Abuse by the NHS: Patient Consent and Confidentiality, Research Paper Example

Executive Summary

The Chu Clinic located in Demopolis, Alabama is an ideal place to implement electronic health records. Because Demopolis is a rural area, there is a great health disparity. Many people in this area suffer from chronic illnesses that can be controlled through proper medical access.  Implementing this system effectively will take adequate training and time. There are many pros to implementing electronic health records. Detailed in this paper, one will find information about barriers, costs, and benefits of implementing electronic health records.

Introduction

The use of electronic health records and tele-nurse has become very popular across the United States recently, yet the Chu Clinic in Demopolis has not converted to this method. Demopolis is a rural area with a population of about 16, 000 people. This would be a great asset to the people of Demopolis.  These techniques allow offices to go paperless. Converting to electronic health records and tele-nursing has been proven to improve the overall success of physicians who are willing to convert to these methods. To make the best decisions, doctors must have the most accurate and up-to-date information for each client.  Proper implementation of these methods will take time to work to perfection.  Electronic health record and tele-nursing will guarantee that each patient receives the best services with a minimum of mistakes According to Furguson, “Telemedicine is the use of medical information exchange from one site to another via electronic communications for the health and education of the patient or healthcare provider and for the purpose of improving patient care” (Furguson, 2000).

Dilemmas

There are many challenges to be faced in implementing electronic health records. People in Demopolis may be more reluctant to try or accept healthcare than persons in larger areas. If Dr. Chu were to implement this technology, he would be the first in Demopolis to do so.  The healthcare field usually relies on precedent cases to deal with any dilemmas they may encounter; however, since this type of technology is still fairly uncommon, there is very little to help guide decision making. The major dilemma has been determining who is responsible for the data that is being viewed and what if the data is not accurate.  Viewing incorrect data or out-dated data can increase the physician’s possibility of legal actions being taken upon them. The greatest advantage of electronic health records is the fact there will be a detailed record of each person that has viewed the client’s records. As a result, doctors will have to be especially careful to ensure that only authorized personnel has access to viewing client’s records.  The government has set laws that govern how and when a client’s medical records can be viewed. First, any healthcare provider is mandated to notify the client if there has been a breach of information. In the United States, more than 500 hundred patients a year are victims of unauthorized viewing or breach in confidentiality (Shaul, 2000).  Nevertheless, it is nearly impossible for a patient to correct an error in his/her medical records. When a patient has been the victim of medical identity theft, the patient and the culprit’s information becomes a new unidentified patient. Determining which information belongs to the original patient and the thief can become a long task. The thief might use the victim’s information to have major or specialty procedures completed. Such claims can be very expensive and cause the victim to max out on allotted treatments by his/her insurance company. Often, the victim does not realize that he/she is a victim until they go in for an actual procedure and their insurance claim is denied

Ethical Issues

Some ethical issues have been raised due to electronic health records. The major question that patients have is who is actually viewing their information and how will unauthorize persons be prohibited from seeing their medical information. Medical identity theft is just as popular as general identity theft. Patients have had their information sold to the highest bidders. Often these companies that are purchasing medical information are related to the healthcare field. In 2009, almost 2 million people were victims of medical identity theft (Booz, 2009).  Many patients choose to opt out of having any of their information transmitted electronically. A study was conducted at metropolitan hospital in New York City. The researchers surveyed more than 5000 people and found that nearly 15 percent of the people surveyed had been misdiagnosed due to an error in medical records and another 14 percent had been given wrong medications due to contradictions in their medical records (Hung, 2005).   This issue has caused doctors to ponder whether or not they should keep copies of client’s paper records in order to have a back-up to refer to in times of confusion. Yet, this will cause doctors to have to spend additional money to maintain paper records in conjunction with electronic records. Medical identity theft has risen by 22 percent in recent years (Booz, 2009). Medical identity theft is very dangerous because the victim could actually lose his/her life due to the thief’s actions. Telehealth benefits all its stakeholders. First, telehealth gives access to healthcare services to people who otherwise may not have access. Many people have transportation barriers that prohibit them from being able to go into a doctor’s office for a visit. These remote services will ensure that patient’s receive the services they need without possible hospitalizations. For instance, the use of teleconference can allow doctors to collaborate in real time about various issues (Hu P.J., Chau P.Y., & Sheng O.L., 2000   ).

