Abstract
The medical profession is steeped in traditions that guide its practice. These traditions were developed to preserve the well-being of patients. Transformations in science, technology, and society, while maintaining a self-governance structure that drives the goal of care provision, have remained hallmarks of the profession. The purpose of this paper is to examine ethical challenges in health care as it relates to Big Data, Accountable Care Organizations, and Health Care Predictive Analytics using the principles of biomedical ethics laid out by Beauchamp and Childress (autonomy, beneficence, non-maleficence, and justice). Among these are the use of Electronic Health Records within stipulations of the Health Insurance Portability and Accountability Act. Clinicians are well-positioned to impact health policy development to address ethical issues associated with the use of Big Data, Accountable Care, and Health Care Predictive Analytics as we work to transform the doctor–patient relationship towards improving population health outcomes and creating a healthier society.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
IOM is now the National Academy of Medicine (NAM).
References
Amarasingham, R., Audet, A.-M. J., Bates, D. W., Cohen, I. G., Entwistle, M., Escobar, G. J., et al. (2016). Consensus statement on electronic health predictive analytics: A guiding framework to address challenges. EGEMs (Generating Evidence & Methods to Improve Patient Outcomes), 4(1), 1163. https://doi.org/10.13063/2327-9214.1163.
Amarasingham, R., Patzer, R. E., Huesch, M., Nguyen, N. Q., & Xie, B. (2014). Implementing electronic health care predictive analytics: Considerations and challenges. Health Affairs, 33(7), 1148–1154. https://doi.org/10.1377/hlthaff.2014.0352.
American Medical Association. (1848). Code of medical ethics. New York: Ludwig & Company.
Annas, G. J. (2003). HIPAA regulations—A new era of medical-record privacy? New England Journal of Medicine, 348(15), 1486–1490. https://doi.org/10.1056/NEJMlim035027.
Bates, D. W., Saria, S., Ohno-Machado, L., Shah, A., & Escobar, G. (2014). Big data in health care: Using analytics to identify and manage high-risk and high-cost patients. Health Affairs, 33(7), 1123–1131. https://doi.org/10.1377/hlthaff.2014.0041.
Beach, M. C., Meredith, L. S., Halpern, J., Wells, K. B., & Ford, D. E. (2005). Physician conceptions of responsibility to individual patients and distributive justice in health care. Annals of Family Medicine, 3(1), 53–59. https://doi.org/10.1370/afm.257.
Berger, M. L., Mamdani, M., Atkins, D., & Johnson, M. L. (2009). Good research practices for comparative effectiveness research: Defining, reporting and interpreting nonrandomized studies of treatment effects using secondary data sources: The ISPOR good research practices for retrospective database analysis task force report—Part I. Value in Health, 12(8), 1044–1052. https://doi.org/10.1111/j.1524-4733.2009.00600.x.
Berwick, D. M. (2011). Launching accountable care organizations—The proposed rule for the Medicare Shared Savings Program. New England Journal of Medicine, 364(16), e32. https://doi.org/10.1056/NEJMp1103602.
Berwick, D. M., & Hackbarth, A. D. (2012). Eliminating waste in US health care. JAMA, Journal of the American Medical Association,307(14), 1513–1516.
Berwick, D. M., Nolan, T. W., & Whittington, J. (2008). The triple aim: Care, health, and cost. Health Affairs,27(3), 759–769.
Bisognano, M., & Kenney, C. (2012). Pursuing the triple aim: Seven innovators show the way to better care, better health, and lower costs. San Francisco: Jossey-Bass Publishers.
Blendon, R. J., Benson, J. M., & Hero, J. O. (2014). Public trust in physicians—U.S. medicine in international perspective. New England Journal of Medicine, 371(17), 1570–1572. https://doi.org/10.1056/NEJMp1407373.
Blumenthal, D. (2010). Launching HITECH. New England Journal of Medicine, 362(5), 382–385. https://doi.org/10.1056/NEJMp0912825.
Centers for Disease Control and Prevention. (2003). HIPAA privacy rule and public health. Guidance from CDC and the U.S. Department of Health and Human Services. MMWR Supplements,52, 2–12.
Centers for Medicare & Medicaid Services (CMS). (2019). Accountable Care Organizations (ACOs): General Information. https://innovation.cms.gov/initiatives/aco/. Accessed 15 June 2019.
Chaudhuri, A. (2016). Internet of things data protection and privacy in the era of the General Data Protection Regulation. Journal of Data Protection & Privacy,1(1), 64–75.
