By M. Pranck. Greenville College.

The machine cheap viagra plus 400 mg with visa impotence vacuum pump demonstration, only if specifically told or requested buy 400 mg viagra plus with amex impotence young male, will utilise data to make a decision, which the machine rather than the clinician then acts on; 7. The machine, automatically utilises data to make a decision, which it then acts on, but advises clinician on all actions immediately; 8. The machine, automatically utilises data to make a decision, which it then acts on, but clinician only advised immediately if exceeds certain parameters; 9. The machine automatically utilises data to make a decision which it then acts on, and reports to clinician at certain agreed periods; and 10. The machine automatically utilises data to make a decision, which it then acts on, with no active feedback to clinician. Moving along this spectrum, there is a progressive increase in machine control and decrease in immediate human control (Figure 8). The clinical user is given increasing levels of active advice and overview by the machine, in terms of patient data and specificity of medical evidence and treatment recommendations, while the machine gets decreasing levels of active immediate advice and overview of its use of patient data by the individual clinician user. In general relatively few Health Knowledge Systems have reached level 3, but there is the capacity for this to change rapidly with significant privacy and security implications. For example, what are the privacy and security implications of a “booking system” that could draw data from several sources and act on its own to decide on suitability or eligibility, and then instigate certain forms of care? However, as the machine becomes less dependent on immediate human overview, there will be an Copyright © 2005, Idea Group Inc. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. Machine versus human control Autonomy of Control Machine Control Human Control Passive Machine Intervention ACTIVE increasing need to consider the risks and benefits in respect of privacy and security. The lack of overview, and integrity of the data and processes by which decisions are made, will be a significant issue. However possibly of greater moment, will be how we perceive, value, or balance the impartiality versus heartlessness of a machine accessing our health information and making decisions based on protocols. Internationally, there is a growing awareness of the need for information system developments to undergo a Privacy Impact Assessment, underpinned by a state sanctioned privacy code (Slane, 2002). For example the New Zealand Privacy Impact assessment recommendations and underlying code sets out a number of principles in relation to unique identifiers, the purpose, source, and manner of collection, storage, security, access, and correction, and limits on storage, use, and disclosure of personal information. Internationally similar principles or rules are common to a myriad of legal, professional, and research codes and acts that relate to the collection, storage, and utilisation of health information. Assessing the impact, or future consequences of current actions, presents a particular challenge for health knowledge systems. The risk-benefit equation, used to assess how certain information is handled may change over time and we have to question how far forward we can see, or how far forward we are expected to see. Privacy and Security Objectives Privacy and security developments may be focused on addressing a number of key objectives or concerns including medico-legal or patient trust or confidence concerns, within the context of a belief that better integrated information will lead to better Copyright © 2005, Idea Group Inc. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. However what is perceived best by or for an individual may be in conflict with what is perceived as best for the community. Each clinician and health service, depending on their location may be conceptually subject to a multitude of privacy and security codes and laws, for which in reality at the clinical coal face there is only limited compliance due to various combinations of lack of knowledge, attention, priority, will, ability, or perception of unacceptable costs and burden. There may be broad agreement that patient privacy should be protected, but a range of views as to what that pragmatically can or should mean in practice and how much any law or code may achieve this. For example, Marwick (2003) outlines similar views and responses as having greeted the introduction in the USA of the privacy rule of the Health Insurance Portability and Accountability Act. However health organisations need to increasingly strive to create a culture that respects and protects health information, and seek to demonstrate and reinforce that culture through a number of basic or initial communication, human resource or technical steps. These include creating with, and communicating to, their communities clear open policies around the nature and purpose of health information flows and utilisation. These include the risks and benefits of information flowing or not flowing and respective privacy versus sub-optimal care risks. In pragmatic terms this may take the form of conversations, leaflets, posters or web-sites. Human resource processes may include training and development and professionalisation of all healthcare workers in terms of their attitude to health information and clear disciplinary procedures for malicious use. Anderson (1996) has highlighted the impor- tance of training and procedures for the high-risk area of providing patient information on the telephone. Davis, Domm, Konikoff and Miller (1999) have suggested the need for specific medical education on the ethical and legal aspects of the use of computerised patient records.

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