ITGS portfolio Privacy and security issues that arise when using Health Information Technology to manage your information.

International Baccalaureate Misc

Portfolio Assignment #2

Privacy and security issues that arise when using Health Information Technology to manage your information.

Area of Impact: 3.3 Health

October 5, 2010

Word Count: 999

News Item: http://healthinsurance.about.com/od/healthinsurancebasics/a/health_IT_overview.htm

Presentation of the Issue

Personal Health Records (PHR), Electronic Health Records (EHR) and Electronic Prescribing (eRx) are all forms of the Health Information Technology (HIT). HIT has become very popular in the past few years because it can benefit both the client and the doctors by managing health care information in an efficient way. Advantages that come along with using HIT would be reducing the amount of paperwork needed for medical records, reducing errors in prescriptions when reading doctor’s handwriting and reducing the employment salary by eliminating workers that maintain medical records.

Although many articles have agreed that “The advantages of EHR are extensive and no one can argue that point. ”There can be consequences and disadvantages when using this type of technology to store personal information. Just like most communication systems, issues regarding security and privacy can arise. Problems like that can occur because many organizations, doctors, specialists and family members have access to your health information. Another issue that may apply would be the equality of access and the ability to actually use this system. Most family households have access to Internet, but a lot of seniors don’t, and the elder population is what makes up most of the clients. Not only would most seniors not be able to access it, users who are not tech-savvy might not be able to access HIT, or it might take the user a while to utilize the system and understand the capabilities of it.

Information Technology Background of the Issue

Health information first started out to be stored in folders and files in offices and hospitals, which can be very dangerous and hard to manage. Now that new technology is being discovered every second of every day, we no longer need the large amount of space and the complicated pile of paperwork to keep personal health information of individuals in the society. With more efficiency and convenience, HIT was founded a decade ago and the amount of users for this form of technology has increased greatly since. This online database program was created to make access to one’s health information easier for not only the client, but also to doctors and different organizations. It can also help doctors better understand the patient’s medical needs by putting all of the client’s health information into an analysis and figuring out patterns from results from various doctors, hospitals or specialists.

Using the HIT can cause many issues to come up without the individual knowing. Because using HIT can be so efficient and convenient for clients, they may easily forget the risks of using it and give personal information away. HIT is a communication system that can simply cause theft of identity, threatening of one’s privacy, reliability towards technology and degrading of efficiency.

Impact of the Issue:

As this form of technology becomes more familiar to people of the society, there is an increase of reliability and authenticity issues. ”Legal issues have arisen regarding who should and could have the right and access to the personal health information”, because at the moment, health information is available electronically to many different organizations and individuals. It seems like the use to paperwork to keep all health information is not reliable because in the event of a fire, all information may be loss, however, it is much easier to get information through HIT because it is easier for thieves to hack into an account than to steal a folder in an office or hospital. Privacy concerns have erupted over several years where thieves would get access to personal and health information of a client through HIT, which results in medical identity theft. This allows the thieves to use your money to pay for medical services. Also, the information available online could be used inappropriately and sent to universities or in any organizations that one would like to enroll in. Even though discrimination against people who have or had an illness is illegal, employers tend to take information regarding health into account, therefore, threatening the client’s privacy.

The use of communication systems can also cause loss of employment and loss of human touch. With the establishment of eRx, pharmacists are no longer required to communicate with clients because, prescribed medication can go right to the door of the client. Human touch would be lost between clients and doctors as the doctors will no longer be commenting based on their personal observations in their own words, but instead, ticking off boxes or filling out forms in a vague manner.

Solution for the Issue:

Ways of protecting health information can be as easy as just knowing that there are consequences for using HIT to something as complicated as changing the laws. It is extremely important to remember to never leak out personal information to strangers, and to understand that there is privacy and security issues when using HIT. Authentication and authorization are two keys words for a user to identify. If the user has a password or something to confirm their identity, then it would decrease the chance of hacking. As for authorization, it is important for the client to limit the amount of people who have access to the health information, so that if issues do arise, it would be easier to control the flow of information. For doctors and other health specialists, it is crucial and the law to keep health information of clients private and secured. Both new and old staff members from health offices and hospitals should be reminded the privacy rules for inheriting personal health information from clients and each all information secure.

