Professional Role · Topic 20 of 26

Health Informatics, Telehealth & Technology Ethics

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Professional role · informatics & telehealth

Health Informatics, Telehealth & Technology Ethics

Keep alerts few and specific, stay accountable for what technology suggests, and for telehealth hold a license where the patient is.

01 · The trap, 2006 reviewAlert fatigue: 49–96% of drug alerts overridden

02 · Telehealth licenseLicensed or permitted where the patient is

03 · Who answers for itClinician stays accountable, not the technology

Alert fatigue

Too many alerts, and clinicians ignore even critical ones

Alert fatigue: desensitization to safety alerts from sheer volume

Clinicians then ignore warnings, even critical ones

2006 review: drug safety alerts overridden in 49% to 96% of cases

Remove inconsequential alerts

Tailor alerts to patient data such as renal function

Tier alerts by severity

Make only severe warnings interruptive

Alerts can be tailored only to patient data the system holds: incorporating renal function results lets nephrotoxic-drug alerts trigger only for patients at high risk.

Clinical decision support: the five rights

Right information

Right person

Right format

Right channel

Right time in workflow

Technology ethics

Technology and AI are adjuncts, not replacements for clinical judgment

The NP stays accountable for decisions and actions

Accountability holds even when a system or technology fails

Automation bias: the tendency to over-rely on automation

Decision support improves performance overall but can introduce new errors

Verify outputs against the patient in front of you verify output

A widely used algorithm predicted cost rather than illness

At a given risk score, Black patients were sicker than White patients

Correcting it would raise their share of extra help from 17.7% to 46.5%

Under Section 1557 (45 CFR 92.210), covered entities must make reasonable efforts to identify and mitigate discrimination risk from patient care decision support tools, a term that includes automated and non-automated tools. Under FDA's January 2026 guidance, CDS software is a non-device only if it meets four criteria, including no image or signal analysis and letting the clinician independently review the basis for its recommendation.

Telehealth licensure

Two states count: the clinician's and the patient's

Meet licensure requirements of the state where the clinician is located

Be licensed or legally permitted in the state where the patient is located patient's state

Nurse Licensure Compact covers RN and LPN/VN licenses only

APRN Compact takes effect only once 7 states enact it

APRN Compact is not yet operational, so an NP needs each state's license

APRN Compact status as of August 2026: 5 states enacted, none implemented. The count changes, so check NCSBN.

Before a telehealth visit

Make sure the patient consents

Answer privacy and security questions

Ask the patient to find a quiet private place

Plan for technical failure

HIPAA and telehealth platforms

HIPAA telehealth enforcement discretion expired May 11, 2023

A 90-day transition applied after it expired

Use technology vendors that comply with HIPAA

The vendor signs a business associate agreement

Medicare telehealth, as of 2026-11-02

Dates as HHS listed them on 2026-11-02; check telehealth.hhs.gov

Non-behavioral flexibilities run through December 31, 2027

Non-behavioral through that date: all eligible Medicare providers may furnish it

Behavioral and mental at home, no geographic limit, audio-only: permanent

Behavioral in-person visit requirement: waived through December 31, 2027

The 2027 non-behavioral date was set by recent legislation. Separately, audio-only is permanent for any telehealth visit at home when the patient cannot use or does not consent to video.

Medicare telehealth: behavioral or non-behavioral?

Dates as HHS listed them on 2026-11-02; check telehealth.hhs.gov

	Behavioral/mental	Non-behavioral
Patient at home	Permanent	Through 12/31/2027
No geographic limit	Permanent	Through 12/31/2027
Audio-only	Permanent	Through 12/31/2027
In-person visit	Requirement waived through 12/31/2027	Not applicable

Controlled substances by telehealth, as of November 2026

This date is close: recheck before relying on it

As of November 2026, DEA and HHS flexibilities run through December 31, 2026 recheck date

Allows schedule II to V telemedicine prescribing, if conditions are met

No prior in-person evaluation needed under these flexibilities

Check for a newer rule

Fourth temporary extension, published 12/31/2025. No later rule was found in the Federal Register on 2026-11-02. See Prescriptive Authority.

EHR safety

ONC's 2025 SAFER Guides: eight self-assessments for EHR safety

Three groups: foundational, infrastructure, clinical process

Practices: contingency planning, patient identification

Practices: CPOE with decision support, test result follow-up

2017 study, 23,630 progress notes: typical note only 18% manually entered

The same typical note: 46% copied, 36% imported

Verify and update carried-forward content before signing before signing

CPOE lowers the likelihood of error on a drug order by 48%

2013 estimate: 17.4 million medication errors averted in the USA in 1 year

A randomized trial of 3,356 clinicians found that limiting the EHR to 1 open record versus up to 4 did not reduce wrong-patient order sessions (90.7 vs 88.0 per 100,000).

Information sharing and privacy

Information blocking: Cures Act rule on electronic health information (EHI)

Provider must not knowingly use an unreasonable practice likely to interfere

Covers access to, exchange or use of EHI, unless an exception applies

Keep patient information off social media no patient posts

Improper social media use can breach patient privacy and confidentiality

It can also violate privacy law and be grounds for board discipline

HHS has set disincentives for health care providers whom OIG finds have committed information blocking, under the 21st Century Cures Act.

Pearl

The alert advises; the clinician decides and answers for it.

Sources · van der Sijs et al. Overriding of drug safety alerts in computerized physician order entry. JAMIA 2006 · AHRQ PSNet: Alert fatigue primer · CDS five rights table (Osheroff), Critical Care Clinics review · ANA position statement: The ethical use of artificial intelligence in nursing practice. OJIN 2025 · HHS Telehealth.gov: Licensure compacts and state licensure requirements · HHS Telehealth.gov: Telehealth policy updates · HHS OCR: HIPAA and telehealth · HHS Telehealth.gov: HIPAA for telehealth technology · Federal Register: Fourth temporary extension of COVID-19 telemedicine flexibilities for prescription of controlled medications (12/31/2025) · NursePractitionerOnline: How to transfer an NP license to another state (updated August 2026; APRN Compact status) · ASTP/ONC: 2025 SAFER Guides · Wang et al. Characterizing the source of text in EHR progress notes. JAMA Intern Med 2017 · Radley et al. Reduction in medication errors due to CPOE adoption. JAMIA 2013 · Adelman et al. Restricting concurrently open records and wrong-patient orders. JAMA 2019 · ASTP/ONC: Information blocking · Goddard et al. Automation bias: a systematic review. JAMIA 2012 · Obermeyer et al. Dissecting racial bias in an algorithm used to manage population health. Science 2019 · 45 CFR 92.210: Nondiscrimination in the use of patient care decision support tools · Covington: 5 key takeaways from FDA's revised CDS software guidance, January 2026 · NCSBN: A nurse's guide to the use of social media · HHS Telehealth.gov: Planning your telehealth workflow · 45 CFR 92.4: Section 1557 definitions, patient care decision support tool · ANNA: Nurse Licensure Compact fact sheet · HHS Telehealth.gov: Getting started with licensure · HHS Telehealth.gov: Prescribing controlled substances via telehealth · NCSBN: Professional boundaries · FDA: Clinical decision support software guidance (January 2026) · The Hospitalist: HM12 session analysis, using IT systems (Osheroff five rights of CDS) · Follow your institution's protocols.