Impact of Information System in Health Sector

¶ … Information Technology on the Healthcare sector

Healthcare systems serve to perform the very important function of preserving human capital. In modern society, health care assumes significance not just in terms of the expenditure it generates, but also because it is a large-scale consumer of goods and services, important employer and contributes in research and development. From the perspective of countries, maintaining and improving health care services require significant investments. Consequently governments and the private sector consistently strive to improve the productivity levels of this sector by controlling costs. It is in this context that information and communication technology can play a key role in making both ends meet - ensure adequate health care for people at affordable costs. (Murphy, p. 12)

There is considerable criticism that health sector is markedly lagging in adopting information technology practices, thus preventing the benefits that can reach the patients and practitioners of the profession. This trend is noticed even in advanced countries like the U.S. And Europe. In the U.S., it is estimated that more than 90% of about 30 billion health transactions still continue to be managed through telephone, fax and the mail modes. A survey by the non-profit organization eHealth Initiative revealed that as much as 40% of health care establishments reported IT budget allocations of a measly 1.5% or less of their total operating expenses budgets. (Murphy, p. 12)

While the induction of IT is healthcare has still some way to go, there have been some significant changes in working practices in some areas. Perhaps the most important development is the availability of current and reliable health information to anyone with internet connection facility. This means that patients can play a greater role in the health care process by finding more information about healthy living, diseases, medical treatment, advances in surgery and so forth. Since internet technology is independent of distances, patients living in different can consult with doctors living elsewhere. In fact, doctors performing complex surgeries resort to online expert's advice and assistance right at the operation theater. For patients living and working in remote and far-flung areas, IT-enabled medical services are a boon as the number of times they need to visit expert medical practitioners can be drastically reduced. The doctors can follow the progress of their patients by exchanging information online and this reduces time and costs for both the parties involved.

IT offers tremendous advantage for medical professionals as well. Medical journals from different parts of the world are now available online and there are several websites offering information and advice. The main benefits include avoiding physical movement of patients or medical staff from locations where adequate expertise is not available, by relying on direct electronic transfer of information; increasing response time of medical institutions, and reducing wastage by monitoring available resources. Integration of electronics, communications and medical technology provide citizens many options from which they can choose the type and extent of health care they need.

National governments are waking up to the reality that IT can play a major role in improving healthcare services. The European Union (EU) proposed the eHealth scheme in 2002, which is an integral part of its EU health strategy covering EU's information system policies and activities for healthcare sector. The strategies under this scheme include developing a comprehensive database on personal health information and medical emergency data, developing health information networks for quick and easy access to health information across the healthcare system and enabling online health services.

The online health services would maintain electronic health records and provide ready information on illness prevention, tele-consultation and e-reimbursement. In April 2004, the EU formulated an action plan for providing better healthcare to European citizens. The plan was aimed at achieving two main objectives: speedy adoption of latest information and communication technologies in the health sector and integration of the entire spectrum of e-Health policies and activities. With this initiative, EU policymakers believe that, by 2010, e-Health would become an essential service available to every citizen and will be adequately budgeted in the national expenditure. (Europa Information Society)

Task 1- External Environment

Technological innovations in the Health sector:

From an overall perspective, an IS/IT strategy for the health sector would center on data communication. In the current scenario, several types of information systems exist to meet different kinds of needs. However, all systems would fall under three broad categories - strategic, tactical and operational. Strategic systems are implemented for achieving the long-term goals of the organization and generally dealt by decision and policy makers. Tactical activities are those that are carried out by personnel and collectively, these activities should lead the organization to the strategic objectives. The operational systems deal with technical and data-based systems required for managing day-to-day operations.

Operational information systems:

Typically, these information systems help manage transactions in the health care system. They provide historical records of past transactions and perform routine record management functions. Data collection, input validation, information processing and output generation are the tasks of operational information systems. Order entry, accounts payable and receivable, inventory control, payroll and general ledger are some of the functions done by these systems.

Management information systems:

Given the dynamic and complex nature of the health sector, managers need information to take quick decisions which may have far reaching consequences such as saving lives and controlling health degradation. Management information systems are prepared with inputs from the operating managers and presented in a form that could be easily assimilated and understood by decision makers. This helps decision making in various key activities such as planning, finance, marketing, logistics, human resources and project management.

Decision support systems:

For solving unstructured management problems, interactive information systems or decision support systems are used. The main advantage of this system is that it can provide multiple solutions for a problem and allow the users to take the best decision. In health care sector, decision support systems allows medical professionals and administrators to devise quality and cost control projects that can eventually lead to affordable healthcare. (Shapleigh, p. 24) Transition and Trendstar are some examples of decision support systems that are finding increasing applications, especially in large hospitals. Group decision support systems allow combining communications from different sources, interaction of computer networks and access to multiple databases, thus providing the platform for effective group decision-making in complex situations (Dennis et al., p. 602). Medical practitioners can use these systems while performing complicated surgeries.

