Technology's role in transforming modern medical practice and systems

¶ … Healthcare: How Technology Has Changed Medicine

OBJECITVE

The objective of this work is to examine how technology has effectively changed the practice of medicine.

(1) Electronic health record (EHR): Originally, the EHRs were viewed as electronic file cabinets to hold patient data from various sources however, they are now viewed as a part of an automated order-entry and patient-tracking system providing real-time access to patient data, as well as a continuous longitudinal record of their care.

(2) Computerized provider order entry (CPOE): CPOE in its basic form is typically a medication ordering and fulfillment system. More advanced CPOE will also include lab orders, radiology studies, procedures, discharges, transfers, and referrals.

(3) Clinical decision support system (CDSS): CDSS provides physicians and nurses with real-time diagnostic and treatment recommendations. The term covers a variety of technologies ranging from simple alerts and prescription drug interaction warnings to full clinical pathways and protocols. CDSS may be used as part of CPOE and EHR.

(4) Picture archiving and communications system (PACS): This technology captures and integrates diagnostic and radiological images from various devices (e.g., x-ray, MRI, computed tomography scan), stores them, and disseminates them to a medical record, a clinical data repository, or other points of care.

(5) Bar coding: Bar coding in a health care environment is similar to bar-code scanning in other environments: An optical scanner is used to electronically capture information encoded on a product. Initially, it will be used for medication (for example, matching drugs to patients by using bar codes on both the medications and patients' arm bracelets), but other applications may be pursued, such as medical devices, lab, and radiology.

(6) Radio frequency identification (RFID): This technology tracks patients throughout the hospital, and links lab and medication tracking through a wireless communications system. It is neither mature nor widely available, but may be an alternative to bar coding.

(7) Automated dispensing machines (ADMs): This technology distributes medication doses.

(8) Electronic materials management (EMM): Health care organizations use EMM to track and manage inventory of medical supplies, pharmaceuticals, and other materials. This technology is similar to enterprise resource planning systems used outside of health care.

(9) Interoperability: This concept refers to electronic communication among organizations so that the data in one IT system can be incorporated into another. Discussions of interoperability focus on development of standards for content and messaging, among other areas, and development of adequate security and privacy safeguards. (Report to Congress, June, 2004, p.160)

INTRODUCTION

The implementation of information technology in the field of health care has not progressed as smoothly and has not been effectively integrated across domains as it was hoped might be the case. There are still technical and practical issues that must be overcome and as well the design and development process of information technology applications must consider key issues that have previously been appointed less important than other issues in design and development of information technology applications. As well, the implementation of information technology has progressed at a much slower rate than was originally expected however, until the issues identified in this report are addressed this will not be possible. This report will conduct a review of the literature that has been published in the past five years in order to determine what issues must be addressed in order to effectuate the implementation of information technology applications across all health care providers locally, regionally, nationally, and internationally in the future.

LITERATURE REVIEW

Electronic Medical Records

The work of Brookstone (2004) entitled: "Electronic Medical Records: Creating the Environment for Change" states that "as physicians become more advanced users of technology, they are exposed to a wider range of tools and technology-based clinical management systems: software and hardware intended to solve problems they face in clinical practice." (Brookstone, 2004) Brookstone states that the level of change "required to implement these solutions is significant and requires a methodological review of work processes before implementation. Even in the most organized practices, it is unlikely that there has been a clear enough documentation of workflow relating to the management of specific clinical data." (Brookstone, 2004)

Drivers of Investment in IT

In a 2004 Report to Congress entitled "New Approaches in Medicare" it is stated that information technology (IT) has the potential to improve the quality, safety and efficiency of health. Diffusion of IT in health care is generally low but surveys indicate that providers plan to increase their investments." (p.1) Drivers of investment in IT are stated to include:

(1) the promise of quality; and (2) efficiency gains. (Report to Congress, June, 2004)

Barriers to investment of IT include the "…cost and complexity of IT implementation which often necessitates significant work process and cultural changes." (p.157)

Characteristics of the Health Care Market

The 2004 Report to Congress states that certain characteristics of the health care market -- including payment policies that reward volume rather than quality, and a fragmented delivery system -- can also pose barriers to IT adoption." (p.157) The provision of new methods for providers and their patients to readily access and use health information, information technology (IT) has the potential to improve the quality, safety, and efficiency of health care." (Report to Congress, June, 2004, p.158) Despite this, very few health care providers have adopted IT fully. Low diffusion is stated to be due in part to the "complexity of IT investment, which goes beyond acquiring technology to changing work processes and cultures, and ensuring that physicians, nurses and other staff use it." (Report to Congress, June, 2004, p.158)

It is additionally stated that there is a great deal that remains unknown about the "role of IT in the health care setting." (Report to Congress, June, 2004, p.158) The delivery of quality health care makes a requirement of providers and patients in the integration of complex information from many different sources therefore "increasing the ability of physicians, nurses, clinical technicians and others to readily access and use the right information about their patients should improve care." (Report to Congress, June, 2004, p.159) The ability for patients in obtaining information that allows them to manage their condition better and that would improve communication with the health care system could also result in an improvement of the "efficiency and quality of care." (Report to Congress, June, 2004, p.159)

