Ethical, legal and social issues for personal health records and applications

Comprehension, Perception, and Projection

Health social networks (HSNs) allow individuals with health information needs to connect and discuss health-related issues online. Political-technology intertwinement (e.g. GDPR and Digital Technology) highlights that users need to be aware, understand, and willing to provide electronic consent (eConsent) when sharing personal information online. The objective of this study is to explore the ‘As-Is’ factors which impact individuals’ decisional autonomy when consenting to the privacy policy (PP) and Terms and Conditions (T&Cs) on a HSN. We use a Situational Awareness (SA) lens to examine decision autonomy when providing eConsent. A mixed-methods approach reveals that technical and privacy comprehension, user perceptions, and projection of future consequences impact participants’ decision autonomy in providing eConsent. Without dealing with the privacy paradox at the outset, decision awareness and latterly decision satisfaction is negatively impacted. Movement away from clickwrap online consent to customised two-way engagement is the way forward for the design of eConsent.

Transformation of the Doctor-Patient Relationship: Big Data, Accountable Care, and Predictive Health Analytics

The medical profession is steeped in traditions that guide its practice. These traditions were developed to preserve the well-being of patients. Transformations in science, technology, and society, while maintaining a self-governance structure that drives the goal of care provision, have remained hallmarks of the profession. The purpose of this paper is to examine ethical challenges in health care as it relates to Big Data, Accountable Care Organizations, and Health Care Predictive Analytics using the principles of biomedical ethics laid out by Beauchamp and Childress (autonomy, beneficence, non-maleficence, and justice). Among these are the use of Electronic Health Records within stipulations of the Health Insurance Portability and Accountability Act. Clinicians are well-positioned to impact health policy development to address ethical issues associated with the use of Big Data, Accountable Care, and Health Care Predictive Analytics as we work to transform the doctor-patient relationship towards improving population health outcomes and creating a healthier society.

A patient focused relationship for specialists in laboratory medicine

Technological change is driving individualized healthcare delivery including laboratory medicine. Ensuring patients gain from their empowerment it is essential that they access data that enables them to utilize reliable information. The potential difficulties of comprehension, information retention and imperfect modes of communication can significantly impair utilization of information by patients. Support for understanding and decision-making needs to be clinically competent and integrated within the healthcare team. Specialists in laboratory medicine are well placed to undertake such a role, the issues around this are explored and proposals for better direct engagement with patients made.

Greater patient health information control to improve the sustainability of health information exchanges

Health information exchanges (HIEs) are multisided platforms that facilitate the sharing of patient health information (PHI) between providers and payers across organizations within a region, community or hospital system. The benefits of HIEs to payers and providers include lower cost, faster services, and better health outcome. However, most HIEs have configured the patient healthcare consent process to give all providers who sign up with the exchange access to PHI for all consenting patients, leaving no control to patients in customized what information to share and with who. This research investigates the impact of granting greater control to patients in sharing their personal health information on consent rates and making them active participants in the HIEs system. This research utilizes a randomized experimental survey design study. The study uses responses from 388 participants and structural equation modeling (SEM) to test the conceptual model. The main findings of this research include that patients consent rate increases significantly when greater control in sharing PHI is offered to the patient. In addition, greater control reduces the negative impact of privacy concern on the intention to consent. Similarly, trust in healthcare professionals leads to higher consent when greater control is offered to the patient. Thus, greater control empowers the role of trust in engaging patients and sustaining HIEs. The paper makes a theoretical contribution to research by extending the unified theory of acceptance and use of technology (UTAUT) model. The findings impact practice by providing insights that will help sustain HIEs.

Role of laboratory medicine in collaborative healthcare

Healthcare delivery and responsibility is changing. Patient-centered care is gaining international acceptance with the patient taking greater responsibility for his/her health and sharing decision making for the diagnosis and management of illness. Laboratory medicine must embrace this change and work in a tripartite collaboration with patients and with the clinicians who use clinical laboratory services. Improved communication is the key to participation, including the provision of educational information and support. Knowledge management should be targeted to each stakeholder group. As part of collaborative healthcare clinical laboratory service provision needs to be more flexible and available, with implications for managers who oversee the structure and governance of the service. Increased use of managed point of care testing will be essential. The curriculum content of laboratory medicine training programs will require trainees to undertake practice-based learning that facilitates interaction with patients, clinicians and managers. Continuing professional development for specialists in laboratory medicine should also embrace new sources of information and opportunities for collaborative healthcare.

