Patient Privacy
The Health Community Keeps a Close Eye on Dengue Fever Outbreaks
Before the 1950s, dengue fever was unknown to the world. Although there haven’t been many outbreaks since, health officials have been seeing more outbreaks in tropic and subtropic areas. The United States Center for Disease Control and Prevention (CDC) reports dengue fever is responsible for infections and deaths yearly throughout the world. With 10 million to 100 million infections and 25,000 deaths yearly, officials have been keeping a close eye on any possible outbreaks of the fever. The most recent outbreak was in Key West, Florida.
Dengue fever is the most common virus transferred from the Aedes aegypti mosquito. This specific mosquito bites during the day around sunrise and sunset. Many times the mosquito bugging you at home is an Aedes aegypti mosquito. Symptoms of the virus usually take three to 10 days to appear. They include headache, fever, exhaustion, severe joint and muscle pain, swollen glands (lymphadenopathy), and rash. Fevers, rashes, and headaches are characteristic of dengue fever. Dengue fever is usually not deadly; only 1% of the victims of the fever die. There are four serotypes or variations of the dengue fever. It is possible to get the fever multiple times, but having a variation prevents you from getting that serotype again.
Recently, the CDC and the Florida Department of Health reported that nearly 5% of the Key West, Florida population had traces of dengue fever in their blood in 2009. Both the CDC and Florida Department of Health worked to together to determine the probable exposure to dengue fever after they had been notified of three locally acquired cases of dengue in Key West. Previously, no cases of the fever were reported in the United States between 1946 and 1980, and Florida hadn’t had an outbreak of dengue since 1934.
Dengue is most common in the topics and subtropics of the world. Recent outbreaks have occurred in Puerto Rico, the U.S. Virgin Islands, Cuba, and Central America. Many of the dengue fever cases were imported when patients returned from Tahiti, Singapore, the South Pacific, Southeast Asia, the West Indies, India, and the Middle East. However, the three outbreaks in Key West were not imported from any of these locations. “These cases represent the reemergence of dengue fever in Florida and elsewhere in the United States after 75 years,” Harold Margolis, chief of the dengue branch at CDC, said. “These people had not travelled outside of Florida, so we need to determine if these cases are an isolated occurrence or if dengue has once again become endemic in the continental United States.”
With the possible reemergence of dengue fever in the United States, scientists from government organizations conducted blood samples from random households in the Key West area. They found that nearly 1,000 of Key West residents had the virus or had it at least three months earlier.
In order to prevent mosquito breeding, remove any standing water. Common breeding grounds include water in old tires, trashcans, and flowerpots. Whenever taking the family outside, don’t forget to use mosquito repellent sprays containing DEET. Wear long sleeve shirts and pants to prevent bug bites. Dengue fever can only be spread from a mosquito transmitting the virus from one person to another. People cannot spread the virus through person-to-person contact.
http://www.cdc.gov/media/pressrel/2010/r100713.htm
http://www.medicinenet.com/dengue_fever/article.htm
Electronic Health Records Cut Healthcare Costs
The business side of healthcare views the electronic patient chart as long overdue. In fact, the medical industry is one of the last major industries to adopt across-the-board computerization to streamline business, improve efficiency and productivity, and maintain long-term accurate records. One of the blocks to health information technology (IT) expansion is the high cost of implementing the new systems.
Assistance to clinics and hospitals to pay for new interoperable IT systems is promised from nearly $54 billion in federal stimulus funds, signed into law by President Barack Obama in February 2009. This includes about $34 billion from the temporary Medicare and Medicaid reimbursement program. These bonuses are scheduled to begin in 2011 for providers who provide “meaningful use” of health IT. They will total as much as $11 million in bonuses per hospital and $64,000 per physician.
Additional stimulus funds have been allocated for health IT, including $598 million in grants to assist hospitals and clinics in implementing EHR (electronic health records) through regional health IT extension centers. An additional $564 million has been earmarked to develop health information exchanges to enable hospitals to share patient information, i.e., making the systems interoperable.
It is hoped that these incentives, (and eventual penalties for those not incorporating them in a timely manner), will make interoperable EHR systems standard by the year 2014. Reform advocates anticipate that EHRs will lead to significant cost savings in the near future, with huge returns in future healthcare savings.
