Aspek Etika dan Regulasi terkait
dengan Informatika Kesehatan
Anis Fuad
Departemen Biostatistik, Epidemiologi dan Kesehatan Populasi
FK UGM
Perpaduan antara evolusi teknologi dan
peradaban manusia
Teknologi
Informasi
Perilaku
manusia dalam
berinteraksi
secara sosial dan
bekerja
Status asuhan
keperawatan
tercetak dengan
rapi di RSUD
Contoh penerapan
paperless medical
record
Essential requirements of Information Technology for Primary
Care (Peterson, 2012)
TIK di
pelayanan
kesehatan
dasar
Supporting the personal
relationship Continuity of
Essential requirements of Information Technology for Primary
Care (Peterson, 2012)
TIK di
pelayanan
kesehatan
dasar
Supporting the personal
relationship Continuity of
care
- e atat pasie se agai perso uka hanya diagnosis
-memelihara relasi dokter-pasien -kontekstual
-sepanjang hayat
-standar pelayanan primer
-alur kerja dokter/nakes
-standar kode utk layanan primer -mampu bertukar
informasi antar nakes
Fitur TIK Kesehatan di Pelayanan Primer (Audet et al, 2014)
register danFitur TIK Kesehatan di Pelayanan Primer (Audet et al, 2014)
register danlaporan
-rekam medis pasien elektronik -daftar obat setiap pasien
-daftar hasil lab
-ringkasan kunjungan
-daftar pasien menurut diagnosis
-daftar pasien yg harus skrining
-daftar pasien dg obat tertentu
-daftar pasien dengan hasil lab tertentu
-memasukan resep -memasukkan daftar pemeriksaan lab -mengirim resep ke farmasi
-melihat daftar lab yg masih dalam proses
-alert interaksi/dosis obat -alert hasil lab
-alert skrining
-mengirim reminder ke pasien pasien dapat :
-meminta rujukan online -konsul lewat email
-peresepan online
-melihat hasil lab secara online
-bertukar ringkasan klinik dengan faskes lain
-bertukar hasil
lab/diagnostik dengan faskes lain
TIK pada pelayanan kesehatan dasar di negara berkembang
(Oluch et al, 2012)
•
Kepatuhan terhadap penggunaan pedoman klinis meningkat jika
sistem reminder diterapkan
•
Menurunnya kesalahan: data, penjadwalan, hasil lab, waktu tunggu
pasien
•
Meningkatnya waktu yang dialokasikan oleh klinisi terhadap pasien
•
Tantangan:
•
Infrastruktur, listrik
•
Ketrampilan menggunakan komputer
Satu operator dengan 2 workstation
Dengan 2 aplikasi berbeda
Ada aplikasi billing system tetapi
Entry dg software
Billing system
Status asuhan
keperawatan
tercetak dengan
rapi di RSUD
Proses Approval olehApoteker
1
2
3
4
5
6
7
8
(Availability, utilization, effectiveness, impact)
Hardware and Software Computing
Infrastructure
•
Purely technical
•
Physical devices
•
Software
•
network
Clinical Content
•
everything on the data-information-knowledge
continuum that is stored in the system
•
Clinical vocabulary/terminologies
•
patie ts’ o ditio (e.g., la oratory test results,
Human Computer Interface
•
An interface enables unrelated entities to interact with the system
People
•
represents the humans (e.g., software developers, system
configuration and training personnel, clinicians, and patients) involved
in the design, development, implementation, and use of HIT.
Workflow and Communication
•
people often need to work cohesively with others in the health care
system to accomplish patient care
•
workflow must be modified to adapt to the HIT, or the HIT system
Internal Organizational Policies, Procedures,
and Culture
•
orga izatio ’s i ter al stru tures, poli ies, a d pro edures affe t
External Rules, Regulations, and Pressures
•
the external forces that facilitate or place constraints on the design,
development, implementation, use, and evaluation of HIT in the
clinical setting.
System Measurement
and Monitoring
•
HIT must be measured and monitored on a regular basis:
•
availability
–
the extent to which features and functions are available and
ready for use
•
utilization
- to determine how the various features and functions are being
used by clinicians
•
effectivenes
s - to ensure that anticipated outcomes are achieved
General Ethics
•
1. Principle of Autonomy
•
All persons have a fundamental right to self-determination.
•
2. Principle of Equality and Justice
•
All persons are equal as persons and have a right to be treated accordingly.
•
3. Principle of Beneficence
•
All persons have a duty to advance the good of others where the nature of this good is in keeping
with the fundamental and ethically defensible values of the affected party.
•
4. Principle of Non-Malfeasance
•
All persons have a duty to prevent harm to other persons insofar as it lies within their power to do
so without undue harm to themselves.
•
5. Principle of Impossibility
•
All rights and duties hold subject to the condition that it is possible to meet them under the
circumstances that obtain.
•
6. Principle of Integrity
Information Ethics
•
1. Principle of Information-Privacy and Disposition
•
All persons and group of persons have a fundamental right to privacy, and hence to control
over the collection, storage, access, use, communication, manipulation, linkage and
disposition of data about themselves.
•
2. Principle of Openness
•
The collection, storage, access, use, communication, manipulation, linkage and disposition of
personal data must be disclosed in an appropriate and timely fashion to the subject or
subjects of those data.
•
3. Principle of Security
•
Data that have been legitimately collected about persons or groups of persons should be
protected by all reasonable and appropriate measures against loss degradation, unauthorized
destruction, access, use, manipulation, linkage, modification or communication.
•
4. Principle of Access
•
5. Principle of Legitimate Infringement
• The fundamental right of privacy and of control over the collection, storage, access, use, manipulation, linkage, communication and disposition of personal data is conditioned only by the legitimate, appropriate and relevant data-needs of a free, responsible and democratic society, and by the equal and competing rights of others.
•
6. Principle of the Least Intrusive Alternative
• Any infringement of the privacy rights of a person or group of persons, and of their right of control over data about them, may only occur in the least intrusive fashion and with a minimum of interference with the rights of the affected parties.
•
7. Principle of Accountability
• Any infringement of the privacy rights of a person or group of persons, and of the right to control over data about them, must be justified to the latter in good time and in an appropriate fashion. These general
