Appendix 1: Classification of the Justifications in terms of the Different Real-world Environmental Parameters and Fundamental Ethical Principles pertaining to the Major Objectives of an IS in Healthcare – Medical Information Systems Ethics

Appendix 1
Classification of the Justifications in terms of the Different Real-world Environmental Parameters and Fundamental Ethical Principles pertaining to the Major Objectives of an IS in Healthcare

Table A1.1. Justifications of the purposes of the major objectives of an IS in healthcare in terms of the real-world environmental parameters

Justifications of the purposes of the major objectives of an IS in healthcareReal-world environmental parametersFundamental ethical principles
– Supporting medical decision-making by the healthcare professional
– Promoting quality, organization, management and planning of the patient’s care
– Working for the good of the patient
– Sharing common, transparent and accessible information
– Ensuring quality and choice of the information transmitted
– Improving continuity of care
– Supporting the monitoring of all healthcare activities
– Helping the Health Ministry to serve the expectations and treatment of cancer for the healthcare user
– Establishing legitimacy of the law and of information processing
– Establishing a duty of security, integrity, traceability and medical data protection
Strategic and methodological
Organizational and regulatory
Relational and cultural
Strategic and methodological
Structural and technological
Strategic and methodological
Strategic and methodological
Relational and cultura
Organizational and regulatory
Structural and technological
Beneficence
– Evaluating performance and defining the domains where action is required, listing the points of dysfunction
– Steering the healthcare structure efficiently while keeping costs under control
– Improving and strengthening interactivity with the actors outside the healthcare structure
– Increasing the availability of the healthcare actors
– Facilitating access to medical information for all users: reducing social inequality
– Respecting the same rule of access to and distribution of the information irrespective of the patient’s profile or status: idea of social fairness
– Distributing the advantages and disadvantages of such a tool equitably in the workload of the healthcare staff
– Sharing the same information and the same medical decision-support tool with all the healthcare professionals in the structure involved in the patient’s healthcare circuit
– Developing and sharing information that is precise and appropriate for everyone
– Facilitating epidemiological or statistical analysis (SAE)
Strategic and methodological
Relational and cultural
Relational and cultural
Organizational and regulatory Structural and technological Organizational and regulatory
Strategic and methodological
Strategic and methodological
Strategic and methodological
Structural and technological
Fairness

Table A1.2. Justifications of the limitations of the major objectives of an IS in healthcare in terms of the real-world environmental parameters

Justifications of the limitations of the major objectives of an IS in healthcareReal-world environmental parametersFundamental ethical principles
– Putting the patient back at the center of the decision-making process by providing him or her with more complete medical information, more quickly: better patient autonomy
– Ensuring the patient consents and sticks to the plan
– Respecting private life, and the right to medical secrecy and confidentiality
– Respecting the right to prior information, rectification and opposition described in the “ICT and Freedom” law
– Establishing individual and/or collective use of medical information
– Reducing the asymmetry of information between the doctor and the patient: establishing a better balance in the doctor–patient relationship
– Adapting the way in which the IS works to suit the organization of the healthcare structure
– Establishing a management/piloting policy concerning the use of medical information
– Increasing transversality of services within the healthcare structure
– Adapting a technology to the knowledge and savoir-faire of the healthcare professional
Structural and technological
Relational and cultural
Relational and cultural
Organizational and regulatory
Structural and technological
Relational and cultural
Organizational and regulatoryStrategic and methodological Organizational and regulatory Structural and technological
Autonomy
– Making the whole collective responsible for the conduct of the healthcare user
– Developing an organization oriented toward collective performance
– Obeying the legislative regulation of medical data
– Respecting the rules concerning storage, hosting and distribution established by the CNIL or similar authorities
– Maximizing the ethical quality of the decision, the aim of efficiency and organizational efficacy in the usage of the medical information
– Minimizing or eliminating harm done to patients because of incorrect information
– Ensuring the reliability of the medical data collection and its permanence
– Ensuring that the resources employed do not exceed what is necessary to achieve the desired objectives
– Reducing unnecessary or misjudged risks
– Ensuring the technical relevance and human appropriateness of the IS
Relational and cultural
Organizational and regulatory Organizational and regulatory Organizational and regulatory Organizational and regulatory
Relational and cultural
Structural and technological
Strategic and methodological
Strategic and methodological
Structural and technological
Non-malfeasance