Using STD electronic medical record data to drive public health program decisions in New York City
We need to keep in mind possibilities related to implementation of technology for use in patient medical records. Electronic medical records makes information much more readily available. This information can then be used to facilitate improvements or decision-making. For instance, in New York there is a network of public health clinics that uses electronic patient records to aggregate specific data that assist in determining public policy (Paneth-Pollak, et al., 2010).
Reference:
Paneth-Pollak, R. Schillinger, J., Borrelli, J., Handel, S., Pathela, P., & Blank, S. (2010). Using STD electronic medical record data to drive public health program decisions in New York City. American Journal of Public Health, 100 (4).
Pamela
Reference:
Paneth-Pollak, R. Schillinger, J., Borrelli, J., Handel, S., Pathela, P., & Blank, S. (2010). Using STD electronic medical record data to drive public health program decisions in New York City. American Journal of Public Health, 100 (4).
Pamela
posted by UTArlington_N5308 at 3:45 PM
29 Comments:
Data driven public health initiatives makes sense to me but I am concerned about the methods of access and extraction. Not everyone has high appreciation for the privacy of information. It would be interesting to see data on the differences in attitudes about information privacy relative to the age of the respondents.
Helen
I have accessed this blog and read several posts. As an employee of a university healthcare setting with more than 1 million patient appointments per year, and 5 thousand employees, I argue strongly in favor of nationalized medical records. The risk of inappropriate use, while not small, is heavily outweighed by the benefit of instant access to records from other facilities. This is particularly true given our societal migration, patients using multiple healthcare venues for care, and will also better allow us to manage, track and evaluate disease statistics nation-wide.
I have read this blog and I agree that it would be great to have electronic medical records. To have access to patient records without the patient having to remember the medicines and medical history would so time saving. I am concerned though about the small hospitals and the implementation of electronic medical records. Where will the resources come from.
Diane
Electronic medical records will provide a complete history of a patient. This will make a great difference in patient care, documentation, and accountability. Nurses need to help establish ethical laws for patient confidentiality. As always nurses remains the patients advocate.
Linda
Implementing an electronic medical record system definitely helps improve patient care, increase communication, and improve outcomes. It can be difficult to get everyone on board though, especially those who have worked with pen and paper for 20 years or so. It can be a challenge to get every employee comfortable with a new system and preserve job satisfaction. I worked for a facility during the change from paper to EHR and several employees were lost during the transition. There is a learning curve depending on the system used. And I agree with Helen-not everyone appreciates the privacy laws the same way.
Jennifer Mitchell
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After reading this blog, I agree that there needs to be a universal electronic medical record system. I am unsure of how this would get funded, but it would save money in the end. For instance, I had a patient that was admitted to another hospital and numerous labs/procedures done. I was not able to get a clear history of her results because of not having access and ended up repeating the same labs. These systems problems happen all the time and cost money.
Christine Perez
I too am a strong proponent of nationwide electronic medical records (EMRs). Like an unborn child, limitless potential exists with EMRs. Electronic medical records can reduce medical errors, improve quality of care, and aid in reducing cost (Stoten, 2009). Some examples of successful systems that utilize EMRs are the Veterans Affair (VA) Hospitals and the National Institutes of Health (NIH). However, it is the same limitless potential that makes me equally concerned. While most people are in favor of EMRs, the way with which data is accessed, stored, and maintained is what concerns me most. According to Stoten, the government has not created standards for EMRs or provided any guidance to implement them. So, how are we to go about creating a nationwide database for EMRs? In Stoten’s article, a proposal to this very problem is made. Stoten proposes that EMRs be kept at a regional level. However, this solution also poses several obstacles. It will be interesting to see how healthcare evolves over the next decade.
Melissa
Reference
Stoten, S. (2009). Health policy issue with the electronic health record. Online Journal of Nursing Informatics, 13(2), Retrieved from CINAHL Plus with Full Text database.
The improved tools nurse can use today reduces the amount of time spent documenting but also increases the impact of carelessness, foolishness and recklessness according to Curtin (2005). The use of information technology enables anyone who has access to learn more information faster about more people than ever before. The coming of electronic health records (ehr) and placing information in the technology will allow unscrupulous people to find more information faster. People have been snooping into other people’s business well almost since the beginning of peoples business. I think the implementation of ehr will just help people to gain access to others business faster than ever.