Technological Health Intervention in Population Aging to Assist People to Work Smarter not Harder: Qualitative Study

Background

Technology-based health care has been promoted as an effective tool to enable clinicians to work smarter. However, some health stakeholders believe technology will compel users to work harder by creating extra work.

Objective

The objective of this study was to investigate how and why electronic health (eHealth) has been applied in Taiwan and to suggest implications that may inspire other countries facing similar challenges.

Methods

A qualitative methodology was adopted to obtain insightful inputs from deeper probing. Taiwan was selected as a typical case study, given its aging population, advanced technology, and comprehensive health care system. This study investigated 38 stakeholders in the health care ecosystem through in-depth interviews and focus groups, which provides an open, flexible, and enlightening way to study complex, dynamic, and interactive situations through informal conversation or a more structured, directed discussion.

Results

First, respondents indicated that the use of technology can enable seamless patient care and clinical benefits such as flexibility in time management. Second, the results suggested that a leader’s vision, authority, and management skills might influence success in health care innovation. Finally, the results implied that both internal and external organizational governance are highly relevant for implementing technology-based innovation in health care.

Conclusions

This study provided Taiwanese perspectives on how to intelligently use technology to benefit health care and debated the perception that technology prevents human interaction between clinicians and patients.

Controlled searching in reversibly de-identified medical imaging archives

Nowadays, digital medical imaging in healthcare has become a fundamental tool for medical diagnosis. This growth has been accompanied by the development of technologies and standards, such as the DICOM standard and PACS. This environment led to the creation of collaborative projects where there is a need to share medical data between different institutions for research and educational purposes. In this context, it is necessary to maintain patient data privacy and provide an easy and secure mechanism for authorized personnel access. This paper presents a solution that fully de-identifies standard medical imaging objects, including metadata and pixel data, providing at the same time a reversible de-identifier mechanism that retains search capabilities from the original data. The last feature is important in some scenarios, for instance, in collaborative platforms where data is anonymized when shared with the community but searchable for data custodians or authorized entities. The solution was integrated into an open source PACS archive and validated in a multidisciplinary collaborative scenario.

Adoption of Electronic Personal Health Records in Canada: Perceptions of Stakeholders

BACKGROUND

Healthcare stakeholders have a great interest in the adoption and use of electronic personal health records (ePHRs) because of the potential benefits associated with them. Little is known, however, about the level of adoption of ePHRs in Canada and there is limited evidence concerning their benefits and implications for the healthcare system. This study aimed to describe the current situation of ePHRs in Canada and explore stakeholder perceptions regarding barriers and facilitators to their adoption.

METHODS

Using a qualitative descriptive study design, we conducted semi-structured phone interviews between October 2013 and February 2014 with 35 individuals from seven Canadian provinces. The participants represented six stakeholder groups (patients, ePHR administrators, healthcare professionals, organizations interested in health technology development, government agencies, and researchers). A detailed summary of each interview was created and thematic analysis was conducted.

RESULTS

We observed that there was no consensual definition of ePHR in Canada. Factors that could influence ePHR adoption were related to knowledge (confusion with other electronic medical records [EMRs] and lack of awareness), system design (usability and relevance), user capacities and attitudes (patient health literacy, education and interest, support for professionals), environmental factors (government commitment, targeted populations) and legal and ethical issues (information control and custody, confidentiality, privacy and security).

CONCLUSION

ePHRs are slowly entering the Canadian healthcare landscape but provinces do not seem well-prepared for the implementation of this type of record. Guidance is needed on critical issues regarding ePHRs, such as ePHR definition, data ownership, access to information and interoperability with other electronic health records (EHRs). Better guidance on these issues would provide a greater awareness of ePHRs and inform stakeholders including clinicians, decision-makers, patients and the public. In turn, it may facilitate their adoption in the country.

