4 Discussion Replies (100 Words Each)

Discussion 1:

Patient portals and other health apps are a great way for patients, as well as healthcare professionals, to have easy access to important health information. This accessibility also provides the patient with the power to make more decisions regarding their healthcare, which in turn provides respect for their autonomy. Some of these patient portals may even be able to connect patients virtually with healthcare provider, which is an irrefutably asset considering the current pandemic. However these technologies are a double-edged sword, while they may be extremely helpful, they also present clear ethical concerns in their implementation. For every additional place that a patient’s data is stored (cloud or hardware), there is an additional risk and potential harm that this data may be accessed by someone who is unauthorized. Where in a “traditional” health information system the responsibility of handling the sensitive data would fall upon the HIM professional. There is also a potential conflict of interest present if a HIM professional is employed by a company that creates these portals and apps, rather than the healthcare institution itself. Another potential ethical concern is the “terms of use” agreements that almost every person must agree to before using any app. This could present a risk of a patient losing control of their data without even knowing they agreed to it. This is a big reason why consumers patients, and families should be included in new health care initiatives, to keep the best interest of the patient and the patient’s sensitive data at the forefront of these new technologies.

1. Snyder CF. The role of informatics in promoting patient-centered care. Cancer journal (Sudbury, Mass.). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3146983/. Published 2011.

2. Harman L, Cornelius F. Ethical challenges in the Management of Health Information, 3rd Edition. 2017: 545-566.

Discussion 2:

Part 1

Patient portals, health ‘apps’ and other patient -oriented technologies challenge HIM professionals to broaden their knowledge and understanding of how they will relate to the public, the flow direction of healthcare information, and for the determination of who will use the the information and its purpose. It also challenges HIM professionals to overcome the challenges associated with providing continuous attention to accommodate the convenience and accessibility for patients of all educational levels and income. 1

Part 2

The rationale for including consumers, patients, families in new health care initiatives is to increase the level of participation and understanding of patient health care data and the usage of new technologies. They are essentially promoting patient advocacy and educating the public to be knowledgeable on the locus of control and assuming responsibility when it comes to the input of their own information.

References:

1. Baur C, Deering MJ. Chapter 21: Digital Health Technologies for Consumers, Patients, and Caregivers. In Laurinda Beebe Harman and Frances Cornelius. Ethical Challenges in the Management of Health Information, 3rd Edition (p.545-566). Burlington, MA: Jones & Bartlett Learning, 2017.

Discussion 3:

• In what ways do patient portals, health ‘apps’ and other patient-oriented technologies challenge how HIM professionals direct and/or secure the flow of healthcare information?

Digital Health Technologies such as patient portals, health applications and other patient-oriented technologies have proven to be very beneficial to patients, care providers, and healthcare in general. However, these patient centered technologies also come with challenges, especially to a Health Information Manager’s management of healthcare information.

One of the issues is that, there is a an inequality between the usage and accessibility of patients who come from different education and income levels 1. Patient portal activity was “systematically lower for blacks, Hispanics, older adults, and persons of low socioeconomic status” 1. Not everyone has access to the internet and this puts those who are already vulnerable patients at a disadvantage, especially those who are uninsured and have limited healthcare like Medicaid patients. The HIM professional will be unable to obtain the best quality of healthcare information from those who do not have the accessibility. Secondly, technological literacy affects health literacy. The HIM cannot properly support the patient in digitally managing his/her health data if he/she puts the wrong information. Again, the quality and success in managing one’s health information relies on the patient since they “are responsible for the quality of the information they provide” 2.

Another problem that arise concerning the lack of healthcare literacy are the problems with legality. More often than not, consumers rapidly press the “I agree” button when it comes to disclosures and policies. HIM professionals will have a hard time protecting a patients’ information especially if the patient is unaware of the policies of the company that provided the health technology, online health record portal or mobile applications. Also, patient’s information given to a vendor, remains to be that vendor’s property. This leads to privacy threats which can be very difficult for HIM professionals since HIPAA does not cover commercial entities 2 .

One issue is that there is a lack of standardization and interoperability within digital health technologies. Data from multiple sources cannot be integrated in patient portals and this prevents the HIM from managing data cross-organizationally and longitudinally.

Lastly, since patient-oriented technologies are connected through the Internet, they are subjected to updates, bugs, virus, security breaches, identity thieves and hackers. The patient’s privacy is at risk, and by the time the HIM professional fixes the problem, it might have been too late for the patient who is waiting on a lab result, a medication prescription, a medication reminder or a provider’s response to vitals, from his/her remote monitoring at home.

• What is the rationale for including consumers, patients, and families in new health care initiatives?

Consumers, patients, and families are rationalized to be included in new health care initiatives in order to achieve the improvement of care experience, the improvement of health of populations, and the reduction per capita costs in healthcare. Healthcare revolves around patients, so it makes sense to involve them in the process. Patients will serve as information nodes, since no one can provide better information about themselves, but their own. They can now enter their own information which leads to better communication between patients and providers. Patients can be more engaged in their own health, and can track of their own records. They are given control access to their data, what information to provide, whom they want to share it with, when and for what, which builds better transparency. Providers can communicate to patients quicker without waiting for an appointment, which will reduce patient copay and insurance costs. Lastly, patients can now be provided with education materials that can help with their overall health.

1. Perzynski AT, Roach MJ, Shick S, et al. Patient portals and broadband internet inequality. J Am Med Inform Assoc. 2017;24(5):927–932. doi:10.1093/jamia/ocx020

2. Baur C, Deering MJ. Chapter 21: Digital Health Technologies for Consumers, Patients, and Caregivers. In Laurinda Beebe Harman and Frances Cornelius. Ethical Challenges in the Management of Health Information, 3rd Edition (p.557). Burlington, MA: Jones & Bartlett Learning, 2017.

Discussion 4:

Patient data must have several consumers that range from the patient themselves loading their own data, to a team of data scientists and clinicians determining best practice. Data professionals are tasked with delivering healthcare information through the use of patient portals and healthcare applications. Each of these diverse applications deliver information to a patient with a focus on privacy and confidentiality.1 Healthcare is becoming patient focused on patient engagement1 and with this shift to open information systems that allow patients to quickly view records and interact with their medical professionals.

Data professionals can then utilize the same data sources for data analytics and research purposes for enhancing quality of care. Thus data professionals must maintain data integrity and confidentiality throughout the entire network that the information is used. Information governance, proper policy and education on the given technologies are just as essential for integrity and confidentiality of data. These measures within governance and policy, especially education of technologies are essential in creating tools that will remain useful for improving the quality of healthcare.

Healthcare professionals can utilize the availability of healthcare data via patient portals and the associated medical portales for the patient data. Caregivers are essential for maintaining the integrity of patient data.

These stakeholders are all essential parts of the healthcare system that need access to data and for that data to be accurate. Each of the stakeholders themselves require different material for their function, thus each need to be included in the user story of a given patient portal or information application. Additionally including some stakeholders may be mandatory due to ethical issues, such as the privacy of a patient.

1). Baur C, Deering MJ. Chapter 21: Digital Health Technologies for Consumers, Patients, and Caregivers. In Laurinda Beebe Harman and Frances Cornelius. Ethical Challenges in the Management of Health Information, 3rd Edition (p.545-566). Burlington, MA: Jones & Bartlett Learning, 2017.

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