Information and Communication Technologies Transform the Practice of Medicine
ANDREW STRANIERI
TONY SAHAMAQueensland University of Technology, Australia
PATHIRAGE KAMAL PERERAIIM, University of Colombo
Overview
▪ Co-existence of medical systems
▪ Healthcare globally is in crisis
▪ Technologies are getting cheaper and more powerful
▪ eHealth is transforming health care by:▪ Tele-medicine▪ Electronic Health Records ▪ Standards in eHealth▪ Decision Support Systems ▪ Data mining in Health
▪ Healthcare system is transforming:▪ Global▪ Patients are becoming empowered▪ Privacy and Security challenges▪ Cultural change challenges
© Stranieri and Sahama 2014
Presenters and Contributors
▪ Associate Professor Andrew Stranieri. Health Informatics Researcher. Federation University, Australia [email protected]
▪ Dr Tony Sahama. Health Informatics Researcher. Queensland University of Technology, Australia http://staff.qut.edu.au/staff/[email protected]
▪ Dr Pathirage Kamal Perera. Indigenous clinician, researcher and academic. Institute for Indigenous Medicine, University of Colombo, Sri Lanka
© Stranieri and Sahama 2014
Health Care Trends
Co-existence of medical systems
© Stranieri and Sahama 2014
Co-existence of Allopathic and Other Medical Systems
Ingestive Remedial Energetic Other
Herbal Medicine Massage Acupuncture Dietary advice
Nutritional Medicine Reflexology Aromatherapy Yoga
Homeopathy Shiatsu Reiki Art therapy
Naturopathy Acupressure Magnet therapy Music therapy
Ayurveda Chiropractic Spiritual Healing Qi gong
© Stranieri and Sahama 2014
Global trend: Co-existence of Allopathic and Other Medical Systems
▪ Co-existence means:▪ Patients anywhere in the world can
access health care from any tradition▪ Not necessarily, integrative medicine
Golden, I., Stranieri, A., Sahama, T, Pilapitiya, S., Siribaddana, S., and Vaughan, S. 2014 Informatics to support patient choice between diverse medical systems to IEEE HEALTHCOM 2014 - 1st International Workshop on Secure and Privacy-Aware Information Management in eHealth
Stranieri, A and Vaughan, S (2011) Coalescing Medical Systems: A Challenge for Health Informatics in a Global World in Smith, A and Maeder, A. 2010. (eds) Studies in Health Technology and Informatics Volume 161, 2010
Andrew Stranieri and Tony Sahama. Eds. (2012) Proceedings of the 3rd International Conference on Holistic Medicine ICHM 2013 Nov 17-19 2012. Sri Lanka. University of Colombo. ISBN 978-955-0460-39-7
▪ Examples▪ Germans access Ayurvedic treatment in Sri
Lanka▪ Australians access TCM specialists
© Stranieri and Sahama 2014
Impact of co-existence
▪ Medical systems will ‘compete’ with each other compelling each to demonstrate their effectiveness
▪ The geographical ‘reach’ of each medical system is larger than ever
▪ Some medical systems will inevitably decline
Indicator Indicator
Shortage of HCP
Malawi has 250 doctors for
16 million
6 week wait for General
Practitioner in regional Australia
Rise of Chronic diseases
Diabetes in Australia 17%
Diabetes in Sri Lanka over
12%
Cost of health care
Australia 12% of GDP
US 17% of GDP
Equity
IndigenousAustralians life expectancy 20
years less
In US, low income
© Stranieri and Sahama 2014
Co-existence: patients need information to choose
▪ How do patients choose:Emergency Palliative Acute Chronic
Effectiveness 10 5 8 7
Empathy 1 7 3 10Empowerment 1 7 4 10
Accessibility 5 3 6 4
Philosophical 1 6 4 8
Privacy 3 7 7 7
© Stranieri and Sahama 2014
Global trend: Co-existence of Allopathic and Other Medical Systems
▪ Co-existence will continue because▪ Emerging super economies of China
and India have strong traditional medicines
▪ TCM, Others already popular in the West, WM already popular in East
▪ TCM, others (in West) provides good models of patient empowerment
▪ Chronic (lifestyle) conditions resistant to WM
▪ Challenges/Research▪ How to support patients to choose a medical
system ?▪ How to ensure Ayurveda ‘competes’ effectively
with other systems? ▪ How to ensure Ayurveda is accessible to
patients outside Sri Lanka ?
