1.  What demographic variables were measured at the nominal level of measurement in the Oh et al. (2014) study? Provide a rationale for your answer.

2.   What statistics were calculated to describe body mass index (BMI) in  this study? Were these appropriate? Provide a rationale for your answer.

3.   Were the distributions of scores for BMI similar for the intervention  and control groups? Provide a rationale for your answer.

4.  Was there a significant difference in BMI between the intervention and control groups? Provide a rationale for your answer.

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5.   Based on the sample size of N = 41, what frequency and percentage of  the sample smoked? What frequency and percentage of the sample were  non-drinkers (alcohol)? Show your calculations and round to the nearest  whole percent.

6.  What measurement method was used to measure the  bone mineral density (BMD) for the study participants? Discuss the  quality of this measurement method and document your response.

7.   What statistic was calculated to determine differences between the  intervention and control groups for the lumbar and femur neck BMDs? Were  the groups significantly different for BMDs?

8.  The researchers  stated that there were no significant differences in the baseline  characteristics of the intervention and control groups (see Table 2).  Are these groups heterogeneous or homogeneous at the beginning of the  study? Why is this important in testing the effectiveness of the  therapeutic lifestyle modification (TLM) program?

9.  Oh et al. (2014,  p. 296) stated that “the adherence rate to the TLM program was 99.6%.”  Discuss the importance of intervention adherence, and document your  response.

10.  Was the sample for this study adequately described? Provide a rationale for your answer.

  Security of Health Care Records

With the increase of health information technology used to store and access patient information, the likelihood of security breaches has also risen. In fact, according to the Canadian Medical Association Journal (CMAJ):

In the United States, there was a whopping 97% increase in the number of health records breached from 2010 to 2011… The number of patient records accessed in each breach has also increased substantially, from 26,968 (in 2010) to 49,394 (in 2011). Since August 2009, when the US government regulated that any breach affecting more than 500 patients be publicly disclosed, a total of 385 breaches, involving more than 19 million records, have been reported to the Department of Health and Human Services. 

A large portion of those breaches, 39%, occurred because of a lost, stolen, or otherwise compromised portable electronic device—a problem that will likely only get worse as iPads, smartphones, and other gadgets become more common in hospitals. (CMAJ, 2012, p. E215). 

Consider your own experiences. Does your organization use portable electronic devices? What safeguards are in place to ensure the security of data and patient information? For this Discussion you consider ethical and security issues surrounding the protection of digital health information.

To prepare

· Review the Learning Resources dealing with the security of digital health care information. Reflect on your own organization or one with which you are familiar, and think about how health information stored electronically is protected.

· Consider the nurse’s responsibility to ensure the protection of patient information. What strategies can you use?

· Reflect on ethical issues that are likely to arise with the increased access to newer, smaller, and more powerful technology tools.

· Consider strategies that can be implemented to ensure that the use of HIT contributes to an overall culture of safety.

Required Readings

McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett Learning. 

• Chapter 5, “Ethical Applications of Informatics”

This chapter examines the ethical dilemmas that arise in nursing informatics. The authors explore the responsibilities for the ethical use of health information technology.

• Review Chapter 23 “Research: Data Collection,      Processing, and Analytics” (pp. 415–416)

In this section, the author explains information fair use and copyright restrictions. The section describes processes for ensuring the security of a computer network.

Brown, B. (2009a). Improving the privacy and security of personal health records. 

Journal of Health Care Compliance, 11(2), 39–40, 68.

The author of this article examines the use of the document titled “Nationwide Privacy and Security Framework for Electronic Exchange of Individually Identified Health Information.” The article describes how the framework aims to construct an approach to address the privacy and security challenges that come with health information exchanges and personal health records.

Dimitropoulos, L., Patel, V., Scheffler, S. A., & Posnack, S. (2011). Public attitudes toward health information exchange: Perceived benefits and concerns. 

American Journal of Managed Care, 17, SP111–SP116.

This article describes a study that sought to determine the attitude of consumers toward electronic health information exchanges (HIE), HIE privacy and security concerns, and the relationship between these concerns and the perceived benefits of HIE. The authors recommend solutions to some of the privacy challenges stimulated by HIE. 

Goodman, K. W. (2010). Ethics, information technology, and public health: New challenges for the clinician-patient relationship. Journal of Law, Medicine & Ethics, 38(1), 58–63. 

In this article, the authors focus on how nurses can use health information technology to help transform health care using the recommendations included in the 2010 Institute of Medicine report “The Future of Nursing, Leading Change, Advancing Health.” The author also discusses the 2011 National Strategy for Quality Improvement in Health Care.

Hoffman, S., & Podgurski, A. (2011). Meaningful use and certification of health information technology: What about safety? Journal of Law, Medicine & Ethics, 39(3), 425–436. 

This article stresses the necessity of sufficient safeguards for EHR systems. The author explores current safety regulations for EHR system design and deployment. The author makes additional recommendations for protecting public health in the digital area.

 

Rothstein, M. A. (2010). The Hippocratic bargain and health information technology. Journal of Law, Medicine & Ethics, 38(1), 7–13. 

The increasing availability of sensitive patient information granted by electronic health records has generated significant debate about patient privacy. This article examines the potential ethical and legal consequences of patient-directed sequestering of sensitive health information.

Optional Resources

Brown, B. (2009b). Privacy provisions of the American Recovery and Reinvestment Act. Journal of Health Care Compliance, 11(3), 37–38, 72–73. 

Retrieved from the Walden Library databases.