Does Use an Electronic Health Record Increase the Risk of Breach of Privacy to Clients - Assignment Example

Electronic Health Record – Breach of Privacy Does using an Electronic Health Record increase the risk of breach of privacy to our clients? We are living in the world of high technology where data are collected from individuals to access the nature and implications related to any field of studies. By efficient data collection and data mining, however the collectors could easily come to know about the minute details of the individuals providing the data. And herein lays a problem. There always remain risks of breach of privacy to the clients. So in the present context the paper will try to find out whether the uses of an Electronic Health Record increase the risk of breach of privacy to the clients. Firstly it will be tried to find out why the concept of Electronic Health Record evolved in Ontario and whether this will have any risk of breach of privacy. It will also try to find out whether the risk (if found) is relevant only in case of Ontario or it may have an impact on the whole of Canada. Next section will try to find what literatures say about the benefits and challenges of these private data going electronic. Finally, it will be tried to find out what are the steps that should be taken in future. Background, definition and scope - does this affect all of Canada? Or just Ontario? How do Nurses factor into the topic? E-health record helps the doctors to know whether the continuation of the medicines is helping the patient during the course. Electronic medical records keeps the data on patients demographics, their medical history lab test results etc accessible by electronic network system. An effective health care function requires accuracy as well as completeness of the health data. There remains a reduced risk in form of any loss of data that occurs in form of loss of papers via locks and pass-keys. The paper record represents “massive fragmentation of clinical health information.” (Schloeffel et al., 2003, p.1, as cited by Gurley, n.d.).This not only leads to the cost of information management to increase but also “fragmentation leads to even greater costs due to its adverse effects on current and future patient care” (Schloeffel et al., 2003, p.1, as cited by Gurley, n.d.). It is very much time-saving also as it brings down unnecessary lab tests. The staffs could readily figure out the problems. Otherwise the patients have to wait in the emergency ward while the staffs are sorting out the causes. It enables the practitioners to access the medical literatures and recent best practices available that help them to carry forward the treatment. Even it provides a huge range of medicine lists for improving the level of knowledge of effective medical practices. In case of physical records, it is very difficult to maintain them. Also the paper works are difficult to maintain for a long time. They may get misplaced or displaced. But such types of problems are not observed in case of the electronic system. Continuous updates are readily available in case of the electronically maintained health data record. Also, the EHR is “accessible from remote sites to many people at the same time” (Young, 2000, p. 99, As cited by Gurley, n.d.). This is not possible in case of physical records. Based on these advantages of the electronic methods, Ontario’s Continuing e-Health program has introduced this way for managing the data on the patients. In Ontario Health Insurance Plan (OHIP), an integrated, electronic health information system prescribes the information from a multiple care for the correct patients. Only registered physicians and pharmacists can access the private data of the patients governed by the Freedom of Information and Protection of Private Act (FIPPA). (Neville, Keough, Barron, MacDonald, Gates, Tucker,et al. 2004) Since electronic health records have so many benefits, it will not only help Ontario but the whole of Canada. Benefits and Challenges: Since EHR (electronic health record) helps to keep all the record of the patient in a compact manner, it has become very easy for the nurses to review all information at a time. The nurse could take look at the medication history, lab reports, ultrasounds or any related issues. If the patient has undergone any medication in past or even if he/she is allergic to any thing, the nurse could know them instantly. So EHR records help in consolidating all the essential information when and where the authorized nurses require it. Thus it becomes very easy for treatment. Any action can be taken readily without wasting time in gathering information. These EHRs has led to a secure pan-Canada network of interoperable EHR system. However there are challenges also that nurses have to face because of this new EHR system. The Kentucky Board of Nursing had received many inquiries on the role of nurses regarding maintaining the confidential information. Such reports point out the breach of confidentiality of nurse. So nurses must be following the standards of practices as encoded in the nursing law. Actually the EHR can be misused easily. Here since it is easy to access the private data, anyone can copy or change the data also. The