© Stranieri and Sahama 2014
Health Care Trends
Healthcare globally is in crisis
© Stranieri and Sahama 2014
Global Trend : Health Care Crisis
▪ Shortage of health care professionals particularly ▪ In rural areas▪ In emerging countries
▪ Rise of Chronic diseases
▪ Costs
▪ Equity
▪ Quality of healthcare-medical errors
Indicator Indicator
Shortage of HCPMalawi has 250 doctors for 16
million
6 week wait for General Practitioner in regional Australia
Rise of Chronic diseases
Diabetes in Australia 17%
Diabetes in Sri Lanka over 12%
Cost of health care Australia 12% of GDP US 17% of GDP
Equity
IndigenousAustralians life
expectancy 20 years less
In US, low income
Medical errors
© Stranieri and Sahama 2014
Global Trend : Health Care Crisis
▪ Shortage of health care professionals particularly ▪ In rural areas▪ In emerging countries
▪ Rise of Chronic diseases
▪ Costs
▪ Equity
▪ Quality of healthcare-medical errors
Armstrong, B.K., Gillespie, J.A., Leeder, S.R., Rubin, G.L., & Russell, L.M., (2007). Challenges in health and health care for Australia. Med J Aust 2007; 187 (9): 485-489. Retrieved on the 16/6/2011 from http://www.mja.com.au/public/issues/187_09_051107/arm11047_fm.html
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eHealth
Technologies are getting more powerful and cheaper
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Technological Maturity
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Desktop
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2004 2006 2008 2010
Proportion of people using the Internet for health purposes in each employment status
Full Time Work
Part Time Work
Retired/ Disabled
Others (includingunemployed andstudents)
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Proportion of people using the Internet for health purposes in each age category
<30
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46-60
>60
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2004 2006 2008 2010
Proportion of people using the Internet for health purposes by gender
Male
Female
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eHealth
Information and Communication Technologies (eHealth) are transforming the
practice of health care© Stranieri and Sahama 2014
A broad description
“eHealth aspires to be a secure unobtrusive, ubiquitous and cost effective means for technology to improve the quality of healthcare delivery by meeting the individual needs of a complex stakeholder network”.
(Black and Sahama 2014)
16© Stranieri and Sahama 2014
eHealth innovations
• Telemedicine. Practice of health care where patient and practitioner are remote
• Electronic Health Record. Virtual record of every health event a patient has through life
• Online information. Easy access online to information about health, condition, physicians, other patients
• Decision Support System. Software that helps less experienced health care professions make decisions like specialists
• Simulation, Computer Games. Software that simulates health care phenomena
• Data mining. The automated analysis of large healthcare datasets© Stranieri and Sahama 2014
Impact of the global trends on healthcare
© Stranieri and Sahama 2014
Impact on Healthcare
• World is in a Healthcare Crisis
• Co-existence of Allopathic and Other Medical Systems
• Technologies are getting cheaper and more powerful
• eHealth is transforming the practice of healthcare
• Patient empowerment, choice
• Privacy, security challenges
• Disruption to the health care professions
• Challenges to legal systems
TRENDS IMPACT
© Stranieri and Sahama 2014
Healthcare practice is changing
• Patients seek information to:• Validate doctors decisions• Self diagnose• Find relevant health care professionals
• Health care organisations:• Pressure to be efficient. Do more with fewer resources• New professional sub-division eg Cancer Nurse Practitioner. Nurse who is trained to
practice as a doctor for cancer.
