Evolution of Health Care Information Systems

Evolution of Health Care Information Systems

The objective of this study is to compare and contrast a contemporary healthcare facility or physician's office health care facility or physician's office operation of 20 years ago and to identify at least two major events and technological advantages that influenced current HCIS practices. The physician's office and health care facility of 20 years ago was a paper-based operation. All records were paper records, appointments were written on calendars and prescriptions were handwritten, notations on the patient's health records was done by writing on the physical paper record and all hospital orders were written by hand. During the 1970s hospital growth and expansion occurred and the expenditures for Medicare and Medicaid were on the rise. At this time mainframes were still in use and microcomputers became available and not only were they smaller but they were also less expensive. However, transformation did not come until the 1980s when two things happened. First the microcomputer or the PC was unveiled and secondly, the local area network came into being. Following close behind was the capacity for distributed data processing, expansion of clinical information systems in hospitals, introduction of billing systems by physician practices, affordable powerful computers being available to smaller organizations and the ability to integration financial and clinical information becoming increasingly important. In the 1990s there was a call for reform of the health care system and this resulted in changes in the way that physician reimbursement to Medicare and growth of managed care and integrated delivery systems as well as the Institute of Medicine calling for adoption of computer-based patient records. (History and Evolution of Health Care Information Systems, nd, paraphrased) In addition, the 1990s was characterized by the Internet's introduction, which resulted in a revolution in how organizations communicate with one another, how services were marketed, and how business was conducted. The cost of hardware also became less expensive. Health care organizations make good use of the Internet by the 1990s and the vendor community expands rapidly with a diverse array of HCIS products and services becoming available with a growing emphasis on clinical applications. During the 1990s, adoption of CPR/EMR systems was small in nature. By the 2000s decade the entire health care environment had transformed. (History and Evolution of Health Care Information Systems, nd, paraphrased) Health care information systems are one of two types: (1) practice management; (2) electronic health records (EHR). ( ) Practice management software enables the organization of patient information including "appointments, lab results, and referrals." (History and Evolution of Health Care Information Systems, nd, paraphrased) Electronic health records contain the same information, as would the traditional patient health record. Today's health care information system is highly integrated with service providers, hospitals, and pharmacies. The physician can order hospital and clinical testing via a handheld device that is linked to the hospital network linking all departments of the hospital together enabling communication in and among this group of providers. A cost-benefit analysis conducted and reported upon states that when analyzing the usefulness of implementing HIT the various factors that must be considered include:

(1) The potential of this technology to improve health care quality, safety, and patient satisfaction -- and how this potential has been demonstrated.

(2) The cost-effectiveness of the technology -- the business case for adoption of the technology -- including the total costs of implementation (both financial and in terms of resources) and any cost savings that accrue. Concerns exist that those who bear the greatest share of such costs are not able to recoup those costs.

(3) The ability to generalize the effects of an HIT intervention on costs and benefits in existing systems (using published experience with or research on these systems) to the technology's use by other health care organizations. (Southern California Evidence-based Practice Center, nd, p.1)

The costs of implementing an HER system is reported and it is stated that five studies "quantitatively assessed the costs of implementing an EHR system" and that the costs are categorized as follows:

(1) cost of the system itself (hardware, software, license, maintenance, and support) and (2) implementation cost (training, temporary loss of productivity, etc.). (Southern California Evidence-based Practice Center, nd, p.)

The reports following the study states that the evidence indicated that implementation of EHR systems are financially "viable at the individual organization level or through a nationwide implementation with high levels of health care information exchange and interoperability." (Southern California Evidence-Based Practice Center.

Implementation of Health Information Technology Systems has resulted in higher efficiency for physicians, hospitals and other health care providers. As well, Electronic Health Records have enabled more safety in prescribing medication to patients since physicians can view what the patient is presently being prescribed by other physicians and avoid prescribing medications that will interfere and interact badly with medications that the patient is already taking.

Other advantages of Electronic Health Records is the immediate access to patient health information so that the individual who has a history of heart attacks, strokes, or the patient who is allergic to specific medications or allergic to bee stings can receive the most appropriate treatment possible in emergency situations that are life-threatening. There were many predictions made about the changes that technology would bring to the health care environment. For example, Wang (2003) stated that Electronic Health Records would result in a reduction in healthcare costs, improve efficiency and productivity, and outweigh the costs from year 2 of the EMR implementation. Walker (2005) predicted that Electronic Health Records and health care information exchange and interoperability would result in "fully standardized and implemented health care information exchange and interoperability" that would 'yield a net value of $77.8 billion per year…" (Southern California Evidence-based Practice Center, nd, p.1) HIT is such that has as its primary goals the increasing of "the extent to which the patient is at the center of his or her health care." (Southern California Evidence-based Practice Center, nd, p.1) There are ten studies reported that conducted an assessment of computer-generated reminders. It is reported that of these, 'seven assessed the use of the reminder program to improve the delivery of preventive care such as mammography and immunizations. All studies reported "greater use of preventive services by patients- or the physicians of patients -- who received computer-generated reminders." (Southern California Evidence-based Practice Center, nd, p.1) Also reported is a study that tested the effectiveness of the use ComputerLink which is an alternative to traditional caregiver support services such as provided by support groups, and health education programs. This was tested in a 12-month randomized trial in family caregivers of people with Alzheimer's disease. It is reported that when compared with the control group with no access to ComputerLink, caregivers in the experimental group reported more improvement in caregiver strain." (Southern California Evidence-based Practice Center, nd, p.1) Five studies are reported that conducted assessment of consumer health informatics in various areas and stated that interventions included "a clinical trial of an interactive computerized patient education system in family practice; and assessments of the effects of computer tailored smoking cessation in family practice, the effectiveness of a computer-generated patient health summary in changing patients' knowledge, attitudes, and behavior concerning health promotion,1and the use of self administered computerized assessments for psychiatric disorders in patients in primary care" (Southern California Evidence-based Practice Center, nd, p.1) It is stated that all of the studies reported "benefits of the computerized health informatics system. A review of 37 studies of computer-generated health behavior interventions intended to motivate individuals to adopt various treatment regimens concluded that such systems are effective." (Southern California Evidence-based Practice Center, nd, p.1) In summary, the use of Health Information Technology Systems has advanced the effectiveness and accuracy of treatment provided by today's hospitals and physicians. The capacity exist for improved accuracy, improved diagnosis and prescribing of medications and improvements in gaining quickly accessed information to optimize the treatments provided to patients in the healthcare environment of contemporary times. When comparing the physician's office or the hospital environment today as compared with that of 20 years ago, the transformation that has occurred is clearly evident. Health Care Information Systems have transformed the way that health care services are accessed and administered in today's health care environment.