Electronic Health Systems Research Articles

A Social Contract for Health Information

Knowledge and PrivacyAs U.S. health care slowly moves toward an integrated system of electronic health records, questions of justice with respect to the use of health information become more pressing (Safran et al., 2006). Better information should mean more knowledgeable providers and patients. But it also will mean more knowledgeable insurers, which in the U.S. gives health insurers greater selectivity about whose coverage to deny or whose premiums to increase. This paper argues that from a social contract point of view of health information, such risk selection by insurers is unjust. The argument is based on the definitive work of John Rawls (1971; 1996; 2001). The injustice of risk selection can easily be remedied by regulation.It is misleading to view moral issues about health information as entirely about privacy. A morally significant idea of privacy depends on the situation in which information is used (Havani, 2007). In health care and in insurance, sharing information on health risks is a necessary and normal part of management. The 1996 Health Insurance Portability and Accountability Act, for instance, reflects this by giving the entities covered by this law permission to disclose protected health information, if this disclosure is part of treatment, payment, or health care operations (45 CFR 164.502[a][1][ii]). This reasonable exception for health care operations, however, is quite broad and includes insurers.Suppose that a patient checks into a hospital and gives consent for relevant information to be shared among care providers, but then the patient is found to have another condition requiring treatment by other providers; for example, the patient has an infection but is found to have HIV. No one would want to impose a barrier to the provision of care, even if the patient is incapacitated and unable to give consent.But payment for care is also part of health care operations. As is explained below, in nearly every case this must be done by some form of health insurance, whether public or private. It is inevitable and necessary to share information with health insurers. The important moral question is what insurers do with this information. This paper argues that there are clear moral limits on this.Health InsuranceInjustice with respect to access to health insurance is especially pressing because, in nearly all cases, health care must be distributed by means of insurance, either public or private. It is worth noting, however, why this point may not have always seemed important, and has not figured in the literature on health care justice. Moral problems about health insurance are superficial in contrast with the morally deeper problem of prioritizing care. Access to health insurance coverage does not determine what is covered and in what order of priority. So this paper will leave untouched the deeper problem of health care justice.But for a social contract theory of health justice it is helpful to distinguish the issue of health insurance access from the deeper issues. Moral questions about health insurance resemble the questions about equity with respect to class and wealth that motivate social contract theories. It is helpful to see that this part of the problem of health care justice can be treated in this familiar way. The leading social contract theorist of health care justice, Norman Daniels (1985), overlooks the possibility of this partial solution to the problem of health care justice, perhaps in part because the deeper problem of prioritization is not addressed this way.This paper, however, does not deal with the issue of income distribution because equity in wealth and income is already a central issue in any social contract theory. This paper moves beyond this issue by assuming that if any of the parties does not have enough money to make insurance payments, wealth or income is redistributed to make these payments on that party's behalf. This paper then argues that the problem of health insurance access can be reduced to the familiar problem of equity with respect to wealth. …

Physicians Not Ready to Board E-Prescribing Bandwagon

Physicians Not Ready to Board E-Prescribing Bandwagon

Patients, Caregivers, and Telehome-Based Care Systems

The Personal Health Assistant Project (PHA) is a pilot system implementation sponsored by the Kozani Region Governors’ Association (KRGA) and installed in one of the two major public hospitals of the city of Kozani. PHA is intended to demonstrate how a secure, networked, multipurpose electronic health and food benefits digital signage system can transform common TV sets inside patient homes or hospital rooms into health care media players and facilitate information sharing and improve administrative efficiency among private doctors, public health care providers, informal caregivers, and nutrition program private companies, while placing individual patients firmly in control of the information at hand. This case evaluation of the PHA demonstration is intended to provide critical information to other decision makers considering implementing PHA or related digital signage technology at other institutions and public hospitals around the globe.

Compelled Authorizations for Disclosure of Health Records: Magnitude and Implications

Each year individuals are required to execute millions of authorizations for the release of their health records as a condition of employment, applying for various types of insurance, and submitting claims for benefits. Generally, there are no restrictions on the scope of information released pursuant to these compelled authorizations, and the development of a nationwide system of interoperable electronic health records will increase the amount of health information released. After quantifying the extent of these disclosures, this article discusses why it is important to limit disclosures of health information for nonmedical purposes as well as how it may be possible to do so.

Identifying Optimal Chronic Kidney Disease Patient Education Web Sites

One in nine adults in the United States has chronic kidney disease (CKD). Randomized studies show electronic health (e-health) systems improve health outcomes in chronic disease. This study describes a systematic evaluation of available CKD Web sites. We evaluated Web sites for educating patients with CKD, focusing on three specific design issues: usability, quality, and content. Thirty Web sites were evaluated between April and July 2004. Cohen’s kappa and intraclass correlation of quartile rankings for two independent evaluators were calculated. Mean score for evaluator 1 was 7.293 (standard error 0.511) and for evaluator 2 was 8.189 (0.413). Cohen’s kappa for the 2 evaluators’ total scores for all 30 Web sites is 0.7671, and intraclass correlation is 0.7703. In general, results show that it is possible to identify Web sites more likely to provide a positive educational experience for CKD patients. Further evaluation is needed to investigate the utility of variably ranked Web sites as educational interventions.

Dying for Data

With the support of and some funding from the federal government, a private-sector effort is underway to develop a comprehensive system of electronic health records linking hospitals, general practitioners, specialists, insurance offices and others across the US. Called the National Health Information Network, the project aims to replace paper-based files with digital record containing a patient's complete medical history, which can be accessed by health providers instantaneously wherever treatment is needed. It will consist not of one centralized system but of a large number of independently managed regional networks, somewhat comparable to the Internet itself. This paper looks at the recent history and some smaller-scale efforts to digitize medical records

The significance of information standards for development of integrated health information system

Information systems play a significant role in helping to improve health outcomes and decision-making at the point of care, as well as in the planning and funding of care. There is no doubt that new technologies, especially information and communication technologies, could dramatically contribute to achieve better results in our activities in general. The healthcare sector, one of the largest sectors of society accounting, is very complex with many different application requirements. There are also a number of different types of actors that need to communicate for various healthcare purposes (patients/citizens, healthcare professionals and organizations providing health care cervices, payment bodies, pharmaceutical industry, the national governments). Standardization is the first and the most important step in building an Integral Healthcare Information System. However, standardization has been recognized in most of the countries as an important tool to achieve some of the general goals in healthcare systems. The relationship between the participants locally, regionally and nationally requires that information is shared for planning, funding and treatment purposes. Health information standards are instrumental for the operation of healthcare organizations, the planning and management of the health sector, for electronic business transactions and the development of a national system of electronic health records as well. It is necessary to make relevant decisions on adoption of specific health information standards, to adjust them to local conditions as necessary, define in sufficient details methods the manner of their introduction and implementation. The successful implementation of each National Health Information Systems Strategy is heavily dependent upon the implementation of information standards.

Wearable schizophrenia treatment with real-time affective context awareness.

The Personal Health Assistant Project (PHA) is a pilot system implementation sponsored by the Kozani Region Governors’ Association (KRGA) and installed in one of the two major public hospitals of the city of Kozani. PHA is intended to demonstrate how a secure, networked, multipurpose electronic health and food benefits digital signage system can transform common TV sets inside patient homes or hospital rooms into health care media players and facilitate information sharing and improve administrative efficiency among private doctors, public health care providers, informal caregivers, and nutrition program private companies, while placing individual patients firmly in control of the information at hand. This case evaluation of the PHA demonstration is intended to provide critical information to other decision makers considering implementing PHA or related digital signage technology at other institutions and public hospitals around the globe.