The Health Insurance Portability and Accountability Act (HIPAA) is an act that helps deal with privacy and security issues regarding the usage of HIT, their goal is to give the users more trust and confidence when using HIT. HIPAA has created The Privacy Rule, which is a Federal Law that gives your rights to your own health information and so that users can set rules and limits on who can access the information. In the present, HIPAA is still trying to perfect The Privacy Rule so using HIT would be safer.

Resources:

Bihari, Michael. “Using Health ...

This is a preview of the whole essay

Resources:

Bihari, Michael. “Using Health Information Technology to Manage Your Information.” About. 6 April 2010. 25 Sept 2010. <http://healthinsurance.about.com/od/healthinsurancebasics/a/health_IT_overview.htm>
Spring, Manda. “EMR Advantages and Disadvantages.” Bright Hub. 16 Dec 2008. 27 Sept 2010. <http://www.brighthub.com/health/technology/articles/7402.aspx>
Mollar, Katt. “Electronic Medical Records-The Pros and Cons.” Submit Your Article. 11 Apr 2009. 20 Sept 2010. <http://www.submityourarticle.com/articles/Katt-Mollar-5424/electronic-medical-records-54667.php>
United States. U.S. Department of Health & Human Services. Health Information Privacy. 23 April 2009. 1 Oct 2010. <http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html>

Using Health Information Technology to Manage Your Information

Computers Can Help You and Your Doctor Manage Your Health Care

From , former About.com Guide

Updated April 06, 2010

About.com Health's Disease and Condition content is reviewed by our Medical Review Board

Using health information technology to manage your personal health information is an important part of our changing health care system. You and your doctor can better manage your health care by improving how you communicate with each other and how you maintain your health information.

Using computers and other electronic devices makes it easy for you, your doctor, and other health care providers (such as hospitals, labs, and X-ray facilities) to store, share and access your health information. Using computers in this way is known as Health Information Technology (HIT) or Health IT.

Using Health Information Technology

Health information technology may be useful for:

reducing paperwork by eliminating the need for handwritten medical records
reducing medical errors by transmitting accurate information electronically and eliminating mistakes due to misreading of your doctor’s handwriting
reducing health care costs by decreasing the need for repeat medical tests by different doctors and eliminating storage space and staff time to maintain medical records
improving your quality of care by decreasing medical errors and assuring that all your health care providers have accurate and timely information

Although HIT has many uses throughout our healthcare system, three important types of health IT may affect you in the near future as more consumers use personal health records (PHRs) and more physicians use electronic health records (EHRs) and electronic prescribing (e-Rx).

Personal Health Records

Your personal health record (PHR) is an online document with information about your health (and the health of family members) that you keep up to date for easy reference. Using your PHR, you can keep track of your family’s health information, such as the date of your children’s immunizations, last physical exam, major illnesses and operations, allergies, or a list of family medicines.

Many PHRs are easy to use and may be provided free from your health plan, the government, your doctor’s office, and private companies. Some PHR companies charge a monthly or annual fee. Since your PHR is online, you can get into and manage your health information from anywhere that you have access to the internet.

Since you can collect, view, manage, and share your health information electronically, having a PHR will allow you to take a more active role in managing your own health care.

Electronic Health Records

An electronic health record (EHR) is computer-based document that is used by your doctor, your doctor’s staff, or a hospital. An EHR (similar to your old paper medical chart) contains health information from your doctor and other health care providers. A typical EHR has information about your health conditions, allergies, treatments, tests, and medications.

Many EHRs can connect with health care providers outside your doctor’s office such as specialists, labs, imaging facilities (X-rays, CT Scans, MRIs), and the local hospital. This allows your doctor to share up-to-date information with your other providers as well as getting quick and easy access to your tests and hospital information.

Since everyone involved in your health care can share accurate information, your EHR can help lower the chances of medical errors and may help improve the quality of your health care. Some EHRs have warning systems built in to let your doctor know about drug allergies or potential problems with drug interactions.

