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Trends in Society
1.2 Internet-empowered consumers will be much more informed about medicine, healthcare choices, and new technology.
Science & Technology
2.1 Biomedical technology innovation will infuse healthcare.
2.2 Electronic medical records will become widespread in hospitals.
How will the Internet affect healthcare of the future?
What type of biomedical and technological innovations is happening in healthcare?
What impact will electronic medical records have in hospitals and other care settings?
What are the practical implications and guidelines for case managers concerning these issues?
The American public, by the millions, is searching the Internet for information on health and health advice. In addition, retailers hope that consumers will access the Web for e-commerce in purchasing everything from drug refills to chronic care equipment and supplies, to health insurance (American Hospital Association, 2000).
Experts believe the Internet is the next frontier in healthcare. Healthcare consumers are pouring into the cyberspace arena, and an Internet-based industry of health information providers is springing up to meet their needs. In 1999, as many as 70 million (74 percent) of the estimated 97 million people online reported visiting one or more of the Web's 20,000 health-related sites for medical information (Hochstetler, 1999). By mid-2000, as many as 98 million American reported using the Internet to find healthcare information, a figure twice as large as two years earlier (Reuters Health, 2000). As more consumers become familiar with the Internet, the Internet is becoming a trusted source of health and medical information.
Along with this rush to the Web is the concern about the quality and validity of information and products offered by some advertisers and providers. The Internet is not yet regulated in a manner that safely controls online purchasing of prescription drugs or other products. The Food and Drug Administration (FDA) has begun to monitor the Internet for fraudulent and unwarranted claims of health products on the Web. In recent months, the FDA has actually warned several sites of questionable content, and these sites have voluntarily modified their content or have closed down. In the mid-1990s, the American Medical Association conducted a review of medical web sites, and found that only about half of all health and medical Web sties are created by credible sources (Bean, 1999). The other half of sites are posted by health products or service companies, individuals and others who have the potential to be less accurate and objective (Bean).
The most frequently accessed sites for health information are for disease information (52 percent), diet and nutrition (37 percent), online pharmaceuticals (35 Technological, Biotechnological, and Cyberspace Trends Percent), health newsletters (33 percent), and women's health (32 percent) (American Hospital Association). As the Web continues to expand and grow with more healthcare offerings, the issues of online prescribing, electronic record management, security of information, and validity of health claims on the Web will be pressing concerns for legislators and the American public.
Closely related to the issues surrounding the Internet are issues associated with the continued innovations in science and technology. In the near future, a broad range of such innovations will flow into healthcare. With these changes comes the need to understand how to manage care, educate providers on new technology, and assure quality patient outcomes.
Biomedical devices: Experts attest that a new wave of biomedical devices will arrive early in the millennium. These devices include:
There are enhanced drug dispensing devices, and implanted monitoring devices that allow continuous disease management of high-risk patients. These types of devices will enhance the lifestyle of the chronically ill who require close monitoring for successful disease management.
E-commerce: Many healthcare organizations will greatly expand their Net-enabled business relationship with consumer, physicians, health plans, suppliers, and other partners in trade. Traditional insurers such as Blue Cross, Blue Shield, and PacifiCare are selling services on the Web, as are entrepreneurial companies such as eHeatlhinsurance.com, and other such insurance companies (American Hospital Association). Health organizations are also moving the Web to enhance purchasing strategies.
The Web revolution in healthcare is occurring because consumers are demanding it, according to experts (Reuters Health, 1999). These experts also attest that providers must use the Internet to stay informed and to serve as their patients' advocates.
Biotechnology: The new era of biotechnology is under way. Many are talking about the Human Genome Project: an international collaborative research effort yielding new information on the precise biochemical code for each gene. With this information, DNA-based diagnostics and therapeutics can be designed and some have begun clinical trials. Some believe that a patient's DNA profile will become part of a completely electronic medical record. In the next few years, as early as 2001 or 2002, we can expect to see the first new biomedical products hit the market, assuming clinical trials allow such events to occur.