Curtin, L., (2005). Ethics in infomatics the intersection of nursing, ethics, and information technology. Nursing Administraion Quarterly. 29 (4). 349-352.
Diane
The United States government, countries across the globe, medical professionals, and the public are strongly advocating national electronic health care records, with keeping the information protected in mind.(Melton, 2009)The reason for this call to action is lowering medical costs and preventing medical errors would be the benefit. Unfortunately,there is a lack of evidence to support this belief (Melton, 20o9). Developing a national electronic record could also give patient's the benefit of being more active in their health care by allowing them internet access to their labs, treatments, and diagnosis.
Christine Perez
Melton, C.L.(2009)Information sharing: Transparency, nursing ethics, and practice implications
with electronic medical records. Nursing Science Quarterly, 22(3)214-219.
Electronic medical records are a great thing, and are up and coming whether we like it or not. But like any other system, electronic medical records are by far not flawless. Beside bridging the learning gap, there are always potential for error or system failure. Even the greatest system does not flow over all information from admission to admission. The greatest challenge to the EMR is overcoming the challenge of change.
With all the talk and need for guidance with regards to EMRs, in an article published by the Society of Medical Informatics of Bosnia and Herzegovina (BHSMI), a Code of Ethics for Health Information Professionals (HIPs) in the International Medical Informatics Association (IMIA) was proposed . The authors described the need for an international code of ethics; and a distinction between law and ethics was made. Briefly discussed were six fundamental ethical principles and the application of those principles. Rules of ethical conduct for HIPs and patients, referred to as subjects in the article, were recommended. While the article was written by a medical organization abroad, the articulation and the appropriateness of the topic was clear. The code as described by BHSMI can be easily applied to all people involved in healthcare.
(2010). Code of Ethics for Health Information Professionals. Acta Informatica Medica, 18(3), 170-174. Retrieved from Academic Search Complete database.
The EHR or EMR has become a must in our healthcare society. We can no longer sit back and not move forward with using technology to the positive aspects it can provide to the healthcare fields. But with every benefit there is always risk and potential harm.
I started in a new position this week at work. I am now working for the information systems as a clinical person to assist with the development of the EHR. In the matter of 3 days on the job, I already have heard about numerous issues that are encountered every moment of every day within this new environment. I found myself sitting there praying for the safety of all patients as we work the "bugs" out.
Providing education and knowledge of the importance of privacy to the end users is what MUST be included as you make the transition to an EHR.
This article discusses the challenges faced within the medical field of maintaining the Hippocratic oath within the world of information technology.
It raises many of the questions discussed in this blog, and more.
"In today’s complex health care environment, especially with the widespread adoption of EHRs, physicians and patients need a new Hippocratic bargain. Physicians and other health care professionals should be obliged to respect
their patients’ choices regarding information disclosure, to preserve the confidentiality of the information entrusted to them, and to disclose information only in accordance with the law and prior agreements with their patients" (Rothstein, 2010).
Rothstein, M. (2010). The Hippocratic bargain and health information technology. Journal of Law, Medicine and Ethics, 38(1), 7-13. Retrieved from CINAHL Plus with Full Text database.
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This is a very interesting topic. I am also a proponent of a nationwide electronic health database. I feel that it will greatly serve the public. People travel and some fall ill or are involved in accidents and cannot recall an accurate health history; some may be too debilitated to speak. With the ability to readily access out-of-state records, providers are able to link together missing pieces of the health history puzzle. I think overall it could be very cost-effective. Why order another MRI if you could access and read the one that was done yesterday?
A national record system would be great. I think it would really require a national health system though, something much more integrated than what we have. I think it would be great, but I can't see us getting there any time soon. There are too many opposing interests.
Thomas D.
I agree with Nurse Kricket. Are there any penalities in place for the misuse of ehr or emr?? I have read much on the positive impact of implementation of ehr but what of the misuse. Are we only hearing what ehr vendors want us to know??
