Technology and Health Care
Innovation has rapidly assumed a position of prominence in world competition. Today's marketplace is characterized by fast-paced and unremitting competition on a global scale. The medical arena also has to compete in this environment; health organizations need a level of innovation to survive in the stiff competition of the market place. As competition becomes more global and time-based, corporations must develop and deliver better new products in less time (Weill and Broadbent, 1998). The challenge for modern medical health organizations is to revitalize them so they can successfully and continuously develop new medical services and new businesses. Internal or external drivers are the factors that force changes (Yee, 1998), innovations may be done at different level in the structure of any health organizations (Swenson, 1997) and that reforms may be universal or limited (Reigeluth, 1994) in nature. Internal drivers for change could include evolving business requirements, health organizationsal restructuring or revision to corporate strategy/business objectives. External drivers could include developments in technology, economic trends that affect the profitability/value for money of the relationship and the need for electronic or technical service.
In order to have a successful innovative activity and to be able to attain the purpose of innovation, health organizations must consider the elements of innovative activity. Experts have distinguished five vital elements of innovative activity. These includes the innovation strategy, innovation skills, innovation shared values, innovation systems and innovation leadership. Innovation strategy is one of the most important elements for innovative activity. Herein, the health organizations should be able to know what challenges them to implement innovation and determine the best strategy to use in its implementation to be able to achieve the core objective of the project. This is where the health organizations should create a strategic plan for innovation, stating the objective of the innovative activity. The second element for innovative activity is the innovation skills. Developing new capacities and improved competencies of the health organizations internally, is the main concept of innovation skills. Herein, the health organizations should be able to know who will be responsible for the innovative activity and its implementation. It is important that selected individuals must have the appropriate skills to sustain the innovative activity until such time that the health organizations has achieved the objective set for the said innovation (Milne, 1993).
Healthcare is a business and, like every other business, it needs good management to keep it running smoothly.(Bureau of Labor and Statistics:2004) The occupation, medical and health services manager encompasses all individuals who plan, direct, coordinate, and supervise the delivery of healthcare. Medical and health services managers include specialists and generalists. Specialists are in charge of specific clinical departments or services, while generalists manage or help to manage an entire facility or system. The structure and financing of healthcare is changing rapidly. Future medical and health services managers must be prepared to deal with evolving integrated healthcare delivery systems, technological innovations, an increasingly complex regulatory environment, restructuring of work, and an increased focus on preventive care. They will be called upon to improve efficiency in healthcare facilities and the quality of the healthcare provided. Increasingly, medical and health services managers will work in organizations in which they must optimize efficiency of a variety of interrelated services for example, those ranging from inpatient care to outpatient follow-up care. Large facilities usually have several assistant administrators to aid the top administrator and to handle daily decisions. Assistant administrators may direct activities in clinical areas such as nursing, surgery, therapy, medical records, or health information. In smaller facilities, top administrators handle more of the details of daily operations. For example, many nursing home administrators manage personnel, finance, facility operations, and admissions, and have a larger role in resident care.
Clinical managers have more specific responsibilities than do generalists, and have training or experience in a specific clinical area. For example, directors of physical therapy are experienced physical therapists, and most health information and medical record administrators have a bachelor's degree in health information or medical record administration. .(Bureau of Labor and Statistics:2004) Clinical managers establish and implement policies, objectives, and procedures for their departments; evaluate personnel and work; develop reports and budgets; and coordinate activities with other managers. Whose responsibility is it to ensure those with low health literacy are adequately informed of pertinent medical information? The responsibility must fall to all who provide health care. Most importantly the physician bears a great responsibility to ensure that the patient understands what they are being treated for and what they are required to do, such as medication regimen,
test instructions, and follow-up instructions.
In health care facilities, including hospitals, medical and dental clinics, and offices, health care providers often see their patients at a "teachable moment." Individualized education and counseling by health care providers at these "moments" in these settings have been shown to have positive and clinically significant effects on behavior in persons with chronic and acute conditions. (Hohn:1998) Providers must be cognizant of these opportunities and prepared to provide appropriate patient education. Institutions that employ providers also must be cognizant and allow sufficient time and training for patient education and counseling to occur. test instructions, and follow-up instructions.
Electronic Records System
The delivery of health care is as old as civilization itself (Department of Health, 2004). Archeological findings give incontrovertible evidence of this fact, and already Babylonian records attest to the provision of health care as a socially validated undertaking. Indian, Chinese and Egyptian records bear similar testimony.
In the beginning, contact between health care providers and health care consumers was limited in scope (Evans and Stoddart, 1994). It encompassed the physician and the patient in a direct and immediate personal interaction. In sociological terms, therefore, the scale of interaction was small.
Patient records in broad-spectrum and electronic patient records in particular, occupy a special place in health care management (Labonte, 1998). Operationally, this results from the fact that the data which constitute the records are the basis of the information that is used in health care decision-making about patients. Ethically, it results from the fact patient records function as patient-analogues in information- and decision-space.
