauthorized use at bay. Data owners should be data stewards, not privacy-agnostic intermediaries. Striking the right balance—protecting privacy so that patients are comfortable providing their data while not allowing privacy to drive secrecy, which reduces validation and trust in the potential benefits arising from those data—will be a difficult challenge for supporters of big data, machine learning, and learning health systems. Privacy under protection and overprotection both cause observable harm to patients today and in the future.

references: 

//www.ncbi.nlm.nih.gov/pmc/articles/PMC6376961/  

//doi.org/10.1016/j.jand.2019.06.004

For covered entities, the Health Insurance Portability and Accountability Act (HIPAA) regulations impose strict privacy and confidentiality requirements for protected health information. According to the definition of covered entities, they are "health plans, health care clearinghouses, and health care providers who electronically transmit any health information in connection with transactions for which [the US Department of Health and Human Services] has adopted standards."41 Many RDNs in clinical practise will find themselves employed by a covered entity and be governed by HIPAA regulations. All RDNs and NDTRs are required to adhere to the Code of Ethics for the Profession, which specifies that they must respect the autonomy of their patients and clients. respect the privacy of patients and clients in accordance with the law.

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//www.jandonline.org/article/S2212-2672(19)30517-9/fulltext#secsectitle0065

Law and regulations have an unbreakable connection to ethical concerns. Ethical, legal, and social challenges are now impacting the health informatics professions such as the confidentiality of private patient information, Patient security, Risk assessment, report design, and data visualization System deployment, Curriculum creation, Ethics in research, Liability, User participation and accessibility Ethical dilemmas arising from data availability and sharing. 

Reference

Legal and ethical issues in health informatics. (2020, 10). USF Health  //www.usfhealthonline.com/resources/health-informatics/legal-and-ethical-issues-in-health-informatics/

Application of AI on Nutrition Informatics can be  Applications for microbiota/genes-diet interactions, research into diet-disease links, chatbots for lifestyle intervention, dietary evaluation using food images, and food composition applications etc. Other issues include the "dehumanization" of care, societal inequalities, determining who is to blame when mistakes or problems occur, and bias in teaching models and providing care. Moreover, stigma, over-medicalization, and stress may all be factors in the prediction of illness start in high-risk patients(Paraskevi Detopoulou et al., 2023).

Techno Ethics (TE) serves as a multidisciplinary research field that incorporates theories and techniques from various domains including communications systems, sociology, innovation, ethical theories, and principles.

The five major ethical dilemmas currently faced by emerging technologies are (i) data privacy, (ii) risks associated with Artificial Intelligence, (iii) developing sustainable environments, (iv) health implications due to technology use, and (v) infodemic and data weaponization issues(Lubna Luxmi Dhirani et al., 2023).

An automated electronic privacy policy is assumed by the software program known as the Structured Patient Privacy Policy (S3P) in an electronic healthcare setting. It is intended to replicate various access levels and rights of different healthcare providers so that developing ethical issues can be evaluated(Mizani & Nazife Baykal, 2007).
 

//www.sciencedirect.com/science/article/pii/S2667268523000311

//books.google.co.in/books?hl=en&lr=&id=YeLaDwAAQBAJ&oi=fnd&pg=PA175&ots=MZSAAp5L2w&sig=ffLnxNiUjprOONVqofDjvNO2Mck&redir_esc=y#v=onepage&q&f=false

//www.ncbi.nlm.nih.gov/pmc/articles/PMC2598216/ .

The relevance of a study-subject's privacy and the confidentiality of their personal data is expanding as clinical research practise evolves. The body of study, however, is scattered, and a synthesis of work in this field is absent. As a result, an integrated review was conducted, informed by the work of Whittemore and Knafl. The constant comparison method was used to analyse data from PubMed, Scopus, and CINAHL searches from January 2012 to February 2017. Six topical aspects were identified from 16 empirical and theoretical studies: the evolving nature of health data in clinical research, data sharing, the challenges of anonymizing data, collaboration among stakeholders, the complexity of regulation, and ethics-related tension between social benefits and privacy.

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//journals.sagepub.com/doi/10.1177/1556264618805643