The Report to Congress states that both the private and the public health care sectors have "engaged in numerous efforts for promote use of IT within health care institutions and across delivery care settings." (2004, p.159) Activities have included:

(1) Development and promotion of industry-wide standards;

(2) Funding of research for investigation of the impact of IT on quality;

(3) Provision of incentives that provide encouragement of investment in IT;

(4) Giving grants to investors in IT; and (5) Development of strategies to improve the flow of information across providers. (Report to Congress, June, 2004, p.159)

Stated additionally in the Report to Congress is that there are multiple functions that must be considered when purchase IT and hundreds of applications that various vendors offer. The various IT applications are stated to be within three categories including those of:

(1) Administrative and financial systems that facilitate billing, accounting and other administrative tasks;

(2) Clinical systems that facilitate or provide input into the care process; and (3) Infrastructure that supports both the administrative and clinical applications. (Report to Congress, June 2004, p.160)

The work published by The Royal Society entitled: "Digital Healthcare: The Impact of Information and Communication Technologies on Health and Healthcare" states: "The single most important factor in realizing the potential of healthcare ICTs is the people who use them. The end users of any new technology must be involved at all stages of the design, development and implementation, taking into account how people work together and how patients, carers and healthcare professionals interact." (2006, p.1) It is additionally stated that it should be recognized by all healthcare professionals that ICTs hold great potential value in the health care workplace. It is important that healthcare managers "ensure sufficient time for healthcare professionals to be involved properly in the design, development and implementation of new technologies. This includes local and national health authorities ensuring that funding and time are allocated for initial training and ongoing support when new systems are introduced." (The Royal Society, 2006, p.1) The Royal Society additionally states that higher education institutions and professional bodies "…must ensure that both basic training and continuing professional development include the use and understanding of ICTs as an integral part of healthcare professionals' everyday role." (2006, p.1)

The Royal Society states the belief that "Healthcare ICTs will change the roles of patients, carers and healthcare professionals in the delivery of healthcare. For example, more healthcare-related material is available now for patients via the worldwide web, leading to a new role for healthcare professionals in guiding patients through the various information sources. Continued research into the socio-cultural impact of healthcare ICTs is required." (2006, p.1) The Royal Society states that data access is both a complex as well as a controversial issue since it is "…technically possible to establish systems that allow different levels of access to an individual's electronic health records. However, it is not clear what a sensible access policy would be because there is an unresolved conflict between privacy and sharing healthcare data for both individual and public benefit." (2006, p.2) In order that a resolution be found to this conflict "…there needs to be further engagement with patients, carers and the wider public to determine where a workable balance lies between privacy issues and data sharing." (The Royal Society, 2006, p.2) The health policy of future government is stated to be presented with a need to "…be informed by the findings of this engagement." (The Royal Society, 2006, p.2)

The Royal Society states that it advocates strongly for "an incremental and iterative approach to the design, implementation and evaluation of healthcare ICTs. This involves engaging the end users at all appropriate stages from determining the specifications through to training and ongoing support once the system is introduced." (2006, p.2) Stated to be a major part of this approach is the design and development since this includes good or bad elements of systems. Particular attention should be paid to the "impact of the speed and scale of the different programs and the varying levels of user-engagement." (The Royal Society, 2006, p.3)

The criteria for evaluating the technical and financial performance should be establishing in the beginning of the development process as should user satisfaction. There is a requirement that "…local, regional, national and international systems must be able to operate together and share information, which requires national and international standards. We encourage the Government to build on its ongoing work to achieve connectivity as quickly as possible between the different national and international standards being developed. It will not be possible to establish fully interoperable systems until these standards are agreed." (The Royal Society, 2006, p.3)

The following figure lists examples of health information technology for hospitals and physicians.

Figure 1

Examples of Health Information and Technology for Hospitals and Physicians

Source: Report to Congress (June, 2004)

SUMMARY AND CONCLUSION

This work has identified the primary barriers and drivers of information technology in the health care environment and as well has noted the various challenges that are presented in implementation of electronic medical record systems and other information technology applications in the health care workplace.

Barriers have been noted to include the immaturity of software and training issues accompanied by concerns over privacy. Cost and complexity have also been noted in this study to present specific challenges to implementation of IT. Interfaces are noted in this study as a particular problem in electronic medical record system implementation. That which serves to drive information technology investment are two factors: (1) the promise of quality and (2) gains in efficiency.

The effort should be specifically driven by management in the health care sector and by higher educational institutions and professional bodies through making sure that basic training as well as ongoing professional development are inclusive of the understanding of the use of the information technology as being integral in the role of the healthcare professional daily. Concerns of patients over privacy will have to be effectively addressed as well as issues relating to integration of systems on local, regional, national and international levels.

While information technology implementation in health care has not progressed at the expected rate, it is likely that as health care professionals become more attuned to and informed of the capacity and potential of information technology applications in the health care workplace that information technology will be implemented widely across the health care sector.