Costs Involved

Implementing electronic health records can cost doctors up to 50, 000 dollars (Booz, 2009). However, the federal government does provide incentive packages for those doctors to help offset the cost of out of pocket fees. Many doctors are apt to converting to electronic health records because the time frame of maintaining health records has recently increased to seven year. That means that a doctor has ensured that paper records are stored properly for that amount of time after the last contact with that client.   Securing paper records is much easier than securing digital records. Often software and programs change within 5 years, after that information must be converted to newer versions of the physicians’ medical system. Paper records can be filled away and locked in a room for however many years are necessary.

Who Benefits from Telenursing/Telehealth?

Rural areas like Demopolis will benefit most from telenursing.  Telenursing does not fit into the already existent medical framework. Telehealth is a process that must be properly implemented and maintained to ensure that both clients and doctors reap all the great benefits. Telenursing is often more beneficial in rural areas where access to specialists is often limited to specific times. According to Fields,

“Telemedicine is the use of telecommunications and information technologies to share and to maintain patient health information and to provide clinical care and health education to patients and professionals when distance separates the participants” (Fields, 1996)

The use of telehealth makes it easier for patients and doctors to connect with each other to help control chronic illnesses.

Costs Involved

Although implementation of Telehealth is costly, the use of it is actually reducing overall healthcare costs. One benefit of telehealth is the decrease in patient hospitalization, visits to the emergency room, and overall out of pocket costs due to doctor visits.  This is very common in Demopolis. Many people who do not have access to transportation are hospitalized for chronic illnesses that can be prevented or controlled. One study conducted in a hospital that had recently implemented telehealth options found that patient hospitalization of patient’s decreases by more than 48 percent, visits to the emergency room decreased by more than 30 percent, and overall medical costs decreased by more than 40 percent. These numbers equate to a decrease in patient medical costs in the amount of nearly 2 million dollars over a year span of time (Fields, 1996)

Barriers of EHR & Tele-Health

Most doctors admit that the cost of implementing electronic health records is the major drawback in them adopting the method. Buying new hardware and software is the most costly of the process. Next, would be the cost of training employees to use the systems correctly. Finally, many doctors worry that the lack of face to face interaction with patients will cause patients to be unhappy with the services they receive. Yet, Veatch points out:

“The stranger/physician relationship is the norm in urban clinic and hospital outpatient services, student health services, military and veteran are hospitals, as well as tertiary care settings and specialist’s referrals. Some sense of the growing importance of anonymous contacts can be gleaned from the national and local data” (Veatch, 1991).

Nevertheless, many patients have expressed that they prefer face to face interaction with doctors and staff members. The Chu Clinic would be no different. Living in a small town like Demopolis, Dr. Chu knows all of his patients by name. They often encounter each other at the local Wal-Mart.  According to Michael Sinno, many doctors are reluctant to switch to the new system because they believe it will change the culture of their practice (2011). Yet, he believes that reluctance can be eradicated if doctors could see just how much easier and smoother daily tasks would be with the use of electronic health records, not to mention the amount of money they would save with the system in the long run(Sinno, 2011). With any system, there is always the possibility of breach of information, electronic health records is no different.

EHR Benefits

Both patients and doctors feel that the benefits of using electronic health records greatly outnumber the cons. Many people in Demopolis do not have access to adequate transportation, so getting to the Chu Clinic can prove difficult for some.  Electronic health records will improve the quality of service that patients receive due to accuracy and coordination of services.  For example, with technology on the rise, it is only a matter of time before systems like these take-over. With greater technology capabilities comes a greater expectation from patients that they receive the best service possible. Technology should improve the quality and effectiveness of the services that doctors provide, not replace it (Gruber, Cummings, LeBlanc, & Smith, 2009). Accurate and up-to-date information means that doctors will make better decisions in a timely manner. The best factor about electronic health records is the fact that the system will send alerts to doctors and pharmacists about possible drug interactions and conflicts to ensure that the patient receives proper dosage and decreases the possibility of errors. This alone will prevent many deaths and medical mistakes from occurring. Also, this process will help to eliminate errors in patient billing. One of the most common complaints of patients is that they have been charged for services they did not receive. EHR will ensure that accurate records are maintained, especially for those patients who have more than one primary doctor. Communication between each doctor will be readily available using electronic health records. A study that was conducted in the United Kingdom concluded that nearly 80  percent of healthcare workers agreed that electronic health records helps them to improve the quality of service they provide to their patients (Layman, 2008).

