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This article is the second part of an article started last week where we discussed some of the ways digital health information is currently being used and some of the possible directions we can expect to see in the near future. In this second column, we’ll discuss further possible directions and focus on considerations that public administrators need to keep in mind regarding these technologies. To view the last article, click here.
Telemedicine and Telepsychiatry
Telemedicine is the delivery of healthcare and the exchange of healthcare information through the use of audiovisual telecommunications technology. While telemedicine has been in use since the 1950s, digital technology has widened its application, particularly in mental health and psychiatric services. Telepsychiatry, and its recent offshoot eTherapy, use digital videoconferencing technologies to extend mental health services to far-flung and underserved communities. The Veterans Administration has been one of the leading users of this service. For people in remote areas or in communities with few health care services, access to treatment is a significant barrier to receiving mental health care services. Digital technologies have revitalized the VA’s efforts to reach underserved areas. Although the opinions on the feasibility and effectiveness of this technology are mixed, many believe it is the best option for providing mental health care to those who would otherwise remain inaccessible.
The Department of Veteran Affairs (VA) is the nation’s largest integrated health care system. In 2011, the agency established the Office of Telehealth Services. The office promotes the use of health informatics to provide health care and health management services. Improving mental health care is one of the 16 major initiatives set out by the VA in 2009 to help the organization better serve veterans. The Office of Telehealth was charged with using internet-based technology to improve veterans’ health care by streamlining access to care. Traditionally, patients and providers have had to travel to a VA hospital or medical center to receive care. These trips can involve arduous and byzantine odysseys. For example, in 2004 Morland, Pierce, & Wong reported that the VA Medical Center in Oahu, Hawaii provided services to veterans living in a vast area (12,000,000 km2). In order for providers to meet their patients’ needs, the VA often flew clinicians to remote destinations, or flew patients to Honolulu to receive care. This inefficient process often delayed care and escalated costs. While some travel will always be necessary, telehealth offers the promise of more rapid response to patients in immediate need.
eTherapy is the most recent expansion of the providing mental health care through digital technology. This offshoot of telepsychiatry includes behavioral health services provided by a range of mental health providers including psychologists and social workers. The American Psychological Association and the National Association of Social Workers provide guidance for practitioners using these treatment modalities. Behavioral health care professions such as psychologists and social workers are licensed at the state level. Consequently, a key issue that is emerging with eTherapy is how to manage digital practice across state lines. These disciplines and policy makers are continuing to identify the legal and ethical boundaries of digital practice.
Challenges for Public Administrators
Meaningful Use. EHRs will become more ubiquitous and an increasingly powerful tool in health care. Public administrators are challenged to ensure that consumers’ are empowered to take advantage of their records to benefit themselves and their families. Administrators will also be challenged to shape policy that ensures that EHRs are transportable, accurate and accessible. This will in part include a paradigm shift in how providers think of health records moving from the current ‘de facto’ provider ownership model of records to patient-centered ownership.
Privacy and Security. The rapid advance of health information technology presents considerable challenges for protecting the public’s health-related information. Additional guidance for digital health information has been added to The Health Insurance Portability and Privacy Act of 1996. However, it is clear that as use of technology advances there is more to be developed. One example is the emerging use of videoconferencing in behavioral health and eTherapy.
Coordination and Interoperability. Currently EHR technology is provided by a variety of private and public technology services. There is a strong push toward open-source technology. The Department of Veterans Affairs Computerized Patient Records System and the Centers for Medicare and Medicaid are leading the charge toward a uniform system. In fact, because these systems are the nation’s largest health care entities, their systems are the closest to a common coordinated digital health record system. For the patient, coordination and interoperability of EHR systems will help to ensure that the promise of digital health records accessibility and portability are truly realized. However, it will most likely take new public policies to mandate the necessary changes to accommodate these interoperability demands across the private sector.
Professional standards. Provider associations and policy makers will need to continue to work together to establish professional practice guidelines for practitioners working in digital health. Administrators will be tasked to help adjust state line practice laws to assist practitioners to conduct legal and ethical practice.
Innovation and Adoption. We have the technology and capability to make digital health part of the fabric of health care. We are still challenged to overcome the barriers to greater adoption of digital health technologies. One example is the expense associated with moving all health care providers into the digital age. It is likely that innovations that make adoption possible will come in large part from local providers, researchers and health care systems with financial support and guidance from the public sector. Public administrators are challenged to be alert for innovation and to facilitate ways for digital health to take root in their communities. More information on research and innovation in health IT can be found at Strategic Health IT Advanced Research Projects (SHARP).
This is far from a complete list of challenges that public administrators face in facilitating digital health. Public Administrators will doubtlessly be involved in creating greater public awareness of EHR and other digital health services, ensuring accessibility by the underserved and facilitating the public’s opportunity to promote the necessary innovations and expansion of digital health.
Authors: Christopher J. Godfrey, Ph.D. Director, Web 2.0 Interdisciplinary Informatics Institute Department of Psychology, Pace University; Hillary J. Knepper, Ph.D. Assistant Professor, Department of Public Administration, Pace University; Camila Bernal and Danica Spence, Undergraduate Research Assistants, Pace University Web 2.0 Interdisciplinary Informatics Institute. Contact: firstname.lastname@example.org