Ponder these pitfalls in electronic linkages
Tighten your policies, procedures
Those who look to technology as a panacea for their record and data transmission problems are finding that the same issues arise as with paper records, says John O’Brien, CRM, a consultant who deals with the legal and ethical issues around the disclosure of personal information.
"They’re hoping that technology will solve problems for them, but since the problems have become invisible, they are often worse in terms of transmitting data."
If you’re considering using the Internet to transmit health care information there are several practical matters to consider before plunging ahead, advises O’Brien, president of Interactive Strategies in Victoria, British Columbia. These include:
• Web page problems.
Even the idea of using a Web page on the Internet to publicize the organization’s policies is not as simple as it sounds, he explains.
"That means all of a sudden storing information and giving people access to it," he says. "Someone can go into that Web page and change what they see and print it. If you’re talking about hospital policy, someone could take that [modified version] to the hospital and say, Here’s your policy.’ I’ve seen that happen with fees [with another type of organization]."
In a health care organization, the main concern may not be fees, but rather a policy that has changed after the first posting, O’Brien explains, such as eligibility criteria. Patients might be entitled to certain services or equipment, but then due to political machinations no longer are.
Information on a Web site can become obsolete and must be updated. Authorization and effective dates also should be included.
• Intranet problems.
Intranets are inherently more secure than the Internet, but it’s important for staff to understand that they are governed by your organization’s existing policies and procedures, he notes. Because it uses the same technologies as the Internet, an intranet may inspire a certain lack of inhibition.
"People are very loose on the Internet and tend to forget protocol and confidentiality," O’Brien says. The more relaxed people become with that security, the more open the system is to misuse.
For example, people using internal e-mail systems tend to get chatty and forget they are sending an official communication, he says. But when the communication is received in black and white, "it appears to be more considered and puts somebody’s back up. Employees need to be conscious of the difference between informal and formal communication and there’s really no such thing as informal [communication] in a corporate setting," O’Brien says.
• Policy problems.
While there is excellent encryption technology available to secure Internet information, O’Brien stresses that proper management and understanding of the limits of technology is crucial for using it effectively. With information on e-mail, in the hard drive, and encrypted, O’Brien points out. "Are you even able to know what constitutes your patient record?"
Policies should be established concerning how encrypted records will be sent doctor to doctor, unit to unit, or between nurse practitioners, he says. Individual electronic transmissions can build informal patient records that an institution may not even know exists.
"It all comes back to managing information," O’Brien says. "It’s so ubiquitous that people tend not to be conscious of it, really. The more we get into high-tech solutions, the greater the risk that we as individuals providing care will lose the thread of information that supports our decision-making process."
• Moving from paper to high-tech.
Providers using the Internet for completion of a documentation tool such as a care plan or assessment document must remember to make the necessary adjustments. If the manual process requires the person completing a document to initial a certain place, when the process becomes electronic there should be a workable system for identifying who completes the document, O’Brien adds. Otherwise, the organization might have a care plan that can’t be completed when needed.
Other concerns in this area include:
Data retention. "Does your organization have a retention plan for all the records? It may be that financial data is kept for seven years, another kind of data for 10 years," O’Brien notes. "When you start moving away from the system you have now, you have to see whether the same retention periods apply and not make assumptions about it."
Electronic signature. What constitutes an electronic signature in the transmission of patient data? he asks. Will it be the electronic computer stamp of the organization or your personal ID?
Impact on quality of care. The effectiveness of care can be affected when an organization converts to different types of technology, O’Brien says. He cites the simple example of how one person might describe a pack of Equal, the artificial sweetener, as light blue and another as dark blue with light blue on it. When descriptions have to do with a patient’s medical condition, and there’s no hard copy to look at, it’s crucial to find a way to standardize.
"It’s very important that staff who don’t have expertise in information management understand what that’s about, how easy it is to be misunderstood," O’Brien adds. "If you’re thinking hard copy and designing electronic, then you’re in trouble.
John W. Hoben, Principal, Hoben Associates, 7724 Newco Drive, Hamlin, NY 14464-9722. Telephone: (716) 964-9247. Fax: (716) 964-9265. E-mail: [email protected] or jhoben@webtv. net.
John J. O’Brien, President, Interactive Strategies, P.O. Box 5713, Station B, Victoria, British Columbia, Canada V8R6S8. Telephone and fax: (250) 388-7791.
Janis Leonard, Manager, Center for Healthcare Emerging Technologies, Ernst & Young, Atlanta. Telephone: (404) 817-5969.
Brenda Siewicki, Principal, national service line leader for computer-based patient records, Ernst & Young, Atlanta. Telephone: (404) 817-5892.
More information on the use of the Internet in health care is available at a web site sponsored by 3Com Corp., Ernst & Young, Sprint, Microsystems, and Sybase. The site is at: http://www.hccybervision.com.
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