American Nurses Association's Code of Ethics for Nurses, Provision 3.2 recognizes that it is the responsibility of the nurses in maintaining the private information of the patients ". . . The standard of nursing practice and the nurse's responsibility to provide quality care require that relevant data be shared with those members of the health care team who have a need to know. Only information necessary for a patient's treatment and welfare is disclosed, and only to those directly involved with the patient's care. Duties of confidentiality, however, are not absolute and may need to be modified in order to protect the patient, other innocent parties, and in circumstances of mandatory disclosure for public health reasons." (BNET, 2006) So if case of breach of trust, nurses will be held responsible for rendering unsafe and ineffective nursing care to patients. It is the duty of the nurse to protect the confidential information of the patients unless the law demands them. They must only disclose data to the persons who really require the information for rendering care or services to the patients. However the patients’ family can access the confidential information about the patients. Any nurse violating the rules and guidelines will be charged and punished. So by introduction of EHR, nurses always have to remain under strict watch so that the data don’t get leaked. What literatures say about the benefits and challenges? “The greatest challenge in the new world of integrated healthcare delivery is to provide comprehensive, reliable, relevant, accessible, and timely patient information to each member of the healthcare team, whether in primary or secondary care and whether a doctor, nurse, allied health professional, or patient/consumer” (Schloeffel et al, 2003, p.2). Certain electronic health record such as “Result Reporting”, “Clinical Messaging” and “Orders” help to provide “high value functionality” to the physicians as mentioned by Carter (2008). (p.269). It helps to access to information and hence enhance the efficiency of the routine task of the physicians. Electronic health records also include electronic attestation and confirmation of the review of the results done by the physicians. Physicians can easily inform the patients about the diseases and when to start the treatment via automated letter writing. Clinical messaging, as it is called in the medical term is secure and reliable. The physicians can easily communicate also with the fellow staffs and colleagues to discuss health related issue and spontaneous decisions can be taken. Moreover Carter (2008) also found out that the process of electronic health record is also cost effective and less time consuming. Electronic health records have both immediate effect and long term effect as pointed out by Carter (2008). The doctors can readily use the database for daily use. Again since it is a computerized system, the data can be preserved in the long run for further research. It has been found again that introduction of the electronic health record system reduces the risk of the medical errors and abolishing of the delays that generally occurs in case of paper records handoffs and missing information. Research based on the electronic health record “can link the clinician to protocols, care plans, critical paths, literature databases, pharmaceutical information and other databases of healthcare knowledge” (Young, 2000, p. 100, as cited in Gurley, n.d.) The EHR is “far more flexible, allowing its users to design and utilize reporting formats tailored to their own special needs and to organize and display data in various ways” (Dick, Steen, and Detmer, 2003, p.46, as cited by Gurley, n.d.). However, these processes also have some disadvantages. “There have been phenomenal scientific and technological breakthroughs; yet patient documentation remains largely the same” (Wellen, Bouchard, and Houston, 1998, p.1, as cited by Gurley, n.d.). Even if the technology was available, there are several barriers which the method has to sort out before it could be implemented successfully. “Technology has continued to move forward at a rapid pace, but many organizational and human issues have slowed the pace of implementation of automated systems for an electronic documentation record” (Young, 2000, p.106, as cited by Gurley, n.d.). There remains a threat that the private data may get disclosed to the general mass and this can lead to breach of breach of privacy to the clients - “Whereas stringent security measures should be applied to protect the confidentiality of patient information, it is also in the patient’s best interest for the [EHR] to be accessible for appropriate, legitimate uses by authorized users” (Dick, Steen, and Detmer 2003, p.25, As cited by Gurley, n.d.).However, the Insurance Portability and Accountability Act of 1996 (HIPAA) “calls for the secretary of Health and Human Services to ‘adopt standards for unique health identifiers, confidentiality policies, and terminology’” (Dick, Steen, and Detmer, 2003, p.13, as cited by Gurley, n.d.). Confidentiality in case of the health professionals and providers impose the duty to protect the information related to health of a patient. It is a must for the health