Do patients dream of electronic doctors?

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Do patients dream of electronic doctors?

In a world of remote monitoring and point-of-care tools, can innovation and privacy really co-exist?

COACH

31 October, 2012

In the dawning age of eHealth, the health care industry is under growing pressure to join the digital revolution. But while hospitals struggle to absorb new technologies, experts wonder what sorts of measures need to be implemented to protect patients' – and doctors' – privacy.

"We're behind in everything," Matt Anderson, President and CEO of William Osler Health System, argued at the recent Techna symposium. "Five years behind Facebook, years behind in every technology."

Techna, the Institute launched in 2011 by the University Health Network in collaboration with the University of Toronto to accelerate the development and exploitation of health care technologies, put the debate front and centre at an annual Symposium that explored technological innovation in health care.

Even the most innocuous and widely available technologies represent a major challenge to a medical industry consistently outstripped by technology, Anderson argues, putting forward the example of Skype, a tool that millions use to keep in touch - and could potentially be used to breach the privacy of doctors.

"What do we do when average people reach out to you?"

Saäd Rafi, Ontario's Deputy Minister of Health, reiterated the importance of privacy in an age of technological innovation. "The two must go hand in hand," he stated, adding that "we can't afford to fail." In an age of unprecedented technological innovation, Canada's health care sector has a golden opportunity to "invent privacy measures" alongside technologies.

Ontario's Information and Privacy Commissioner, Ann Cavoukian, has been working to do just that. Presenting details from her 2011 position paper, "Privacy By Design," Cavoukian argued that "The future of privacy cannot be assured solely by compliance with regulatory frameworks; rather, privacy assurance must ideally become an organization’s default mode of operation."

But are regulations and policies truly flexible enough to allow technological innovation to flourish in Canada's hospitals? Cavoukian argues they are.

Cavoukian has been working with Dr. Khaled El Amam, Canada Research Chair in Electronic Health Information in the Department of Pediatrics at the University of Ottawa. El Amam has developed a "de-identification tool" for use with medical databases, which Cavoukian says is effective in resisting attacks on patient information.

The security measure helps protect patients from searches that exclude names but might contain information such as birth date, gender, or even postal codes—information that could potentially be "pieced together" with public records – with disastrous results.

"The protocol uses an encryption system to identify and locate records relating to an individual that may exist in multiple datasets," writes Cavoukian. "It involves encrypting personal identifiers in each dataset […], resulting in a complete list of matched records, without revealing any personal identifiers."

The integration of such tools into a hospital network, however, is a lengthy process, one slowed further by the need to ensure privacy in every aspect of design and implementation.

At the same time, the health care sector faces unprecedented pressure to streamline, minimize costs, and maximize patient care through technology. In an age of exponentially rising health care costs and a depressed world economy, e-innovations are not just a luxury—they're a necessity.

And they're being produced close to home.

Cavoukian mentioned COACH (Cognitive Orthosis for Assisting aCtivities in the Home), a system to monitor Alzheimer patients at home involving an unobtrusive camera, alongside a video screen that occasionally prompts patients to perform simple actions such as hand washing. A product of Associate Professor Alex Mihailidis , Barbara G. Stymiest Research Chair in Rehabilitation Technology at the Toronto Rehabilitation Institute and Professor at the Institute of Biomaterials and Biomedical Engineering (IBBME) and the Department of Occupational Science & Occupational Therapy, the device was designed with Cavoukian's Privacy by Design principles, and was tested in clinical trials this year.

But as David Jaffray , Vice President of Radiology and Director of UHN's Techna Institute and Associate Professor at the University of Toronto in Medical Biophysics and IBBME argued, maybe the experts need to explore the question itself further. "Is it about privacy? Or is it about security and consent?"

That's a question best left between you and your (electronic) doctor.

University of Toronto Institute of Biomaterials and Biomedical Engineering

Do patients dream of electronic doctors?

In a world of remote monitoring and point-of-care tools, can innovation and privacy really co-exist?