E Health
This document was uploaded by user and they confirmed that they have the permission to share it. If you are author or own the copyright of this book, please report to us by using this DMCA report form. Report DMCA
Overview
Download & View E Health as PDF for free.
More details
- Words: 1,841
- Pages: 9
Legal and ethical issues of E-health 1
Healthcare through Internet: How ethical and legal is it? Dr. Mohammad Ashrafzadeh, DHA
Legal and ethical issues of E-health 2
INTRODUCTION Healthcare technology and use of computer based programs have been going through massive changes. E-health is a new paradigm that is the direct cause of advances in network technologies, telecommunication and information systems. Tan (n.d.) asserted that “…new experience and knowledge that crosses traditional disciplinary boundaries, particularly cross-disciplinary and multidisciplinary research in the fields of information technology and health care, along with emerging knowledge to promote evidence-based medicine, e-medicine, and remote e-health services, are causing not just episodic but systemic transformation of traditional health care systems and environments” (p. 4). In order to transform the business of healthcare, use of electronic commerce (e-commerce) and electronic business (e-business) concepts initiated efforts to use the availability of low cost and high speed Internet related or wireless technology. Discussion The advent of tele-health has led to the provision of e-health. E-health, simply put, symbolizes the electrification of all aspects of healthcare. ValiCert’s report (2001) indicated that the META Group Trend teleconference in 1Q2000 titled "A Practical Introduction to EHealth" presented their categorization of e-Health as the 5 Cs: Care, Content, Commerce, Connectivity, and Computer Applications. Healthcare systems and organizations are developing and installing major Internet based applications in several areas including enrollment, human resources, claim processing, and eligibility. As it is common knowledge the healthcare industry in the United States produces more paperwork than any other industries. ValiCert (2001) reported that according to the Health Care Financing Administration (HCFA), U.S. healthcare
Legal and ethical issues of E-health 3 expenditures totaled $1.15 trillion in 1998. On the whole, healthcare expenditure continues to increase due to several factors including the aging population, price of medicine and healthcare technology, bigger investment in information technology, and advanced medical knowledge. ValiCert’ report continued to indicate that the nation's total health bill in 2004 was $1.87 trillion, or 16% of the gross domestic product (GDP). In 1980, the health care cost was just 9% of GDP and by 2008 analysts estimate the spending number to reach $2.16 trillion (NPR, 2006). According to the ValiCert’s report for every dollar spent on healthcare, it is estimated that 20 to 25 cents is spent o administrative overhead. This estimation of administrative overhead translated to a “whopping $250 billion spent in 1998 on paperwork, unnecessary or duplicative tasks and improper billing” (p. 3). This situation also exists in mental health care. In order to eliminate the duplicative tasks and inappropriate billing, psychotherapists tend to use a promising portal, the Internet. However, the delivery of services in behavioral e-health is still at the stage of infancy. Maheu (2001) indicated that guidance for structuring the interactions with patients in behavioral healthcare can be found in the conventional telehealth research literature, where it has been discussed that uploading the traditions and requirements of expert practice is possible while using telecommunication technology. Maheu (2001) citing Reed, McLaughlin, and Milholland, (2000) asserted that telecommunication technologies have the tendency for development into profitable but not necessarily better or more effective health care system when they are driven by commercial rather than practitioner’s interests. More specifically, as several behavioral e-health web sites offer information and community support, some have indiscriminately offer direct
Legal and ethical issues of E-health 4 professional care to consumer without a rigor research to establish safety and efficacy or efficiency in services delivered. One of the main concerns of American consumers in the healthcare industry is confidentiality of security of their healthcare issues. With an increasing number of healthcare organizations conducting business via electronic transactions, the public has grown concerned about confidentiality of their personal healthcare information (Valicert, 2001). Hacking and identity theft has become the concern of the day and public continues demanding a solution by the government. This issue had become very urgent and needed to be addressed immediately. Congress focused on some of these issues in a section of Health Insurance Portability and Accountability Act (HIPAA) entitled Administrative Simplification, which was the topic of the day and under spot light in 2000 and 2001. Valicert (2001) asserted that “This section of HIPAA mandates the use of a series of electronic claims processing standards. HIPAA administrative simplification regulations include: patient and provider identifiers, and code sets.” The Department of Health and Human (2003) issued a fact sheet whereupon asserted that HIPPA Administrative Simplification rules include: 1. Electronic health care transaction and code sets 2. Health information privacy (final rule issued); 3. Unique identifier for employers (final rule issued); 4. Security requirements (final rule issued); 5. Unique identifier for providers 6. Unique identifier for health plans 7. Enforcement procedures
