A. Most professionals would agree that technology has added value to the patient and health care professional’s experience, including that of the case manager. A segment of this value stems from the innovative modes and expanded options by which health care professionals can communicate and engage with clients, clients’ support systems, caregivers, professional colleagues, and industry stakeholders alike.

B. The unique ways in which access to care has been enhanced through technology extend from remote health and telemedicine to electronic health records and personal health portals. There are an abundance of positive outcomes to reflect the merits of this generation of innovation on the health care delivery process along with return on investment across the transitions of care (Free et al., 2013; Koivunen, Niem, & Hupli, 2014; Moorhead et al., 2013).

C. Technology’s leveraged presence and utilization have yielded a new generation of ethical dilemmas for case managers to maneuver. Health care professionals strive to stay proficient with a constant flow of evolving products and programs in their work place, while reconciling updated federal and state regulations with organizational policies.

D. The speed at which this innovation occurs can be exacerbated by an atmosphere of business competition, one where organizations strive to incorporate new technologies to obtain their requisite market share. There are a variety of programs and products to meet their expanding target patient populations.

E. However, implementation processes to digitalize patient information and other health information technology are often rushed. These efforts leave end users, especially health care professionals contributing to unintended casualties (Daly, 2011). What results for case managers is increased vulnerability for ethical as well as potential legal sanction for their practice.

F. The ethical tenets of case management practice (also discussed in Chapter 18) serve as foundational pillars for the workforce (Box 19-1). They are the one constant for all professional case managers independent of discipline of origin, practice setting, and amid swift industry change.

G. Rapidly shifting societal constructs and contexts influence the way in which case managers interpret how each tenet is adhered to (Fink-Samnick, 2013a).

H. This chapter focuses on the alignment of case management’s ethical tenets with two of these constructs, electric communication and social
media. Each has revolutionized while challenging each facet of a case manager’s practice. For the application of ethical standards in the general practice of case management, refer to Chapter 18.

I. With case management and technology at the apex of case management, care coordination, and transitions of care, the stakes rise for the workforce. Varying interpretations of professional regulations and scope of practice by employers find case managers wrestling to which direction their ethical compass should point. This chapter provides guidance to that end.

A. Blogs—A Web site on which someone writes about personal opinions, activities, and experiences. It contains online personal reflections, comments, and often hyperlinks provided by the writer (Merriam-Webster, 2015a).

B. Boundary—The edge of appropriate or professional behavior (Gutheil & Simon, 2002). They allow for a safe personal connection between patients and their health care providers (Baca, 2011).

C. Boundary crossing—A deviation from classical therapeutic activity that is harmless, nonexploitive, and possibly supportive of the therapy itself (Gutheil & Simon, 2002).

D. Boundary violation—When the health care provider displaces or confuses his or her own needs with the patient’s needs (Gutheil & Simon, 2002).

E. Cloned medical records—The ability to carry forward old clinical information into the latest note—an explicit feature of some electronic health records (EHRs)—is often referred to as cloning. The problem lies in copying forward old information, such as patient complaints from an earlier visit or results of certain tests or old blood pressure readings that have been resolved, resulting in care activities that otherwise are unnecessary and potentially may pose safety concerns (Lowes, 2012).

F. Conflict of interest—A conflict of interest is a set of circumstances that creates a risk that professional judgment or actions regarding a primary interest will be unduly influenced by a secondary interest (Lo & Field, 2009).

G. Crowdsourcing—The practice of obtaining needed services, ideas, or content by soliciting contributions from a large group of people and especially from the online community rather than from traditional employees or suppliers (Merriam-Webster, 2015b).

H. Digital health—The ability to digitize human beings, by a variety of means (e.g., sequencing, sensors, imaging) fully exploiting our digital infrastructure of ever-increasing bandwidth, connectivity, social networking, the Internet of all things, and health information systems (Topol in Nosta, 2013).

I. Distance counseling—The provision of counseling services by means other than face-to-face meetings, usually with the aid of technology (American Counseling Association [ACA], 2014).

J. Dual relationships—Any situation in which a health care professional-patient/client relationship may be contaminated by a second co-occurring relationship (e.g., business or financial relationships,
romantic involvement, blood ties, marital relatedness) (Segen’s Medical Dictionary, 2011). They exist when there are other personal or professional demands, stresses, or considerations in the relationship in addition to the provider-patient relationship (Baca, 2011).

K. Electronic—A mode of communication and information acquisition, transmission, and storage, such as used in computers, telephones, cell phones, personal digital assistants, facsimile machines, etc. (National Association of Social Workers & Association of Social Work Boards, 2005).

L. Electronic technology—The digital or Internet-based technologies and devices. The following kinds of devices and tools are of special importance because of the growing concern related to vulnerability and risk in their use. These include but are not limited to laptops; home-based personal computers; personal digital assistants (PDAs) and smartphones; hotel, library, or other public workstations and Wireless Access Points (WAPs); USB flash drives and memory cards; CDs; DVDs; backup media; e-mail; smart cards; and remote access devices (including security hardware) (Certification of Disability Management Specialists’ Commission [CDMS], 2010).

M. Encryption—Process of encoding information in a way that limits access to authorized users (ACA, 2014).

N. Friend—To add a person to one’s list of contacts on a social networking Web site (Dictionary.com, 2015a).

O. Information technology (IT)—The overarching term to describe technologies that process information, most often in electronic form (National Association of Social Workers & Association of Social Work Boards, 2005).

