The need to have appropriate information sharing system when a patient is referred from one clinician to another, or one health facility to the other has been on the rise. There has been a general concern among medical practitioners that the current systems do not allow for adequate sharing of patients’ information during the hand-offs. For this reason, there has been need to close the loop and allow for a comprehensive sharing of information between the clinicians as a way of understand the conditions of the patient better. Closed-Loop Referrals have become popular as a way of ensuring that health practitioners share patients’ information as appropriate. According to Kelly and Shah (2009), closing the loop, “Implies that clinical information flows easily during a medical referral- the referring clinician is able to let the recipient clinician know the pertinent information about the patient being referred, and the recipient can let the referring clinician know the opinions and recommendations that result from the referral.” This two-way communication design allows the clinicians understand how a patient’s case can be addressed in the most effective manner. Technology has played a pivotal role in making this possible.
It is important to note that despite the progress that has been made in closing the gap during referrals, security gaps have emerged, jeopardizing the positive gains that have been made in this field. These security issues have affected communication in various ways, and to varying degrees. There are cases where these loops have had serious negative consequences to information within given systems. In other cases, the gap has exposed patients’ information to third parties, which is against policies in this sector. It is important to understand these security gaps in order to be able to address them appropriately.
One of the leading security issues in this system is unauthorized users. When this system is developed to enable clinicians share vital information during patient referrals, there are cases where unauthorized users get access to the system. These unauthorized users may be other hospital workers who are not authorized to use this system. This means that they can pass inappropriate message to other users, which may be misleading. To address this issue, users should have their accounts protected by strong passwords to deter unauthorized persons from using them. Another security issue is the possible eavesdropping by third parties, especially when handling classified customer information. There are cases where third parties get ways through which they can eavesdrop on some important information on patients and share such information with other parties in bad faith (State Health Information Exchange Program, 2012). This security gap may pose serious integrity issue for the health care facility and the practitioners involved. The gap can be controlled by having a secure point of service stations that cannot be accessed easily by third parties.
The issue of corrupt data has also affected the initiative to use telecommunication technologies to close the loop during referrals. Corrupt data refers to any piece of information about a patient that is not accurate as authored by the referring clinician or the receiving practitioner. Corruption of data can occur because of a number of reasons. One of the ways through which data can get corrupt is by deliberate action of unscrupulous individuals who get access to the system and feed wrong information. Another reason that could bring about corruption of data is a situation where the system has bugs that affect data once it fed into it. Irrespective of the reasons that cause this corruption, corrupt data has serious negative impact on the actions of the health practitioners who are receiving the patient. This is because the data they shall receive may be complete opposite of the true status of the patient. This means that they will start treatment using irrelevant information. As Cress (2012) observes, it better to start treatment with no information at all than to do so with distorted information. To address this issue, database administrator and operating system administrator should develop strong firewall that will protect data from any interference from external sources. Each of the users of this system must also observe security measures by protecting their accounts with passwords and ensuring that third parties do not have access to their user accounts. This means that in case there is access to any user accounts by third party, the users of such accounts will be held responsible for complacency. This will make the users responsible for all the activities taking place through their accounts.
The issue of accountability may also raise security concern, especially when there are a huge number of users sharing the same system. The ultimate aim of this system is to bring together as many health practitioners and healthcare facilities as possible in order to create an efficient way of sharing essential information during the process of referrals. However, the problem comes when the number of users is too high that it becomes impossible to account for information circulating in the system. Lack of accountability in this sector may result into massive consequences, especially when it becomes impossible to trace specific individuals who could have posted a given information. Lack of accountability also encourages unprofessionalism among the practitioners. They know that they may not be held accountable for their information because they cannot be traced after sharing such erroneous data. To overcome this security gap, the system should have specific users at all times who will be fully responsible for any information coming from their use accounts. Such users will be responsible for ensuring that their accounts remain protected from any form of intrusion. This may involve ensuring that their offices and workstations are not accessible to unauthorized users.
According to Starfield (2008), another security issue that may arise when this system is used to close the loop during referrals is the fact that there will be too many accounts. Each of the users would need their own accounts and this may overstretch the capacity of the system. It is true that the ultimate aim of this strategy is to bring together as many health practitioners as possible within a given region so that they can easily share relevant information about patients during referrals. However, this number should be regulated to enhance security and accountability. There should be a specific number of users per given region to make the system easily manageable. The table below identifies these security gaps.
Table 1: Security Issues Identified for Gap Analysis for Closed Loop Referrals.
References
Cress, C. (2012). Handbook of geriatric care management. Sudbury: Jones & Bartlett Learning.
Kelly, K. M., & Shah, S. M. (2009). Emergency neurology: Principles and practice. Cambridge: Cambridge University Press.
Patti, R. J. (2009). The handbook of social welfare management. Thousand Oaks: Sage Publications.
Starfield, B. (2008). Primary care: Balancing health needs, services, and technology. New York: Oxford University Press.
State Health Information Exchange Program. (2012). Getting to impact: Harnessing health information technology to support improved care coordination. Washington, DC: The Office of the National Coordinator for Health Information Technology.