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Privacy In Electronic Health Record Systems Information Technology Essay

Health is a major concern for everybody in this world. The implementation of Information and Communication Technology in the medical field has customized the present definition of health care. It suggested the perfect solution is that will benefit both patient as well as healthcare specialists. eHealth provides alternatives in a broad spectrum and it includes various healthcare products, systems and services. It includes tools for medical researchers as well as for patients and individuals. Various services or systems that are protected under eHealth are; health information sites, electronic health information, telemedicine services, Consumer health informatics, Health care Information Systems, Health knowledge management.

The challenging issue which is associated with the eHealth system is the safety of Medical Files. Because the data is transmitted within the network from one spot to another so it is suffering from the major security matter. An electric medical record (EMR) stores personal data which includes medical test outcomes, prescription, hospitalizations, etc.

Privacy in the ehealth system can be categorized into two categories; Content oriented level of privacy and contextual level of privacy (2). So eHealth system can be referred to as a secure system if it can package with both these areas of privacy. Content oriented privacy indicates the capability or power of medical care and attention stakeholders in disclosing the patients' private information to other gatherings (marketing, insurance) whereas contextual level of privacy indicates the power of a harmful entity to guess the condition of an individual correctly by figuring out the field/site of his medical professional.

Background

In earlier days physicians used to make use of paper charts for documenting the encounters with the patient. Details about medications, tests, X-rays etc the individual has taken, needs to be registered in the chart for future research. As the health care became increasingly more complicated, it became tiresome for physicians to maintain a good patient record on these paper graphs. They needed new technology to help them to cope up with the increasing needs.

With the improvement in the info and communication technology, the thought of storing the individual records electronically came up in around 1960's, when Dr. Lawrence Weed presented the idea of Electronic Health Record. Weed's technology allowed a third party to confirm the diagnosis to avoid any problems. In 1972, Regenstreif Institute developed first medical record system which merged both inpatient and outpatient data saving (3). Electronic Health Files (EHR) Systems stores the entire health and medical history of an individual in a computerized, electronic format. The record includes the details about patient demographics, improvement notes, medications, previous medical history, essential signs, lab data, immunizations and radiology reviews. Keeping these vast documents in this sorted out manner, makes it better to retrieve and maintain, when compared to the paper graphs (4).

As the medical care and the information technology became increasingly more sophisticated, it became necessary to share the individual records among the various medical departments like clinical, nursing, laboratory, radiology, hospital supervision etc in order to maintain an effective medical record about the patient. When medical records including very sensitive data about the individual were shared electronically among the different departments, personal privacy and security problems became a significant problem to the EHR systems.

The recent studies on security and privateness concerns in EHR systems shows that, there is increasing number of threats resulting from the allocated and decentralized implementations of EHR Systems, and also the use of communication over wide open and insecure internet. Unauthorized accesses, Denial of service are to name a few. Insufficient standardization among these systems managed to get very difficult for the system administrators to put into practice a secure system (5).

Research Problem

The main problem associated with an eHealth system is the level of privacy, security and confidentiality of Electronic Health data (EHD). EHD stores private and sensitive data of the individual and data of EHD can be used by physicians, medical, laboratory, and pharmacy. The publication of personal sensitive data can seriously compromise the individual privacy. For this reason reason many person does not go for eHealth treatment being that they are afraid of the increased loss of their Health record including information about their disorder or disability. Inside a review conducted in Canada, it's been found out that 11-13% of Canadians have organised back information from a health specialist because they were worried of the privacy of these data (6). Inside a survey conducted in the us, 77% of the populace can be involved about their medical information being used for marketing purposes (7). We want to figure out the people's concern about the privateness of their health care record at Stockholm. We will verify the opinion of public about the privacy of their health information and being able to access eHealth service.

Purpose of Research

The reason for conducting this research is to examine the present situation of the Health treatment system in Sweden. Research result will be helpful for patient, health care professionals and health care organizations. How the present situation related to the privacy and the confidentiality of medical care data is affecting the decision of accessing the eHealth Service. This study will reveal the importance of Security in this field.

Goals and Goal Audience

The findings of the survey can not only be ideal for the Health care service of Sweden but additionally it is helpful for rest of the world. Predicated on the result created from this survey, other countries can assess the present degree of patient's concern about eHealth privacy. Our audience can be anyone who is related to healthcare services; professional medical professionals, experts, nurses, administrators, patients.