P. Internet—A worldwide network of computer networks that share information (National Association of Social Workers & Association of Social Work Boards, 2005).

Q. Internet of Things—a computing concept that describes a future where everyday physical objects will be connected to the Internet and be able to identify themselves to other devices (Techopedia, 2015).

R. Media sharing sites—A Web site that enables users to store and share their multimedia files (e.g., photos, videos, music) with others. Such sites provide a modest amount of free storage and paid subscriptions for greater storage. The media is played/viewed from any Web browser and may be selectively available via password or to the general public. A media sharing site can also be used to back up files (PC Magazine, 2015).

S. Mobile device—A portable computing device such as a smartphone or tablet computer (Oxford Dictionaries, 2015). Today’s mobile devices are multimodal and are used for multiple purposes such as taking pictures, text messaging, e-mailing, video calling, and accessing the Internet and health care organization-based (case management employers) clinical applications such as electronic medical records.

T. Moral distress—A human response to conflict, which is created by on-the-job ethical conflicts (Moffat, 2014).

U. Netiquette—Etiquette governing communication on the Internet (Merriam-Webster, 2015c).

V. Online—A mode of communication where the user is in direct contact with the computer network to the extent that the network responds rapidly to user commands (National Association of Social Workers & Association of Social Work Boards, 2005).

W. Podcast—A program (as of music or talk) made available in digital format for automatic download over the Internet (Merriam-Webster, 2015d).

X. Privacy—The right of an individual to withhold her/his information from public scrutiny or unwanted publicity (National Association of Social Workers & Association of Social Work Boards, 2005).

Y. Privacy setting—Privacy settings are controls available on many social networking and other Web sites that allow users to limit who can access your profile and what information visitors can see (IT Law Wiki, 2015).

Z. Professional networking—A type of social network service that is focused solely on interactions and relationships of a business nature rather than including personal, nonbusiness interactions (Vacellaro, 2007).

AA. Social media—Technology-based forms of communication of ideas, beliefs, personal histories, etc. (e.g., social networking sites, blogs) (ACA, 2014).

BB. Security—The protection of hardware, software, and data by locks, doors, and other electronic barriers such as passwords, firewalls, and encryption (National Association of Social Workers & Association of Social Work Boards, 2005).

CC. Social network—An online community of people with a common interest who use a Web site or other technologies to communicate with each other and share information, resources, etc. It may also be a Web site or online service that facilitates this communication (Dictionary.com, 2015b).

DD. Skype—A computer program that can be used to make free voice calls over the Internet to anyone else who is also using Skype (Webopedia, 2015).

EE. Technology—A set of prescribed events that are embedded in hardware, software, or telecommunications and that direct activities, decisions, or choices. Sometimes, technology is divided into hard technologies, such as switches and electronics, and soft technology such as the processes and procedures associated with accounting or risk assessment (National Association of Social Workers & Association of Social Work Boards, 2005).

FF. Text message—An electronic message sent over a cellular network from one cell phone to another by typing words, often in shortened form, as “l8t” for “late,” on the phone’s numeric or QWERTY keypad (Dictionary.com, 2015c).

GG. Tweet—A very short message posted on the Twitter Web site: the message may include text and keywords, makes reference to specific users, links to Web sites, and links to images or videos on a Web site (Dictionary.com, 2015d).

HH. Videoconference—Use of electronic media to conduct client-related case conference in a virtual environment and to connect with multiple health care providers who are not necessarily in the same location, however involved in the client’s care. In such environment, clientrelated personal health information is exchanged, which warrants adherence to ethical (e.g., privacy, confidentiality) and legal (e.g., HIPAA) standards.

II. Virtual relationship—A non-face-to-face relationship (e.g., through social media) (ACA, 2014).

JJ. Wiki—A Web site that allows users to add and update content on the site using their own Web browser. This is made possible by Wiki software that runs on the Web server. Wikis end up being created mainly by a collaborative effort of the site visitors (TechTerms.com, 2015).

KK. World Wide Webb (WWW)—A subset of the Internet that allows access using a standard graphical protocol (National Association of Social Workers & Association of Social Work Boards, 2005).

A. The Case Management Society of America (CMSA) describes in its standards of practice for case management (CMSA, 2010) that case management practice extends across all health care settings, including payer, provider, government, employer, community, and home environment. Use of digital communication and other technologies apply to all these settings, and therefore, adhering to ethical standards is an expectation.

B. The use of technology has influenced all areas of case management. The ethical use of social medial and digital technology overlay all of the case management practice standards. This chapter introduces ethics concepts in context with a case manager’s use of technology.

C. This chapter discusses how ethics underpins case management use of technology. The ethics standard recognizes that case managers should behave and practice ethically while adhering to the tenets of the ethical code, which underlies his/her professional credential (e.g., nursing, social work).

D. Some of the standards for case management practice described by CMSA (2010) apply in important ways to the use of digital media and communication technologies, especially those that pertain to privacy and confidentiality. Case managers should be well aware of how best to maintain client’s privacy and confidentiality while using such tools in provision of care and resources.

E. Case managers use remote monitoring technology as well as social networking, medical information technology, and digital tools in order to enhance client self-management skills and abilities and improve client health knowledge. The Ethics standard described in the CMSA standards of practice is especially applicable in this regard. Case managers shall adhere to said standard at all times while caring for their clients/support systems.

A. Information and communication technology in health care are rapidly evolving, courtesy of the fast growing penetration of the Internet and mobile device use (Koivunen et al., 2014).