Chen, C. P., & Zhang, C. Y. (2014). Data-intensive applications, challenges, techniques and technologies: A survey on big data. Information Sciences,275, 314–347.
Childress, T., & Beauchamp, J. (2001). Principles of biomedical ethics. New York: Oxford University Press.
Clay, M. (2005). Ethics consultation: From theory to practice. Psychiatric Services,56(3), 367–368.
Cohen, I. G., Amarasingham, R., Shah, A., Xie, B., & Lo, B. (2014). The legal and ethical concerns that arise from using complex predictive analytics in health care. Health Affairs, 33(7), 1139–1147. https://doi.org/10.1377/hlthaff.2014.0048.
Cookson, R., & Dolan, P. (2000). Principles of justice in health care rationing. Journal of Medical Ethics, 26(5), 323–329. https://doi.org/10.1136/jme.26.5.323.
Cushman, R., Froomkin, A. M., Cava, A., Abril, P., & Goodman, K. W. (2010). Ethical, legal and social issues for personal health records and applications. Journal of Biomedical Informatics, 43(5 Suppl): S51–S55. https://doi.org/10.1016/j.jbi.2010.05.003.
Davenport, T. H., & Dyché, J. (2013). Big data in big companies. SAS Institute Inc. https://docs.media.bitpipe.com/io_10x/io_102267/item_725049/Big-Data-in-Big-Companies.pdf. Accessed 7 June 2019.
Delmonico, F. L., Arnold, R., Scheper-Hughes, N., Siminoff, L. A., Kahn, J., & Youngner, S. J. (2002). Ethical incentives—Not payment—For organ donation. New England Journal of Medicine, 346(25), 2002–2005. https://doi.org/10.1056/NEJMsb013216.
Department of Health & Human Services. (2016). Examining oversight of the privacy and security of health data collected by entities not regulated by HIPAA. Washington DC: U.S. Department of Health and Human Services.
Fisher, E. S., & Shortell, S. M. (2010). Accountable care organizations: Accountable for what, to whom, and how. JAMA, Journal of the American Medical Association, 304(15), 1715–1716. https://doi.org/10.1001/jama.2010.1513.
Fisher, E. S., Staiger, D. O., Bynum, J. P. W., & Gottlieb, D. J. (2007). Creating accountable care organizations: The extended hospital medical staff. Health Affairs, 26(1), w44–w57. https://doi.org/10.1377/hlthaff.26.1.w44.
Fleming, N. S., Becker, E. R., Culler, S. D., Cheng, D., McCorkle, R., Da Graca, B., et al. (2014). The impact of electronic health records on workflow and financial measures in primary care practices. Health Services Research, 49(1 Pt 2), 405–420. https://doi.org/10.1111/1475-6773.12133.
Frank, L., Basch, E., & Selby, J. V. (2014). The PCORI perspective on patient-centered outcomes research. JAMA, Journal of the American Medical Association, 312(15), 1513–1514. https://doi.org/10.1001/jama.2014.11100.
Frieden, T. R., & Berwick, D. M. (2011). The “Million Hearts” Initiative—Preventing heart attacks and strokes. New England Journal of Medicine, 365(13), e27. https://doi.org/10.1056/NEJMp1110421.
Fuentes, M. R. (2017). Cybercrime and other threats faced by the healthcare industry. TrendsLabs Research. [Online]. https://documents.trendmicro.com/assets/wp/wp-cybercrime-and-other-threats-faced-by-the-healthcare-industry.pdf.
Fuks, A., Brawer, J., & Boudreau, J. D. (2012). The foundation of physicianship. Perspectives in Biology and Medicine, 55(1), 114–126. https://doi.org/10.1353/pbm.2012.0002.
Gibson, J. L., Martin, D. K., & Singer, P. A. (2004). Setting priorities in health care organizations: Criteria, processes, and parameters of success. BMC Health Services Research, 4(1), 25. https://doi.org/10.1186/1472-6963-4-25.
Hodson, H. (2016). Revealed: Google AI has access to huge haul of NHS patient data. New Scientist. [Online]. https://www.newscientist.com/article/2086454-revealed-google-ai-has-access-to-huge-haul-of-nhs-patient-data/.
Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.
Jones, S. (1997). The failure of the NHS-distributive justice and health care in Britain. In J. Craughan & R. Fisher (Eds.), UCL Jurisprudence Review (Vol. 7, pp. 163–182). London: Faculty of Laws, University College London.
Kenny, N. P., Mann, K. V., & MacLeod, H. (2003). Role modeling in physicians’ professional formation: Reconsidering an essential but untapped educational strategy. Academic Medicine, 78(12), 1203–1210. https://doi.org/10.1097/00001888-200312000-00002.
