Question

Case study

Last month you were hired with the title Health Informatics Specialist at an independent community care hospital with 350 beds. The hospital includes a comprehensive outpatient clinic, a rehabilitation center with both inpatient and outpatient services, a cardiac care center, and an emergency room. In addition, four family health centers are located throughout the community. More than 930 primary care and specialty physicians are associated with the hospital, which has a staff of just over 2000 employees. The hospital has an EHR in place. The hospital has a working relationship with a major academic medical center located 23 miles away. Acute care patients who need more extensive treatment are usually transferred to the medical center. These are often emergency situations, and data are freely shared among the institutions with the best interests of the patient in mind. Located directly beside the hospital is a 194-bed skilled nursing home. While the nursing home has its own medical staff consisting of a physician and two nurse practitioners, patients needing consults or additional care are usually seen at the hospital with follow-up at physicians’ offices. While the nursing home, most of the physicians’ offices, and the hospital are independent institutions, there is a long history of sharing health-related data when treating patients who live at the nursing home and are seen at the hospital or in the physicians’ offices. This coordination is seen as a general benefit for a number of patients. It appears that most patients have signed a form giving the hospital permission to send information to the nursing home. However, these forms have been stored in individual offices, so it is difficult to determine who has signed what forms and what permission has or has not been given to share information among the nursing home, hospital, and independent medical practices.

Discussion Questions

1. What additional information is needed to clarify what problems may exist and what changes may be needed in terms of data that are shared among the institutions?

2. Can the EHR system and/or e-mail be used to share data among these different institutions more effectively and securely? If yes, how would this be done? For example, what agreements, policies, and procedures might need to be developed?

3. In your position as Health Informatics Specialist, how would you go about determining whether there are other potential security issues that now need to be managed by the hospital?

4. From your reading in chapter 25, name two federal agencies and describe their role in the regulatory oversight of Health IT.

5. What are three major issues with mHealth applications and wearable devices?

Answer 1

1. As the situation shows that the patients are either referred to the hospital or the medical centre for extensive treatments. Thus the medical records of the patients should be available to all the centres. The data of the patients should be available in a common database server so that all the hospital in the community will have access to the medical records. It is mentioned that the patients sign forms to show their consent that the nursing home can share the information to the hospital. But these signed forms are stored in the respective offices making it difficult for the hospital, nursing home and independent medical physicians to know who have signed what forms for sharing the information. This can be overcome by sharing the medical records through electronic database along with these consent forms among the hospital, nursing home and physician’s office.
2. The EHR system and email can be used to share data among these institutions more effectively and securely. Before sharing the data the hospital and the institution should get consent from the patient regarding what information should be shared, to whom and when it should be shared. The signed forms should also be shared among the institutions. An authorised consent form mentioning the patients’ demographic and medical data should be formed and followed by all the institutions.
3. The other security issues are the privacy and safety of the electronic health records. The privacy of the patients’ data should be kept in mind while sharing the data through electronic devices. The data should be secured with username and password and it should be given only to authorised personnel in the institution. It should not be shared with the other co-workers. Some of the authorized personnel are physicians, medical record department. As it is electronic, we cannot totally relay on it for the medical data. Some of the important data should be in paper form and kept in the respective institution. The data should all be backed up and the backed up data should be kept in a safe place where it cannot be destroyed easily. Such as in places where there is prevalence of floods, the backup data should be kept in higher floors and water proof packages.
4. The two federal agencies that keep an eye on the health IT are: Health Insurance Portability and Accountability Act (HIPAA) and Joint Commission on Accreditation of Health Care Organizations (JCAHO). HIPAA, which works to reduce costs while protecting patients and providing better medical care, is a major piece of health care regulation and was instituted to improve the efficiency and effectiveness of the health care system. JCAHO works to ensure that health Care organizations provide quality care.
5. Three major issues with mHealth applications and wearable devices are: security, privacy and cost.