History of the EHR
Health organizations often face the challenge of accessing historical health records of patients in a fast and efficient way. To address this issue, health facilities in Australia are now resorting to the use of Electronic Health Record systems that facilitate the storage and easy retrieval of patients’ historical medical records. The EHR is a patients-centered information system. The system facilitates the collection, storage, and secure sharing of medical history with the permission of the patients among other care providers (Melnyk, Fineout-Overholt, 2011). Information that the EHR system accommodates includes patients’ medical history, immunization period, all laboratory results for all tests that patients have undergone, information on allergies, diagnosis, various treatment plans, and medications that patients have received in the course of their life.
The history of electronic health records dates back to the 1960s. The innovation of the technology arose from the concerns that doctors could not find necessary medical information for patients during sophisticated situations that required urgent availability of such data. The EHR was developed in conjunction with software programs that had the capacity to store a large amount of information. One of the critical considerations in the early development of the EHR was the establishment of systems that could foster prompt accessibility of information, provide safe storage of updated patient data, and/or ensure accuracy of the data stored in the systems (Assuli, Shabti, & Lesho, 2013).
In the 1960s, Larry Weed developed the idea of problem-oriented medical records and incorporated it into medical practice. Earlier, doctors and other medical practitioners documented only the diagnosis and any treatment provided in papers. The primary goal of Weed was to develop an innovation that had the capability of generating and permitting third-party verification of medical records. Although the innovation would mark an important new development in the medical practice, physicians reluctantly received it (Assuli et al., 2013). In 1991, the US Association of Medicine recommended all medical officers to deploy central processing units to augment their exercise by the beginning of 2000. However, by this year, no significant adoption of EHR had been achieved in the US.
The US and Canada exhibited low levels of adopting the EHR by 2000. Kavilanz (2011) reveals that the US only used EHRs in its 20% share of medical facilities and a 5% share of clinics. These figures were even less in Canada. However, currently, many of the hospitals in Canada, the US, and even Asia in nations such as Korea and India have already implemented the EHR. Australia has also implemented its version of the EHR, namely Personally Controlled Electronic Health Records (PCEHR), which has been renamed My Health Record. Through the EHR system, Australia hopes to guarantee the easy sharing and retrieval of patients’ health records by health care workers. The implementation of this strategy will also enable patients to access quick and effective care services from health facilities. The National E-Health Transition Authority (NEHTA) is responsible for overseeing the implementation process of this program in Australia.
In the case of the US, if everything operates according to the plan, the EHR will be operational and interchangeable by the end of 2016. The US Department Of Health and Human Services asserts that the number of hospitals that have adopted the EHR increased from 9% in 2008 to more than 80% by 2013 (Newhook, 2014). This goal has been achieved through incentives such as the allocation of 24.3 billion US dollars to promote and fund information technology initiatives in the US healthcare sector (Newhook, 2014). The ease of availability of health records for patients in online platforms to ease its sharing attracts ethical concerns about confidentiality. Therefore, different nations, including Australia, Canada, and the US have established standards for the EHR. The standards seek to ensure that medical practitioners do not reveal patients’ medical information without permission from relevant parties. This issue underlines today’s critical concerns about the accountability of medical information in the EHR.
The Relationship between the EHR and My Health Record
EHR and My Health Record seek to enhance continuity of care. Enhancement of continuity is an important outcome for health care information systems. Health care records are pivotal in enabling care providers to exchange patients’ clinical and demographic information that is necessary to effect the appropriate treatment (McMurray et al., 2012). However, this information should be shared in a manner that ensures that breach of information confidentiality does not occur. To this extent, both My Heath Records and EHR have similar concerns. My Health Record consists of a secure summary of one’s health information that is shared online. The patients can control all traffic into the personalized platform, including people who are permitted to view the health information. One can share health information with doctors, healthcare institutions, and other care providers. Hence, My Health Record is a health care information-sharing system with constructs that permit the owner of the information to control its accessibility. Hence, the system is developed with critical consideration of the need to grant one the right to control one’s medical information.
Similarly, EHR aids in accountability transfers facilitate regulatory compliance, and/or provides a means of following up the quality of the healthcare delivered. For this system, McMurray et al. (2012) find it playing an important role in facilitating the documentation of patients’ medical information. Nevertheless, the researchers assert that the documentation culture consumes 25 percent of the caregivers’ time in a health care facility (McMurray et al., 2012). My Health Record aids in improvising more accurate, better quality, secure, and speedy, and even well-coordinated health care. Hence, My Health Record is a form of EHR in which the control of accessibility of one’s medical information is in the hands of the owner of the information.
