Nursing Informatics: Electronic Health Record, Essay Example

Part One:

1. I work as a nurse educator in the cardiac surgical care unit of a mid-sized hospital that is currently at the Level 4 stage of EHR development: Clinical Knowledge, Decision Support, and Integrated Care Pathways.  We have a speciality-specific support module in the form of our step-down (SDU) unit for heart patients.  We are also able to view relevant guidelines and protocols, access non-patient specific information, and evidence-based integrated care pathways (Health Canada, 2005).
2. The province of Quebec is currently in the process of assigning electronic health records to citizens in select parts of the province with the goal of improving health services that are accessible to multiple service providers while still protecting consumer information.  The Quebec Health Record will connect consumers on a voluntary basis with hospitals, community health clinics, laboratories, and other aspects of the health care system.  The Government of Quebec is also creating an informatics interface that will join health and social services into one network, thereby increasing the efficiency and accountability of all health care professionals (Government of Quebec, 2011).
3. In order to achieve the goal of a pan-Canadian Electronic Health Record, it requires the support and compliance of many different stakeholders at the individual, corporate, and provincial levels. One of the major challenges in implementing a successful EHR system are the different structures utilized within provincial health care systems.  While some services are looked after by provincial and territorial governments, other services like public health are controlled at the local level.  A massive educational and technological shift is necessary to ensure compatibility and cooperation between these different organizations so that patient care is not compromised.  Health Canada identifies five components of the EHR system that must be standardized to avoid overlap of services and a consistent approach to health services.  These include identifiable codes for patients, providers, facilities, health information, and administrative functions (Health Canada, 2001).

References

Government of Quebec. (2011). The Quebec electronic health record in the Capitale-Nationale region. Retrieved from http://www.dossierdesante.gouv.qc.ca/en_citoyens_experimentation_capitalnationale.phtml

Health Canada. (Jan 2001). Toward electronic health records. Office of Health and the Information Highway. Retrieved from http://www.hc-sc.gc.ca/hcs-sss/pubs/eealth-esante/2001-towards-vers-ehr-dse/index-eng.php#Conceptual

Health Canada. (2005). EHR level hierarchy. Toward Electronic Health Records. Retrieved from http://www.hc-sc.gc.ca/hcs-sss/pubs/ehealth-esante/2001-towards-vers-ehr-dse/table4- eng.php

Part Two:

1. The Dossier de Sante Quebec project (DSQ) has a strict system of rules created to ensure accountability and the protection of personal information. Although a variety of health care professionals will gradually gain access to an individual’s DSQ, or Electronic Health Record, they won’t automatically have access to all information as the professional role of health care providers dictates their level of access.  Beyond being bound by professional codes of ethics, those who have access to DSQs must verify their identity, use only workstation’s that have been adapted for EHR use, and authenticate their identification regularly through personal passwords.  An individual’s DSQ is intended only for the use of licensed health care professionals.  Therefore, no one else can access it, even with the individual’s permission.  The health information contained in the DSQ is encrypted and designed so that any potential violations of security are immediately reported to the appropriate authorities (Government of Quebec, 2011).
2. Education of both health care professionals and the general public is key to addressing data protection concerns about Electronic Health Records. The ethical debate about privacy and new technologies is fuelled, in part, by media reports which tend to sensationalize problems within this new information system while not necessarily discussing its successes.  This creates the appearance that medical records are vulnerable, and is further complicated by current media debates about the security of all private information and the ‘threat’ of cyber attacks and other technology-based intrusions.  A strategy that addresses the training of those who access EHR information as well as the education of consumers will strengthen public support for the program while providing all Canadians with the tools necessary to make the most of the EHR (Weitz, et. al., 2003).
3. I have mixed feelings about the safety of my health information in respect to my EHR. Although I know that governmental agencies have the best of intentions in creating a pan-Canadian information system that will ultimately improve the quality of all health care agencies, I also am aware of the role that human error can play in the handling of sensitive information.  Despite this, I am willing to take certain risks that my private information might be compromised if it means that, in an emergency situation, healthcare providers are given full access to my pertinent details.  This echoes Weitz’s assertion that consumers do not always require informed consent about the dispersal of their medical information, with “over 95 percent of  respondents [agreeing], for example, that ‘health information necessary for treatment should be available to service providers when and where they need it'” (2003, p. 298).

References

Government of Quebec. (2011). The right to privacy and respect for privacy.  Retrieved from http:/www.dossierdesante.gouv.qc.ca%2F&anno=2

Weitz, M., Drummond, N., Pringle, D., Ferris, L. E., Globerman, J., Hébert, P., Tracy, C. S. and         Cohen, C. (2003). In whose interest? Current issues in communicating personal health information: A Canadian perspective. The Journal of Law, Medicine, & Ethics, 31(2), 292-301. doi: 10.1111/j.1748-720X.2003.tb00090.x

Part Three:

1. The introduction of an EHR system needs to be carefully regulated and monitored to ensure that the safety of patient information is not compromised. Wynia and Dunn (2010) suggest that patients remain unconvinced that the personal data contained in EHRs will remain secure, despite the fact that EHRs have many more fail-safes and security functions built in to them than the traditional patient file that may only be secured by a locked cabinet.  The inherent security of this system will decide whether patients and physicians decide to use the system.   The risk of accidental or deliberate exposure of information seems no less possible than with traditional records systems; indeed, the EHRs’ security parameters (such as its ability to keep track of who accesses information, from what location, and when) may act as a deterrent in preventing unauthorized access to patient files.
2. The need for collaboration on cases is an integral aspect of providing accurate patient care and diagnoses. Wynia and Dunn write that “Many patients want complete control over what data shows up in their PHR and who gets to see it; yet if doctors believe a PHR is incomplete or inaccurate, and if they cannot share it with colleagues consulting on the case, then they will be less likely to use it and PHRs will not achieve the benefits they should” (2010, p. 71).  It’s crucial that members of the health team are not denied access to information solely because of patient fears regarding privacy.  However, I think that the Government of Quebec’s approach to privacy–wherein the specific role of team members dictates their level of access–creates an environment that encourages a safe and ethical approach to accessing EHRs (Government of Quebec, 2011).
3. The hospital that I work at has very strict regulations concerning access to patient information. All of our workstations are controlled by passwords, which themselves are changed on a regular basis and require a high level of security using a unique combination of numbers, letters, and symbols that can’t have any personal connection (i.e. your birth date) to the user. Additionally, our login and session information is tracked and stored within a database for review so that system administrators are able to monitor our computer use in relation to our schedules, should a problem ever arise.

References

Government of Quebec. (2011). The right to privacy and respect for privacy. Retrieved from            www.dossierdesante.gouv.qc.ca%2F&anno=2

Wynia, M. and Dunn, K. (2010), Dreams and Nightmares: Practical and Ethical Issues for Patients and Physicians Using Personal Health Records. The Journal of Law, Medicine & Ethics, 38: 64–73. doi: 10.1111/j.1748-720X.2010.00467.x