Attitudes towards Social Networking and Sharing Behaviors among Consumers of Direct-to-Consumer Personal Genomics

Little is known about how consumers of direct-to-consumer personal genetic services share personal genetic risk information. In an age of ubiquitous online networking and rapid development of social networking tools, understanding how consumers share personal genetic risk assessments is critical in the development of appropriate and effective policies. This exploratory study investigates how consumers share personal genetic information and attitudes towards social networking behaviors.

METHODS

Adult participants aged 23 to 72 years old who purchased direct-to-consumer genetic testing from a personal genomics company were administered a web-based survey regarding their sharing activities and social networking behaviors related to their personal genetic test results.

RESULTS

80 participants completed the survey; of those, 45% shared results on Facebook and 50.9% reported meeting or reconnecting with more than 10 other individuals through the sharing of their personal genetic information. For help interpreting test results, 70.4% turned to Internet websites and online sources, compared to 22.7% who consulted their healthcare providers. Amongst participants, 51.8% reported that they believe the privacy of their personal genetic information would be breached in the future.

CONCLUSION

Consumers actively utilize online social networking tools to help them share and interpret their personal genetic information. These findings suggest a need for careful consideration of policy recommendations in light of the current ambiguity of regulation and oversight of consumer initiated sharing activities.

The personal health record paradox: health care professionals' perspectives and the information ecology of personal health record systems in organizational and clinical settings

Background

Despite significant consumer interest and anticipated benefits, overall adoption of personal health records (PHRs) remains relatively low. Understanding the consumer perspective is necessary, but insufficient by itself. Consumer PHR use also has broad implications for health care professionals and organizational delivery systems; however, these have received less attention. An exclusive focus on the PHR as a tool for consumer empowerment does not adequately take into account the social and organizational context of health care delivery, and the reciprocal nature of patient engagement.

Objective

The purpose of this study was to examine the experiences of physicians, nurses, and pharmacists at the Department of Veterans Affairs (VA) using an organizationally sponsored PHR to develop insights into the interaction of technology and processes of health care delivery. The conceptual framework for the study draws on an information ecology perspective, which recognizes that a vibrant dynamic exists among technologies, people, practices, and values, accounting for both the values and norms of the participants and the practices of the local setting. The study explores the experiences and perspectives of VA health care professionals related to patient use of the My HealtheVet PHR portal and secure messaging systems.

Methods

In-depth interviews were conducted with 30 VA health care professionals engaged in providing direct patient care who self-reported that they had experiences with at least 1 of 4 PHR features. Interviews were transcribed, coded, and analyzed to identify inductive themes. Organizational documents and artifacts were reviewed and analyzed to trace the trajectory of secure messaging implementation as part of the VA Patient Aligned Care Team (PACT) model.

Results

Study findings revealed a variety of factors that have facilitated or inhibited PHR adoption, use, and endorsement of patient use by health care professionals. Health care professionals’ accounts and analysis of organizational documents revealed a multidimensional dynamic between the trajectory of secure messaging implementation and its impact on organizational actors and their use of technology, influencing workflow, practices, and the flow of information. In effect, secure messaging was the missing element of complex information ecology and its implementation acted as a catalyst for change. Secure messaging was found to have important consequences for access, communication, patient self-report, and patient/provider relationships.

Conclusions

Study findings have direct implications for the development and implementation of PHR systems to ensure adequate training and support for health care professionals, alignment with clinical workflow, and features that enable information sharing and communication. Study findings highlight the importance of clinician endorsement and engagement, and the need to further examine both intended and unintended consequences of use. This research provides an integral step toward better understanding the social and organizational context and impact of PHR and secure messaging use in clinical practice settings.

[Measures to ensure data confidentiality in Clinical Units in order to achieve quality accreditation in Andalusia]

OBJECTIVE

To analyse the measures introduced by Health Care Units to ensure the confidentiality of health information on patients that been validated as adequate by an assessment team of the Agency for Healthcare Quality in Andalusia (Spain).

MATERIAL AND METHODS

A retrospective study was conducted on Health Care Units accredited by the Agency for Healthcare Quality in Andalusia. A total of 272 Health Care Units were evaluated between January 2003 and December 2010. We analysed the measures that were assessed as adequate to ensure the confidentiality of data by this team, establishing categories after analysing records of the application that supports the certification process (ME_joraC).

