Patient Protection and Affordable Care Act
Purpose Even under the threat of repeal, the Patient Protection and Affordable Care Act (the ACA) has laid the groundwork for reform in a number of areas. Universal insurance coverage has been the most publicized, but there is a lot more to this law. The ACA provides for insurance exchanges, accountable-care organizations, patient-centered outcomes research, health literacy programs, physician quality reporting initiatives, and electronic health records; one of the strategies has been the emphasis on evidence-based medicine (EBM). The focus of this session will be on the Big Data push, and its implications for evidence-based medicine and clinical decision support (CDS) in the context of patient-centered care and clinical ethics. Objectives At the completion of this unit, students will be have knowledge of the ethical issues involved in recent health care reform. Students will analyze policy, clinical practice guidelines, cultural competence, and a variety of other ethical considerations. Students will apply theories and principles to analyze, evaluate, and synthesize the embedded ethical issues. Assignment Read the assigned readings. Answer question 1,2,3 Your answers must be a minimum or 250 words, not including citations and references. Discussion Questions 1. Describe and support your view of the moral status of CDS and Big Data in terms of one of the following: CDS and Big Data are value neutral — They are passive, like TV or radio, such that they are not good or bad in themselves. The systems are value neutral and raise no ethical issues. Ethical scrutiny is appropriate only when evaluation the uses to which they are put. CDS and Big Data are value laden — They are designed for a specific purpose, like a hand gun, and once we are aware of that purpose we must examine the intent of the designer and manufacturer to determine the values instilled into the technology. CDS and Big Data are shared-value entities –The systems are a complex network of technologies, data, and values, such that moral responsibility should be assigned to all who build and use them. 2. In what ways do evidence-based medicine and CDSs promote ethical values of clinical professions in the delivery of care and in which ways do they detract from them? 3. Are there healthcare-related tasks that computers should never be permitted to perform even if the machine were more accurate, precise, and reliable than a human?
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