The Advantages of Interoperable EHRs
There are many ways in which EHRs improve the safety and quality of care for patients as well as cut costs for healthcare providers. Some of them include:
- Medication data stored in EHRs can prevent potentially dangerous drug interactions, duplicative therapies, allergic reactions to medications, and medication errors.
- E-prescribing prevents errors resulting from illegible handwriting and follows the prescribed drugs to allow patients taking recalled drugs to be quickly identified and alerted.
- Systems requiring computerized physician order entry (CPOE) include embedded protocols and alerts that enable providers to make the best care decisions, minimizing complications, lengths of stay, and re-admissions.
- Costs associated with “defensive medicine” may be reduced by EHR systems by providing proof that physicians have followed evidence-based protocols, offering grounds for avoiding or minimizing malpractice claims.
- With government and private payers increasingly employing various quality metrics to justify differentials in payments to providers, EHR systems will allow providers to provide outcome data to show that they have met the quality measures.
- Patients with chronic conditions, such as diabetes, can be tracked electronically, allowing for notification of recommended tests or procedures to prevent complications and increased cost procedures such as amputations.
- Duplicate testing can be avoided by following patients through multiple points of care, preventing one provider from ordering a test recently administered by another.
- EHRs eliminate the need for transcribing physicians’ notes and the storage of paper documents.
- The widespread use of EHRs will produce massive outcome data that will be mined by researchers to lead to more refined evidence-based protocols, improving outcomes and reducing costs.
- The current fee-for-service payment system provides incentives for additional visits and procedures that could be shifted to a system with added incentives for more efficient care–such as e-visits, preventative care, and patient education–for higher quality outcomes and improved data collection.
- Easy access to medical records enables patients to be more engaged in their health, widely believed to improve wellness and lower costs.
Though the financial costs for purchasing and implementing EHR systems are significant and return on investment is not immediately seen for many facilities, the additional data will position hospitals and other healthcare providers to better save money in the future. Reductions in space requirements, staff time, and duplicate tests make cost savings possible in the short-term, with improvements in care quality offering long-term savings.
Epic, a Leading Provider of Healthcare Software
Epic is currently one of the leading providers of software for the healthcare industry and offers a number of solutions for hospitals, medical practices and groups, and various integrated healthcare organizations. Designed specifically for medium and large facilities, the information technology solutions that Epic provides have actually revolutionized the industry and will continue to do so because of the sheer number of clients that the company currently has. They have worked with multi-hospital systems, community hospitals, safety net providers, academic facilities, and children’s organizations amongst others, and all of these facilities have benefited from the introduction of such advanced integrated software.
Epic integrated healthcare systems offer immense value to healthcare facilities via a range of benefits, but they boast of being different from other companies within the industry. They actually provide connection software that will facilitate documentation sharing so as to provide healthcare to individuals quickly, easily, and safely. With clinicians and others experienced in both patient care and technology on board, they can be said to be at the cutting edge of development. Epic knows exactly what is required and that is why they provide such excellent benefits.
For example, Epic has made sure that all of its solutions are easy to implement and so can be up and running in no time. The system is also completely secure so you can have peace of mind that no patient confidentiality lapses will occur. Furthermore, the doctor or surgeon in question can manage his or her own information and the flow of data so they can feel and actually will be completely in control at all times. All information can be shared with ease so you can have complete confidence in the system.
With a range of systems available for the sharing of public health records, Epic simplifies the process of information sharing and enables the individual healthcare facility to choose a program that is right for them. With such advances available, Epic is definitely a provider of IT solutions worth looking into.
http://www.epic.com/about-index.php
Behavioral Healthcare
Behavioral healthcare is one of the most important forms of healthcare around at the moment as a result of the rising number of people that are suffering with behavioral problems. Often confused with mental health, an individual’s behavioral health largely depends on their development and mental blocks rather than specific illnesses like depression, bipolar disorder, and other similar conditions. Covering addictions, crisis stabilization, and developmental disabilities, amongst other areas, behavioral therapy comes in a huge variety of forms and thus can be treated in a wide range of ways.
Behavioral therapy can be administered by any number of healthcare facilities and should incorporate a pharmacy management service in order to ensure that all individual patients get exactly what they want and need from their treatment programs. Such services can also help to improve and support the healthcare facilities available to offer behavioral treatment.