Legal and ethical issues of E-health 5 However, Valicert (2001) pointed out that congress recognized that the standardization of information formats and greater use of electronic technology present additional privacy and security risk. In summary, HIPAA focus areas may be listed as follows: 1. Transaction Standards, Code Set Definitions, and Unique Identifiers 2. Data Security 3. Information Privacy 4. Auditing and Monitoring HIPAA rules were established to provide ethical and legal provision of e-health. To that end accreditation bodies such as Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and Commission on Accreditation of Rehabilitation Facilities (CARF) and other accreditation groups developed their own set of standard for healthcare organizations. Utilization Review Accreditation Commission (URAC) (2005), a healthcare accrediting association, reported that Health Internet Ethics or hi-ethics indicates 14 principles for health web sites, demonstrating a commitment to ensure that “consumers can realize the full benefits of the Internet to improve their health and that of their families.” These principles are: 1. Privacy policies 2. Enhanced privacy protection for health related personal information 3. Safeguarding consumer privacy in relationships with third parties 4. Disclosure of ownership and financial sponsorship 5. Identifying advertising and health information content sponsored by third parties 6. Promotional offers, rebates, and free items or services
Legal and ethical issues of E-health 6 7. Quality of health information content 8. Authorship and accountability 9. Disclosure of source and validation for self-assessment tools 10. Professionalism in the online environment 11. Qualifications of those responsible for health care services delivered via the web site 12. Transparency of interactions, candor and trustworthiness 13. Disclosure of limitations of the site as a source of health care services 14. Mechanism for consumer feedback concerning the web site Before providing mental healthcare services through technology, the service providers must gain and document training for the use of specific technologies to provide psychotherapy. As a word of caution to the practitioners, they must take care that technology that is being used in the provision of mental care is supported by sound empirical evidence of its efficacy. Several facets of working with technology require the service provider to be aware of hidden factors that may positively or negatively influence communication with the patients. These factors can be technical proficiency and legal training. Technical proficiency could include e-mail, which is dependent upon participants' writing skills and can lead to a greater number of misinterpretations. Maheu (2001) pointed out that chat rooms have not been researched adequately regarding their influence on the communication of people with social or emotional difficulties. Initial assumption rotates around their potential for eliciting incomplete or impulsive thoughts, due to the time pressure created by the delay in sending and receiving messages. Videoconferencing can be
Legal and ethical issues of E-health 7 disturbing and distracting drawing attention to factors in the peripheral movement, such as tapping, rocking, or scratching one’s face or hair. Another factor that may be of concern in video-conferencing is the presence of the video camera, which may place the person in an awkward position if the person is camera shy. Reliability of therapeutic contact is also crucial when establishing rapport and delivering services face-to-face. Internet services are still not completely reliable, especially if the person uses dial-up services rather than highspeed services. In these situations and given the particular patient and condition, it could confusing and harmful to a patient to lose Internet contact with the therapist. Backup plans and procedures and other informed consents issues must be discussed thoroughly before treatment. Legal training is another important aspect of e-health. Maheu (2001) indicated that healthcare professionals are caught in a bind of having access to several technologies for practice, but not having legal protections for themselves or their patients. Legal and legislative bodies are in process of establishing and instituting laws in this area and there are number of new regulations and laws that are still unknown or new to the legal as well as healthcare communities. Conclusion Considering the above issues, State of Pennsylvania has started a substantial change toward provision of quality in mental health access and treatment through Internet. As part of this massive undertaking, the State’s Department of Public Welfare (DPW) has established different access points. Home and Community Services Information System (HCSIS) is an information system that serves DPW program offices that support all Home
Legal and ethical issues of E-health 8 and Community Based Services (HCBS) waivers and programs. In addition, the department offers a new state of the art database for claim processing through Internet. Another step to this end is the use of PROMISe database. PROMISe is the name of a new claims processing and management information system for the Pennsylvania Department of Public Welfare. PROMISe is the acronym for Provider Reimbursement and Operations Management Information System in electronic format. PROMISe is online, real time, HIPAA ready, and initiated as of March of 2004. PROMISe incorporates claims processing and activities for the Department of Public Welfare programs: •
Office of Medical Assistance Programs (OMAP)
•
Offices of Mental Health and Substance Abuse
•
Office of Mental Retardation
•
Office of Social Programs
•
Departments of Aging, Health and Education
As in the state of Pennsylvania, HIPAA rules and policies have initiated a revolution in the use of technology in the healthcare system across the country. Both in national and state levels considerable changes and upgrades were initiated due to the advent of HIPAA. Since implementation of HIPAA rules, States’ Departments of Health and Human services as well as the healthcare organizations have undertaken upgrades of their systems mainframes in order to meet the privacy act and provide ethical services for the population.