Also, some EHRs have medical alerts to remind your doctor to perform certain tests or procedures. For example, if you have , your doctor’s EHR may remind your doctor to check your feet at every visit or order a blood sugar test.

Depending on the EHR used by your doctor, you may be able to link your personal health record with your doctor’s electronic health record and share information back and forth.

Electronic Prescribing

Electronic prescribing or e-prescribing (eRx) is a way for your doctor and other health care providers to send your prescriptions to your pharmacy electronically. Instead of writing out a prescription and having you take it to your drugstore, your doctor orders your medication through her office computer, which then sends a secure electronic prescription to your pharmacist.

Electronic prescribing helps to:

avoid mistakes due to your doctor’s handwriting or your pharmacist’s misreading of your doctor’s
avoid harmful drug interactions by letting your doctor know that the drugs being ordered may interact with a medication you are already taking
allows your doctor to see what medications are on your health plan’s to make sure the drug being ordered is covered

Privacy and Security Issues

Over time, all of your health information will be available electronically, not only to you and your doctor but also to other health care providers and your health plan.

Because many organizations and people may have access to health information there is concern about the privacy and security of health information technology tools. Over the past several years there have been security breaches in hospitals and doctors’ offices resulting in medical identify theft. Access to your personal information may allow thieves to bill for medical services in your name.

Through the Health Insurance Portability and Accountability Act (HIPAA) of 1996, the federal government has established strict rules to protect the privacy and security of your electronic information. HIPAA gives you rights over your health information and sets rules and limits on who can look at and receive your health information.

Your doctor, other health care providers and your health plan are required to keep your information private by teaching their staff how your information may and may not be used and shared and take appropriate and reasonable steps to keep your health information secure.

http://healthinsurance.about.com/od/healthinsurancebasics/a/health_IT_overview.htm

EMR Advantages and Disadvantages

Article by MandaSpring (14,839 pts )
Edited & published by (37,078 pts ) on Dec 16, 2008

As a brief overview, let me take the time to give an EMR definition in a nutshell. EMR (Electronic Medical Record) is an information sharing system for both patients and doctors. The doctors add their data, research, prescriptions, etc. into this web based file and the patient, as well as the patient’s other doctors, have access from anywhere in the world.

As with any new system there are advantages and disadvantages. This technology can make storing and sharing information easier and more efficient not to mention convenient. But unfortunately, there are disadvantages with EMR.

EMR Advantages

The advantages of EMR are extensive and no one can argue that point. Just some of the over all benefits that EMR provides doctors and patients world wide include, but are not limited to:

1. An enhanced quality of care due to the amount of information at hand from every available and viable medical source.

2. Faster and more efficient diagnosis and treatments.

3. More convenient data trail; paperwork can often go uncompleted but electronically stored is faster an easier therefore it gets done effectively.

4. When medical audits take place all information is readily available making workflow and procedures faster and smoother.

EMR Disadvantages

As I mentioned before there are some disadvantages to EMR. Of course, none are so serious that it will hinder the rapid growth and use of EMR on a more permanent level but for now the technology merely needs to be mastered. So, what are some of these problems?

1. Financial difficulties to upgrade to the EMR such as buying software, etc..

2. Training to utilize this new system and understand the capabilities of this technology.

3. Technology factors like making sure that it is integrated with widely used systems and computer software for ease.

4. Security matters including keeping the information safe.

5. Legal issues meaning privacy and confidentiality of records, who should and could have access to the important data, etc.

EMR and the Military

The military is probably one of the best reasons for this to work and why it is not going to be put to rest. Military personnel already use EMR. It is the only thing that makes sense for them. They are positioned all over the world and get sick and wounded. At a moments notice the doctor that sees them must be able to access all data on prior medical history, prescription, lab results, absolutely everything in order to effectively treat them.

Conclusion

So, now you are more educated on the advantages and disadvantages of EMR. With so many skilled professionals working everyday to ensure safety, stability and a compatible structure for world wide use we are likely to benefit from this very soon. The medical information and research future of tomorrow depends upon this method of and clinical sharing.

http://www.brighthub.com/health/technology/articles/7402.aspx

April 11 2009

In this digital age, more and more bulks of information which used to be paper-based, from library catalogues to telephone books, are digitized and stored in a central location for easy access. The idea of EMRs started about 40 years ago.