provider. Doctors are taught in their Hippocratic Oath to emphasize on this rule. Now this is also found in the professional code of practice and in legislation, for instance, the Medicine Act. The rule is equally applicable in case any professionals related with health like nurses or physiotherapists as well as the pharmacists. Nurses have this confidentiality rule in the Nursing Act and the Regulated Health Professions Act. In case of hospitals or any social agencies related to health, the rule is encoded in Public Hospital Act, the long-Term Care Act or other legislations of same type. Hospital Management Regulations under the Public Hospitals Act states: “Except as required by law or as provided in this section, no board shall permit any person to remove, inspect or receive information from medical records or from notes, charts and other materials relating to patient care.” (Young, 2007, p.4) In the Canadian Nurse Association (CNA), Code of Ethics also states: ‘Nurses must protect the confidentiality of all information gained in the context of the professional relationship, and practice within relevant laws governing privacy and confidentiality of personal health information.’ (Young, 2007, p.4). In fact CNA has emphasized on this right of privacy by stating ‘an individual’s right of privacy of personal health information is paramount’ (Privacy of Health Information, 2001. p.1). Thus confidentiality is very much related to the security of the data. But problem is that there is no strict rule in case of addressing the security matter and so the doctors, nurses and other staffs related to maintenance of the EHR has to continuously face challenges for protecting the data. Impact on health care and human resource management: If electronic health record are maintained everywhere, a lot of time will be saved. The nurses can easily streamline the processes and give more time in treatment of the patients. They will be able to react quickly and appropriately in cases of emergencies. Proper maintenance can provide a secured access to the minute details regarding a patient’s health by authorized persons. Since it’s a consolidated form of data, the whole medical history of a patient can be readily known enhancing the treatment. It will also foster consistency and best practice approach for managing the clinical problems in the time of crisis. Since the data are maintained in one network, seamless communication can take place between professionals related to health care. In the electronic health record system, since there are automated reminders, it will help to know the patient’s information on critical illness and present condition. Thus electronic health record method will provide an up-to-date and accurate information ensuring consistency. However an efficient data mining will require “standardized terminology, system architecture, and indexing” (Young, 2000, p. 106, As cited by Gurley, n.d.) for sharing data on the electronic platform requiring a standard language and a unique health identifier. Anyone can’t maintain such important data efficiently. The person maintaining the data must have knowledge about the medical terminologies used in the patients’ records. So it is the work of human resource management to look after these facts that only efficient persons are included in such jobs. Also the concerned individuals must be aware of the responsibilities regarding the privacy of the data. Nurses who are well equipped with the medical terms and understands the responsibility of protecting data must be deployed for an efficient electronic health record program. Recommendations: what should be done next: who should be addressed: What recent literature studies lay down? Seeing the benefits and challenges of the EHR system, following recommendations can be made. The patients should give his/her consent on when and how his/her health information will be used. The procedures must be authenticated from both the sides of patients and health care professionals. Only those people who are currently related to the issue must only be permitted to access the data. This must however be done after a proper consultation with the patients. Different data modules must be made in line to different degree of sensitivity of the data. Good cares have to be taken so that any unauthorized persons can not access the data. In case any such instance of usage is found, strict legal framework must be set up for controlling these illegal behaviors. The authorized person accessing the information has to have a unique ID and care must be taken so that no one else can access his/her information. The staffs and nurses must be trained well so that cases of breach of privacy may not occur. They should realize their responsibility in relation to maintenance of data securely. Last but not the least, regular investigations must be done so that incase of any breach of privacy with the client, instant measures can be taken. The EHR can function efficiently only when the people related to it are functioning well. Every individual related in collecting data, maintaining record and utilizing them for different purposes must realize their own duties. ‘The doctor-patient relationship is one that is built on trust.”