Telecommunications and Networking Concepts for Health Care

Over the past couple of decades, information and communication technology (ICT) has revolutionized our society, the ways we interact with one another and even the way we work and live our day-to-day lives.  In addition, information technology has been used in other industries such as banking, retail, and travel to transform their businesses.  Despite the numerous studies and the evidence presented detailing the ways that ICT can revolutionize the health care industry, health care remains the only major industry that has lagged in and often resisted the adoption of ubiquitous technologies used in other sectors of the economy that can improve the way health care can be accessed and delivered (Dixon, 2010). 

Although the electronic health record (EHR) is an important step in making patient medical information more accessible and shareable, many believe that health care providers, health care organizations, and insurers receive more direct benefits than patients.  However, the use of telecommunications and networking through online technology can take advantage of data in the health record and allow providers and patients to exchange information continuously, not just via office visits (Dixon, 2010).

This online technology is part of an application in health broadly defined as eHealth, which includes telemedicine, electronic medical records, and health information systems with decision support, mobile health and eLearning tools” (Shiferaw & Zolfo, 2012).  eHealth has the potential to create a better healthcare delivery system and the possibility of universal health care coverage by creating access to health care services for individuals that otherwise would go without much needed health care, enhances the quality of healthcare, improves primary health care interventions and can offer solutions for situations where human resources for health are scarce (Shiferaw & Zolfo, 2012).  

A technology enabled medical practice is another concept of eHealth that uses a combination of tools to improve communication with and care of patients wherever they are in the world.  This type of practice has the potential to build a strong relationship between the patient and his/her team of providers.  The patient portal is a secure Web site that enables the provider and patient to communicate securely online and is the administrative core of the practice.  Patients have the ability to securely log into the portal with any device that can be connected to the Internet and can use the portal for routine and non-urgent requests any time that is convenient for them.  Patients have the ability to request prescription refills, schedule appointments, request referral authorizations and can even view their outpatient medical records (Dixon, 2010).  The requests made online by the patients are a benefit to the administrative staff because there is a reduction in phone calls and they are better able to determine the patient’s needs.  The portal can also provide a way to transmit lab test results to patients in a timely fashion.  Providers also benefit from this online technology because they can gather detailed statistics about what services their patients are using; thus, allowing them to review business processes and manage resources (Dixon, 2010).

Cloud computing is a new way of delivering computing resources and services that many managers and experts believe can be used to improve health care services, benefit health care research, and change the face of health information technology (Kuo, 2011).  Almost everyone in this day and age with access to an electronic communications device uses on form or another of Cloud Computing - it is literally everywhere (Shimrat, 2009).  In the past, many of the software applications, services, and data were housed safely on a local network that was secure in your building; however, those same applications, services, and data are now housed in the domain of the Internet.  All one has to do now is log onto any computer that has Internet access, no matter where you are in the world, and you will have immediate access to your files, software, data, etc. that you may need.   The private health information that was once housed on these networks have now been migrated onto the Internet.  Many small solo-physician practices have decided that rather than incur the costs of updating and building local computer infrastructures that they are better off and find it less expensive to pay monthly charges to keep everything “in the cloud” (Shimrat, 2009).  “Clouds are a large pool of usable and accessible virtualized resources (such as hardware, development platforms and/or services” (Kuo, 2011, p. 2). Clouds can be reconfigured when needed to make adjustments for more and more information that will be utilizing the space.  

Finally, telemedicine is often defined as the interactive exchange of medical information and care from one site to another via electronic communications in an effort to reduce risks, improve patients’ health status and reduce costs.  Telemedicine is also referred to as “telehealth” or “e-health”; however, over the last few years, the term telemedicine and its focus has moved from primarily being on the delivery of care from point to point the focus being more about using the term telehealth because the healthcare business has shifted to electronic medical records and took a longitudinal view of the patient (Andrews, 2013).  Telemedicine is a valuable and much needed resource for physicians and patients alike.  It gives physicians and other health care providers the ability to evaluate, diagnose and treat patients in remote areas using telecommunications technology such as communications devices, video streaming, video chatting, and virtual office visits.  These types of technology have been a part of telehealth for a long time but now especially since the health care industry is moving toward electronic health records the use of technology is now more about how technology can enhance the view a clinician has of the patient and how it can be used to enhance efficiencies and workflows to drive better health outcomes.

There are several trends that are not only having an impact on telemedicine but are also shaping its future.  The United States is not only experiencing a shortage of clinicians but also a maldistribution of providers.  A maldistribution of providers means that there are more providers that are located or concentrated in some areas and a shortage of providers in other areas, especially in rural areas.  According to the YouTube video, What is telemedicine?, telemedicine gives these providers and physicians the ability to be more readily available and accessible to more patients (California TRC, 2012).   Health care costs are also shaping the future of telemedicine because telemedicine has the ability to improve access to services in rural and underserved areas which can reduce the overall costs of care.  Finally, an emphasis has been put on treating chronic conditions and preventing hospital re-admissions which is making telemedicine more and more of a go-to solution that is proven to improve patient’s access to services and can reduce the overall costs of care while identifying and treating problems sooner by reducing a delay in care.

Telemedicine has also been proven to be beneficial in disaster relief and can actually be used as a model for the integration of telemedicine in communities nationwide.  Telemedicine equipment being used in disaster relief shows the immediate benefits of how using satellite based communications and mobility ensures that patients get the appropriate expertise anytime, anywhere.  It also shows how medical information can be captured and transferred to physicians and specialists for real time consultation and care.