Robotic surgery: Many types of surgical procedures have already begun to use aspects of robotic surgery, and more will be added in the future. Voice-directed laparoscopic surgery is already on the market. Robotic surgery may be soon found in cardiology, urology, orthopedics, and many other precise surgeries.
The most interesting technologies in this arena include:
According to the AHA survey findings, the installation and use of electronic medical records (Emirs) will become widespread in the next three to five years, with 81 percent agreement from the expert panel surveyed. Most hospitals and many medical practice offices will shift their medical record keeping to electronic formats, but not entirely forsake paper files. Voice-recognition systems will electronically convert dictation by doctors and nurses into data. Personal digital assistants (PDAs) such as the popular "Palm Pilot" will allow accelerated use offers’. The cost-savings for switching to EMRs is showing promise, as well as the improved "completeness" of records (i.e., fewer incomplete charts) and continuously updated medication lists, and other sections of medical records.
The digital transformation of healthcare is also going to be accelerated by the rapidly growing field and use of wireless networks. Wireless networks can allow telecommunications across nursing care floors or link an entire regional system. Again, PDAs will playa huge role in this area, and will combine phone, pager, messaging and Data-entry in one unit. Although not inexpensive, the benefits of such systems are also believed to lower the cost of managing information and records.
Confidentiality
All communication and records pertaining to the patient's care are to be treated as confidential by the hospital, except in cases such as suspected abuse, and mandatory reporting of public health hazards. Hospitals are to emphasize and assure the confidentiality of such information at all times. Confidentiality means that all patient information is to receive special care, to assure that only that staffs that have the need to access such records will have the ability to do so.
Case managers in acute care and other care settings, including those who work for third-party payers or case management agencies, must be familiar with their agency's policies on handling of patient records.
Some questions to consider include:
The issue of confidentiality centers on the case manager's responsibility to navigate employer and payer needs with patient information and patient's rights. It is important for case managers to know what information must be relayed to the patient's health plan. Also, it is equally important to not withhold the telling of that information from the patient. In the natural day-to-day work with other professionals, case managers may need to discuss patient information to assure proper care is arranged. This information may include highly sensitive information. The main goal, in any patient case, should be to preserve the patient's and family's confidentiality and privacy to the highest degree possible
Every aspect of privacy is a patient right. All healthcare provider's discussions regarding patient cases, consultation, physical examination data, and therapies, should be conducted as to protect patient privacy.
Patient privacy is a potential problem in two-bed hospital rooms and wards, where other patients and visitors can hear discussions not intended for them to hear. In such settings, it is helpful if the care providers discuss patient information in a care conference setting (special conference room or similar room) if the material is extremely sensitive and confidential.
Some of the important legislation or regulations regarding proper handling of Trends healthcare information includes:
1974 - Privacy Act (the proper handling of information between parties)
1988 - JCAHO Accreditation manual for hospitals 1996 - Health Insurance Portability and Accountability Act (HIP AA)
The 1974 Act simply tried to define the proper handling of information between any parties that needed employee information or patient information for care. It has helped for basic records and patient charts in all healthcare areas.
The 1988 JCAHO manual identified privacy and confidentiality as two of the most important patient rights. In addition to these rights, the Commission added ethical practices of healthcare organizations in 1995.
The 1996 HIP AA only applies to electronic data and not other forms of information such as hard-copy records on paper. The HIP AA was intended to provide baseline requirements in a technology neutral environment so that all who were affected by the law could adopt specific standards that met their needs. The act mandated that security standards must be in place while Congress took the next three years to define privacy measures for electronic data. Congress did not meet the three-year deadline, so the work passed on to the Secretary of Health and Human Services in 1999.
As though knowing that Congress would not finish the law, HIPAA identified penalties for the wrongful disclosure of electronic patient data so that the courts could impose fines should transgressions be noted.
