Integration of ICTs in the Health System: Basic Services and Risks to Privacy
Challenges, achievements and gaps
When we talk about new technologies in our everyday life, it is more than becoming familiar with internet and its potential as a main source for data. Information of all kinds, if we are privileged enough to have regular access, can be transformed into knowledge.
One of the fields where technology is influential is health care. I don’t say anything new when I affirm that health care, research and prevention affect women differently from men, whilst bearing in mind that women are not a homogeneous group.
At the premise, a health care system should be gender-sensitive considerations by implementing a responsive method to gender differences, where accurate information is consistently provided. Information and communication technologies accompanied with adequate training for use can positively impact this in some basic ways, like providing information about diseases, or a detailed description of all risks and collateral factors that are usually neglected as secondary causes or processes, how to respond to health situations and where to go for help. At the same time, much governmental efforts have been concentrated on recording, storing, digitising and mapping personal data, with consequences to rights to privacy and security.
This article will present examples from both situations, the policies that support them and methods used depending on different social contexts.
From theory to praxis: main concerns of governments
In Europe: ICTs applied to health sciences and services is one of the main concerns of most European countries. For instance, The Quality Plan for the National Health System in Spain now incorporates ICTs to improve its service and efficiency. One main strategy is a State project called “Health Online”, with a primary objective of normalising the use of ICTs by the public on issues related to health.
In the last decade, almost every autonomous region in Spain has prioritised the implementation of ICTs within four areas of application: developing a reliable system of user-identification (Health Identity Card); digitising the medical history of each patient (Digital Clinical History); developing support systems at the different pharmaceutical fields (delivery, information, prescription); and “distance appointment” between the family doctor and the specialist, as well as “distance assistance” to patients to avoid long displacements and other inconveniences.
Implementation of such technological approaches and retention of personal data necessitates adequate responses to ensure that the privacy and safety of current or potential patients are not compromised. This is particularly important in contentious areas related to health such as reproductive rights. The Spanish Society for Gynecology and Obstetrics (SEGO) dedicates a large chapter to the protection of data, based on the Protection of Data Law. It emphasises that information about a patient has to be very basic, destined to her own benefit and by no means used for medical goals divorced from her specific needs. The patient must be informed about where the file with her personal data are located, who is the responsible for it and the possibility to eventually exercise her right to request for the elimination of the data. In short, priority is placed on confidentiality, consent, safety and information.
One of the main concerns of the European Union is the creation of a roadmap called “I am life”, with a detailed description on the importance of ICTs in the proper and systematic registration and analysis of personal data. It also mentions that “intelligent monitors” can be utilised to check vital functions using sensors and network technologies. However, despite plans to incorporate social ethical issues, the chapter dedicated to women’s health is not extensively developed: policies related to the protection of data are not clearly indicated. Further, in some contexts such as in instances of sexual assault, women survivors require additional services: emotional support, psychological assistance and long term attention are required but not always offered.
In Latin America: In Chile, there is a sophisticated system that utilises ICTs combined with an exhaustive registry of data, which enables complex research in the field of mental health, restricted to the metropolitan area of Santiago. It records factors like incidences of mental health problems faced by the female population, and takes into consideration other variables such as the current use of health services, prevision programs or disabilities of all kind. The results show that thus far, twice the number of women is affected by psychiatric diseases as compared to men. Such “social diagnosis” and attention to gender disaggregated data is an important starting point to further develop effective responses at individual and personalised levels.
In Africa: In South Africa, by collecting information about the way each country in the Africa region organises its agenda of reproductive rights and matters related to women’s health matters, reliable statistical databases and effective exchange of experiences are enabled. The possibility of developing an access point to information at, for instance, hospitals, becomes more achievable than ever before. The main challenge rests on convincing women about the advantages of using ICTs to find out more about their own health. The advantages are not concentrated in the treatment of a disease, but can also play a central role in the prevention area: for example, information about high risk factors and related matters such as discrimination and abuses on HIV infection can be provided.
In Asia: In Thailand, some basic development and implementation of ICTs can respond to the health needs of poor communities who are stateless, most of whom consist of women. In some regions, there are no registrations of birth and as such, a significant group that doesn’t exist in legal terms or can have access to basic rights. Having a registration - a method that doesn’t necessitate high costs or investment - could help to eliminate their vulnerability to exploitation, the black market and human smuggling, and support their access to basic state benefits like health care services, education and domestic travels with less risks.
A provisional conclusion
This article merely presents a rapid overview of some approaches to the implementation and integration of ICTs in health and medical policies by the State. Although there are risks presented through the amassing of personal data within the health system, where there is a threat in loss of privacy and the use of such data for social control, with an emphasis on the protection of patients’ rights, basic health services can be more attainable for a wider section of the populace.
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