References

Andrews, J. (2013). Telehealth fits new landscape. Retrieved August 9, 2013, from http://www.healthcareitnews.com/news/telehealth-fits-new-landscape

California Telehealth Resource Center [CaliforniaTRC].  (2012, December 18). What is telemedicine [Video file].  Retrieved from http://www.youtube.com/watch?v=at7o1DeYAZs

 

Dixon, R. F. (2010). Enhancing primary care through online communication. Health Affairs, 29(7), 1364-1369. doi: 10.1377/hlthaff.2010.0110  

Kuo, A. M. (2011). Opportunities and challenges of cloud computing to improve health care services. Journal of Medical Internet Research, 12(3), e67-75. doi: 10.2196/jmir.1867

Shiferaw, F., & Zolfo, M. (2012). The role of information communication technology (ICT) towards universal health coverage: the first steps of a telemedicine project in Ethiopia. Global Health Action, 51-8. doi:10.3402/gha.v5i0.15638

Shimrat, O. (2009). Cloud computing and healthcare?: Bad weather or sunny forecast? Retrieved August 9, 2013, from http://www.himss.org/files/HIMSSorg/content/files/Code%2093_Shimrat_CloudComputingandHealthcare_2009.pdf

 

Legal and Ethical Aspects of Health Information Management

Health care spending in the United States exceeds $2 trillion annually and on a per capita basis far exceeds any other industrialized nation.  As many studies have documented, this money is often spent frivolously and has contributed and linked to much of the inefficiency and waste in both the public and private health care sectors.  Despite the trillions of dollars spent and the ever increasing high cost of health care, the United States continues to lag far behind other developed countries in key measures such as infant mortality and life expectancy (Rothstein, 2007). 

The expansion and improvement of health information technology (HIT), such as the nationwide implementation of electronic health records (EHRs), has been proven to improve health outcomes and increase the effectiveness and efficiency of health care delivery.  “Supporters of EHRs assert that they avoid duplication of history taking and tests, promote coordination of care, reduce medical errors, ensure access to records from remote locations and in emergencies, permit better disease management, and facilitate electronic decision support” (Rothstein, 2007, p. 488).  Health care providers have been able to adopt and increase their use of HIT without compromising the quality of health care delivery.

The advent of HIT has dramatically changed the practice of health information management.  Along with this change, many new challenges dealing with the ethical and legal aspects of how patient health information is collected, processed, stored, and transferred have come to the forefront and must be addressed by health care professionals when handling patient health data.  Health care professionals are faced with core health information issues that include what information should be collected, how the information should be handled, who should have access to the information, and under what conditions the information should be disclosed (Cassidy, 2011).

The terms privacy and confidentiality are often used interchangeably; however, in health care these two terms are very different.  Privacy refers to the ability of a patient to prevent their personal health information from being disclosed to other individuals unless the patient otherwise granted permission through consent.  There are exceptions to this, for instance, if a person is thought to be in danger or potentially could endanger another person.  Confidentiality is the conditions under which the personal health information was obtained or disclosed within a confidential relationship with a health care provider and will not be re-disclosed without the written permission of the patient (Rothstein, 2007).

Ethical principles are integral to all patient consultations with confidentiality being the key issue (Edwards, 2009).  During and after a patient consultation the patient’s confidentiality should be protected.  The provider must ensure that consent is obtained to share information outside of the immediate health care team treating the patient.  This information should only be shared on a ‘need-to-know’ basis.  Measures should be taken to ensure that every patient’s medical information remains confidential.  For instance, text messaging is a new method that many providers are using to communicate with their patients and other providers.    It allows patients to have access to their information or have discussions with their provider about their health issues without having face-to-face contact (Edwards, 2009).  Health care organizations should ensure that there is an up-to-date organizational confidentiality policy in the patient’s file.  In addition, providers must make sure all messages are documented in the patient’s records and when done the messages should be deleted from the mobile device and/or computer that was used to transmit these messages. 

Finally, healthcare professionals often look to codes of ethics specific to their practice when seeking ethical guidance.  The code of ethics for a professional association incorporates values, principles, and professional standards (Flite & Harman, 2013).  “Professional values for health information management (HIM) include the importance of education and technical competency, patient safety, data validity and accuracy, truthfulness, compassion, and dedication to providing quality services in professional roles” (Flite & Harman, 2013, p. 2).  In other words, the main health information issues include what information should be collected, how the information should be handled, who should have access to the information, and under what conditions the information should be disclosed (Cassidy, 2011).

References

Cassidy, B.  (2011).  AHIMA's Code of Ethics. Journal of AHIMA, 82(3), 10.  Retrieved from             http://www.ahima.org/

Edwards, M. (2009). Patient confidentiality and data protection. Practice Nursing, 20(8), 411-413. Retrieved from http://www.practicenursing.com/

Flite, C. A., & Harman, L. B. (2013). Code of ethics: Principles for ethical leadership. Perspectives in Health Information Management, 1-11. Retrieved from www.ahima.org
Rothstein, M. A. (2007). Health Privacy in the Electronic Age. Journal Of Legal Medicine, 28(4), 487-501. doi:10.1080/01947640701732148

Health Informatics in the 21st Century - Introduction

Health Informatics in the 21st Century
Tracey Cromwell
HCA 496 - Health Informatics Capstone
Professor Qing Yan
September 30, 2013

Please click on the link below to see a few things that you can expect to see in the following weeks if you stay tuned to this blog.  I look forward to sharing information about Health Informatics with you.

To see My Introduction Page click here:

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