Aspek Etika dan Regulasi terkait dengan Informatika Kesehatan Anis Fuad Departemen Biostatistik, Epidemiologi dan Kesehatan Populasi FK UGM
[email protected]
Perpaduan antara evolusi teknologi dan peradaban manusia Teknologi Informasi
Perilaku manusia dalam berinteraksi secara sosial dan bekerja
Menggunakan, menerima, Adaptasi dan mengembangkan
What you fill in today may not be useful tomorrow
Status asuhan keperawatan tercetak dengan rapi di RSUD Banyumas
Contoh penerapan “paperless medical record”
http://www.jagatreview.com/2014/06/pr-rumah-sakit-pondok-indah-group-terapkansistem-informasi-rumah-sakit-digital/
Workflow pelayanan di National University Hospital (NUH) Singapore
Rekam medis elektronik terintegrasi dengan layanan farmasi
Essential requirements of Information Technology for Primary Care (Peterson, 2012) Supporting the personal relationship
Continuity of care
Care coordination
TIK di pelayanan kesehatan dasar
Integrating standard workflow
Capturing the diagnostic process
Essential requirements of Information Technology for Primary Care (Peterson, 2012) Supporting the personal relationship
-rujukan berjenjang -open data standard
Continuity of care
-mampu bertukar informasi antar nakes
Care coordination
TIK di pelayanan kesehatan dasar
-mencatat pasien sebagai “person” bukan hanya diagnosis -memelihara relasi dokter-pasien -kontekstual -sepanjang hayat
Integrating standard workflow
Capturing the diagnostic process
-standar pelayanan primer -alur kerja dokter/nakes
-data elemen: keluhan utama riwayat penyakit riwayat keluarga sosial -standar kode utk layanan primer
Fitur TIK Kesehatan di Pelayanan Primer (Audet et al, 2014) Menghasilkan informasi pasien
Menyediakan register dan laporan
Keterlibatan pasien
Fitur TIK Kes di Layanan Primer Pertukaran informasi secara elektronik
Fasilitas pemasukan perintah (order entry) Sistem pendukung keputusan
Fitur TIK Kesehatan di Pelayanan Primer (Audet et al, 2014) Menghasilkan informasi pasien
pasien dapat : -meminta rujukan online -konsul lewat email Keterlibatan pasien -peresepan online -melihat hasil lab secara online
-bertukar ringkasan klinik dengan faskes lain -bertukar hasil lab/diagnostik dengan faskes lain -menerima ringkasan kepulangan pasien yang dirujuk dari faskes vertikal
-rekam medis pasien elektronik -daftar obat setiap pasien -daftar hasil lab -ringkasan kunjungan
Menyediakan register dan laporan
Fitur TIK Kes di Layanan Primer
Pertukaran informasi secara elektronik
Fasilitas pemasukan perintah (order entry) Sistem pendukung keputusan
-daftar pasien menurut diagnosis -daftar pasien yg harus skrining -daftar pasien dg obat tertentu -daftar pasien dengan hasil lab tertentu -memasukan resep -memasukkan daftar pemeriksaan lab -mengirim resep ke farmasi -melihat daftar lab yg masih dalam proses
-alert interaksi/dosis obat -alert hasil lab -alert skrining -mengirim reminder ke pasien
TIK pada pelayanan kesehatan dasar di negara berkembang (Oluch et al, 2012) • Kepatuhan terhadap penggunaan pedoman klinis meningkat jika sistem reminder diterapkan • Menurunnya kesalahan: data, penjadwalan, hasil lab, waktu tunggu pasien • Meningkatnya waktu yang dialokasikan oleh klinisi terhadap pasien • Tantangan: • Infrastruktur, listrik • Ketrampilan menggunakan komputer • Kepatuhan terhadap pedoman meski sudah mendapatkan reminder
MENU ENTRY DATA
MENU REPORT
Satu operator dengan 2 workstation Dengan 2 aplikasi berbeda
Ada aplikasi billing system tetapi Tidak memenuhi kebutuhan rumah sakit
Entry dg software Billing system
Entry dg software Askes
Status asuhan keperawatan tercetak dengan rapi di RSUD Banyumas
RSCM sudah menerapkan rekam medis elektronik, e-prescribing, PACS
Proses Approval olehApoteker
7
(BPJS, Kemkes, Dinkes)
6 4 5 3
2 1
8(Availability, utilization, effectiveness, impact)
Hardware and Software Computing Infrastructure • Purely technical • Physical devices • Software • network
• the user is not aware that most of this infrastructure exists until it fails
Clinical Content • everything on the data-information-knowledge continuum that is stored in the system • Clinical vocabulary/terminologies • patients’ condition (e.g., laboratory test results, discharge summaries, or radiographic images). • demographic data and patient location
Human Computer Interface • An interface enables unrelated entities to interact with the system and includes aspects of the system that users can see, touch, or hear.