The main proponents of EMRs cite the following advantages:

(1) The use of EHRs supposedly reduces errors in medical records. There is no doubt that handwritten records are subject to lots of human errors due to misspelling, illegibility, and differing terminologies. With the use of EMRs standardization of patient health records may eventually become acheivable.

(2) Paper records can be easily lost. We have heard how fires, floods and other natural catastrophes destroy physical records of many years, data which are lost forever. Digital records can be stored virtually forever and can be kept long after the physical records are gone. EMRs also help keep records of health information that patients tend to forget with time, i.e. inoculations, previous illnesses and medications.

(3) EMRs make health care cost-efficient by consolidating all data in one place. Previously, paper-based records are located in different places and getting access to all of them takes a lot of time and money. In a systematic review, Kripalani et al. evaluated the communication transfer between primary care physicians and hospital-based physicians and found significant deficits in medical information exchange. The review recommended the use of EMRs to resolve these issues and facilitate the continuity of care before, during and after hospitalization. EMRs translates into better treatment for patients. Take the example of one asthma center's experience with EMR: "A major benefit associated with EMR implementation was the increase in the number of children who were hospitalized with an asthma exacerbation and received an asthma action plan upon discharge. Prior to the EMR system, [only] 4% received an asthma action plan upon discharge. After implementation of the EMR system, 58% received an asthma action plan upon discharge."

(4) EMRs can save lives. VeriChip, developed by VeriChip Corporation is the first one of its kind ever approved by the US FDA. It enables rapid identification of at-risk patients and access to their medical history, thereby enabling rapid diagnosis and treatment especially in emergency situations. Classic examples are people with diabetes and/or heart problems who have high risk of collapsing and having attacks. VeriChip is also useful in vehicular accidents and other trauma incidents where the victims aren't capable of answering questions. In cases of large-scale catastrophes, VeriChip facilitates tracking and identification of victims. According to a coroner in Mississippi, VeriChip helped identify victims during the Hurricane Katrina incident.

Earlier this year, Google Health was launched, an online personalized health records service. Google Health is based on the principle that since it's the patient's medical record, the patient should control it, decide what should be in it, and who gets access to it. One of the features of the service includes records from hospitals and pharmacies that are Google Health-enabled or are registered Google Health partners.

The HealthVault is another online health information storage service offered by Microsoft with features similar to Google Health. Keith Toussaint, senior program manager with Microsoft HealthVault recently stated " leading hospitals like Beth Israel Deaconess Medical Center are actually integrating their systems with both us and Google -- because some people like one or the other. It's a Coke or Pepsi thing."

What are the disadvantages of EMRs? Not surprisingly, privacy rights advocacy groups are the main opponent of EMRs. Here is what they have to say:

(1) EMRs threaten our privacy. In this day and age when people's mantra is "I need my privacy", not many people are comfortable about having their entire medical history recorded and digitized for almost just anybody to see - in other words, incursion into people's privacy. The confidentiality of doctor - patient relationship is still sacrosanct. Besides, medical data can be used against a person in some cases - be it for a job application, insurance coverage or a college scholarship. Although it is against the law to discriminate against people with illnesses and disabilities, it is a fact of life that the fitter you are, the more competitive you are in the job market. The planned incorporation of genetic data in EMRs further adds to people's fear of incursion into their private sphere.

(2) EMRs can lead to loss of the human touch in health care. In the process of digitalization, the interpersonal aspect in health care may be lost. In handwritten hospital charts, doctors and other health care practitioners may write what they think and they feel based on their personal observations in their very own words. EMR is simply about ticking off boxes and crossing out things in electronic forms. The doctors are forced to think in categories and can seldom express a personal opinion on an individual case. Because of the lack of flexibility of many electronic reporting systems, cases of misclassification of patients and their conditions have been reported.