© Stranieri and Sahama 2014
Status of eHealth around the world
© Stranieri and Sahama 2014
eHealth in allopathic medicine around the world
WESTERN MEDICINE
▪ Gorillas. Big ehealth spending but health outcomes not great. Slow, hard to change▪ USA▪ Canada▪ UK▪ Australia
▪ Deer. Nimble, quick to change. Smaller spending. Faster changes▪ Denmark▪ New Zealand
▪ Beginning to adopt Slovenia
▪ Not yet adopting. Emerging regions? (e.g., South East-Asian countries)
INDIGENOUS, AYURVEDIC
▪ Not yet much eHealth
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eHealth for Ayerveda
Tele-medicine
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Telehealth. Two kinds
• Synchronous. • Doctor in one place, patient in another at the same time use
video conference using internet. • Usually higher definition than skype,viber. • Sometimes with digital equipment eg digital stethoscope
• Asynchronous. Store and Forward• Doctor in one place, patient in another at different times
Health care professional uploads images, videos for specialists to access when they can
© Stranieri and Sahama 2014
TeleHealth: Examples
• http://www.hd3dtelemedicine.com.au/
• Tele-dentistry into aged care facilities
• Tele-psychiatry with 3D Immersion
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eHealth: More telemedicine
• http://www.hd3dtelemedicine.com.au/
• Tele-wound. Nurses in home to specialists
• Store and Forward
• Tele-oncology. Oncologist to Cancer nurse
• 2D video conferencing. Vidyo
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Tele-health for Ayurveda
▪Challenges/Research▪ Tele-health consultations with foreign patients in their own
country following or before Indigenous/Ayurvedic treatment▪ Tele-Ayurvedic consultations between practitioners all over Sri
Lanka and Specialists in Colombo▪ Tele-Ayurvedic consultations between remote patients around
Sri Lanka and Specialists▪ Tele-consultations in the field to help train
Indigenous/Ayurvedic physicians© Stranieri and Sahama 2014
Tele-health References
HD3D Telemedicine. www.hd3dtelemedicine.com.auMARIÑO R, Clarke K, Manton DJ, Stranieri A, Collmann R, Kellet H, Borda A. Teleconsultation and telediagnosis for oral health assessment: an Australian perspective. In: K Raghavan, S Kumar (Eds.). Teledentistry. Springer. (In press). 2014Stranieri, A., Collmann, R and Borda, A. (2012) High Definition 3D Telemedicine: the next frontier? Global Telehealth. Australian Telehealth SocietyPulseIT http://www.pulseitmagazine.com.au/
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eHealth for Ayurveda
Electronic Health Records
© Stranieri and Sahama 2014
eHealth: Electronic Health Record
Virtual, online record of every health event a person encounters from before birth to after death
Currently, data is stored in each organization’s databases (or paper files) inaccessible to others
Leads to lost data, medical errors, patient/carer frustration
Hospital database
GP database
Dentist database
Pharmacydatabase
Psychologist database
…© Stranieri and Sahama 2014
eHealth: Private Database
Distributed database architecture for establishing an electronic health record
Hospital database
GP database
Dentist database
Pharmacydatabase
Psychologist database
…
Private Microsoft Healthvaulthttps://www.healthvault.com/lk/en
DEMO
Public Personally controlled electronic health record
http://www.ehealth.gov.au/ DEMO© Stranieri and Sahama 2014
9© Stranieri and Sahama 2014
Stakeholder Requirements
Healthcare Provider Requirements
Patient Requirements
Sweet spot!
Concerned over the safety of their
sensitive information and
possible breaches of privacy
Expect better, faster, easy access
to as much information as
possible
10© Stranieri and Sahama 2014
Empowering, yet limited
However:
60% of GPs will neveruse the eHealth
records (Source: Online Poll by Australian Doctor Magazine July 2013)
Perception that it does not make the practitioner’s job
easier
Practitioner’s may not have full access
to clinical dataLitigation concerns
for practitioners
PCEHR data is collected by the government who own all IP rights
Sour
ce:
http
s://
ww
w.s
urve
ymon
key.
