Applied ethics and eHealth: principles, identity, and RFID.

The social and ethical implications of contemporary technologies are becoming an issue of steadily growing importance. This paper offers an overview in terms of identity and the field of ethics, and explores how these apply to eHealth in both theory and practice. The paper selects a specific circumstance in which these ethical issues can be explored. It focuses particularly on radio-frequency identifiers (RFID). It ends by discussing ethical issues more generally, and the practice of ethical consideration

eHealth and ethics: theory, teaching, and practice.

The use of information and communication technologies (ICT) is increasing rapidly in many spheres of contemporary life in Europe. The ethical use of ICT in all areas of its application is of growing importance. This is especially evident in the field of healthcare. The regional, national, and Europe-wide electronic aspects of health services and systems are related fundamentally to these two developments. This chapter explores the relevance of ethics to eHealth generally. It outlines two main contrasting ideas that have influenced ethical thought: Kantian ethics and consequentialism. It investigates the ways in which teaching and practice for ICT professionals and trainees can be enhanced and extended to increase the awareness of ethical issues in eHealth. It takes as examples two technological applications that are in increasing use in the eHealth field: electronic health records and radio frequency identification devices. The chapter ends with a brief discussion and conclusions about how this ethical awareness can be expanded beyond ICT professionals to other stakeholder groups, and to other eHealth technologies or applications

Health Technology Assessment and Decision-Making Processes: The Purchase of Magnetic Resonance Imaging Technology

Medical devices play an essential role in health care. For instance, magnetic resonance imaging (MRI) has revolutionized the way images of the human body are acquired. However, although medical devices improve diagnosis and treatment, they are also one of the causes of increasing health expenditure. Thus, the purchase of new technologies and the determination of how and when they should be used are among the most important decisions made in the health care system in general, and by hospital decisionmakers in particular. Health technology assessment (HTA) studies aim to provide a range of stakeholders with accessible, usable and evidence-based information to guide decisions about the use and diffusion of technology and efficient allocation of resources. For this reason, HTA acts as a bridge between evidence and decision-making by ensuring better synthesis, communication and dissemination of information. However, empirical research on decision processes in the purchase of medical devices is sparse, and a gap on this topic was found in the literature. The present research focuses on the Portuguese health system and sheds light on the characterization of decision-making processes by those involved in MRI purchases, in order to understand the influences of HTA. In terms of research design, two strategies were chosen, aiming at different objectives. To characterize the decision-making process a mixed method was chosen. Data was collected using a questionnaire (40 respondents), and parallel semi-structured interviews (27 participants). Both data sets were analysed and merged. Descriptive statistics were chosen as a data analysis strategy, as well as content analysis (categorical analysis). To assess competences for decision-making a questionnaire retrieving only quantitative data was developed (369 valid respondents), and Exploratory Factorial Analysis was performed, followed by Structural Equation Modelling (Confirmatory Factorial Analysis and Path Analysis). Results show that steps in the decision process are well-defined. Cost and suppliers’ characteristics are seen as the most important indicators to guide decisions. Few studies are performed to support the decision, and these are mostly related to the workload of the Radiology Department. No national or international HTA study was used to support any decisions. The decision process is characterized by a bounded rationality, influenced by intuition and a consultant decision-maker. The decision is a bottomup process where information gathering and consensus building is undertaken by a committee, although external consultancy is also used. The reasoning and justification for selection of committee members is unclear. The process is considered to be bureaucratic, time-consuming and long. Patients are negatively perceived as stakeholders in the process. Their experiences, needs and expectations are not considered. vi Decision-makers in Portugal have limited knowledge and training in areas of decision-making, health informatics, health economics and especially HTA. This may limit their ability to truly understand the future implications of their purchase decisions. Recommendations are made to: (1) deepen the present research in particular regarding the elements that influence the strategies and tactics adopted in the decision-making process for the acquisition of medical devices (2) foster the uptake of HTA by decision-makers with the establishment of an HTA in-house unit, able to carry out TA studies considering the hospital context and aiming to inform managerial local decisions on the uptake or disinvestment of medical devices (3) promote a team comprise by not only TA multidisciplinary researchers but also by professionals from the health institution able to carry out HTA studies (3) foster common languages and values to increase uptake of HTA studies

The Ethics of Medical Data Donation

This open access book presents an ethical approach to utilizing personal medical data. It features essays that combine academic argument with practical application of ethical principles. The contributors are experts in ethics and law. They address the challenges in the re-use of medical data of the deceased on a voluntary basis. This pioneering study looks at the many factors involved when individuals and organizations wish to share information for research, policy-making, and humanitarian purposes. Today, it is easy to donate blood or even organs, but it is virtually impossible to donate one’s own medical data. This is seen as ethically unacceptable. Yet, data donation can greatly benefit the welfare of our societies. This collection provides timely interdisciplinary research on biomedical big data. Topics include the ethics of data donation, the legal and regulatory challenges, and the current and future collaborations. Readers will learn about the ethical and regulatory challenges associated with medical data donations. They will also better understand the special nature of using deceased data for research purposes with regard to ethical principles of autonomy, beneficence, and justice. In addition, the contributors identify the key governance issues of such a scheme. The essays also look at what we can learn in terms of best practice from existing medical data schemes

