Telemedicine Information Systems Evolution Paper

Telemedicine

Information Systems Evolution Paper

The gifts and risks of telemedicine: History and ethics

Introduction to telemedicine: A brief history

Telemedicine, or using technology to provide healthcare through remote means, may seem to have been spawned by recent, new advances in communications technology. It has proved invaluable to people living in rural areas inaccessible to modernized healthcare systems and to patients who cannot be moved without their health being severely compromised. However, telemedicine is actually over thirty years old. The National Aeronautics and Space Administration (NASA) played a critical role in the development of telemedicine as early as the 1960s. "NASA built telemedicine technology into early spacecraft and spacesuits to monitor astronauts' physiological parameters" (Allan, 2006, par.1). It is even possible to argue that something as simple as two doctors consulting with one another qualifies as telemedicine, or reading an online medical journal.

NASA worked with healthcare organizations to use its new technology to benefit communities in need. For example, in 1972 NASA created the Rural Papago Advanced Health Care (STARPAHC) program for telemedical help for Arizona's Papago Indian Reservation. "Engineered by NASA and Lockheed Missiles and Space Co. (now Lockheed-Martin), the system used two-way microwave transmissions to link paramedical personnel located in mobile (vans) and fixed stations with medical experts at hospitals in Tucson and Phoenix. The program lasted until 1975" (Allan, 2006, par.5). Today, thanks to telemedicine, a specialist at a North Carolina University Hospital can "diagnose a rural patient's hairline spinal fracture at a distance, using telemedicine video imaging," without the need to physically transport the patient at great risk to a specialist in a far-off city (Welsh 2004, par. 4). Almost every type of medicine can deploy telemedicine, from reading X-rays, to monitoring patient's blood pressure, to providing a psychiatric consultation.

Who maintains patient records?

In today's version of telemedicine, the practice of doctors viewing and consulting a case from a distance is far more common -- NASA is seldom involved! However, the widespread use of telemedicine also means that it is more prone to potential ethical breaches of confidentiality because of the need to share patient records through virtual means. It is essential that all patient records are kept confidential manner by providers and there is careful attention to "the quantity and quality of data and other information received. Findings, recommendations and telemedical services delivered must be documented with care, to ensure quality and consistency (Ethics, 2002, FMA, par. 14). If a patient receives telemedical treatment it must be recorded in the patient's file, so that later caretakers know to take former and current drugs into consideration when providing treatment. It is hoped that widespread electronic record-keeping will better ensure that consistent and comprehensive records are kept for all patients, regardless of how they are treated. However, electronic record-keeping itself raises some security concerns.

What are some ways that patient information can be used for fraud and abuse?

Any accounts on a computer can be 'hacked.' Also, simply through the process of telemedicine itself, there can be difficulties performing a procedure due to a technological failure or incorrect data transmitted electronically. "Patients relying upon intravenously delivered medicine, remotely controlled via the Net, could have their lives threatened by a cyber attacker who altered their medicinal flow rate" (Dark side, 1999, Science Daily, par. 3-4). Even proper, routine care, can be used against a patient, if an employer, insurance company, or other organization is given private, information that suggests the patient may be at high medical risk or simply has an expensive chronic illness.

Patient information submitted for false reimbursement?

Submitting patient information that is tampered with for a false reimbursement from an insurance company is a crime. The greater availability of patient records can make it easier to create false claims, through electronic tampering. This is yet another risk of telemedicine, which must be guarded against through encryption and proper security infrastructure.

Selling patient information to external entities?

People with long-term diseases like diabetes, or even those only genetically predisposed to genetic conditions, could be denied job opportunities or refused health insurance "if information stolen from data banks were sold to corporate bidders (Dark side, 1999, Science Daily, par. 3-4). Given the expense chronic conditions can cause, and the highly competitive job market, patient data must be unassailable, and it must be illegal to sell what should be protected information. Otherwise, patients may be deterred from seeking genetic testing or care because of fears that the information could be used against them.

What are some policies on the release of information, retention, and destruction of records?

Ethical guidelines observed by legitimate organizations honor the fact that patient data and other information should only be "transmitted to a doctor or other health professional on the request or with the informed consent (permission) of the patient" or an approved caretaker and "the data transmitted must be relevant to the problem in question" (Ethics, 200, FMA, par.18-19). Appropriate security must be used when designing electronic record-keeping systems. "Computer architecture" must incorporate "built-in security mechanisms to protect information sent between medical systems components" (Dark side, 1999, Science Daily, par. 6). Said one hospital: "We've put in audit trails to tell us who's accessed what; we've enhanced passwords and installed encryption, firewalls and dedicated lines. One of the things we've learned is that in addition to all of that, we need to manage the human factor and put in controls around unauthorized access by authorized users" (Dark side, 1999, Science Daily, par. 9).