RESULTS

Using on- site surveys, areas of improvement were found in the safeguarding of medical records (64.1%) and the internal control of implementing the information security measure (19.6%). The measures introduced into the Health Care Services were mainly technological actions (28.5%), which were related to the increasing presence of electronic history. It also frequently provided solutions related to implementation (17.9%) and dissemination (22.3%) protocols for use of medical records.

CONCLUSIONS

Accreditation processes help to identify areas for improvement and the introduction of procedures for ensure confidentiality of data in the healthcare system. Technological solutions that respond to the needs created by the computerisation of medical records, and the effective implementation of protocols and monitoring the adherence to these protocols using self-assessment, strengthen the efforts to ensure confidentiality. Furthermore, it promotes the involvement and responsibility of the professionals on this topic.

Mobile personal health records: an evaluation of features and functionality

PURPOSE

To evaluate stand-alone mobile personal health record (mPHR) applications for the three leading cellular phone platforms (iOS, BlackBerry, and Android), assessing each for content, function, security, and marketing characteristics.

METHODS

Nineteen stand-alone mPHR applications (8 for iOS, 5 for BlackBerry, and 6 for Android) were identified and evaluated. Main criteria used to include mPHRs were: operating standalone on a mobile platform; not requiring external connectivity; and covering a wide range of health topics. Selected mPHRs were analyzed considering product characteristics, data elements, and application features. We also reviewed additional features such as marketing tactics.

RESULTS

Within and between the different mobile platforms attributes for the mPHR were highly variable. None of the mPHRs contained all attributes included in our evaluation. The top four mPHRs contained 13 of the 14 features omitting only the in-case-of emergency feature. Surprisingly, seven mPHRs lacked basic security measures as important as password protection. The mPHRs were relatively inexpensive: ranging from no cost to $9.99. The mPHR application cost varied in some instances based on whether it supported single or multiple users. Ten mPHRs supported multiple user profiles. Notably, eight mPHRs used scare tactics as marketing strategy.

CONCLUSION

mPHR is an emerging health care technology. The majority of existing mPHR apps is limited by at least one of the attributes considered for this study; however, as the mobile market continues to expand it is likely that more comprehensive mPHRs will be developed in the near future. New advancements in mobile technology can be utilized to enhance mPHRs by long-term patient empowerment features. Marketing strategies for mPHRs should target specific subpopulations and avoid scare tactics.

National health information infrastructure model: a milestone for health information management education realignment

OBJECTIVE

Challenges and drawbacks of the health information management (HIM) curriculum at the Master's degree were examined, including lack of well-established computing sciences and inadequacy to give rise to specific competencies. Information management was condensed to the hospital setting to intensify the indispensability of a well-organized educational campaign. The healthcare information dimensions of a national health information infrastructure (NHII) model present novel requirements for HIM education.

MATERIALS AND METHODS

Articles related to challenges and barriers to adoption of the personal health record (PHR), the core component of personal health dimension of an NHII, were searched through sources including Science Direct, ProQuest, and PubMed. Through a literature review, concerns about the PHR that are associated with HIM functions and responsibilities were extracted. In the community/public health dimension of the NHII the main components have been specified, and the targeted information was gathered through literature review, e-mail, and navigation of international and national organizations. Again, topics related to HIM were evoked.

RESULTS

Using an information system (decision support system, artificial neural network, etc.) to support PHR media and content, patient education, patient-HIM communication skills, consumer health information, conducting a surveillance system in other areas of healthcare such as a risk factor surveillance system, occupational health, using an information system to analyze aggregated data including a geographic information system, data mining, online analytical processing, public health vocabulary and classification system, and emerging automated coding systems pose major knowledge gaps in HIM education.

CONCLUSIONS

Combining all required skills and expertise to handle personal and public dimensions of healthcare information in a single curriculum is simply impractical. Role expansion and role extension for HIM professionals should be defined based on the essence of HIM roles and responsibilities. Forming a curriculum development team consisting of various professional profiles brings divergent views regarding the HIM curriculum and paves the way for HIM to branch out at the Master's and Ph.D. levels based on advanced information technology.