Balancing Rights and Utility in Determining Power Relationship Ratios in e‐Health Systems
Stephen Darlington The Australian National University, Canberra, Australia stephen. darlington @ anu. edu. au
Abstract: Governments and private health organizations are adopting e‐health systems as a means to improve medical service delivery and reduce costs. While some e‐health systems show indications of success there have been some expensive failures, most notably in the UK. Power‐relationship ratios determined by a chosen balance of rights versus utility could explain e‐health system success or failure. Rights over the portability of medical information have become a contentious e‐health issue which could limit desired effectiveness and efficiency. There are conflicts over information governance issues such as consent, privacy, choice, fairness, balancing the rights of the individual versus the common good, questions about who owns health information and what can be done with it. This paper uses a historical institutional framework to compare the path dependencies inherent in adopting opt‐in, opt‐out or mandatory e‐health systems which may result in different outcomes. Each approach makes assumptions about a balance of rights versus utility that may directly impact medical service delivery and costs. These decisions institutionalize e‐health power‐relationship ratios between e‐health actors. The concepts of capacity, competence and ableness are used in an effort to determine powerrelationship ratios and what rights e‐health stakeholders should have. Striking an optimal balance between rights and utility may well be one of the key choices governments make in order to successfully institutionalize e‐health systems, transform service delivery, increase the efficiency and effectiveness of public sector service provider and citizen interaction, and, through the lens of citizen satisfaction, enhance the legitimacy of e‐government systems in general.
Keywords: e‐health, rights, utility, power relationship ratios, citizen interaction
1. Introduction
This paper focuses on the portability of a patient’ s medical records and the information governance issues that may cause conflict between key stakeholders in e‐health systems.
E‐health systems that create portable health information in a digital format are being widely adopted by governments and private health organisations as a means to reduce costs while improving medical service delivery. For instance, economic modeling by Deloitte for Australia( DoHaA 2012) estimated a cost saving to the health system of approximately $ 11.5 billion over 15 years. Cost reductions were expected to be achieved through more effective medication management leading to reduced hospital admissions and GP visits as well as from improved continuity of care – efficiencies gained from better clinician access to patient information( DoHaA 2012, Turner 2012). By mid‐2012 the Australian Government had funded the Personally Controlled Electronic Health Record( PCEHR) to the tune of $ 700 million( Turner 2012). The anticipated reduction in healthcare costs compared to expenditure to institutionalize an e‐health system is therefore significant.
However, expected benefits have not always materialized. The UK abandoned its electronic medical record( EMR) system after £ 12.7 billion( Campbell 2011) had been spent on the program. The Australian state of Victoria did likewise after spending over $ 400 million( LeMay 2012).
Another reason sometimes given for the adoption of e‐health systems is the expansion of citizen rights as a means of improving efficiency and effectiveness( Huijboom 2009: 21‐28). Australia’ s PCEHR institutionalizes this concept and makes patient rights a central component of the e‐health system. The PCEHR is an attempt to strike a balance between respecting some stakeholder rights and affecting others. Stakeholder rights, as part of the broader issue of information governance, are now key issues of contention that may define system success or failure. Policy decisions about whether to adopt opt‐in, opt‐out or mandatory e‐health systems raise issues of consent, privacy, choice, fairness, balancing the rights of the individual versus the common good, and questions about who owns health information and what can be done with it.
These contrasting e‐health systems will produce different outcomes. Each systems approach makes assumptions about a balance of rights versus utility that may directly impact medical service delivery and costs. These decisions institutionalize e‐health power‐relationship ratios between e‐health actors. I argue that striking an optimal balance between rights and utility may well be one of the key choices governments make in
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