The established relationship between My Health Record and Electronic Medical Records (EMRs) underlines the importance of transitioning to EMRs health care information systems. However, McMurray et al. (2012) report low adoption rates for the EMRs in clinical settings in Canada. McMurray et al. (2012) also argue that care providers encounter challenges in sending and receiving digitized information. Consequently, “the adoption of digitized documentation is inconsistent across healthcare sectors, and interoperability between information systems is limited” (McMurray et al., 2012, p.220). Based on this realization, the researchers found it sound to conduct a research to investigate the impacts of electronic and paper information parallel system on fostering efforts of communication exchange during the process of transitioning of the patient within the health care continuum. Despite these arguments, both My Health Record and EHR facilitate a controlled sharing of patients’ health information that is necessary for a more effective diagnosis and treatment process.
The Current Strategy, use and Implementation Status of EHR/My Health Record
Current Implementation Status for EHR/My Health Record
McMurray et al.’s (2012) work constitute an important starting point when analyzing the status of the implementation of EHR, including My Health Record/ PCEHR systems in the global context and even in Australia. McMurray et al. (2012) examine the implication of EMRs coupled with parallel paper medical records on the continuity of information in health care facilities. The focus of the article is on the implication of the Electronic Information Systems’ (EIS) interoperability on the capacity of health care providers to communicate among themselves and the implication of digital records on the transformation of information handling and processing systems within health care facilities. While the authors contend that by 2012, the implemented EHR systems had fostered the exchange of information between patient and care providers globally, the implementation process experienced some challenges that related to the usability of the systems and information security. However, in the case of the US, if things go according to the set plans, the EHR will be interchangeable in 2016.
In Australia, PCEHR, now called My Health Record, comprises a federal government initiative that is aimed at streamlining the Australian healthcare system. Its implementation has led to the transitioning from paper-based health records. The system permits health care professionals across Australia to view patients’ information online. However, patients must authenticate the sharing of their information among care providers. Australia has been implementing the system over the last five years with a cost of over $647 million (Anderson, 2013). The National E-Health Transitioning Authority (NEHTA) executes the task of developing and implementing the system. The implementation process brings together various stakeholders that include nursing clinicians, professionals from advocacy groups, medical fields, and its allied areas of research, community groups, and the ANF federal office (Anderson, 2013).
Despite some challenges in the implementation of My Health Record system in Australia, the system works with minimal concerns. For example, efforts have been made to promote secure sharing and retrieval of patient information. In this respect, practitioners can only access and interact with My Records systems only with the help of the patient or a representative. Moreover, if the practitioners intend to access their patients’ records for other purposes other than facilitating the treatment process, they will need to seek authority from their patients. This plan is part of the documented mandate of the National Authentication Service for Health Public Key Infrastructure (NASH PKI).
The NASH PKI has constituted a document that validates health practitioners who are licensed to practice in Australia before they can access patients’ electronic health records. The document requires them to load their certificates onto their smartcards. The smartcards are then installed in conjunction with the HPI-I of the practitioner who can now access patients’ records. Practitioners must have authority from their patients through the issuance of the Individual Healthcare Identifier (IHI) that is unique to each patient. This procedural program structure is essential since it guarantees the security of patients’ information, particularly during the exchange of patients’ health information between different health care organizations.
Besides the permission granted to health organizations of identifying senders and recipients of patient information by NASH PKI, measures have been taken to ensure no malicious alteration of messages during their transfer from the sending facility to the recipient (Greenwood, 2012). Such measures are important in mitigating organizations’ legal liabilities because of unauthorized access to patient information.
Currently, in Australia, the implementation of My Health Record/PCEHR is successful. As of 11th March this year, PCEHR statistical findings indicated that an excess of 2.6 million people now has My Health Record (Australian Government Department of Health, 2016). On average, one person subscribes to the system after every minute. The Australian Government Department of Health (2016) reveals that during the incoming participation trials, an estimated one million people will gain accessibility to the system. The Australian EHR system addresses various concerns for such systems in the global context. Hence, the Australian EHR is a good benchmark for the implementation of EHR systems for nations that are yet to execute them.
Current Strategy, Use, and Implementation Issues
In the global context, EHRs have some underlying issues that influence their implementation processes. However, the major debate is on data security. Greenwood (2012) asserts that care coordination and easiness of medical information transfers that form the basic operation tenet for EHRs pose a threat to records’ safety coupled with information confidentiality. Indeed, the provider has the responsibility of ensuring the security of the data that is held in the EHR, as opposed to shifting the responsibility to the designer of the system. This process requires strict compliance with various encryption protocols established in different nations. In the US, security demands compliance with the HIPAA of 1966 rules concerning security and privacy of health information. In addition, controlling the accessibility of information, combating threats to information privacy, and conducting audit trials are some of the important mechanisms for responding to problems that are associated with the use of EHRs in the global context.