com
/s/p
cehr
cons
ulta
tion
An Australian Perspective
PCEHR provides patient controlled access to summary patient informationOpt-in modelEvent summary (critical information only)
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National E-Health Transition Authority, "NEHTA BluePrint," 13 August 2010.© Stranieri and Sahama 2014
Accountable Systems
13
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An IA Model: Accountable-eHealth Systems
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Ehealth record for Ayurveda
▪Challenges/Research▪ Indigenous/Ayurvedic Patient Management Software is
emerging▪ Software for Indigenous/Ayurvedic hospitals exists ▪ Software for Ayurvedic physicians is emerging eg
http://www.sattvaayusoft.com/▪What is needed is affordable PMS for all physicians designed to
link to electronic health records and hospital systems▪ Systematic studies to discover Ayurvedic physicians attitudes
to recording consultations and eHealth records© Stranieri and Sahama 2014
Standards
Role of Standards in eHealth
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eHealth: Standards
• Terminology standards. Names of health care concepts are exactly the same around the world
• Messaging standards. The format of a message from one computer to another is the standard so variables don’t get mixed up
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SNOMED-CT Terminology Standard
Rheumatoid Arthritis
Inflammatory Disorder
Clinical Finding
Root
19 branches• ICD-10 International Classification
of Diseases
• Snomed-CT Ontology http://www.ihtsdo.org/snomed-ct/
DEMO
• Ontology with 300,000 concepts
• Each concept has a unique Concept ID
© Stranieri and Sahama 2014
Messaging Standard: HL7
Syntactic Interoperability
• Data exchange between two systems – process taking data structured under one schema for transformation to another
• How to ensure first names are not confused with surnames, blood pressure with age, etc
• Health Level 7 (HL7) http://www.hl7.org/
DEMO
▪ AEHIN http://www.aehin.org/
GP
Email a request for blood tests
Laboratory
Save the request for blood test and send a reply to the GP
© Stranieri and Sahama 2014
Messaging Standard: HL7
MSH|^~\&|EPIC|EPICADT|SMS|SMSADT|199912271408|CHARRIS|ADT^A04|1817457|D|2.5|PID||0493575^^^2^ID 1|454721||DOE^JOHN^^^^|DOE^JOHN^^^^|19480203|M||B|254 MYSTREET AVE^^MYTOWN^OH^44123^USA||(216)123-4567|||M|NON|400003403~1129086|NK1||ROE^MARIE^^^^|SPO||(216)123-4567||EC|||||||||||||||||||||||||||PV1||O|168 ~219~C~PMA^^^^^^^^^||||277^ALLEN MYLASTNAME^BONNIE^^^^|||||||||| ||2688684|||||||||||||||||||||||||199912271408||||||002376853
GP
Email a request for blood tests
Laboratory
Save the request for blood test and send a reply to the GP
© Stranieri and Sahama 2014
eHealth Standards for Ayurveda
CHALLENGES• How can HL7 be deployed for
use in Ayurvedic messaging
CHALLENGES/Opportunities• How to expand Snomed-CT
to include terms from Ayurveda and other medical systems
First meeting on Ayurveda/SnomedSeptember 2014
© Stranieri and Sahama 2014
DSS and CDSS
Role of Decision Support Systems in general and Clinical settings
© Stranieri and Sahama 2014
Decision Support Systems
• Type 1 Provision of information that requires further processing and analysis by users before a decision can be made.
• Type 2 Trend analysis of patients’ clinical status and/or clinical alerts.
• Type 3 Use of inference engines and a knowledge base to generate recommendations.
• Type 4 Systems with autonomous learning capabilities (e.g., case-based reasoning, neural networks, discrimination analysis)
(CDSS) is an application that analyzes data to help healthcare providers make clinical decisions.
© Stranieri and Sahama 2014
Decision Support Systems: Applications
• Alerts and Reminders: • Symptom management:• Diagnostic Assistance: • Prescription Support:• Image Recognition and
Interpretation:• Therapy Critiquing and
Planning: • Training• Other
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eHR Data Sets
Data Handling Utility
Usage Checking Utility Accountability Utility
Message Handling Utility
Rules Management UtilityConsent Function
Accountability Function
IA Agent
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HIS vs HIT
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Proposed data warehouse model (Example: Cardiac Surgery) Multiple Profile Manager Overview
Sequence Diagram for Query Flow in Bucket Index using Bloom filter under AES-DAS model© Stranieri and Sahama 2014
eHealth: Online information
• Patient Empowerment Self diagnosis with internet information
• https://www.patientslikeme.com/
• http://www.healthdirect.gov.au/
• https://www.cochrane.org/
© Stranieri and Sahama 2014
Health Information: PatientsLikeMe
• Self diagnosis with internet information • Quality of information varies
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Health Information: Health Services Directory
Courtesy. Laurie Hawkins. Health Consultant
Designed as Software as a Service so can readily be deployed in an emerging region
www.echannelling.comhttp://www.nhsd.com.au/© Stranieri and Sahama 2014
Health Information: Better Health Channel
Australian Government funded project to maintain a quality web site with up to date and accurate information
Very expensive to maintain
© Stranieri and Sahama 2014
Health Information for Ayurveda
▪ Implement a Health Services Directory in Sri Lanka.
