Thursday, January 16, 2020
Electronic Health Records Essay
The medical and healthcare field is characterized with the cumbersome practice of obtaining and maintaining extensive documentation of patient information. Medical staff, physicians and healthcare practitioners are legally responsible to maintain a comprehensive, efficient as well as effective way to collect, maintain and archive patient information. Traditionally, this process of information collection and maintenance was accomplished manually resulting in an endless paper trail of information. Everything from patient encounters to informational charts to billing was executed in a paper based environment and soon this record keeping method became too overbearing and tedious to manage. The integrity of this manual paper-based process continued to be compromised with issues surrounding the convenience, data mining ability, cost and safety of this method. The advent of new health care disciplines such as nursing, medical technologists and associated health care disciplines, and the emergence of hospitals, infirmaries and clinics as formalized structures of health care delivery expanded the scale of interaction between health care providers and health care consumers. However, in spite of these and associated developments, the tradition of privacy and confidentiality remained. Operationally, the new health care professions were seen as extensions of, and as subsidiary to, the medical profession and similar injunctions concerning privacy and confidentiality applied. (Doyle, 2001) Further, health care decision making continued to centre in the direct and interpersonal relationship between the professional and the client that had characterized it from its very beginning. An important step in the transformation of this scenario occurred with the introduction of electronic means of storing and manipulating patient data. The pace of this transformation was accelerated by the development of advanced computer-based information technology. At first glance, these developments may seem like purely technological improvements: mere steps, as it were, along the road to the greater ease of collecting, storing and manipulating patient data. However, what actually happened was more profound. The advent of electronic means of data storage, retrieval and manipulation facilitated the evolution of health care decision-making structures away from the small-scale immediate-contact model that had characterized medicine and health care from the beginning to a new model that no longer dealt with the physician-patient encounter as sole decision-resource but instead centered on the information package that described and defined the patient from a decision-making perspective. That is to say, considered in one way, the modern electronically based data package that describes the patient can be seen as a mere variation on the traditional package that was paper-based and that involved the manual manipulation of a material medium. From that perspective, electronic records do not differ fundamentally from paper-based records. While electronically based records may be more compact, more easily available, etc. , this is merely a peripheral difference as far as their nature as records is concerned. Therefore in this sense, there is nothing about electronic patient records that in principle makes them different from paper based records. ItÃ¢â¬â¢s a normal trend for clinical departments to work for years with their own people, budget, and vendors to come up with a method of capturing their patient and billing data electronically, and that personalized method is one definition of an EHR. In actual fact, one point of argument regarding EHRs is simply a question of semantics. There are various definitions for an EHR. At one end of the scale, an EHR includes everything from patientÃ¢â¬â¢s past medical history to diet and lifestyle preferences. At the other end, it can be as simple as an e-mail message to a fellow clinician. Our definition of an EHR is simply a repository of clinically important data that may be accessed and searched with relative ease and in a rapid manner. Today, the use of EHR systems has revolutionized the medical field industry by facilitating a more efficient record keeping process and a more effective communication medium for medical personnel to exchange information. Many healthcare personnel now understand the importance and the impact these EHR systems are having on the overall delivery of customer service and the general administration of healthcare. Medical practitioners are constantly faced with challenges including the need to improve the quality of care, adhere to new clinical restrictions and processes, reduce waste and reduce errors. In recent times these challenges have been less of a burden as automated integrated systems help coordinate such process much better. Computerized systems like EHR systems help in reducing the amount of paperwork for medical offices, providing an easier way to access patient information, promoting more uniform delivery of processes and in some respects suggesting appropriate diagnosis and treatment for certain conditions. While the health care information superhighway has brought such benefits as detailed health and medical information and has increased the efficiency of managed care organizations in data collection and analysis, outsiders who have access to patient sÃ¢â¬â¢ medical histories are using them as tools of discrimination in employment, promotions, insurance coverage, and even politics. Dr.Ã Denise Nagel, president of Coalition for Patient Rights of New England, state, Ã¢â¬Å"The traditional right of medical privacy, protected by the Hippocratic Oath, is being eroded as our medical records become transformed into commodities desired by insurers, employers, researchers, and yes, even police. Ã¢â¬ (Gellman, 2002) She goes on to give the example of a woman, who with only average computer skills, was able to access information about the psychiatric condition from her medical record in an insurance companyÃ¢â¬â¢s database. Concerned that future employers would obtain it as easily as she had, she requested its removal, but was turned d own by the company (Tobler, 2002). When a confidential list of 4,000 AIDS patients wound up in newsrooms in Tampa, Florida, last year, it was discovered that the computerized medical records had been tapped by a major pharmaceutical company (Bennett, 2002). These examples arouse concern about how private medical data really is. Patients have the right to keep their medical history private for their own protection, but that privacy is increasingly being threatened by the growth of the information superhighway. There would have to be a provision that even for legitimate purposes, the subjects of the records would have to be notified if patientsÃ¢â¬â¢ records were to be accessed, the reason why they were being accessed, and the extent to which such an intrusion into the privacy of the individual was going to take place. This would have to go hand-in-hand with the right of the subject of the record to challenge the claim that privacy must be breached by the duly empowered social agency. Similar remarks apply to the activities of other duly authorized social institutions. For example, some jurisdictions have started to construct networked data sharing agencies that monitor the filling of medical prescriptions. (Bennett, 2002) The alleged purpose of such a surveillance network is safety: It is to ensure that the prescriptions that are actually being filled for a given patient do not conflict or synergetically interact with each other, or otherwise have a deleterious effect on the patientÃ¢â¬â¢s health. Another, ancillary purpose is to control the misuse of drugs, to prevent physician-shopping for multiple prescriptions of controlled substances that are then sold illegally, etc. Specifically, one may distinguish between social harm that would be avoided or minimized and personal harm for the individual patient. If the claim is that societal harm would be minimized by such an intrusion into personal privacy, certain considerations must be borne in mind. First, any action that limits the application of a principle has consequences that extend beyond the immediate action itself. Thus, abandoning the principle of privacy on a given occasion has the tendency to undermine the sense of trust that people have in social institutions and in the maintenance of their rights. Consequently, when such an intrusion for security purposes occurs, care must be taken that the potential harm in undermining confidence in societal protection of individual privacy is outweighed by the harm that it is intended to prevent. Second, the Principle of Equality and Justice would entail that any such abrogation of the individualÃ¢â¬â¢s right of privacy must be demonstrably necessary and could not be achieved by a less intrusive course of action. Third, any such abrogation of the individualÃ¢â¬â¢s right of privacy would have to be limited in extent, such that it may not go beyond the limits necessary to achieve the otherwise legitimate aims that have been justified by the preceding two considerations. In other words, it must adhere to the principle of the least intrusive alternative. By contrast, intrusions into privacy that focus in the welfare of the individual patient could not be justified in such a fashion. The reason is to be found in the Principle of Non-Malfeasance itself. The core of the Principle of Non-Malfeasance is not simply that harm should be minimized, but harm should be minimized where the nature of that harm is determined not by the agent but by the intended recipient of the action.