(3) EMRs are not that efficient. Despite efforts in digitalization and standardization, EMRs are actually far from being standardized and not as efficient as it is purported to be. It often happens that one clinic's EMR system is not compatible with that of a general practitioner or another clinic's system, thus belying the claim of added efficiency. In addition, not all users of EMRs are satisfied with the current state of the art. Although the objective is mainly efficiency and healthcare quality, one study showed that nurses in the Netherlands are not completely satisfied with their EMR implemented in 2006-2007.

(4) EMRs are not safe and secure. Google Health and HealthVault are quick in assuring patients of the safety of their online health accounts. Access to the patient's account is only possible using log ins and password. In addition, HealthVault assures that "all health information transmitted between HealthVault servers and program providers' systems is encrypted" and that Microsoft does it best to use the "highest standards of security to safeguard consumer health information from theft, loss, or damage."

However, there are cases wherein passwords and encryptions do not seem to be adequate as data protection tools. Stories of data hacking, stolen identities and blackmail abound. Even high security databases such as those run by banks and credit institutions are often compromised. This impression was aggravated by the many well-publicized incidences of data loss or breach. A few examples are listed below:

November 26, 2007, Canada. Hackers accessed medical information on HIV and hepatitis from a Canadian health agency computer. - September 22, 2008, UK. The National Health Service (NHS) reported the loss of 4 CDs in the mail containing information on 17,990 employees. - September 30, 2008, US. The company Blue Cross and Blue Shield of Louisiana confirmed breach of personal data, including Social Security numbers, phone numbers and addresses of about 1,700 brokers. The data was accidentally attached to a general email.

In addition, there is criticism over Google Health not being a "covered entity under the Health Insurance Portability and Accountability Act of 1996 and the regulations promulgated thereunder (HIPAA)" under its terms and conditions and is therefore not subject to HIPAA privacy of individually identifiable health information. The HealthVault terms and conditions do not mention HIPAA privacy laws so it is not clear what its status is regarding this issue.

(5) VeriChip is not for humans. It is to be expected that although many of us are amenable to the use of RFID chips in pets, the idea of implanting similar chips in human beings is bound to raise hackles in humans, no matter what the US FDA says. A big opponent of the VeriChip and similar chips of its kind is the consumer advocacy group Spychip.com. In a position paper, Spychip and many advocacy and consumer awareness groups see RFID tagging (be it on your person or on the items you buy) as a major threat to privacy and civil liberties. They see the tagging as some kind of "Big Brother" operation. Another group, the No VeriChip Inside Movement, likens VeriChip as "cataloguing" humans similar to the way the Nazis have tattooed numbers on the skin of concentration camp detainees. Popular Hollywood films on privacy incursions (e.g. The Net, Public Enemy No. 1) increased further people's paranoia about personal data.

Where do we go from here? Without doubt, we have the technology to make EMRs standardized and efficient. Google Health, Microsoft HealthVault and similar online personalized health information accounts are enabling patients to take control of their medical records. The main issues that need to be overcome are data security, protection of privacy and gaining the confidence of the patients. It doesn't seem evident that the use of RFID and similar tagging chips will become acceptable or popular anytime soon. However, we live in a digital world and we cannot hold back progress indefinitely. With improved technology and data protection tools, let us hope the EMR issue will be resolved soon.

http://www.submityourarticle.com/articles/Katt-Mollar-5424/electronic-medical-records-54667.php

Health Information Privacy
Your Health Information Is Protected By Federal Law

Most of us believe that our medical and other health information is private and should be protected, and we want to know who has this information. The Privacy Rule, a Federal law, gives you rights over your health information and sets rules and limits on who can look at and receive your health information. The Privacy Rule applies to all forms of individuals' protected health information, whether electronic, written, or oral. The Security Rule, a Federal law that protects health information in electronic form, requires entities covered by HIPAA to ensure that electronic protected health information is secure.

http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html

Spring, Manda. “EMR Advantages and Disadvantages.” Bright Hub. 16 Dec 2008. 27 Sept 2010. <http://www.brighthub.com/health/technology/articles/7402.aspx>

Mollar, Katt. “Electronic Medical Records-The Pros and Cons.” Submit Your Article. 11 Apr 2009. 20 Sept 2010. <http://www.submityourarticle.com/articles/Katt-Mollar-5424/electronic-medical-records-54667.php>