Kim, K. K., Joseph, J. G., & Ohno-Machado, L. (2015). Comparison of consumers’ views on electronic data sharing for healthcare and research. Journal of the American Medical Informatics Association, 22(4), 821–830. https://doi.org/10.1093/jamia/ocv014.
King, L. S. (1983). The social transformation of American medicine. JAMA, The Journal of the American Medical Association,249(16), 2237.
King, L. S. (1991). Transformations in American medicine: From Benjamin Rush to William Osler. Baltimore: The Johns Hopkins University Press.
Kluge, E. H. W. (2004). Informed consent and the security of the electronic health record (EHR): Some policy considerations. International Journal of Medical Informatics, 73(3), 229–234. https://doi.org/10.1016/j.ijmedinf.2003.11.005.
Laiteerapong, N., & Huang, E. S. (2015). The pace of change in medical practice and health policy: Collision or coexistence? Journal of General Internal Medicine,30(6), 848–852.
Levin, Rep. S. M. [D-M.-17]. (1990). Patient Self Determination Act of 1990. Retrieved from https://www.congress.gov/bill/101st-congress/house-bill/4449.
Martinez-Inigo, D., & Totterdell, P. (2016). The mediating role of distributive justice perceptions in the relationship between emotion regulation and emotional exhaustion in healthcare workers. Work and Stress,30(1), 26–45.
Martinez-Losas, P., Higueras, J., & Gomez-Polo, J. C. (2017). The computerized interpretation of the electrocardiogram: A double-edged sword? Enfermeria Clinica (English Edition),27(2), 136–137.
Mcgraw, D., Rosati, K., & Evans, B. (2012). A policy framework for public health uses of electronic health data. Pharmacoepidemiology and Drug Safety, 21(Suppl 1), 18–22. https://doi.org/10.1002/pds.2319.
McNamara, A. R. (2015). The accountable care paradigm shift: New ethical considerations. AMA Journal of Ethics,17(7), 622–629.
McWilliams, J. M., Landon, B. E., Chernew, M. E., & Zaslavsky, A. M. (2014). Changes in patients’ experiences in Medicare Accountable Care Organizations. New England Journal of Medicine, 371(18), 1715–1724. https://doi.org/10.1056/NEJMsa1406552.
Mennemeyer, S. T., Menachemi, N., Rahurkar, S., & Ford, E. W. (2016). Impact of the HITECH act on physicians’ adoption of electronic health records. Journal of the American Medical Informatics Association, 23(2), 375–379. https://doi.org/10.1093/jamia/ocv103.
Minelli, M., Chambers, M., & Dhiraj, A. (2013). Big data, big analytics: Emerging business intelligence and analytic trends for today’s businesses. Hoboken: John Wiley & Sons.
Muhlestein, D. B., & Smith, N. J. (2016). Physician consolidation: Rapid movement from small to large group practices, 2013–15. Health Affairs, 35(9), 1638–1642. https://doi.org/10.1377/hlthaff.2016.0130.
Murphy, S. N., & Chueh, H. C. (2002). A security architecture for query tools used to access large biomedical databases. In Proceedings of the AMIA symposium (pp. 552–556).
Office for Human Research Protections. (2016). Federal policy for the protection of human subjects (‘common rule’). [Online]. https://www.hhs.gov/ohrp/regulations-and-policy/regulations/common-rule/index.html.
Orr, R. D., Pang, N., Pellegrino, E. D., & Siegler, M. (1997). Use of the hippocratic oath: A review of twentieth century practice and a content analysis of oaths administered in medical schools in the U.S. and Canada in 1993. Journal of Clinical Ethics,8(4), 377–388.
Parikh, R. B., Kakad, M., & Bates, D. W. (2016). Integrating predictive analytics into high-value care. JAMA, The Journal of the American Medical Association, 315(7), 651–652. https://doi.org/10.1001/jama.2015.19417.
Pellegrino, E. D. (1993). The metamorphosis of medical ethics. JAMA, The Journal of the American Medical Association,269(9), 1158–1162.
Pellegrino, E. D. (1994). Allocation of resources at the bedside: The intersections of economics, law, and ethics. Kennedy Institute of Ethics Journal,4(4), 309–317.
Pellegrino, E. D. (1995). Interests, obligations, and justice: Some notes toward an ethic of managed care. The Journal of Clinical Ethics,6(12), 312–317.