References
Legal and ethical issues of E-health 9 Department of Health and Human Services, (2003). The fact sheet. Retrieved July 10, 2006 from http://www.hhs.gov/news/press/2002pres/hipaa.html Maheu, M. (2001). Exposing the risk, yet moving forward: A behavioral E-health model. Retrieved July 11, 2006 from http://jcmc.indiana.edu/vol6/issue4/maheu.html NPR News. (2006). Generic drugs ease U.S. health care bill. Retrieved July 10, 2006 from http://www.npr.org/templates/story/story.php?storyId=5146544 Tan, J. (n.d.) The next health care frontier. E-healthcare information system, 4-5. Retrieved July 8, 2006 from http://media.wiley.com/product_data/excerpt/85/07879661/0787966185.pdf ValiCert. (2001). Insurance claim processing in e-health era: Leveraging the internet to securely conduct business processes. 3-4. Retrieved July 10, 2006 from http://www.healthleadersmedia.com/pdf/white_papers/wp_valicert_1201.pdf URAC, (2005). URAC health web site accreditation tames Internet’s wild, wild west. Retrieved July 11, 2006 from http://www.healthleadersmedia.com/pdf/white_papers/wp_URAC_022205.pdf
Healthcare through Internet: How ethical and legal is it? Dr. Mohammad Ashrafzadeh, DHA
Legal and ethical issues of E-health 2
INTRODUCTION Healthcare technology and use of computer based programs have been going through massive changes. E-health is a new paradigm that is the direct cause of advances in network technologies, telecommunication and information systems. Tan (n.d.) asserted that “…new experience and knowledge that crosses traditional disciplinary boundaries, particularly cross-disciplinary and multidisciplinary research in the fields of information technology and health care, along with emerging knowledge to promote evidence-based medicine, e-medicine, and remote e-health services, are causing not just episodic but systemic transformation of traditional health care systems and environments” (p. 4). In order to transform the business of healthcare, use of electronic commerce (e-commerce) and electronic business (e-business) concepts initiated efforts to use the availability of low cost and high speed Internet related or wireless technology. Discussion The advent of tele-health has led to the provision of e-health. E-health, simply put, symbolizes the electrification of all aspects of healthcare. ValiCert’s report (2001) indicated that the META Group Trend teleconference in 1Q2000 titled "A Practical Introduction to EHealth" presented their categorization of e-Health as the 5 Cs: Care, Content, Commerce, Connectivity, and Computer Applications. Healthcare systems and organizations are developing and installing major Internet based applications in several areas including enrollment, human resources, claim processing, and eligibility. As it is common knowledge the healthcare industry in the United States produces more paperwork than any other industries. ValiCert (2001) reported that according to the Health Care Financing Administration (HCFA), U.S. healthcare
Legal and ethical issues of E-health 3 expenditures totaled $1.15 trillion in 1998. On the whole, healthcare expenditure continues to increase due to several factors including the aging population, price of medicine and healthcare technology, bigger investment in information technology, and advanced medical knowledge. ValiCert’ report continued to indicate that the nation's total health bill in 2004 was $1.87 trillion, or 16% of the gross domestic product (GDP). In 1980, the health care cost was just 9% of GDP and by 2008 analysts estimate the spending number to reach $2.16 trillion (NPR, 2006). According to the ValiCert’s report for every dollar spent on healthcare, it is estimated that 20 to 25 cents is spent o administrative overhead. This estimation of administrative overhead translated to a “whopping $250 billion spent in 1998 on paperwork, unnecessary or duplicative tasks and improper billing” (p. 3). This situation also exists in mental health care. In order to eliminate the duplicative tasks and inappropriate billing, psychotherapists tend to use a promising portal, the Internet. However, the delivery of services in behavioral e-health is still at the stage of infancy. Maheu (2001) indicated that guidance for structuring the interactions with patients in behavioral healthcare can be found in the conventional telehealth research literature, where it has been discussed that uploading the traditions and requirements of expert practice is possible while using telecommunication technology. Maheu (2001) citing Reed, McLaughlin, and Milholland, (2000) asserted that telecommunication technologies have the tendency for development into profitable but not necessarily better or more effective health care system when they are driven by commercial rather than practitioner’s interests. More specifically, as several behavioral e-health web sites offer information and community support, some have indiscriminately offer direct
