Case study answer of Should Google Organize Your Medical Records?

Answer 1

Should Google Organize Your Medical Records

1. What concepts in the chapter are illustrated in this case? Who are the stakeholders in this case?

Chapter concepts illustrated in this case include:

* Responsibility - accepting the potential costs, duties, and obligations for decisions. Google must assume the bulk of responsibility for securing the data and ensuring it's used only for authorized purposes.

* Accountability - a feature of systems and social institutions: It means that mechanisms are in place to determine who took responsible action. Again, Google must ensure accountability of its systems and those responsible for creating and maintaining the system.

* Liability - a feature of political systems in which a body of laws is in place that permits individuals to recover the damages done to them by other actors, systems, or organizations. Federal and state governments must pass and enforce laws protecting medical data and its uses. Google must assume liability for the system.

Of the five moral dimensions discussed in the chapter, at least three play a major role in the proposed system:

* Information rights and obligations

* Accountability and control

* System quality

Stakeholders in this case include patients and health-care consumers, doctors and other medical professionals, insurance companies, health-care related businesses like pharmaceutical companies, governments, and storage providers like Google, Microsoft and Revolution Health Group.

2. What are the problems with America's current medical recordkeeping system? How would electronic medical records alleviate these problems?

The current medical record keeping system is based on the traditional paper-filing system. Only about 15 percent is currently digitally recorded. In the traditional setting records are copied and duplicates are given to patients and doctors. This system is a very slow process and inefficient at times. The process becomes difficult to share with other doctors and insurance companies. It is also very expensive because you need a lot of people to file and handle paperwork. By having electronic medical records everything will be available at your fingertips with the click of a few buttons. You can transfer a lot of information and it will be all paperless, but on the other hand, it opens a gateway for security breaches in the system.

3. What are the pros and cons of electronic patient records? Do you think the concerns over digitizing our medical records are valid? Why or why not?

The pros of electronic patient records:

* Once in practice, this process becomes very simple.

* It is less laborious and time consuming, while at the same time being more accurate.

* It eliminates human error due to misinterpretations as a result of bad handwriting, etc.

* As the information is stored digitally, it would cost less.

* Archives of data would take up less space (as they would be stored virtually and not physically).

* Easy access to medical history/data for the professionals concerned.

* Geographical boundaries are no longer a limiting factor.

Some cons of electronic patient records:

* The first hurdle in implementing electronic medical records is the initial set-up cost. Though the cost would be comparatively low in the long run, it would take a HUGE initial investment to get the system up and running.

* Human error cannot be completely erased as technicians would be in charge of the initial transfer from paper to the online system.

* This would also mean that these technicians have to be well trained, with a working knowledge of both IT systems & processes, along with at least a cursory knowledge of medicine as well.

* It lacks the human touch, and not all patients are comfortable to have their doctors replaced by computers.

* Privacy issues are also a major concern in today's world. This information could be devastating if it falls into the wrong hands, and in some cases, the patient may not even be aware of his personal information being misused.

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Of course the concerns over digitizing medical records are valid, especially the last one. For a system to be usable, especially where the health of millions (hundreds of them) are concerned, it has to be as close to perfect as possible. Remember, these are people's lives we are dealing with here, not some consignment of inanimate goods. Hence, we have to ensure that the electronic healthcare system is the best it could be, before entrusting the data, and in extension, the lives of people across the globe to it.

4. Should people entrust Google with their electronic medical records? Why or why not?

Google is an online giant, with a strong spirit of innovation and a reasonably good track record in everything that it has dabbled in. Furthering their reputation to make good services available to the public for free, it has launched an application called Google Health, with the intention of making patients' records easy accessible and more complete and to streamline recordkeeping.

However, I am of the strong opinion that people shouldn't entrust Google with their electronic medical records. This is private data of hundreds of millions of people, which is of extremely sensitive nature. Google, in spite of its pompous mission statement of "organizing the world's information and making it universally accessible and useful", is, at the end of the day, an organization focussed on making profits. Its core objective is to form as large a database of personal information as possible so it can harness these resources to further its main objective of increasing revenues through advertising.

There have been several complaints from Google users about their personal data being used by it to further its ad-making business, which, though vehemently denied by Google, is highly disconcerting. I think a good option would be to make this a government-run project, or at least have a consortium of private players working in tandem with the government on it. This at least ensures that the State is kept abreast of developments every step of the way, and is a control check which oversees that the core function of Electronic Health Records (EHR), which is of serving the people, is not diluted as a result of greed for profit

5. If you were in charge of designing an electronic medical recordkeeping system, what are some features you would include? What are the features you would avoid?

If I were in charge of designing an EHR system, here are some of the features I would include:

* A unique username and password, along with a biometric ID system to ensure that access Is only on a need-to-know basis, and only after being granted permission by the patient. This permission should also be time-limited, for instance, maybe for a duration of 7 days, after which it would lapse and those needing information from the patient would have to apply to him/her again for a fresh go-ahead.

* A secure encrypted website for extra security, with further online security systems in place.

* At least 2 complete backups of all data, stored securely in servers in separate geographical locations.

* Ensure that hospitals have HIS (HOSPITAL INFORMATION SYSTEMS) and Clinical Information System (CIS) up and running, with well trained staff.

* Have a Clinical Decision Support System (CDSS) in place which would link health observations like patient data with health knowledge like established clinical protocols to help doctors take right decisions for improved healthcare.

* Install a Computerized Physician Order Entry (CPOE) system, which would ensure electronic entry of doctor's instructions for the treatment of patients under his or her care.

* The full potential of EHR can be utilized only when rural areas too are taken care of, especially in countries like India. So, Mobile e-health & Tele hospitals/Tele medicines should be set up in line with this goal.

* Implement ERP in the healthcare sector. Hospitals can reduce their overheads through ERP as it helps to integrate all functions namely accounts , finance , human resources and bring them systems under one common database on the basis of ERP architecture. Based on the requirements, hospitals have to decide on the appropriate software.

Following are the features I would avoid:

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The entire system, though complicated in implementing and at the back end, should not be complicated to the front end users (patients, doctors, etc). It is impossible to train millions of patients, and doctors are busy professionals with little time to spare on IT training, so it is imperative that the user interface be as intuitive as possible.

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It should not be exorbitantly priced to the end user. Companies may stand to make a few profits on this, which is justified by the high cost of implementation, but it should not make the end user pay up so much more that he gets discouraged at the very prospect of signing up. This would defeat the very purpose of setting up EHR in the first place.

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Those companies in charge shouldn't be given a free reign. There should be checks and controls in places to ensure that no malpractice takes place.

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The whole process should be audited regularly in all aspects (not just financial) by a government-appointed committee to ensure that the controls and checks involved are followed to the letter.