▪ Discover how Sri Lankan’s Exploration into the patterns of access to online information in Sri Lanka
▪ Establish a ‘Trusted’ Ayurveda medicine repository of information for interested patients (English and other languages)
© Stranieri and Sahama 2014
eHealth: Remote Patient Monitoring
• Stream data from patients body wirelesses sensor network to cloud databases
• Health Care Professionals anywhere can access the data
• Applications. Falls, Ventricular fibrillation, post operative early detection of sepsis
• Remote Patient Monitoring needs new architectures Balasubsamanian et al
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Remote patient monitoring challenges/opportunities for emerging regions
• Field test of remote patient monitoring architecture. • Applications of remote patient monitoring eg early detection of sepsis
following hospital discharge. • Collect physiological data from patients wearing sensors and correlate
with Ayurvedic assessments• Automated Ayurvedic Pulse Detection
© Stranieri and Sahama 2014
Remote patient monitoring Ayurvedic pulse detection
Deepa, N., Ganesh, A., (2012) Optical sensor for Indian Siddha Diagnosis System. Procedia Engineering 38 ( 2012 ) 1126 – 1131 Joshi, R. R., 2005 Diagnostics Using Computational NadiPatterns. Mathematical and Computer Modelling 41 (2005) 33-47
Ullrich, S. and Kuhlen, T., Haptic Palpation for Medical Simulation in Virtual Environments April 2012 (vol. 18 no. 4) pp. 617-625
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Decision Support Systems: Tridhosa Assessment
Knowledge Based System
Knowledge Base
Inference Engine
UserFacts
Expertise
Weight below average for my build.
average for my build. above average for my build.
Weight loss tend to lose weight easily
maintain my weight easily I gain weight easily
Skindry, rough, especially in winter soft, ruddy oily, moist
Hair dry fine, thin, reddish, or prematurely gray thick, wavy
Skindry, rough, especially in winter soft, ruddy oily, moist
Hair dry fine, thin, reddish, or prematurely gray thick, wavy
Body size slim medium largebone Light, small bones, Pr Medium bone structuLarge, broad shoulders, Heavy b complexion Dark complexion, Tan Fair skin, sun burns eaWhite, pale, tans evenlyskin texture Dry, pigmentation an Freckles, many moles Soft, glowing and youthfulface shape Long, angular,Thin Heart-shaped,pointed Large, round, Fulleyes Small, black, sunken, Yellow , bright, grey, Big, beautiful, blue, calm, lovingeye lashes Scanty eye lashes Moderate eye lashes Thick / Fused eye lasheseye blinking Excessive Blinking Moderate blinking More or less stable
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eHealth: Simulation
• Scenari-Aid www.scenariaid.com
• EdHeads http://www.edheads.org/activities/knee/
• SecondLife http://www.secondlife.com
© Stranieri and Sahama 2014
Simulation for Ayurveda
• Design and implement simulations for Ayurvedic medicine
• Simulation for education of Western patients of Ayurvedic procedures
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Data Mining
Data mining in Healthcare
© Stranieri and Sahama 2014
Data mining
Extraction of potentially meaningful patterns from data (Frawley 91)
© Stranieri and Sahama 2014
Data mining: medical applications
• Image retrieval and classification.