Limitations

Because of the time constraint, the populace that we are targeting for this survey includes only undergraduates, graduates, post graduates and post doctoral students (age group 18-35) in KTH (both Main Campus and Kista Campus).

We are executing this review on limited range of age group, so the result won't include the view of elder individuals.

Research Methodology

In this section, we provided the explanation of the study strategy conducted in this newspaper. We determined inductive reasoning way for our research work. We tried to draw a generalized summary from a finite collection of specific observations.

Research Question

The research questions that happen to be resolved in this article are:

To what scope, privacy of health care records affects the individual's decision of being able to access eHealth service?

Are there certain communities of folks for whom the privateness is a significant issue while accessing the eHealth service?

Literature Review

Mentioned here are the literatures that helped us to choose and filter down to a specific research subject matter.

Primary Literature

"Electronic-Healthcare Information Security" by Kudakwashe Dube, Fredrick Mtenzi, Charles A Shoniregun. This booklet explores the security and level of privacy challenges that need to be looked at while developing an electric health record system. Also, this reserve evaluates the various factors that have an effect on level of privacy and security of the patient data in an e-Health system. This e book gave us an excellent insight in regards to a variety of level of privacy and security issues related to e-Health. It certainly helped us in formulating the study problem.

"E-health good care information systems: an introduction for students and pros" - by Joseph K. H. Tan. We selected this book as it covered detailed summary of an EHR system. This publication analyses the components of an EHR systems, talks about the progression of e-Health paradigm and evaluates the scope of EHR strategies and effects. This e book provides information about the e-health care and attention technology management and the security issues related to e-health systems. This publication is a useful guide for the researchers in the e-Health data level of privacy area.

"The Build of Research" by Wayne Booth, Gregory Colomb and Joseph Williams. This book was the guiding light how actually we should do a technological research. This book helped us to structuring and organizing the research work and the article writing.

"Swedish Strategy for eHealth. Safe and accessible information in health and social care. Position report 2009", a written report by the Ministry of Health insurance and Community Affairs, Sweden. This report gave us a very good idea of how the e-Health systems work in Sweden. Also this statement helped us to understand the Swedish government's regulations to uphold the patient data privateness in e-Health systems.

Secondary Literature

Also as part of our books review, we researched some of the prior reports publicized on similar research problem.

"Making sure the Personal privacy and Confidentiality of Electronic Health Files" - Report by Nicolas P. Terry and Leslie P. Francis. This report argued that, in order for an EHR system to reach your goals, the system must receive the popularity of the health professionals and patients. Based on the statement, the EHR system should address and protect the concerns about the privacy and confidentiality of the individual data.

"Building Open public Trust for Electronic Health Information" - Article by Mike Smit, Mike McAllister and Jacob Slonim. This record is a listing of an thoughts and opinions poll conducted in United States to learn if the people are performed back from using the EHR systems due to security and level of privacy concerns.

Survey

Based on the info obtained from the literature review and the previous reports, we ready a questionnaire. The questionnaire included 10 questions and the questions were designed and structured to get a concept about the security and personal privacy concerns of an individual when using an EHR system. The complete set of the questionnaire are available in the Appendix 1. We used Google forms to produce the survey. The data was gathered and stored to a Google spreadsheet when an individual submits the study.

Once the study was made, the survey hyperlink was written by email one of the students in the KTH College or university. The survey was retained completely anonymous and no private information was gathered. Keeping anonymity was important as we were dealing with the personal privacy concerns, and also we wished to get the honest opinion of the user. The study was allocated on 13 December 2010 and we received 127 responses. We have considered all the responses that we received till January 3rd 2011. 127 reactions was a fair amount to execute the statistical research on the info captured.

Privacy Obstacles in EHR

The security of the Professional medical information mainly handles the security of the privateness and confidentiality of the patient's personal Medical documents that are reached through the eHealth services. Though the technologies have been advanced in the modern world but it has not been omitted the chance related to the privateness concern. The rate of level of privacy and confidentiality breaches are increasing day by day and these breaches immediately attacking the trust in eHealth information Management.