Behavioral healthcare is a very wide area of healthcare because it incorporates so many problems and issues. As such, it can be difficult to coordinate treatment with other necessary areas of the healthcare industry. Communication and education are absolutely vital in delivering effective and efficient care. The training of staff should also be of the highest quality because comprehensive knowledge of the area is especially important when trying to provide the best possible treatment plans. This is why accreditation can be absolutely vital in ensuring the best possible care is provided for all of those in need.
At the moment, there are 1,800 behavioral healthcare facilities accredited by the Joint Commission but it is important that more healthcare facilities seek accreditation so that they can raise the standard of treatment they offer. Behavioral therapy should always be of the highest quality to offer a solution to individual problems now and keep the same issues from coming back and causing problems in the future.
http://www.jointcommission.org/AccreditationPrograms/BehavioralHealthCare/bhc_facts.htm
Privacy Issues of Electronic Health Records
With the current emphasis on the implementation of interoperable Electronic Health Records (EHR) dominating much of the discussion in healthcare reform and cost containment, the issue of patient privacy rights is one that must be adequately addressed. Since 2005, the National Committee on Vital and Health Statistics (NCVHS), formed in 1996 with the enactment of the Health Insurance Portability and Accountability Act (HIPAA), has focused much of its attention on privacy and confidentiality considerations associated with the development of a Nationwide Health Information Network (NHIN).
NCVHS believes that interoperable EHRs are greatly beneficial to the public with the caveat that appropriate privacy protections are included. The support of the NHIN depends upon the public trust and confidence that personal health information will be protected from misuse and inappropriate disclosure. NCVHS continues to study these issues extensively, reporting to the Secretary of Health and Human Services (HHS) in a series of letter reports from 2006–2008 that were published in May 2009.
Before finalizing the model of the NHIN, the NCVHS recommends a deliberative policy-making process including public input along with pilot projects that recognize the complicated, contentious, and crucial nature of protecting sensitive health information. The NHIN must be developed in a manner that enhances healthcare while protecting privacy. Following is a summary of key points included in the recommendations letter from NCVHS to HSS on the matters of privacy and confidentiality.
Definitions
Often clouding the discussions concerning privacy is the differentiation of the terms “privacy,” “confidentiality,” and “security.” Too frequently, they are used imprecisely and interchangeably. The NCVHS definitions are as follows:
- Health information privacy is an individual’s right to control the acquisition, uses, or disclosures of his or her identifiable health data.
- Confidentiality, which is closely related, refers to the obligations of those who receive information to respect the privacy interests of those to whom the data relate.
- Security is altogether different. It refers to physical, technological, or administrative safeguards or tools used to protect identifiable health data from unwarranted access or disclosure.
Importance of Privacy and Confidentiality
Privacy and confidentiality are not new concepts. Since the time of Hippocrates, physicians have pledged to honor the confidentiality of patient information, disclosing that information only with the direct authorization of the patient or to protect an overriding public health interest. Many are rightfully concerned about potential ramifications if employers, insurers, and other third parties are given access to personal health information.
It is often essential for patients to share sensitive information to healthcare providers. The trust in professional ethics for confidentiality encourages the sharing of information individuals would not want to be publicly available. Likewise, trust in the confidentiality of the information protects the public’s health, since those with potentially communicable diseases are not afraid to seek treatment, knowing they are protected from embarrassment or harm of due to public availability of that information.
The incomplete and fragmented nature of paper health records is a weakness of the current system. Paradoxically, it is that fragmentation that protects individuals from having their personal health information disclosed. Confidentiality is achieved by default due to the information being difficult to gain access to. However, a price is paid for this default protection due to the unavailability of the information in emergencies. Therefore, there are significant arguments for the shift to interoperable EHRs, as long as reasonable privacy and confidentiality can be assured.
Public support for the NHIN depends on public trust and confidence, especially in this age when electronic transactions are common and security lapses are highly publicized. The interests of privacy and confidentiality must be balanced with the benefits of NHIN. With the increased availability of personal health information comes the increased risk to privacy and confidentiality.
Flexibility and Uniformity
The most controversial issues of privacy and confidentiality surround the level of individual choice of NHIN participation and the ability to control the access of those records. It requires balancing the interests of individuals seeking control over access to personal health information and the need for healthcare providers to access accurate medical history. It becomes a conflict over the desire for a flexible system that accommodates a variety of individual choices with the need to avoid a system that is too complex and unnecessarily expensive.