After reading much more on this subject, I agree that there are many ethical considerations. One article I read discussed data mining for the purposes of advertising and marketing, which seem like a major invasions of privacy. I know I am annoyed when I receive obviously targeted healthcare related advertisements in the mail or by email. It does feel like very invasive/intrusive. Layman (2003) discussed "infoethics" and how the concepts of autonomy, fidelity, and justice may be compromised by use of electronic medical records. Specifically related to justice, the author notes it is breached when data is posted about only certain populations - low income or Medicaid populations, for example.
Reference:
Layman, E. (2003). Health informatics: Ethical issues. Health Care Manager, 22(1). Retrieved from http://libproxy.uta.edu.
I am in favor of electronic health records, but feel there is still alot that needs to be defined in the way of appropriate access and other ethical considerations. Layman's (2003) article that I referenced earlier in this blog includes great examples of how the electronic medical record (EMR) can be a two-edged sword. Take the ethical concept of autonomy for example. Layman describes a scenario in which the EMR takes the place of the "living, breathing person" at times for information on which to base decisions. What happens to autonomy when that information is from the EMR that contains errors instead of the patient? Anyone who has tried to correct an error in their record would probably have comments about this!
Rothstein, M. (2010). The Hippocratic bargain and health information technology. Journal of Law, Medicine and Ethics, 38(1), 7-13. Retrieved from CINAHL Plus with Full Text database.
Nurse Kricket,
I agree with this article, I do believe there will need to be new standards and regulations, put in place to protect the patient's privacy. Patients should not become victims of the new EMR system. All information should be guarded and only used by the proper employees. Nurses need to be at the forefront when these regulations are decided.
Linda
After further reading the comments by Christine, Jennifer, Nurse Kricket, Nokie, Diane, and Pam, I do not think that there is any dispute among those who have posted on this blog that EHRs/EMRs should be implemented. I am also going to make the assertion that we all pretty much agree that it should be accessible nationwide, if need be. However, as I stated previously, I think where the dispute comes into play is how information will be accessed, stored and overseen. Another point that is of concern to me is how are we to go about transitioning from our existing systems to new online systems to systems that have the potential to be later linked to a nation wide system of EHRs/EMRs.
In terms of implementing EHR, I think one of the biggest obstacles is the learning curve. They say that people who have been around computers growing up have the easiest time in converting to EHR, but I have to admit that it can still be a challenge. My father is a computer engineer, so I have been around computers since the age of 4, and when my facility switched to the EHR even I had challenges.
I to agree with Jennifer. The learning curve will be a big challenge. I am fortunate to work in a hospital that has many nurses over the age of 50 and have computer charted thier entire careers. Computers are used to play bejeweled. The IT director is not completely aware of his task with these nurses. He believes implementing the ehr will be easy and seamless. Because the IT director does not truely know what it takes to admit, chart daily and dismiss patients.
I have read this blog and agree that EMR would be a good progress for the medical community. For example, patient history and medication. These two things are asked repeatedly when patients are admitted. I think it would be great if we can pull up history and home medication records and have to only ask if there have been any recent changes. This will speed up admitting a patient and there would be a more accurate account
Betty
I have read some of your articles and still do not approve of electronic medical record. It is true that it improves access to health care treatment like the advert frequently shown on ABC about a man whose father had a heart attack and had to be taken to the hospital. People’s personal data can enter into wrong hands and become a risk to their welfare in a place where crime is prevalent.
Virginia
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Well a few comments come to mind as I read back through this blog and also read some of the new entries since I visited last. With all do respect, we do not have a choice as to whether we adopt an electronic health record system. It must be done. What needs to be done is to embrace, research, and support how we bridge the IT world to the healthcare provider at the bedside. I believe my place of work is trying their best to do this. They are hiring people into the IT world who have the clinical background. The collaboration is so important. They also closely tie the clinicians at the hospitals to the entire process. Click on the link below and then click on the pdf under the topic Using Health IT: Eight Quality Improvement Stories.
http://healthit.ahrq.gov/portal/server.pt/community/ahrq_national_resource_center_for_health_it/
Okay, the link obviously did not post correctly, my apologies. Go to AHRQ website, select Health IT on the left had side of the page, then scroll down and click on the pdf under "Using Health IT: Eight Quality Improvement Stories"
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