Legal and ethical issues of E-health 4 professional care to consumer without a rigor research to establish safety and efficacy or efficiency in services delivered. One of the main concerns of American consumers in the healthcare industry is confidentiality of security of their healthcare issues. With an increasing number of healthcare organizations conducting business via electronic transactions, the public has grown concerned about confidentiality of their personal healthcare information (Valicert, 2001). Hacking and identity theft has become the concern of the day and public continues demanding a solution by the government. This issue had become very urgent and needed to be addressed immediately. Congress focused on some of these issues in a section of Health Insurance Portability and Accountability Act (HIPAA) entitled Administrative Simplification, which was the topic of the day and under spot light in 2000 and 2001. Valicert (2001) asserted that “This section of HIPAA mandates the use of a series of electronic claims processing standards. HIPAA administrative simplification regulations include: patient and provider identifiers, and code sets.” The Department of Health and Human (2003) issued a fact sheet whereupon asserted that HIPPA Administrative Simplification rules include: 1. Electronic health care transaction and code sets 2. Health information privacy (final rule issued); 3. Unique identifier for employers (final rule issued); 4. Security requirements (final rule issued); 5. Unique identifier for providers 6. Unique identifier for health plans 7. Enforcement procedures
Legal and ethical issues of E-health 5 However, Valicert (2001) pointed out that congress recognized that the standardization of information formats and greater use of electronic technology present additional privacy and security risk. In summary, HIPAA focus areas may be listed as follows: 1. Transaction Standards, Code Set Definitions, and Unique Identifiers 2. Data Security 3. Information Privacy 4. Auditing and Monitoring HIPAA rules were established to provide ethical and legal provision of e-health. To that end accreditation bodies such as Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and Commission on Accreditation of Rehabilitation Facilities (CARF) and other accreditation groups developed their own set of standard for healthcare organizations. Utilization Review Accreditation Commission (URAC) (2005), a healthcare accrediting association, reported that Health Internet Ethics or hi-ethics indicates 14 principles for health web sites, demonstrating a commitment to ensure that “consumers can realize the full benefits of the Internet to improve their health and that of their families.” These principles are: 1. Privacy policies 2. Enhanced privacy protection for health related personal information 3. Safeguarding consumer privacy in relationships with third parties 4. Disclosure of ownership and financial sponsorship 5. Identifying advertising and health information content sponsored by third parties 6. Promotional offers, rebates, and free items or services
Legal and ethical issues of E-health 6 7. Quality of health information content 8. Authorship and accountability 9. Disclosure of source and validation for self-assessment tools 10. Professionalism in the online environment 11. Qualifications of those responsible for health care services delivered via the web site 12. Transparency of interactions, candor and trustworthiness 13. Disclosure of limitations of the site as a source of health care services 14. Mechanism for consumer feedback concerning the web site Before providing mental healthcare services through technology, the service providers must gain and document training for the use of specific technologies to provide psychotherapy. As a word of caution to the practitioners, they must take care that technology that is being used in the provision of mental care is supported by sound empirical evidence of its efficacy. Several facets of working with technology require the service provider to be aware of hidden factors that may positively or negatively influence communication with the patients. These factors can be technical proficiency and legal training. Technical proficiency could include e-mail, which is dependent upon participants' writing skills and can lead to a greater number of misinterpretations. Maheu (2001) pointed out that chat rooms have not been researched adequately regarding their influence on the communication of people with social or emotional difficulties. Initial assumption rotates around their potential for eliciting incomplete or impulsive thoughts, due to the time pressure created by the delay in sending and receiving messages. Videoconferencing can be