Human Factors

It is a universal problem that Healthcare specialists are unwilling to the info and Communication systems for Medical services. According to the review (http://www. ibimapublishing. com/journals/CIBIMA/volume3/v3n4. pdf), 76% of specialist physicians consider that the individual factors is the most important on their behalf and 53% of them aren't interested for the use of Information and communication Solutions for Medical services. eHealth system will be looked at as a successful methodology if it fulfills the criteria of end user and patient friendly systems. eHealth system must be designed keeping in mind the relationship of medical researchers and patients. System is quite complex from the back end but the front end should be not difficult so that patient/user can handle it properly. eHealth system can suffer from privacy concern due to human being factors if an individual is not a computer literate or he/she is not psychologically sound to understand security issues. (http://docbox. etsi. org/Workshop/2009/200901_SECURITYWORKSHOP/STF352_PETERSEN_securityAndPersonalizedEhealthSystems. pdf). According to experts, "Solutions need to allow medical and health care sta to spend more, not less time with their patients. Users need to benet from the machine, not feel burdened by it. " (http://www. ibimapublishing. com/journals/CIBIMA/volume3/v3n4. pdf).

Integrity and Confidentiality Protection

As increasingly more Healthcare organization is shifting towards eHealth services and all the assistance are being digitized, the security breaches are creating a significant issue in the Healthcare Information Management. These security breaches are performed by reducing the confidentiality or Integrity of the Healthcare Records. Confidentiality really helps to obscure the delicate data from unauthorized individuals and Integrity confirms the accuracy and steadiness of Medical data.

As medical records are sent by way of a communication channel, and this channel is shared with the other internet services. Adjustment or eavesdropping of data can breach the level of privacy of entire system seriously. Data must be created and inserted in to the network nodes only by the authentic entities but it is just a challenging activity to keep track of this activity in the network. Inside a review conducted in Canada (2000), it's been discovered that almost 17% of respondent felt that their information had not been kept confidential. Inside our survey we found that 47% of the populations are concerned about the identity theft while being able to access eHealth system.

Law and Ethics

It may also be mandated by the administration/law to disclose the medical details to parties other than Health care stakeholders. These get-togethers may be Business corporation or Research corporation. Medical data is disclosed to general public officials to consider disease outbreaks and research ways to improve the quality of healthcare. The distributed of health data to public representatives raises a major question on the maintenance and processing of the data. From our study, we found that 29. 9% of the respondents are not willing to talk about their private information to help general population representatives look for disease outbreaks and research ways to enhance the quality of healthcare. Companies and organizations (under medical sector) have been discovered to allow prescription data to be gathered by data mining companies. Companies and organizations within the medical sector, that control e-Healthcare information databases, have been seen to make ethically doubtful business decisions. For example, pharmaceutical companies and physicians allow prescription data to be gathered by data mining companies who then mine it and sell information on the info retrieved (Robert M. Make. Rx data mining: Improving health care or invading privacy? Fosters Daily Democrat Weekend Citizen, Sep 30, 2007). Inside our review, 28. 3% of the respondents said that they received promotional advertising on healthcare products from marketing organizations.

Results and Findings

We used a standard statistical examination tool (SPSS 18. 0. 0 - accredited under KTH) to investigate our review data. [http://progdist. ug. kth. se/public/licensed. shtml]. We got the total reactions of 127 students that are sent out as 52 and 75 from Feminine and male respectively. 80% of the respondents participate in ICT institution of KTH. Study result demonstrates 83% of the respondent accesses eHealth services less frequently. Regardless of the rate of recurrence of accessing the eHealth service, we encouraged the respondent to complete the whole review because we wanted to get their opinion about the privacy concern while being able to access eHealth service.

With the help of SPSS tool, we made the cross tabulation record on the two of the review questions (desk 1).

Are you concerned about identity theft or scam related to eHealth? * Did you ever kept back information from a health supplier because you were frightened of who see these details and for what it would be used. Crosstabulation

Did you ever before presented back information from a health company because you were afraid of who see this information as well as for what it would be used?

No

Not Sure

Are you worried about identity theft or fraudulence related to eHealth?

No

57. 6%

12. 1%

Not Sure

51. 5%

21. 2%

Yes

21. 3%

8. 2%

Table 1: Combination tabulation derive from SPSS tool.

From the statement, it could be witnessed that 70. 5% of the respondents, who are worried about identity robbery or fraud related to eHealth services, presented back again their medical information from a health service provider. This result plainly suggested that the matter about privacy affects the decision of a person to gain access to eHealth service. This helped us to answer one of our research questions.

In circumstance of second research question we found from our review results that, females are definitely more worried about the privateness. 61. 5% of the female respondents said that they are concerned about the identity theft and scam related to eHealth compared to 38. 7% of male respondents.

Gender* Are you concerned about id theft or scam related to eHealth? crosstabulation

Are you concerned about identity fraud or fraudulence related to eHealth?

