In Home Care, How Risky is Digitally Sharing Health Information?

We live in an age when nearly every medical and caregiving professional has a smartphone or tablet. These mobile devices can be extremely useful on the job – especially in home care. But when it comes to sharing health information, providers should be wary.

Canadians have already seen privacy breaches involving electronic medical records. And sadly,
there have been numerous cases of longterm care staff using mobile devices to capture inappropriate images of residents.

Of course, most health care workers would never treat patients this way. But the digital landscape is changing rapidly, and new mistakes are bound to occur. These slip-ups aren’t just bad for the public perception. Sometimes, they fall into legal grey areas.

In home care, sharing client information through mobile devices is critical.

Nurses and personal support workers (PSW) are often on the road. Some work in remote regions. Mobile technology allows them to engage in quick and simple collaboration. It helps workers provide specialist expertise to at-home clients who wouldn’t otherwise receive it.

How can home care providers share health information to provide better care for clients – without entering risky territory?

In this post, we’ll look at the hazards involved in digital sharing and tell you how to avoid them.

The Mobile Revolution: a Gift to Home Care Providers

It’s no secret that mobile technology has changed the way people find health information and manage medical conditions. Now, they’re expectations are extending beyond online symptom checkers and apps that count calories.

More than ever, patients want digital access to the professionals who provide their care. A recent PwC study found that 79% of patients would either definitely or likely use an email service with their doctor. And 80% would use an electronic results reporting service for lab test results.

If you work in home care, these finding probably comes as no surprise. Most patients prefer the convenience and independence of receiving health care at home.

Of course, home care providers want to meet the preferences of their clients. Mobile tools can help by keeping clients and practitioners connected remotely, resulting in more responsive care at home.

And there are further benefits for professionals who use mobile technology on the job. Namely: smartphones, tablets, and personal computers make sharing information between workers easy.

It goes without saying that collaboration within a client’s circle of care is crucial. And collaboration can only happen when caregivers and medical professionals receive relevant medical updates.

If a client’s dosage of pain medication has changed, the nurse caring for her should know about it – instantly. If the client has a complex wound, the nurse should be able to share relevant information and images with a specialist who can help treat it, in real-time.

Mobile technology can turn these scenarios into reality. Luckily, there are mobile-friendly tools designed specifically for communication in home care.

But for most practitioners, sending and receiving information in familiar electronic formats, such as text messages, is second nature. For this reason, there may be times when these formats are most reliable for ensuring updates are sent and received.

Sharing Health Information Digitally – the Law and the Risks

If you’re involved in home care delivery, you know the benefits of sharing health information in real time.

Frontline workers can ensure their clients receive responsive care remotely. And if you’re looking at the big picture: provider organizations can treat more clients, more efficiently. Consider what these benefits mean for remote and Northern communities, where access to direct health care expertise is limited.

But what about the risks?

It’s hard to imagine that a few lines of text on a smartphone could constitute a privacy violation. But of course, it can. And in some circumstances, it can even land you and your agency in hot water – legally.

So what, exactly, is allowed under the law? When it comes to sharing health information, there’s a lot of uncertainty.

In a recent University of Toronto study, 41% of Canadian surgery residents surveyed said texting was the most common way they communicated patient information with staff. A whopping 66% were unaware of legislation related to texting and patient information.

Clearly, this is a complex issue even in traditional health care settings. It only makes sense that home care providers are confused.

Existing advice tends to focus on email communication between providers and patients.

Privacy commissioner recommendations differ from province to province. Ontario indicates that using email should generally be avoided. In Alberta, using insecure networks is discouraged. Commonly-used sites like gmail aren’t considered secure (more on that in the next section).

Another interesting point: Alberta allows for the use of insecure networks for messages containing “limited personal health information”. But what does that mean?

In general, statements from privacy authorities are cautious, but open to some interpretation. Practitioners have received significant fines for sharing information recklessly. But what about unintentional breaches?

Secure Networks: the Key to Compliance

So what, exactly, are a home care provider’s duties when it comes to client privacy?

For care professionals who work in client homes, sharing health information through digital networks is pretty much unavoidable. And in some cases, it’s easiest to share this information through texts and emails on mobile devices.

Given the lack of clear-cut consequences, it’s tempting to forget all about recommendations and restrictions. But accidents can happen, and clients can be damaged in the process – along with a service provider’s reputation.

What if a cellphone is lost, or an email goes to the wrong address? We say, better safe than sorry.

When it comes to legal obligations, the Canadian Medical Protective Association (CMPA) notes that privacy legislation “generally requires custodians to adopt reasonable safeguards to protect …personal health information…”.

Exactly what constitutes “reasonable safeguards” may be up for debate. But the CMPA makes suggestions. And one in particular provides a convenient solution for concerned providers.
The use of encryption.