• Retrieve mammogram that are most similar to a current image, benign that look malignant and malignant that look benign. N-gram/neural network
Kulkarni, P., Stranieri, A., Kulkarni, S., Ugon, J., and Mittal, M. 2014. Hybrid Technique based on N-gram and Neural Networks for Classification of Mammographic Images. Second International Conference on Signal, Image Processing and Pattern Recognition (SIPP 2014) in Wyatt, D (Ed) Computer Sciences and Information Technology (CS&IT) Vol 4. 297-306
© Stranieri and Sahama 2014
Data mining for Ayurveda
Challenges and Opportunities• Image analysis of tongue
Stranieri, Andrew & Sahama, Tony R. (2012) Data mining traditional Chinese medicine (TCM) lessons learnt from mining in law and allopathic medicine. In Song, Jian (Ed.) Proceedings of the 2012 IEEE 14th International Conference on e-Health Networking, Applications and Services (Healthcom), IEEE, Beijing, China.
© Stranieri and Sahama 2014
Patient Empowerment
Patient empowerment, policies, procedures and
protocols© Stranieri and Sahama 2014
Privacy and Security
Privacy and security including managing the risk in particular
when exchanging health information
© Stranieri and Sahama 2014
Privacy and Security
A sociotechnical analysis
Tony Sahama , Leonie Simpson & Bill [email protected]
© Stranieri and Sahama 2014
Privacy and Security in eHealth
Information and Communication Technologies (ICT) have the potential to improve many facets of modern healthcare service delivery
The implementation of electronic health records (EHR) systems is a critical part of an eHealth system
Despite the potential gains, there are several obstacles that limit the wider development of electronic health record systems
Among these are the perceived threats to the security and privacy of patients’ health data, and a widely held belief that these cannot be adequately addressed.
© Stranieri and Sahama 2014
Our Hypotheses
We hypothesise that the major concerns regarding eHealth security and privacy cannot be overcome through the implementation of technology alone
Human dimensions must be considered when analysing the provision of the three fundamental information security goals: confidentiality, integrity and availability
A sociotechnical analysis to establish the information security and privacy requirements when designing and developing a given eHealth system is important and timely
A framework that accommodates consideration of the legislative requirements and human perspectives in addition to the technological measures is useful in developing a measurable and accountable eHealth system
Successful implementation of this approach would enable the possibilities, practicalities and sustainabilities of proposed eHealth systems to be realised.
© Stranieri and Sahama 2014
SECURITY AND PRIVACY FOR EHRs① Critical Information Security Services
a) Confidentialityb) Integrityc) Availability
② Information Statesa) Transmissionb) Storagec) Processing
③ Security Measuresa) Technologyb) Policy & Practicesc) Education Training and Awareness
How do we understand these characteristics, attributes & measures as a Human?© Stranieri and Sahama 2014
Figure 1: Security measures for Information Dimensions [6]© Stranieri and Sahama 2014
LEGAL ISSUES FOR EHRs/SEHRs Privacy concerns
− Competing interests & emergency disclosure
− Data migration
− Non technical security breaches
− Function creep
Ownership of & access to records
− Public HCPs – records subject to public access laws
− Private HCPs – records ‘owned’ by HCP
− SEHR systems may require participation agreements
© Stranieri and Sahama 2014
LEGAL ISSUES FOR EHRs/SEHRs (cont…,) Intellectual property (copyright) issues
− Do EHRs constitute intellectual property?− Who has copyright – HCP or Consumer?
Governance arrangements for SEHR systems− State governance− Privatised governance (self regulation)− SEHR systems may require participation agreements
Consent models for SEHR systems− Non consent model− Implied consent – opt out model− Implied consent + exceptions – opt out + exceptions− Express consent model− Express consent + exceptions – opt in + restrictions
© Stranieri and Sahama 2014
Information accountability (IA) is a concept focused on appropriate-use of and after-the-fact accountability for information usage
Transparency and the presence of accountability mechanisms are necessary to build trust in the system and are also expected to act as a deterrent for intentional misuse
eHealth systems built to follow the principles of IA are called Accountable-eHealth (AeH) systems [13]
Figure 2 illustrates the role of IA in the eHealth domain. In this scenario, observe how patients’ healthcare information might flow in the eHealth environment.
© Stranieri and Sahama 2014
① The three main aspects of the IAF: Legal, Social and Technological and their interrelationships are shown in Figures 3
② Accountable eHealth systems rely on appropriate legislation for the governance and regulatory mechanisms to be established
③ AeH systems in the Australian context depends upon the establishment of an appropriate underlying legal framework to adequately address a range of specific issues including information ownership, access and control, data breach notification and broader issues involved in the legal management of the system as a whole
④ The recent enactment of the Personally Controlled Electronic Health Records Act 2012 (Cth.)