(Frist, 1997, p.2).The patients must feel comfortable in disclosing all the details to the doctor. Until and unless the doctors don’t get all the information regarding the health of the patients, he can’t carry out the further tests. But those data disclosed are too personal to be accessed by others. So it’s the duty of the individuals to take care that this trust does not break. The nurses must be more careful towards handling of the personal data. The authority of the health care organization must see to it that the case of the Ottawa hospital (where a nurse was found of using pateints’ personal data in illegal way) does not repeat any more. Various authorities have infact already made rules to relation to maintaining of breach of privacy. The US Food and Drug Administration also have laid down many regulations that have to be followed for maintaining the electronic health information. The aims of the regulations are to enhance the uprightness of electronic information and privacy. Various studies have been made in context of maintenance of electronic health record. In a study conducted by Patricia Kosseim (2005), the application of fundamental privacy principles, such as "accountability," "openness," “identifying purposes” and "consent," must be applied to treatment purposes related to electronic health information. (Kosseim, 2005). He found in initial strategic plan of the pan-Canadian health infostructure, there is no question relating to the importance of privacy. But later it emphasized on the privacy and security of the information data. Again Marshall and Roch (n.d.) have produced a detailed study regarding the standards and security for maintenances of the EHRs. (Marshall, Roch, n.d.)also investigated how Canada should learn the guidelines of how to learn lessons regarding the implementation of interoperable electronic health records in case of Canada from other countries which are successful in setting up examples in this filed. (Marshall, Roch, n.d.). Concluding remarks As the world is getting more and more sound technologically, obviously the EHR has a definite role to play. Above analysis prove that EHR has many benefits. But disclosure of personal information can tarnish the positive aspects of the EHR system. As noted Sandra Cotton, from West Virginia Nurses Association, "More than ever before, nurses need to be aware of privacy and confidentiality concerns,". (Badzek, 1999) Data must be secured well so that any unauthorized person can not access them. Even in case of disclosure, the patients’ consent should be asked for. Everyone should handle the risk of breach of privacy with utmost care. There must be more involvement by the government and the private sector “to make changes where possible to instigate, motivate, and provide incentives to accelerate the development of solutions to overcome the barriers” (Young, 2000, p. 109, As cited by Gurley, n.d). Thus with a little care, an efficient electronic health record can enhance the health of the individuals and simultaneously reduce the cost. References: 1. Badzek, L. (1999). Confidentiality and Privacy: At the Forefront for Nurses. American Journal of Nursing, 99(6), 52-54. available at: http://journals.lww.com/ajnonline/pages/articleviewer.aspx?year=1999&issue=06000&article=00048&type=fulltext (accessed on August 17, 2009) 2. BNET. Health Care Industry (2006). Role of Nurses In Maintaining Confidentiality of Patient Information. Retrieved from: http://findarticles.com/p/articles/mi_qa4084/is_200601/ai_n17171049/ 3. Carter. J.H. (2008). Electronic health records: a guide for clinicians and administrators. America: ACP Press. 4. Canadian Nurse Association. n.d. Privacy and Health Information: Challenges for Nurses and for the Nursing Profession. Retrieved from: http://cna-aiic.ca/cna/documents/pdf/publications/Ethics_Pract_Privacy_Health_Nov_2003_e.pdf 5. Frist. B, (1997). Protecting Our Personal Health Information: Privacy In The Electronic Age Hearings Before The Committee On Labor And Human Resources, U.s. Senate. Pennsylvania: DIANE Publishing. 6. Gurley, L. (n.d.). Advantages and Disadvantages of the Electronic Medical Record. American Academy of Medical Administrators. Retrieved from: http://www.aameda.org/MemberServices/Exec/Articles/spg04/Gurley%20article.pdf 7. Kosseim. P, (2005). The Advent of Electronic Health Records (EHRs) in the Current Legal and Policy Context. Office of the Privacy Commissioner of Canada. Retrieved from: http://www.priv.gc.ca/speech/2005/sp-d_051130_pk_e.cfm 8. Marshall. M, Roch. J, (n.d). Governance of the Electronic Health Record. Canada Health Infoway. Retrieved from: http://www2.infoway-inforoute.ca/MediaCoverageDocs/Vol.16_No1_2006_Governance%20of%20the%20Electronic%20Health%20Record_Health%20Ethics%20Today.pdf 9. Neville, Keough, Barron, MacDonald, Gates, Tucker, et al. (2004). Towards an Evaluation Framework for Electronic Health Records: An Inventory of Electronic Health Records Initiatives Across Canada. Retrieved from: http://www.nlchi.nf.ca/pdf/Initiatives_mar04.pdf 10. Young. D.M.W., (2007).BACKGROUND PAPER– REGULATION OF THE SECURITY OF ELECTRONIC HEALTH RECORDS. Retrieved from: http://www.langmichener.ca/uploads/content/EHR%20Paper_26Feb08.pdf Read More