Allowing individuals to choose precisely what information is shared, when, and with whom could result in the inadvertent withholding of necessary information. The lack of flexibility in a system that would disallow individual choice would result in public reluctance to participate in the NHIN. Privacy concerns could also result in the an individual’s failure to disclose relevant information or their refusal to seek any healthcare at all.
Public NHIN Participation
Though a mandatory system of participation in the NHIN would be easier, more comprehensive, and less expensive, it would likely not have public support due to privacy issues. It could also result in individuals foregoing medical care because of privacy concerns and the potential ramifications of the release of sensitive data.
The two basic approaches for individual choice of participation are opt-out and opt-in. With the opt-out approach, the individual may choose to not participate, though health information is assumed to be available for authorized persons. This opt-out approach could mean greater NHIN participation at a lesser cost. The opt-in approach requires healthcare providers to obtain explicit permission before accessing information from the NHIN. This approach increases individual control over health records, but adds administrative burdens.
Individual Control
There is a question of how much control over the access of specific personal health information an individual should have the right to maintain. Those who argue that individuals should not have the right to control the contents of their health records contend that limited access to health records could inhibit the ability of healthcare providers to make informed decisions. They also argue an increase in malpractice liability due to errors resulting from incomplete health information. If individuals have complete control, healthcare providers may have less confidence in the accuracy and completeness of the records.
Those who advocate individual rights of information control assert that under a functioning NHIN, old, sensitive information would remain accessible indefinitely, even though it is not currently relevant to clinical decision. The release of that information could possibly lead to stigma, humiliation, or discrimination. Individuals with medical conditions such as mental illness, substance abuse, or sexually transmitted diseases might be hesitant to seek treatment if they are not confident of the confidentiality of the information. This would endanger both individual and public health.
Access to health records could be filtered in a number of ways. For instance, they could be limited by the age of the information, the type of condition or treatment, or by the type of provider. Three proposals have been suggested to, but have not been endorsed by, the NCHVS:
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Entire records of a particular type of condition, such as substance abuse, mental health, or reproductive health, could be maintained outside of the NHIN.
- Blocking access to some parts of a health record.
- Deleting altogether some parts of a health record from EHR.
Blocking information would mean that it still exists within the NHIN, but it would not be accessible without a provision for obtaining blocked information in emergencies or allowing only certain providers rights to access, such as allowing mental health information to be accessed only by mental health providers. Blocked information could be made available in a non-identifiable form for statistical analysis or other research purposes.
Controlled Disclosure
The NCHVS believes that the principle of “role-based access criteria” should be a standard for EHRs now and the NHIN in the future. Not all individuals who require access to personal health information need the same level of access. Institutions need to establish access rules based on a “need to know” level in order to protect the privacy of patients, only providing the minimum amount of information necessary.
Controlled access also applies to non-medical access to personal health information. For example, individuals are often compelled to sign authorizations permitting third parties such as potential employers to access their health information as a condition for employment. Though individuals are not forced to sign them, they will not be considered for the job if they don’t. There are currently no limits placed on the scope of information disclosed or duration of authorization.
EHR systems create increased risk to confidentiality due to greater accessibility of more complete information than is now available in paper-based systems. Authorization today is often overbroad because of the impracticality of searching paper records in order to disclose the personal information needed for a specific purpose.
Arguably, the conversion to EHRs creates an unequalled opportunity to protect confidentiality. Contextual access criteria could be integrated into NHIN to allow the disclosure of only the information required. Only authorized personal information relative to its needed use would be disclosed. If contextual access criteria isn’t part of the NHIN design, there would be significant consequences to the protection of confidentiality.
In addition to the issues discussed above, the NCHVS addresses regulatory issues, including fair information practices that will be significantly affected by the NHIN over current practices; enforcement and penalties to deter wrongdoing and security breaches; and limitations of third party uses of medical information, including commercial entities not subject to the privacy rule.
The NCHVS believes it is essential to establish and maintain public trust in the NHIN. The committee recommends that the HHS first educate the public on what is to be gained by the NHIN, along with a fair assessment of the risks. The NHIN cannot be forced onto the public, but rather the public must be informed about the strengths, weaknesses, risks, and benefits of the system to become convinced of its value. The focus of NHIN development must be on direct, individual benefits and improving individual care in order to secure public participation, along with thoroughly addressing the needs for privacy and confidentiality, without which the program cannot succeed.