No

Not Sure

Gender

Female

19. 2%

19. 2%

Male

30. 7%

30. 7%

Table 2: Cross tabulation result from SPSS tool.

81. 9% of the respondents are and only accessing all their medical data to validate their treatment data and 11. 3% of the respondents are not sure regarding this.

88. 2% of the respondents are interested to examine who has had access to their personal health information.

29. 9% of the respondents aren't willing to talk about their personal medical information to help public officials look for disease outbreaks and research ways to enhance the quality of healthcare.

We found a solid relation between your privacy concern of people and their interest to talk about their personal health care information. Individuals who are more concerned about their privacy aren't willing to share their personal information. From Stand 3, we can easily see that 47. 5% of the respondents are worried with the eHealth personal privacy and that's why they aren't interested to talk about their any delicate healthcare records. Alternatively, 54. 5% of the respondents aren't so worried about the level of privacy issues and they are ready to discuss their information.

Are you worried about identity robbery or scams related to eHealth? * Are you willing to share your individual information to help public officers look for disease outbreaks and research ways to enhance the quality of health care? Crosstabulation

Are you willing to talk about your individual information to help general public officers look for disease outbreaks and research ways to improve the quality of healthcare?

No

Not Sure

Are you concerned about identity robbery or scam related to eHealth?

No

21. 2%

24. 2%

Not Sure

6. 1%

30. 3%

Yes

47. 5%

21. 3%

Total

29. 9%

24. 4%

Table 3: Mix tabulation result from SPSS tool.

Conclusion and Discussion

Conclusions

Healthcare system is taking the new form with the progress in the info and Communication Systems which is trying to adopt all the possible way of dealing with today's problems associated with the system. The transmission and storing of very sensitive medical data in the digital form over the network made the machine prone to the security related issues. EHR constitutes the lifelong storing of patient's medical data, so in addition to the doctors and medical expert there are many other entities who are enthusiastic about fetching this data. Insurance firms and healthcare products marketing businesses are the perfect groups that are considering getting the medical data. This fact has been encouraged from our survey also, 28. 3% of the respondents accepted that they received the ad from the marketing organizations.

In this paper we stated the value of level of privacy in eHealth system. Privacy can be comprised in lots of ways while being able to access eHealth services. We mentioned that privacy can be breached by the outsiders (eavesdropping) as well as insiders (disclosure), so the security and guidelines must be employed both the leading and rear end of the machine. Previous statistics and our review result showed that folks are worried about the identification theft and scam while being able to access any eHealth services. This evidently claims that their concern influences their decision of being able to access eHealth services. Personal privacy and security issues are operating as a major roadblock and it is necessary to overcome this obstacle to be able to simply accept it globally.

Discussions

The main components of present eHealth system is obviously the IT components, it constitutes hardware, software and communication channel. Privacy can be breached by breaking the security of any of these entities. It has been observed that most of the program and hardware are not accepted based on providing high guarantee level rather it is produced and accepted as a result of marketing and promotion conducted by the software's distributors. This is taken attention by the government through the use of standard policies and rules onto it. From our review, we discovered that 78. 7% of the respondents feel that government should control the companies that can access the personal professional medical data.

Suggestions for future research

Literature references

Appendix A

Questionnarie

Gender *

Male

Female

Select your age group *

18-22

23-29

30-35

>35

Do you belong to school of Information and communication Technology? *

Yes

No

How frequently do you use eHealth services?

Once in a week

Once in a month

Once within an year

Never

Do you think that it is important for your doctor to be able to access all your medical records to be able to provide the best good care?

Yes

No

Not Sure

Is it important that you should have the ability to access all of your medical documents to validate your treatment data?

Yes

No

Not Sure

Are you concerned about identity fraud or fraud related to eHealth?

Yes

No

Not Sure

Is it important for individuals to be able to review who has already established usage of their personal health information?

Yes

No

Not Sure

Are you willing to share your personal information to help open public officials look for disease outbreaks and research ways to improve the quality of healthcare?

Yes

No

Not Sure

Did you ever organised back information from a health company because you were scared of who would see this information and then for what it might be used.

Yes

No

Not Sure

Have you received any promotional advertisements on healthcare products from marketing firms?

Yes

No

Not Sure

Do you think that government should control the businesses who access your personal medical care data?

Eg: Private Health Insurance companies, health products marketing agencies

Yes

No

Not Sure

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