Stephen Darlington
continue to negotiate policy and structure and a dominant framework of stakeholder rights has yet to emerge from those negotiations. However, what does seem clear is that the rapid development of information communication technology( ICT) is a critical juncture for the old healthcare systems resulting in punctuated equilibrium enabling a move from provider‐driven to patient driven healthcare systems with path dependencies very different from the old system.
3. Stakeholder interests in e‐health systems
Patient rights can include consent, choice, privacy and service delivery outcomes, although individuals will value these differently. Their satisfaction collectively with each may influence the perceived success or failure of the e‐health system. For example, Jolly( 2011) has identified patient rights with e‐health systems as an area of particular importance requiring significantly more rigorous research and has“ argued that privacy concerns have been central to delays in the uptake of e health [ sic ] in the United States”. Townsend( 2012) highlighted three areas of key patient concern in Australia: the limitation of privacy control settings to actually meet patient privacy expectations; the need to fully educate both patients and healthcare providers and their staff on how to effectively use the PCEHR system; and the likelihood that patients will keep information to themselves fearing that it may be used against them by health insurers, life insurers and other doctors.
The major benefits patients may expect from e‐health systems include:“ increased communication with healthcare providers, timely transfer of accurate medical records, better decision making by healthcare providers and the individual patient themselves”( NEHTA 2013), faster service or less waiting, all leading to improved quality of care.
Healthcare providers are concerned about firstly, the completeness of patient records – patients may not choose to fully divulge all pertinent medical information, and medical records may not be kept up to date. The practical impact of this concern has led healthcare provider organisations in Australia to advise doctors to“ examine and assess the patient as they’ ve always done noting this information in their own records” which may limit expected efficiencies( Townsend 2012). Secondly, they are concerned about liability for incomplete records and privacy breaches. And thirdly, they are concerned with property rights. Ownership of medical records, rights of access and transfer and their associated costs affect healthcare provider commercial interests.
Potential benefits for healthcare providers include: reducing hospital readmission rates, faster clinical assessments, more accurate diagnoses and referrals, and more effective treatment and prescribing of medicine( NEHTA 2013). There is also the potential of e‐health systems to positively transform service delivery. For example, a patient’ s right to life may well be enhanced by efficient and effective e‐health systems that enable healthcare providers to improve their duty of care and thus improve patient outcomes while at the same time lowering the cost of doing so.
The state’ s main concerns may be indicated by the type of e‐health system selected for the public health system adopted when legislating healthcare policy. Opt‐in systems are likely to reflect a state’ s desire to improve citizen interaction with service providers by shifting power‐relationship ratios towards the patient, increasing patient satisfaction with service delivery outcomes and therefore enhancing the legitimacy of e‐ government systems in general. However, opt‐in e‐health systems run the risk of low stakeholder uptake which may reduce the expected benefits of lower cost and widespread improvements in patient outcomes. Opt‐out and mandatory e‐health systems are likely to reflect the state prioritizing utility over stakeholder rights in order to achieve perceived benefits. Both lessen choice and increase state coercion therefore shifting power‐relationship ratios away from patients towards healthcare providers and the state.
Regardless of which system is chosen reducing costs and improving service delivery are likely to be key state goals driving the implementation of e‐health institutions and affecting the rules and procedures of the initial system design. Given governments are the major source of funding in most health systems( WHO 2011) they are likely to see e‐health systems as a way to monitor health expenditures, improve the use of scarce resources and enable“ better policy development as a result of the high quality data potentially available for use in research and planning”( NEHTA 2013) in order to achieve their goals. The choice of system will directly impact stakeholder rights that are respected and those that are affected. Rights respected and affected by system choice will be discussed in terms of institutional choice and path dependency.
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