Without getting overly technical, here’s what providers need to know. Encryption converts data into formats that can’t be understood – except by those with permission to access it. Encrypted communications is a highly-effective way keeping the information contained within digital communications private.

Importantly, encryption is generally accepted as a reasonable safeguard of personal health information. It’s recommended by organizations like CMPA.

The easiest way to protect texts and emails containing client health information is to use a communication network or platform that encrypts them. Look for health IT solutions capable of providing this level of security – along with other features that strengthen care teams around at-home patients.

Of course, technology always works better when it’s supported by a complementary team culture. Leaders within home care provider organizations should ensure that staff understands the importance of client privacy.

Staying Aware

Mobile devices make sharing health information easy and convenient for home care teams. But as technologies evolve, so too do privacy standards.

Staying on top of these shifts is important. Whether you operate a home care agency or provide one-on-one care, try to stay in the know. Read rules and guidelines set out by relevant organizations. Subscribe to publications that provide and explain updates on subjects related to health care and privacy.

Technology with encryption capabilities offers impressive data protection. But this technology should be supported by a culture of respect for privacy. Leaders within home care provider organizations should foster this culture among staff.

Feature image courtesy of Esther Vargas

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COPD Education – Onboarding

Objective

To complete a thorough needs assessment / initial evaluation for a COPD patient of an outpatient clinic

Actors
Patient, Educator (Nurse, RT, the Physician could also be the educator)

Timelines
One 60-90 min session with the Educator

Description
  • This protocol should be established for all COPD patients from a given clinic, independently of whether they are new patients or they are known to the clinic. This protocol is the basis to engage the patient into other protocols such as education, exacerbation follow-up, etc.
  • We need to identify patient goals/concerns to guide the interventions
  • A thorough evaluation is carried on, with the objective of understanding where the patient is on their disease journey and follow-up treatable traits: dyspnea, exacerbation or dyspnea and exacerbation.
  • It includes the use of objective questionnaires such as the mMRC, CAT, HADS, Frailty Scale, etc.
  • Identify if the patient needs to be referred to other resources (e.g. Physiotherapist, social worker, occupational therapist)
  • Once Onboarding is completed, the patient continues to the COPD Education workflow
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COPD Education – Continuous Maintenance

Objective 

To cover in depth all the necessary elements of self-management education as per the LWWCOPD, with priorities based on patient goals and identified treatable traits

Actors
Patient, Educator (Nurse, RT or Physician)

Timelines
A number of “Core” educational modules have been identified which cover the basic COPD education from the LWWCOPD program. Additionally, optional modules can be used to respond to patient needs. The timeline (frequency, number of modules to be covered at a given education session) is fully customizable, although we recommend to have education sessions every 2-weeks during the “active” phase of education. Once this is completed, the patient continues to the Maintenance Mode (see below).

Description
  • Launched at the onboarding protocol
  • Provide basic overview of COPD self-management based on LWWCOPD (medication adherence, inhaler techniques, PLB technique & energy conservation) up to the development of an Action plan for early exacerbation recognition and management.
  • Prioritize self-learning by the patient (e.g. watching videos, reading educational materials, completing homework) in addition to live sessions with the Educator. Educational materials are sent to the patient directly via the platform, and become the patient’s own library. The Educator can customize which “homework” the patient receives.
  • Educators have access to “User guides” to standardise their educational intervention. These user guides include: objectives, interventions, suggested questions, evaluation of self-efficacy, and learning contracts for each module.
  • Once the core education is completed, the patient can continue to the Respiratory Status Follow-up Workflow (run in parallel)

The Maintenance Mode
  • As soon as the maintenance mode is engaged, the frequency of visits Educator/Patient is reduced to once every 6 months.
  • During the Maintenance Mode sessions, the educator has access to all the education modules and can choose any piece of content that needs to covered with the patient. 
  • A streamlined evaluation (similar to the initial eval.) is done during each “maintenance” visit to identify any substantial changes on the patient’s needs that will require some adjustment. The patient could come back to an “active” education mode (more frequent education sessions, e.g. every 2 weeks).
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COPD Respiratory Status Follow-up

Objective

Monitoring of stable patients from a clinic in order to identify early any aggravation of symptoms (exacerbation) and implement an action plan

Actors
Patient, Educator (Nurse, RT or Physician)

Timelines
Scheduled regular automated follow-up to the patient symptoms. Intensity/Frequency can be adjusted by the Educator depending on patient needs (e.g. daily, every week, etc.). Ongoing through the year.

Description
  • Launch: Patients who have completed the Core Educational including setting-up an action plan.
  • Regular automated questions allow to identify any change in patient’s symptoms and severity.
  • If an exacerbation is detected the patient gets a reminder to engage their self-management strategies while waiting for the Educator to call back.
  • An alarm is generated for the Educator, so they immediately call back the patient. At this call they will evaluate any further intervention required and schedule additional follow-up.
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