Expert systems:

They are knowledge-based systems, used to make decisions or solve problems in a particular field. An expert system incorporates the technical and analytical knowledge and rules accepted in the professional and provide decisions based on these inputs. A popular expert system in healthcare is MYCIN, which enables diagnosis of infectious diseases and suggest possible therapies. Another example is the widespread use of casemix systems for hospital information systems management (Smith, p. 63). Expert systems are believed to have great potential applications in future health care management.

Future innovations:

Expert systems and decision support systems are still in its early stages in health care management. Advances in computer modeling and artificial intelligence are expected to result in more advanced and better expert systems in future that will make problem solving easier and quicker. Artificial intelligence systems, like humans, have the capacity to learn and develop new knowledge from existing data and interactions. Since computers have the innate ability to analyze large amounts of data, an artificial intelligence system can possibly link up seemingly disparate data and information and come up with new and innovative solutions. It an also perform the important function of alerting a medical practitioner when there is data to suggest that the patient's condition has changed or could change. Artificial neural networks, based on the model of the human neuron, are emerging as a potential technology that would enable accurate decision making even in the absence of information and data. Neural computing could find immense use in the design of National Health Information Systems and Public Health Care Systems.

It is evident that IT can have a positive and result oriented impact on the management of health care. But in practice, there are many issues that prevent easy integration of IT and medical systems. Some deep-rooted problems that inhibit adoption of IT relate to costs, competition, human resources, and infrastructure and so on. One of the greatest impediments is the huge investment that is required for setting up computer networks, data base management, training and hiring skilled personnel, maintenance and upgrading hardware and software. Small and medium sizes health care centers may not be able to set up full-fledged systems. The intense competition in health care prevents free sharing of information on patients, population and medical advances. This is perhaps one reason why even large medical centers still depend on traditional methods for handling patients and do not have a complete IT strategy. Another problem is the lack of technology infrastructure such as networking capacity, bandwidth, data transfer systems, power and connectivity, which prevent integration of IT in medical centers.

Impact of non-technical issues on IT strategy:

There are various non-technical issues that impact the IT/IS strategy in health care sector. External forces such as social and cultural environment, economic conditions, political environment, government policies, organizational considerations and attitude of personnel determine the success of failure of adopting IT systems in health care management. The cultural fabric on which the society has developed is a key ingredient in the sense that it defines the perspectives of IT and IS in medical care. For example, it is difficult to find ready acceptance of IT in certain African and backward Asian nations, where ancient beliefs and systems still drive the medical practices. It is common knowledge that IT has flourished more in countries with strong and knowledge-based economies. For instance, India, despite not being a very rich country, has a strong knowledge economy and is making great strides in IT and communications.

It is not logical to expect countries struggling to feed citizens invest in IT. The political framework in which the health care system operates is significant, because political compulsions can prevent free exchange of information, which is central to the development of IT. Governments of politically unstable countries like Afghanistan, Zimbabwe or Iraq would neither have the time nor resources to foster development of IT. These factors also determine the quantity and quality of human resources, which are vital for IT-based health care. Government policies involving international trade, development of healthcare and IT infrastructure and human resources, fiscal policies, taxation also play an important role. Organizational considerations such as competition, corporate strategies and business policies can prevent or stop use of IT systems, if they perceive it to be detrimental to their business interests. For instance, a pharmaceutical company may not be willing to share information on its research efforts, for fear of competitors developing competing products. Doctors may not be ready to share all their knowledge and expertise, as they may be afraid of losing clients and revenues. Hospitals may be reluctant to share information on patients.

Task 2 - Internal Environment

Internal environment in designing IT/IS strategy:

One problem posed by the health sector is that while the sector itself is in the nature of public service, the service providers can be either public or private. Depending on the nature of service providers, the priorities with respect to information technology may vary. Therefore, it may not be possible to have an IT/IS strategy that encompasses the entire spectrum of health sector. A health care system is based on integration of several complex forces and success depends on how well these forces can integrate and deliver the final output. For example, use of IT may require linking the IT systems with primary healthcare systems, hospital set-up, management support systems and the external systems.

From the perspective of information technology, a typical healthcare system in a hospital would strive to achieve four objectives - (1) sharing common patient information (2) electronic delivery of results (3) two way order communication system (4) the electronic patient record. It is evident that the objectives become complex in the ascending orders, with the fourth one, the electronic patient record being the ultimate. (Robins, p. 181) Any IS/IT strategy would have to define the level of objective and accordingly the action plan needs to be formulated. The various problems that can occur during the design stage of formulating the IT/IS strategy are as below (Bloomfield et al., p. 17).

