For example, if a corporation wanted to make ordering prescriptions on-line mandatory for a group of retirees, major resistance and

political lobbying might be encountered because some retirees would not be ready to go on-line. They would prefer to visit their local pharmacies, gaining assurance from those whom they have trusted for years and discussing dosages and alternative prescriptions face to face. Many elderly patients also do not like having to remember a series of passwords and policy identification numbers and fear being kicked out of the system for not doing it correctly. They are also fearful of security and privacy violations, because of the many horror stories that they have heard over the years. Conversely, if the system were to be presented to newly hired school teachers, the reaction might well be different, given the group¶s likely experience with the Internet and also their intense time management issues.

concerns about privacy and ethics; issues brought on by a lack of standards and standardization; issues of data validity and identity authentication; and concerns about potential misuse, misinterpretation, and mismanagement of electronic information sources.

MISMANAGEMENT Another major risk category in implementing e-health technologies has to do with mismanagement of e-technologies. According to a survey by the Northeast Chapter of the AMA, ³only 14 percent of physicians would recommend the Internet as a medical information resource for patients´ (West, 1998). This attitude is attributed to the fact that physicians believe that consumers will be unable to distinguish high-quality information from poor-quality information on the Internet. Since virtually anyone can post information on the Internet, it is sometimes difficult to separate scientific medical information from not-so-scientific claims. Further, the potential for misuse of information (such as that in patient records) that is collected and then made available via the WEB is another major concern.

The purpose of this paper is to propose a case-based approach to instruction regarding ethical issues raised by the use of information technology (IT) in healthcare. These issues are rarely addressed in graduate degree and continuing professional education programs in health informatics. There are important reasons why ethical issues need to be addressed in informatics training. Ethical issues raised by the introduction of information technology affect practice and are ubiquitous. These issues are frequently among the most challenging to young practitioners who are ill prepared to deal with them in practice. First, the paper provides an overview of methods of moral reasoning that can be used to identify and analyze ethical problems in health informatics. Second, we provide a framework for defining cases that involve ethical issues and outline major issues raised by the use of information technology. Specific cases are used as examples of new dilemmas that are posed by the introduction of information technology in healthcare. These cases are used to illustrate how ethics can be integrated with the other elements of informatics training. The cases discussed here reflect day-to-day situations that arise in health settings that require decisions. Third, an approach that can be used to teach ethics in health informatics programs is outlined and illustrated.

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