⑤ And, advances but the implementation issues remain unresolved.
© Stranieri and Sahama 2014
Figure 3: Information Accountability Framework [12] © Stranieri and Sahama 2014
eHEALTH PROCESSES AND PROTOCOLS
1. While the process of converting existing physical health documents and medical records to digital versions or copies has begun, the development of effective large scale systems of EHRs is still a long way off
2. Public awareness and acceptance of EHRs is limited and the involvement of professionals (such as clinicians and healthcare decision makers) in this EHR journey varies around the globe. In many places, the owners or custodians of the medical/health data and information (e.g., PCEHR or PHR, EMR and EHR) are not yet clearly identified. It is important that a physical person (e.g., human) is responsible for the contents of the digital document (e.g, EHR, EMR & PHR)
3. The integrity and non-repudiation of these EHR documents and/or processes may be affected by the actions of the responsible person. Addressing this represents an ongoing challenge in both HIT policy and the related legislative debate
4. To better understand the information flow between public and professionals in a given eHealth scenario, we present a graphical view of in a sociotechnical perspective, by integrating a human dimension (Figure 4)
5. This graphical depiction has global application, without prejudicing country specific legal and/or legislative protocols.
© Stranieri and Sahama 2014
Figure 4: Graphical view of SEHR in sociotechnical perspective [15] © Stranieri and Sahama 2014
EHR; PHR (PCEHR); EMR & IAF
▪PHR: is recognisable, individual information stored, collected, shared and controlled by individual (the public view)▪EMR: is amended, updated PHRs that managed by authorised clinicians and healthcare organisation (the professional view)▪IAF: is a concept focused on appropriate-use of and after-the-fact accountability for information usage.
© Stranieri and Sahama 2014
A. We argue that an eHealth system should be designed to support improved healthcare services and/or to enhance the quality of clinical decision making processes
B. Such an eHealth system should consider the “critical pivotal point” (intersection of PHR, EMR, EHR and IAF, marked as Ω in Figure 4), seriously, from the outset of system design and development
C. We observe and hypothesise, such interconnections comprise with human behaviour, information flow, [for example, the state of the information: is it in storage, in transmission (being transferred from place to place) or in use (being processed)], and information accountability measures are aspects the majority of eHealth systems have failed to address [16].
© Stranieri and Sahama 2014
① The three main aspects of the IAF: Legal, Social and Technological and their interrelationships are critical and important
② We explores issues related to information privacy in the context of measures being adopted for shared EHR systems in Australian context
③ EHR and SEHR systems must be designed so as to enhance security and minimise breaches. This is especially so in the case of SEHR systems where issues of access and use accentuate security concerns. Despite legislative initiatives designed to enhance security and minimise breaches, such as those outlined earlier, the integrity of records cannot be achieved through the application of technology alone and is especially difficult in large-scale schemes with a diverse user populations
④ We approach these issues from a sociotechnical approach - considering the perspectives of various stakeholders: patients, health professionals and privacy advocates in order to form a ‘context sensitive health informatics’ perspective. This approach is based on understanding information security and privacy measures as ‘human factors’ when implementing eHealth scenarios.
© Stranieri and Sahama 2014
▪ Shared electronic health record (SEHR)▪ Understanding interaction between people and
information systems▪ Policy and Practices related to Information Management▪ Education and Training in the Security implications of
potential actions▪ Legal Challenges…..! untested legal initiativesRequiring future study on EHR vs SEHR
© Stranieri and Sahama 2014
Wrap up
▪ Co-existence of medical systems
▪ Healthcare globally is in crisis
▪ Technologies are getting cheaper and more powerful
▪ eHealth is transforming health care by:▪ Tele-medicine▪ Electronic Health Records and their Challenges and Benefits. ▪ Standards in eHealth; trends and application development Examples▪ Decision Support Systems ▪ Data mining in Health
▪ Patient empowerment, policies, procedures and protocols
▪ Privacy and Security including managing the risk in particular when exchanging health information.
© Stranieri and Sahama 2014