One of the primary claims advanced that because of their distinct ontological status and because of the unique place they occupy in health care decision-making, electronic patient records should be treated in an ethically special way (Raebum and Rootman, 1998). Specifically, they should be treated according to ethical principles that are analogues of the very same principles that normally should govern our conduct towards persons in the real world.
While the special ontological status of electronic patient records was dealt with in some detail in the preceding chapters, the issue of ethical treatment received little consideration (Springett, 2001). The purpose of the present chapter is to remedy this lack. Its aim, therefore, is threefold: to show that the treatment of electronic patient records should indeed be subject to ethical principles rather than pragmatically derived rules of conduct; to show further why these ethical principles should be analogues of the principles that govern conduct towards persons; and, finally, to sketch what the application of these analogue principles might look like in actual terms. Insofar as it fulfils these tasks, the study lays the foundation for the ethical inferences that will be drawn in succeeding chapters concerning the rights and duties of health care professionals, of health care institutions and of health informatic professionals with respect to patient information in general and electronic patient records in particular (Whitelaw et a.l, 1997).
The short answer is that the nature and role of electronic patient records allows for no other option (Wiggers and Sanson-Fisher, 1998). As was argued in the previous chapters, the completeness of the package that constitutes the patient record, its efficient competence and the increased scale of health care decision-making which has come to rely on data about patients rather than on interaction with the patients themselves, have changed the record from being merely a series of disjointed descriptions that model patients for specific purposes, to being patient-analogues in information- and decision-space. It is this analogue role which states that electronic patient records should be treated according to ethical principles rather than merely heuristic rules of conduct. It is also this role which entails that these ethical principles should be the same principles or at least relevant analogues of the same principles that verify ethical manners towards the people who are the subjects of these records.
However, the distinguishing parameter is that access to this kind of setting is normally confined to a very restricted and more or less clearly identified set of individuals. Further, the presumption that normally underlies access to these kinds of situations is one of privacy and confidentiality: Those who normally are in a position to observe the subjects or the interactions are presumed to have a more or less clearly understood obligation of confidentiality, the inherently public nature of the interaction in that context notwithstanding.
It follows that if the research involves such limitation on who normally would have access to the relevant situation, then naturalistic observation requires permission from the privacy right holders. Moreover, in some cases certain ethnic and cultural sub-groupings here come to mind such permission must be obtained not only from the individuals who are being observed, but also from the collectivity in which the observed individuals are culturally embedded. The reason is that the data which will be obtained in this sort of setting are not unique and proprietary to the individuals who are being directly observed. Instead, the data are also data about the social grouping in which the observed subjects are embedded. Consequently, in observing this sort of situation, where group-relative privacy is normally assumed, the privacy rights of the collectivity would be infringed if permission was not also obtained from the collectivity itself. Accordingly, informed, competent and voluntary consent both by the individuals actually being observed as well as by the collectivity in which the individuals are embedded, is necessary from both parties.
The preceding considerations are relevant to electronic patient records because increasingly, as field research methodology makes use of electronic means, patient-relative data are developed in public and communal settings where these data can be used to devise community health policies and guidelines (Acheson Report, 1998). The fact that permission may have been obtained from the subjects of the records may not be sufficient, and the fact that the data are gathered by naturalistic observation does not guarantee that considerations of privacy and confidentiality do not obtain. These considerations also have relevance to projects that involve naturalistic observations of patients in the health care setting, in a physician's office, etc.
Another area of research that makes extensive use of patient records is epidemiology. Indeed, electronic records, because they may be accessed and manipulated so easily and in so many ways, have become ideal tools for epidemiological studies (Gillies, 1998). Such studies may be conducted either for the sake of pure science or, as is more usual, for more mundane and practical purposes such as monitoring the health status of a population, tracking the prevalence and incidence of certain health conditions, measuring the effectiveness of health care interventions or planning health care delivery on a macro-scale.
The preceding chapters have already dealt with some of the issues that arise in this connection, albeit on the smaller scale of institutional performance and professional intervention. Insofar as the issues are similar, analogous remarks apply. Thus, under the rubric of necessity, one of the requirements at the macro-level of regional or system-wide planning is the availability of, and the access to, relevant data in a timely fashion (Labonte, 1998). Consequently, the obligation that governments have to provide appropriate health care for their citizens entails a corresponding right to develop health care data bases that allow the discharge of this obligation. Such data bases cannot be developed without access to patient records since only these contain the information that is necessary for such purposes. Consequently governments have a right to access electronic patient records for bona fide epidemiological purposes and to develop and maintain appropriate data-bases.
The argument from necessity that underlies the construction of epidemiological data-bases applies not merely to governmental agencies and health care institutions that provide health care. With due alteration, it also underwrites the right of third-party health care providers and insurance agencies to construct similar data-bases (McQueen and Anderson, 2001). Like government, they cannot carry out their mandate if they do not have access to appropriate epidemiological data.
However, the relationship between private insurance companies and health care providers, and the individuals whom they serve, is importantly different from the relationship between socially mandated health care providers and ministries of health and ordinary members of society. While the social health care provider's right to collect and use data is grounded in society's duty to provide health care and in that sense encompasses
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