View source for Patients' safety, privacy and effectiveness--a conflict of interests in health care information systems?

==Review: Sweden’s National Board of Health and Welfare: Broader Use of IT in Health Care, Including Access to Patient Data, Necessitates Legislative Changes==

Nymark M. Patients' safety, privacy and effectiveness--a conflict of interests in health care information systems? Med Law. 2007 Jun; 26(2):245-55.

== Introduction ==

M. Nymark, Legal Advisor to Sweden’s National Board of Health and Welfare (NBHW), presents the results of his agency’s analysis conducted in 2001-2004 as part of Swedish government’s national InfoVU project and made public in November 2005.  The project dealt with the increasing use of IT in health care, its impact on patients' rights and privacy, and a number of legal aspects of IT use in health care.

In addition to the NBHW’s conclusions on legal issues pertaining to the management and processing of patient data, the article presents a number of legislative issues specific to Sweden, which need to be addressed in order to meet the patients', regulators’, and health care providers’ interests in the new electronic environment.

== Sweden ==

Sweden has a decentralized health care system, with 20 county and 290 municipal councils have the primary responsibility for providing health care to their residents, including quality assurance and financing all care activities.  To fulfill this mandate, they employ the services of private care providers.  

Councils act, to a large extent, independently; however, the Swedish government still maintains the overall responsibility for health care-related legislation (such as the Health and Medical Services Act) and its actual implementation.

Under such legislation, one of the primary objectives (and obligations) of health care providers is proper and safe medical care.  Medical records are fundamental to patient safety, and with the introduction of IT into health care, a lot of effort has been concentrated on providing better access to patients’ medical records, as a way to improve patients’ health and reduce the risk caused by wrong or missing data.

At the same time, a number of legislative acts has been historically aimed at safeguarding the confidential relationship between patient and doctor, including protection of personal medical data.  The laws passed with this objective in mind (such as the Secrecy Act of 1980, the Medical Records Act of 1985, or the Health Care Data Protection Act of 1998), could not anticipate today’s use of IT in medical services, including patient records increasingly moving from paper to electronic formats.  As a result, such laws and regulations “unintentionally limit the ability to make use of modern e-Health solutions.”

== Analysis ==

The author gives a broad overview of issues stemming from obsolete regulations in this area.  He states Sweden’s need for new legislation, which would reflect the current IT involvement in access to patient records, as well as the nature of health care changing from static to based on a workflow and close collaboration among multiple entities.

While these issues are important for most developed nations, including the United States, what makes Sweden’s case special is a certain distribution of responsibilities between the central government and local councils.  The latter are tasked with financing and providing the actual medical services, with an obligation to use “resources efficiently, effectively and productively” and make sure they are “spent on individual health care” and not “on unnecessary and time consuming administration”, while patient privacy and data confidentiality is primarily the central government’s concern.  As a result, local councils emphasize service availability, patient safety and cost efficiency, and are “not eager to spend endless time and money on administrating individual rights, strict mandatory access control and information labeling and security classification.”  Unfortunately, the author does not propose any means of resolving this conflict of interests, simply stating that it will be further investigated by a government commission formed by the Swedish government in 2006.

Alexey Panchenko

[[Category:OHSU-BMI-512-SP-08]]