Legal and ethical issues of E-health 7 disturbing and distracting drawing attention to factors in the peripheral movement, such as tapping, rocking, or scratching one’s face or hair. Another factor that may be of concern in video-conferencing is the presence of the video camera, which may place the person in an awkward position if the person is camera shy. Reliability of therapeutic contact is also crucial when establishing rapport and delivering services face-to-face. Internet services are still not completely reliable, especially if the person uses dial-up services rather than highspeed services. In these situations and given the particular patient and condition, it could confusing and harmful to a patient to lose Internet contact with the therapist. Backup plans and procedures and other informed consents issues must be discussed thoroughly before treatment. Legal training is another important aspect of e-health. Maheu (2001) indicated that healthcare professionals are caught in a bind of having access to several technologies for practice, but not having legal protections for themselves or their patients. Legal and legislative bodies are in process of establishing and instituting laws in this area and there are number of new regulations and laws that are still unknown or new to the legal as well as healthcare communities. Conclusion Considering the above issues, State of Pennsylvania has started a substantial change toward provision of quality in mental health access and treatment through Internet. As part of this massive undertaking, the State’s Department of Public Welfare (DPW) has established different access points. Home and Community Services Information System (HCSIS) is an information system that serves DPW program offices that support all Home
Legal and ethical issues of E-health 8 and Community Based Services (HCBS) waivers and programs. In addition, the department offers a new state of the art database for claim processing through Internet. Another step to this end is the use of PROMISe database. PROMISe is the name of a new claims processing and management information system for the Pennsylvania Department of Public Welfare. PROMISe is the acronym for Provider Reimbursement and Operations Management Information System in electronic format. PROMISe is online, real time, HIPAA ready, and initiated as of March of 2004. PROMISe incorporates claims processing and activities for the Department of Public Welfare programs: •
Office of Medical Assistance Programs (OMAP)
•
Offices of Mental Health and Substance Abuse
•
Office of Mental Retardation
•
Office of Social Programs
•
Departments of Aging, Health and Education
As in the state of Pennsylvania, HIPAA rules and policies have initiated a revolution in the use of technology in the healthcare system across the country. Both in national and state levels considerable changes and upgrades were initiated due to the advent of HIPAA. Since implementation of HIPAA rules, States’ Departments of Health and Human services as well as the healthcare organizations have undertaken upgrades of their systems mainframes in order to meet the privacy act and provide ethical services for the population.
References
Legal and ethical issues of E-health 9 Department of Health and Human Services, (2003). The fact sheet. Retrieved July 10, 2006 from http://www.hhs.gov/news/press/2002pres/hipaa.html Maheu, M. (2001). Exposing the risk, yet moving forward: A behavioral E-health model. Retrieved July 11, 2006 from http://jcmc.indiana.edu/vol6/issue4/maheu.html NPR News. (2006). Generic drugs ease U.S. health care bill. Retrieved July 10, 2006 from http://www.npr.org/templates/story/story.php?storyId=5146544 Tan, J. (n.d.) The next health care frontier. E-healthcare information system, 4-5. Retrieved July 8, 2006 from http://media.wiley.com/product_data/excerpt/85/07879661/0787966185.pdf ValiCert. (2001). Insurance claim processing in e-health era: Leveraging the internet to securely conduct business processes. 3-4. Retrieved July 10, 2006 from http://www.healthleadersmedia.com/pdf/white_papers/wp_valicert_1201.pdf URAC, (2005). URAC health web site accreditation tames Internet’s wild, wild west. Retrieved July 11, 2006 from http://www.healthleadersmedia.com/pdf/white_papers/wp_URAC_022205.pdf
Related Documents
E Health
May 2020 1
E-health
November 2019 3
E-health
April 2020 0
E-mental Health
December 2019 5
E-2 Applicant's Health Statement
June 2020 1