The Ethics of Medical Data Donation

This open access book presents an ethical approach to utilizing personal medical data. It features essays that combine academic argument with practical application of ethical principles. The contributors are experts in ethics and law. They address the challenges in the re-use of medical data of the deceased on a voluntary basis. This pioneering study looks at the many factors involved when individuals and organizations wish to share information for research, policy-making, and humanitarian purposes. Today, it is easy to donate blood or even organs, but it is virtually impossible to donate one’s own medical data. This is seen as ethically unacceptable. Yet, data donation can greatly benefit the welfare of our societies. This collection provides timely interdisciplinary research on biomedical big data. Topics include the ethics of data donation, the legal and regulatory challenges, and the current and future collaborations. Readers will learn about the ethical and regulatory challenges associated with medical data donations. They will also better understand the special nature of using deceased data for research purposes with regard to ethical principles of autonomy, beneficence, and justice. In addition, the contributors identify the key governance issues of such a scheme. The essays also look at what we can learn in terms of best practice from existing medical data schemes

Phenomenological Assessment of Integrative Medicine Decision-making and the Utility of Predictive and Prescriptive Analytics Tools

The U.S. Healthcare system is struggling to manage the burden of chronic disease, racial and socio-economic disparities, and the debilitating impact of the current global pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). More patients need alternatives to allopathic or “Western” medicine focused on fighting disease with mechanism, pharmaceuticals, and invasive measures. They are seeking Integrative Medicine which focuses on health and healing, emphasizing the centrality of the patient-physician relationship. In addition to providing the best conventional care, IM focuses on preventive maintenance, wellness, improved behaviors, and a holistic care plan. This qualitative research assessed whether predictive and prescriptive analytics (artificial intelligence tools that predict patient outcomes and recommend treatments, interventions, and medications) supports the decision-making processes of IM practitioners who treat patients suffering from chronic pain. PPA was used in a few U.S. hospitals but was not widely available for IM practitioners at the time of this research. Phenomenological interviews showed doctors benefit from technology that aggregates data, providing a clear patient snapshot. PPA exposed historical information that doctors often miss. However, current systems lacked the design to manage individualized, holistic care focused on the mind, body, and spirit. Using the Future-Focused Task-Technology Fit theory, the research suggested PPA could actually do more harm than good in its current state. Future technology must be patient-focused and designed with a better understanding of the IM task and group characteristics (e.g., the unique way providers practice medicine) to reduce algorithm aversion and increase adoption. In the ideal future state, PPA will surface healthcare Big Data from multiple sources, support communication and collaboration across the patient’s support system and community of care, and track the various objective and subjective factors contributing to the path to wellness

Opportunities And Challenges of E-Health and Telemedicine Via Satelite

The introduction of Information and Communication Technology (ICT) in the health scenario is instrumental for the development of sustainable services of direct benefit for the European citizen. The setting up of satellite based applications will enhance rapidly the decentralisation and the enrichment of the European territory driving it towards a homogenous environment for healthcare

On designing an algorithmically enhanced NHS: towards a conceptual model for the successful implementation of algorithmic clinical decision support software in the National Health Service

Established in 1948, the National Health Service (NHS) has lasted 75 years. It is, however, under considerable strain: facing chronic staff shortages; record numbers of emergency attendances; an ambulance wait-time crisis; and more. Increasingly, policymakers are of the view that the solution to these problems is to rely more heavily on one of the NHS’s greatest resources: its data. It is hoped that by combining the NHS’s data riches with the latest techniques in artificial intelligence (AI), that the means to make the NHS more effective, more efficient, and more consistent, can be identified and acted upon via the implementation of Algorithmic Clinical Decision Support Software (ACDSS). Yet, getting this implementation right will be both technically and ethically difficult. It will require a careful re-design of the NHS’s information infrastructure to ensure the implementation of ACDSS results in intended positive emergence (benefits), and not unintended negative emergence (harms and risks). This then is the purpose of my thesis. I seek to help policymakers with this re-design process by answering the research question ‘What are the information infrastructure requirements for the successful implementation of ACDSS in the NHS?’. I adopt a mixed-methods, theory-informed, and interpretive approach, and weave the results into a narrative policy synthesis. I start with an analysis of why current attempts to implement ACDSS into the NHS’s information infrastructure are failing and what needs to change to increase the chances of success; anticipate what might happen if these changes are not made; identify the exact requirements for bringing forth the changes; explain why the likelihood of these requirements being met by current policy is limited; and conclude by explaining how the likelihood of policy meeting the identified requirements can be increased by designing the ACDSS’s supporting information infrastructure around the core concepts of ‘utility, usability, efficacy, and trustworthiness’