The Chu Office

In order for a concept to meaningful, it must improve the quality of life and healthcare of the client. It ensures that the patient receives safe and accurate services by reducing health disparities to improve public health. Proper training and implementation is a must to ensure that any program is effective.  Many people are reluctant to implement electronic health records because they do not feel they are tech savvy. In order to make each member of the team comfortable with the system, proper training must be provided.  Another great tactic is to have a technology person on staff to assist members who are having difficulty. To implement tele-health at the Chu Clinic will cost between $15, 000 and $23, 000 dollars. These costs are estimated for the purchasing and set up of electronic health records components. Providers usually are required to pay a monthly subscription fee to have access to software programs. According to a physician’s office in Michigan, there are five components needed to properly implement EHR. In their case, it costs about $33, 000 dollars upfront and an additional $4,000 dollars per year to maintain. The first component is the hardware, which can include computers, printers, scanners, and database servers. The second component is EHR software, which will include interface modules. These prices could vary depending upon whether or not the Chu Clinic chooses an onsite EHR deployment or SaaS EHR deployment. Next, will be implementation assistance costs. These costs could include electrician and consultant support. Also attorney fees may be feasible as many physicians consult an attorney about confidentiality concerns. The fourth component is training costs. Each person working for the Chu clinic will need to be properly trained. That includes nurses, doctors, and other office staff. The final component is fees related to network maintenance (Fleming, McCorkle, Becker &, Ballard, 2011).

Conclusion

The paperless office will not occur over night within the Chu Clinic. Accomplishing this task will take time and effort from each member of the Chu Clinic.  The only way to ensure that identity theft does not occur requires that all stakeholders work together. Patients must be very watchful and question any irregularities.   Medical identity theft can cause death. In some cases the victim and the thief’s medical identity are very different.  Both EHR and tele-nursing are great ways to go paperless. Electronic health records are also a great way to give patient’s access to their medical records. More than 78 percent of patients say that they have never seen their medical records (Booz, 2009). Patient portals make it possible for patients to view their records. This will allow patients to view lab result and communicate with doctors about their concerns. Likewise, being able to see a nurse without filling out the mountains of paperwork is a great asset to those who want to use it. Governmental organizations have been measuring the annual expenditures for the United States dating back to the early 60’s. They calculate the cost of health related products and rendering of services.  In 2011, healthcare costs reached 2.7 trillion dollars or 8,680 dollars per person in the United States. Eliminating paper is a great way to save money in the healthcare field, provide accurate access to up-to-date information, and access to healthcare in rural areas.

References

Booz, A. H.  (2009). Medical identity theft final report. U.S. Department of Health and Human Services.

Chestere, M. (2003). Abuse by the nhs: patient consent and confidentiality. Consumer Policy Review, Clinical Medicine, 13(2)

Fleming NS, Culler SD, McCorkle R, Becker ER, Ballard DJ (2011). The Financial And Nonfinancial Costs Of Implementing Electronic Health Records In Primary Care Practices.  Health Aff.

Furguson, T. (2000). Online Patient-Helpers and Physicians Working Together: A New Partnership for High Quality Health Care. British Medical Journal 321: 1129-1132.

Gruber, D., Cummings, G., Leblanc, L., & D. Smith (2009). Factors influencing outcomes of clinical information systems implementation. CIN: Computers, Informatics, Nursing (27), 3. 151-163.

Hung, P.K. (2005). Towards a privacy access control model for e-health services. Faculty of Business and Information Technology. University of Ontario Institute of Technology, Canada.

Layman, E. (2008). Ethical issues and the electronic health record. The Health Care Manager, (27) 2. 165-167.

Shaul, M. (2000). What You Should Know before Embarking on Telehome Health: Lessons Learned from a Pilot Study. Home Healthcare Nurse 18(7): 470.

Sinno, M. (2011). 8 Problems surrounding meaningful use. Vice President and CIO, Cooper University Hospital, Snehal Gandhi, MD, Director of Medical Informatics, Cooper University Hospital and Molly Gamble

Veatch, R. (1991). The Patient-Physician Relation: The Patient as Partner, Part 2. Indianapolis, Indiana University Press.