Similar to the global context’s concerns of the current strategy and use of EHRs, the present approach and concerns about the use of My Health Record in Australia are to ensure that organizations comply with the stipulated ethical guidelines of handling patient information. One such instance would be the sharing of patients’ records between two facilities and/or access to such information by unauthorized personnel working in the facilities. This issue has been one of the major concerns among stakeholders, especially in organizations that uphold ethical and legal guidelines. As a result, there has been a call for all those involved in accessing patients’ records to abide by the ethical code of conduct regarding the handling of all patient information (Wafa, 2010).
One of the ethical issues raised by stakeholders is the subject of patients’ data discretion. Nevertheless, all health workers have an ethical and legal responsibility to uphold the secrecy of their patients’ information (Melnyk & Fineout-Overholt, 2011). Therefore, health care workers are not allowed to disclose any information that concerns the health of a patient to any unauthenticated persons. Authenticated persons in this context refer to those persons that have their names highlighted in the sick people’s attorney form or whom the patients have given authorized access to their information through a directive issued in advance by the patient (Moore & Savage, 2012).
Owing to concerns of breach of discretion of patients’ health records, medical practitioners have a legal and ethical obligation to guarantee the privacy of all of their patients’ records, including billing and insurance information that has been issued by a physician, individual, or facility tasked with the responsibility of taking charge of the patient (Anderson 2013). Confidentiality also extends to conversations that are held between the physicians and their patients. The current Australian ethical guidelines outline confidentiality protocols of handling patients’ information contained in My Health Record such as the duty by health organizations and facilities to provide patient information, as long as the information facilitates the patients’ treatment process (Moore & Savage, 2012). Appropriate rules and guidelines guarantee that the sharing of information electronically through My Health Record must comply with these ethical requirements.
Using the EHR/My Health Record introduces an important question about the information that should be sent and hence the need to consider the scrutiny of PHI by other assigned personnel in an effort to address healthcare issues relating to a specific medical facility. The argument by critics has been that such measures would be counterproductive since they may expose the confidentiality of patients’ information through providing access to unaccredited persons. Fortunately, PHI regulations provide that all entities covered under the act should only disclose patients’ medical data to facilitate their treatment, healthcare operations, and payment of medical bills. In such cases, covered entities have been given the legal privilege to perform the above activities without having to obtain written permission to do so by the patient (Greenwood, 2012). However, any other information meant to facilitate functions other than the ones mentioned must only be disclosed after obtaining written permission from the patient.
Plans to expand the Implementation of EHRs/My Health Record
My Health Record is a promising invention that eases the process of diagnosis and treatment in Australia. Following the successful implementation of the system from July 2012, Australia endeavors to ensure that the system implementation is expanded. For example, in 2014, My Health Record was reviewed with recommendations made for the improvement of the system’s operations with the objective of increasing its usability among individual and healthcare providers (Australian Government Department of Health, 2016).
From 2015 to 2016, the government has been working hard to implement various recommendations to expand the implementation of the system. The suggestions address areas of usability improvement such as reviewing user interfaces and revising key incentives for its adoption by healthcare providers. Plans are also underway for educating and training healthcare providers on how to use the system. The government of Australia is conducting participation arrangements coupled with trials with the aim of establishing future mechanisms for increasing the meaningful usability of My Health Record. The government also plans to continue spearheading national rollout for eHealth emerging technologies and services. It works within various territories and states with the objective of supporting the foundation of eHealth and the Australian eHealth strategy.
The plan of the government to expand the implementation of My Health Record entails a continuous search for proven strategies for enhancing the systems’ security to increase its uptake by individuals. In Australia, covered entities have been greatly limited to the extent of disclosing patient information (Greenwood, 2012). For example, during the sharing of patient information between organizations, the disclosure should be limited to the facilitation of achieving a specific pre-determined objective. Under the current guidelines, the focus has been directed to information that specifically relates to the patient’s existing medical condition. Hence, if the information does not facilitate the treatment process, it should not be shared through the EHR system. Moreover, such information should be sent in a format that guarantees confidentiality. In addition, practitioners who are involved in the exchange of such information need to follow the PKI guidelines such as the requirement of the patient to log in into their My Health Record system using the IHI access number.
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