Pellegrino, E. D. (1997). Managed care at the bedside: How do we look in the moral mirror? Kennedy Institute of Ethics Journal, 7(4), 321–330. https://doi.org/10.1353/ken.1997.0036.
Pellegrino, E. D. (2001). The internal morality of clinical medicine: A paradigm for the ethics of the helping and healing professions. The Journal of Medicine and Philosophy, 26(6), 559–579. https://doi.org/10.1076/jmep.26.6.559.2998.
Phillips, K. A., Ann Sakowski, J., Trosman, J., Douglas, M. P., Liang, S. Y., & Neumann, P. (2014). The economic value of personalized medicine tests: What we know and what we need to know. Genetics in Medicine, 16(3), 251–257. https://doi.org/10.1038/gim.2013.122.
Poissant, L., Pereira, J., Tamblyn, R., & Kawasumi, Y. (2005). The impact of electronic health records on time efficiency of physicians and nurses: A systematic review. Journal of the American Medical Informatics Association, 12(5), 505–516. https://doi.org/10.1197/jamia.M1700.
Raghupathi, W., & Raghupathi, V. (2014). Big data analytics in healthcare: Promise and potential. Health Information Science and Systems. https://doi.org/10.1186/2047-2501-2-3.
Rawls, J. (1971). A theory of justice. Cambridge: Harvard University Press.
Reuzel, R. P. B., van der Wilt, G. J., ten Have, H. A. M. J., & de Vries Robbe, P. F. (2001). Interactive technology assessment and wide reflective equilibrium. The Journal of Medicine and Philosophy, 26(2), 245–261. https://doi.org/10.1076/jmep.26.3.245.3015.
Saarni, S. I., Hofmann, B., Lampe, K., Lühmann, D., Mäkelä, M., Velasco-Garrido, M., et al. (2008). Ethical analysis to improve decision-making on health technologies. Bulletin of the World Health Organization, 86(8), 617–623. https://doi.org/10.2471/BLT.08.051078.
Self, R., & Coffin, J. (2017). Advanced alternative payment models. The Journal of Medical Practice Management: MPM,32(6), 399.
Shabani, M., Vears, D., & Borry, P. (2018). Raw genomic data: Storage, access, and sharing. Trends in Genetics, 34(1), 8–10. https://doi.org/10.1016/j.tig.2017.10.004.
Shams, I., Ajorlou, S., & Yang, K. (2015). A predictive analytics approach to reducing 30-day avoidable readmissions among patients with heart failure, acute myocardial infarction, pneumonia, or COPD. Health Care Management Science, 18(1), 19–34. https://doi.org/10.1007/s10729-014-9278-y.
Spencer, K., Sanders, C., Whitley, E. A., Lund, D., Kaye, J., & Dixon, W. G. (2016). Patient perspectives on sharing anonymized personal health data using a digital system for dynamic consent and research feedback: A qualitative study. Journal of Medical Internet Research, 18(4), e66. https://doi.org/10.2196/jmir.5011.
Stark, P. (2010). Congressional intent for the HITECH Act. The American Journal of Managed Care,16(12 Suppl HIT), SP24–SP28.
Starr, P. (1982). The social transformation of American medicine: The rise of a sovereign profession and the making of a vast industry. New York: Basic Books.
Sweeney, L. (2000). Simple demographics often identify people uniquely. Carnegie Mellon University, Data Privacy Working Paper 3. Pittsburgh 2000. [Online]. https://dataprivacylab.org/projects/identifiability/paper1.pdf.
van Biesen, T., & Weisbrod, J. (2017). Doctors feel excluded from health care value efforts. Harvard Business Review. [Online]. https://hbr.org/2017/10/doctors-feel-excluded-from-health-care-value-efforts.
Vydra, T. P., Cuaresma, E., Kretovics, M., & Bose-Brill, S., Vydra Pressler, T., Cuaresma, E., et al. (2015). Diffusion and use of tethered personal health records in primary care. Perspectives in Health Information Management, 12(Spring), 1c.
Whittington, J. W., Nolan, K., Lewis, N., & Torres, T. (2015). Pursuing the triple aim: The first 7 years. Milbank Quarterly, 93(2), 263–300. https://doi.org/10.1111/1468-0009.12122.
Acknowledgements
The authors would like to thank Matthew Vest, Ph.D, MA for valuable feedback and insights on this paper.
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Brill, S.B., Moss, K.O. & Prater, L. Transformation of the Doctor–Patient Relationship: Big Data, Accountable Care, and Predictive Health Analytics. HEC Forum 31, 261–282 (2019). https://doi.org/10.1007/s10730-019-09377-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10730-019-09377-5