People • represents the humans (e.g., software developers, system configuration and training personnel, clinicians, and patients) involved in the design, development, implementation, and use of HIT. • includes the ways that systems help users think and make them feel
Workflow and Communication • people often need to work cohesively with others in the health care system to accomplish patient care • workflow must be modified to adapt to the HIT, or the HIT system must change
Internal Organizational Policies, Procedures, and Culture • organization’s internal structures, policies, and procedures affect every other dimension
External Rules, Regulations, and Pressures • the external forces that facilitate or place constraints on the design, development, implementation, use, and evaluation of HIT in the clinical setting. • Example?
System Measurement and Monitoring • HIT must be measured and monitored on a regular basis: • availability – the extent to which features and functions are available and ready for use • utilization - to determine how the various features and functions are being used by clinicians • effectiveness - to ensure that anticipated outcomes are achieved • Impact – to document unintended consequences that manifest themselves following use of these systems
Kerangka Etik dalam Informatika Kesehatan
General Ethics • 1. Principle of Autonomy
• All persons have a fundamental right to self-determination.
• 2. Principle of Equality and Justice
• All persons are equal as persons and have a right to be treated accordingly.
• 3. Principle of Beneficence
• All persons have a duty to advance the good of others where the nature of this good is in keeping with the fundamental and ethically defensible values of the affected party.
• 4. Principle of Non-Malfeasance
• All persons have a duty to prevent harm to other persons insofar as it lies within their power to do so without undue harm to themselves.
• 5. Principle of Impossibility
• All rights and duties hold subject to the condition that it is possible to meet them under the circumstances that obtain.
• 6. Principle of Integrity
• Whoever has an obligation has a duty to fulfil that obligation to the best of their ability.
Information Ethics • 1. Principle of Information-Privacy and Disposition
• All persons and group of persons have a fundamental right to privacy, and hence to control over the collection, storage, access, use, communication, manipulation, linkage and disposition of data about themselves.
• 2. Principle of Openness
• The collection, storage, access, use, communication, manipulation, linkage and disposition of personal data must be disclosed in an appropriate and timely fashion to the subject or subjects of those data.
• 3. Principle of Security
• Data that have been legitimately collected about persons or groups of persons should be protected by all reasonable and appropriate measures against loss degradation, unauthorized destruction, access, use, manipulation, linkage, modification or communication.
• 4. Principle of Access
• The subjects of electronic health records have the right of access to those records and the right to correct them with respect to its accurateness, completeness and relevance
• 5. Principle of Legitimate Infringement
• The fundamental right of privacy and of control over the collection, storage, access, use, manipulation, linkage, communication and disposition of personal data is conditioned only by the legitimate, appropriate and relevant data-needs of a free, responsible and democratic society, and by the equal and competing rights of others.
• 6. Principle of the Least Intrusive Alternative
• Any infringement of the privacy rights of a person or group of persons, and of their right of control over data about them, may only occur in the least intrusive fashion and with a minimum of interference with the rights of the affected parties.
• 7. Principle of Accountability
• Any infringement of the privacy rights of a person or group of persons, and of the right to control over data about them, must be justified to the latter in good time and in an appropriate fashion. These general principles of informatic ethics, when applied to the types of relationships into which HIPs enter in their professional capacity and to the types of situations they encounter when thus engaged, give rise to more specific ethical duties. The Rules of Conduct for HIPs that follow outline the more important of these ethical duties. It should be noted that as with any rules of ethical conduct, these Rules cannot do more than provide guidance. The precise way in which the Rules apply in a given context, and the precise nature of a particular ethical right or obligation, depends on the specific nature of the relevant situation.
Kesimpulan • SDM terlatih masih merupakan orang yang lebih tepat untuk memberikan pelayanan kesehatan. Software tidak dianjurkan untuk mengesampingkan keputusan manusia • Klinisi yang menggunakan perangkat informatik harus memiliki kualifikasi klinis dan terlatih menggunakan software • Perangkat elektronik harus dievaluasi dan divalidasi secara tepat • Evaluasi meliputi kinerja, kemanjuran (efikasi) dan pengaruhnya terhadap organisasi, budaya organisasi dan SDMnya • Pengembang, pemelihara dan pengguna aplikasi harus wajib memperhatikan aspek etika • Kewajiban melindungi kerahasiaan dan privacy harus seimbang dengan upaya melindungi akses terhadap informasi • Perlu ada tata kelola mengenai penggunaan data kesehatan elektronik untuk riset.