Healthcare institutions are full of computers. They are constantly in use within nursing units, laboratories, clinics, the operating room, intensive care units, the admitting department, and just about anywhere else data needs to be handled. What is held within computers is vital patient information and records that are now transported via the Internet to other agencies, skilled nursing facilities, and doctor's offices. This practice is ripe for privacy issues and violation of the HIP AA. The wonder of technology allows for the speedy transfer of medical data. The real question is, who should have access to this?
Privacy implies several different issues. While it means the right to be left alone, it also entitles everyone to decide for themselves how, when, and to what degree others may dispose of the medical data (Van Bummed, 1999). The real ability and desire to exchange patient data electronically among those authorized to do so has left healthcare with a serious conundrum: how to balance the need for new technology with the need to protect the information from alteration and misuse (Amatayakul, 1999).
Linked to concerns regarding data privacy is the real fact that most e-mail today is not considered secure. Experts are seeking better encryption mechanisms and a better way to have patients communicate with providers, and providers confidentially communicate with one another on crucial data (Amatayakul).
What is being done to safeguard privacy?
Organizations are expected to develop policies for protecting patient confidentiality. This also includes accuracy of real data, and assuring that only those who have the right to data have access to that data. Privacy and security are then linked in this vital issue.
Confidentiality, privacy, and access to information are of concern within hospitals, home care agencies, third-party payers, and on Capitol Hill. Debate on key pieces of legislation began in 1996, and the debate is not yet resolved in the year 2000.The issues looming large before concerned citizens, healthcare providers, and legislators include:
At the Federal level Secretary Shalala, Health and Human Services Secretary through 2000, proposed legislation (the Privacy Act of 1997) to assure consumer protection of privacy. The five overall goals of this legislation defined: (Amatayakul).
Since the initiation of the proposed 1997 legislation on privacy, there has been considerable response from employers, insurance companies, and others worried about the ramifications of such legislation. Mergers of healthcare data firms have lead to privacy and data ownership dilemmas that must be resolved, as this practice-mergers-is expected to be a more common phenomenon in the 2000's (Larkin, 2000). At the care level, patient's groups and medical group are split on the governments proposed privacy regulations. They worry the rules don't protect privacy of medical information and some fear losing access to important data (Reuters, 2000). In April of 2000, a panel of industry leaders met to discuss challenges such as privacy of patient data. This is a worry to every segment of care.
The information that case managers and other healthcare providers handle each day is more sensitive than the information than most other industry, and can cause more harm if in the wrong hands. The reliance upon paper records, the lack of computer literacy has increased the risks in privacy areas. But now the electronic exchange of clinical data has become a virtual necessity in today's world (Amatayakul). The goal for now and in the future is to help the healthcare industry create an environment that will help exchange of health information efficiently but securely.
You are the case manager for a busy home care agency located in a large suburb. This morning, you are visiting a man recently released from the trauma unit at the local hospital. Mr. Johns had suffered multiple traumas in an automobile accident six days earlier, and now requires physical therapy and nursing follow-up. During your assessment, you learn several things. First, although not mentioned in the accident report, Mr. Johns confides in you that he had been drinking when the accident occurred. Second, Mr. Johns has not told his wife that he was intoxicated at the time his SUV flipped over.
Should the case manager make note of his confessed drinking on your assessment?
Should the case manager pass that information along to the appropriate authority?
Should this information also be passed along to the insurance payer?
While it may seem that there are no good answers to these questions, the case manager is obligated to advocate for both patient's rights to privacy and the required reporting mechanisms. As a case manager, you must be familiar with legal requirements and obligations to report certain data to authorities, such as details concerning vehicular violations, communicable diseases, abuse and neglect, and other reporting criteria in your region and state.
In the case study presented, it would be appropriate for the case manager to consult with the patient's primary physician, and perhaps a social worker, to assure that the client is not fabricating his story or to validate the information before contacting the authority charged with handling vehicular violations such as Dull. In any event, the case manager must be objective and proactive in handling post-accident or post-hospitalization data that is collected.