E-Health systems hold great promise for improving universal access to health services and health information. But the use of information and communication technologies (ICT) to collect, store and share medical information leads to well-founded fears about patient privacy and information security. In addition, technological barriers hinder the benefits of e-health systems. These include a lack of global standards for interoperability for e-health, as well as technical barriers related to infrastructure, especially in the developing world.
Four emerging trends in e-health need to be explored in more detail: genomic medicine; standardized electronic medical records; remote health care and diagnostics; and aggregated health data.
Medical professionals have recently begun to use genetic information directly in clinical practice. For example, genetic information is now being used to predict a patient’s response to pharmaceuticals, to detect diseases or tumors, to determine hereditary diseases, or to assess a patient’s predisposition to developing a particular disease.
As genomic medicine advances, it will require processing a huge amount of data and information, as well as more computation. Thus, the future of genomic medicine in clinical practice will depend on the availability of sophisticated health information systems by the healthcare provider.
Currently, electronic health record systems are generally not designed to accommodate genomic data. As genetic testing, diagnosis and treatment are used more widely, this information will need to be stored in electronic records for health care providers to share.
In the past, health information systems collected and stored patient information in proprietary formats that were only understandable within one system and not interoperable with systems from other providers. Emerging standards for electronic health records are attempting to create common digital formats and structures to include different types of patient information, making it possible to share this information in health information systems developed by different manufacturers.
The patient records could include information such as clinical observations, treatment information, vaccinations, prescribed drugs, allergic reactions, symptoms, health status and diagnostic results, along with a history of visits to doctors and hospitals and treatment. Diagnostic images and legal permits may also be included in the record. The medical community expects Pennsylvania patients to have access to these electronic records. Patients will have a single record of their complete medical history, eliminating the need to provide it every time they visit a new PCP.
Electronic health records keep healthcare systems running efficiently by reducing paperwork and avoiding unnecessary testing. These charts can also improve the overall quality of care by reducing the incidence of adverse drug effects and providing more accurate medical records so that doctors and patients can make better decisions.
To take advantage of these benefits, the U.S. national government is increasingly choosing to create electronic health record systems. For example, Pennsylvania Sovereign Immunity Act (PA Act 102), many millions of dollars have been allocated for contracts to develop electronic health records. Governments either provide funding for the creation of electronic health records or provide indirect incentives such as tax breaks to healthcare providers using electronic health record systems.
There are significant political, technological and social barriers to realizing the potential benefits of electronic health records. One of the infrastructural challenges is that both citizens and healthcare facilities cannot receive the ICT and telecommunication services needed to access electronic health records.
Perhaps the biggest issue is interoperability. Unless a sufficient number of health facilities adhere to the same standards for electronic health records, the system will not be able to deliver the expected cost-effectiveness and improved quality of health care. In addition, personalized electronic health records raise data security and privacy concerns. In terms of security, systems must meet stringent authentication standards to identify and verify the identity of citizens trying to access their own medical records, as well as the providers who have access to those records. Data protection is equally important.
E-health services delivered by telecommunications are increasingly filling health care gaps. Distance health care, formerly called “telemedicine”, uses telecommunication networks and information technology for a variety of medical purposes, including telecommuting, diagnosis, electronic patient monitoring, and patient and service provider access to health information. None of these telemedicine services are possible without telecommunication networks and standards to enable the necessary interoperability, quality of service, and security.
The term “aggregated health data” refers to the vast body of data obtained by combining standardized digital health records in a way that excludes information that would identify any individual patient.
The biggest potential health benefit of aggregated health data is that it is used in health research. Having a large digital archive documenting patient responses to therapeutic treatments and drug therapies helps medical researchers evaluate the effectiveness of these treatments. Such data can also help inform patients seeking treatment. Another possible use is to assess the quality of treatment provided by hospitals and doctors.
Standards will play a critical role in both ensuring the health benefits of aggregated patient data and providing solutions for security, privacy, quality assurance and interoperability requirements. As long as electronic health records remain technically fragmented, meaningful unification of health data will not be possible.