New ACP Ethics Manual reflects reimbursement, health IT trends
As health IT use and efforts to lower costs remain on the healthcare community's collective consciousness, the American College of Physicians (ACP), updated its Ethics Manual to reflect changes among areas of concern including confidentiality, the use of social media, stewardship of resources, pay-for-performance reimbursement programs and patient-centered medical homes. 

Published Jan. 3 in the Annals of Internal Medicine, ACP noted the latest edition is "not a substitute for the experience and integrity of individual physicians, but it may serve as a reminder of the shared duties of the medical profession."

"Confidentiality is a fundamental tenet of medical care," wrote Lois Snyder, JD, a member of the ACP Ethics, Professionalism and Human Rights Committee and author of the manual. "It is increasingly difficult to maintain in the era of EHRs, electronic data processing, email, faxing of patient information, third-party payment for medical services and sharing of patient care among numerous health professionals and institutions."

The manual advised that providers follow appropriate security protocols, adhere to best practices for electronic communication, be aware of risks for security breaches and learn state and federal laws, including HIPAA.

Social media
"Physicians who use online media, such as social networks, blogs and video sites, should be aware of the potential to blur social and professional boundaries," Snyder wrote.

"Physicians must remain cognizant of the privacy settings for secure messaging and recording patient-physician interactions as well as online networks and media and should maintain a professional demeanor in accounts that could be viewed by patients or the public," she continued.

Stewardship of resources
A physician's first and primary duty is to the patient, but the manual also said that "physicians have a responsibility to practice effective and efficient healthcare and to use healthcare resources responsibly."

"Parsimonious care that utilizes the most efficient means to effectively diagnose a condition and treat the patient respects the need to use resources wisely and to help ensure that resources are equitably available," Snyder wrote. 

"Pay-for-performance programs can help improve the quality of care, but they must be aligned with the goals of medical professionalism," Snyder wrote. The main focus of the quality movement in healthcare as the manual warned against playing to the measures and suggested that providers not make treatment decisions on program incentives for a small number of specific elements of a single disease.

Patient-centered medical homes
The manual advised consulting providers to respect the relationship between a patient and their primary care provider, but "the patient-centered medical home model promotes whole-person, patient-centered, integrated care across the healthcare system and has overall responsibility for ensuring the coordination of care by all involved clinicians."

The ACP Ethics Manual is intended to help providors make difficult decisions with the ultimate purpose of enhancing the quality of care provided to patients. It is available in its entirety