Home surveillance

Governments are now turning their focus on integrating electronic medical records to include surveillance into private homes. The Canadian Home Care Association is urging the government to seize the opportunity for information technology into homes where most health care is delivered.

A report titled “Integration through Information Communication Technology for Home Care in Canada,” was sponsored by Canada Health Infoway, a federally-funded nonprofit group working to “accelerate the use of electronic health information systems and electronic health records across the country.” Its members include the country’s 14 Deputy Ministers of Health.

“Canadians live, work and access their health care in their communities, and as they age, Canadians want to remain in their communities where they can continue to make meaningful contributions,” the report says. No one can argue with this, or that when an illness strikes, home healthcare can help people remain safely in their homes, live independently, and reduce doctor's visits and strain on hospitals. But this report isn’t talking about simply providing services to improve the ability of people to communicate with their healthcare provider, electronically sharing information they choose. Nor is it simply talking about a private service to access emergency assistance or that would notify loved ones when help is needed, as might be desired to protect a frail elderly living alone or someone with the beginnings of dementia.

This is government monitoring and integrating home surveillance data into a federal health database for the government to manage care and supervise compliance.

Home healthcare providers, contracted by you or your doctor, are already given medical record information necessary to provide you needed care. This initiative expands telemedicine applications into increasingly intrusive monitoring of you and your activities inside your home. There are no protections in place as to limits on the private information it could collect or how the information could be used. At the very least, such protections should be in place before a system, with such potentials for abuse, is launched. Digital data it collects can be stored and transmitted to any entity in the federal health IT system and enable third party interventions, that may or may not be voluntary or requested. As the report says:

The potential for technology within home care is exciting and captures the imagination of home care leaders across the country. Being able to have immediate access to a client’s historical medical record on admission into home care; and conversely being able to share information about the client’s functional status and approach to care at home with the broader health care team would increase the efficiency of the system...and will enable the gathering of objective comparable data on system utilization and outcomes to inform policy development.

The report differentiates between active and passive monitoring. Active monitoring is where people have to turn on equipment or push a button and voluntarily share information on their health or seek information and help. While it doesn’t negate the need for doctor’s visits and in-person care, it can provide people with a tool to help them communicate with their care provider and enable care modifications without trips to the hospital.

In contrast, “a passive system does not require any action by the client to make the system work.” As you read the report’s description, ask yourself if this is a right you want government to assume, under the guise of making sure you eat and take the medications it prescribes for you, to keep you healthy or safe; if this is a role for federal, integrated government surveillance; and once such a nationwide system is in place, how it could be misused:

Passive monitoring systems range from video cameras to sensors and motion detectors. The opportunity is to use the technology to help someone at a distant location determine if there are issues in the home. Some passive systems put cameras in the... person’s home that allow someone somewhere else to see what the camera sees. Others use sensors that can detect motion to alert others if [or what] the elderly person is not eating, has not taken their medication, or has fallen. These systems may be used to watch over elderly people who might not realize they need help, like someone with early stage Alzheimer’s who might forget to eat or take medications. They can also be used to detect falls or other problems as they happen, or to monitor third parties like home health aides and other home help. It is not known yet how well these types of systems will be accepted by clients as they may object to this level of observation...

An important application would be in the area of medication management. Home care typically manages six times the number of medications than the institutional sector on any day. There are no good systems for tracking medication management and events in the home and community sector...

Building blocks to an electronic health record system, according to the report, includes digital imaging, drug information, and laboratory information systems. A comprehensive and effective electronic health record, accessible across the country, “will not be realized until the key elements of the home care sector contribution are embedded,” said the report. Since the home setting is where most health behavior and interventions actually take place, home systems are essential for any electronic health record, it says.

The system is said to increase the number of patients that can be efficiently managed. “Telehomecare and administrative data also contain important information that needs to be shared with the broader health care team and linked...[to] the full range of providers/sectors.” Effective application of electronic technology in the home care setting will ensure that the system is appropriately and efficiently used and can improve the ability to measure, assess and manage healthcare, the report concludes. But who is determining those managed care performance measures and what are the ramifications for not complying with ones you or your doctor don't feel are evidenced-based and best for you, or those that are undesired? With telehomecare, these considerations have added importance since they'll be no escape and your health behaviors will be monitored even inside your own home.

This story took added significance and food for thought today, as Consent of the Governed wrote about how we’re steadily being de-sensitized to turning over increasingly more of our privacy rights to the government and accepting federal intrusions and oversight, in the name of added security. Something to think about.

© 2008 Sandy Szwarc