Securing management commitment and involvement

Inability to convince the top management and operating managers on the IS/IT strategy

Lack of clear strategic objectives, time schedule

Linking the IS/IT strategy with the overall business plan of the establishment

Lack of adequate data and information

Lengthy and ambiguous time schedules for implementation

Resource constraints - technological, financial, infrastructure and manpower

Cost issues

Lack of competence in formulating strategies for integration of various components

Isolation of IT as a disparate function external to the health care system

Many of the above problems are inter-related. For instance, difficulties in linking the IT strategy with the strategic goals of the organization would certainly cast apprehensions in the minds of the top management. There is evidence to suggest that there is lack of understanding of the significance of IT at higher levels of management, which is probably due to the fact that IT strategies are led by an IS professional and not by a senior business manager. (Earl, p. 78) The IS professional would not be fully aligned to the business and strategic objectives of the establishment, thus leading to a gap in understanding. This situation is the root cause for a chain of problems. A management that is not fully convinced would be hesitant to offer full commitment and involvement, which could defeat the very purpose of implementing the IS strategy. Often, management sanctions the implementation of information strategy but loses interest once the project is commenced and allows it to drift away, which results in failure.

A major problems confronted by the IS manager is the fragmented nature of the workforce in the healthcare establishment. This makes interdisciplinary initiatives particularly difficult and the IS manager faces challenges in making operating managers appreciate the advantages of the proposed strategy. Unless the collective agreement of the operating staff is obtained, it is highly unlikely that even the best laid out IS strategy would succeed. The IS manager has to contend with the reality that doctors and medical technicians can be total strangers to the language of information technology.

Adequacy of current systems:

This is perhaps the ground problem that the IS manager would face in the design of any new strategy. Generally, health care establishments are not intensive users of IT systems and practices. And it is neither easy nor practical for the IS manager to replace all the existing systems at one go and install new systems for implementing the new strategy. It is to be noted that the operating staff would be tuned to the existing systems and it would require a great deal of persuasion and training to convince them to adopt them to the new systems. In assessing the current systems, factors such as culture, data quality, data protection policies and security measures must be considered, as they cannot be dropped overnight.

Resource constraints:

IS/IT systems require significant investments and the tangible benefits may not flow immediately. Due to this reason, establishments are not willing to commit financial resources for procurement of hardware, software and for training the operating staff. As a result, the IS manager faces problems in progressing with the proposed strategy at the desired pace. It is also quite possible there are not enough trained and skilled staff for implementing the IS systems and practices. In most organizations, it is the responsibility of the IT team to train all the users and lack of people and/or expertise to provide training can be a daunting problem. Lack of adequate infrastructure in the form of computing power, high speed connectivity, data processing capacity, networking systems and back-up systems can be another roadblock right at the design stage.

Consequence analysis:

major issue in the formulation and implementation of IT/IS strategy is the assessment of consequences that it can lead to. This problem is best highlighted by the example of Casemix, a popular hospital management information system in Great Britain. In some instances, there were some critical comments after the initial strategy was implemented. 'None of the reports are of any use to us'; The finance department uses it for contracting but the doctors don't use it all'; 'The system always seems to be down when I want to use it'; 'My data are not complete' (Lord, p. 174) These discouraging comments can drive even the most resourceful IS strategist to despair. It is therefore very important that the IS manager makes a thorough analysis of the possible consequences of the IS strategy and then build the appropriate strategy covering all risks at the design stage itself.

Emergency care is perhaps among the most critical functions of healthcare. In the U.S., emergency healthcare is provided through the public emergency response systems, commonly referred to as 911 centers. Many counties have started using IT driven systems, namely the Enhanced 911 and the Emergency Medical Dispatching systems, which uses IT to link digital identification from incoming telephone calls to a computer database with local information. This database is expected to include precise information about the location of the telephone in a building or a public place, thus increasing the possibility of tracking the individual accurately and instantly. Valuable time can be saved which can save lives as in the case of patients with cardiological problems and reduce the trauma of patients to a great extent in other cases. (Athey; Stern, p. 407)

Task 3: Summary Report

The health care industry is yet to integrate IS and IT into its practices for a variety of reasons. Nevertheless, the potential that IT holds in the advancement of healthcare services has been well appreciated and institutions and national governments have shown the tendency to use IT-driven systems for the benefit of patients and the overall profession. At present, the health care uses various information systems for operations, managerial decision making and for unstructured decision making and solving complex problems in the course of administrating health care. Decision support systems and expert systems are being developed for providing assistance in expert medical treatment; however their use is still not very widespread. IS/IT systems are expected to play an increasingly significant role in the administration of healthcare in future with advances in computer technologies such as digital applications and artificial intelligence.

Use of digital technologies has shown the path for increased quality and productivity of health care services starting from diagnosis phase, covering treatment and till the stage of rehabilitation. With modern technologies, it is possible and feasible to link people's homes, medical centers, laboratories and drug stores. In such a scenario, clients can have access to the entire range of medicines and services available and choose the best alternative at competitive prices. For the service providers and marketers, digital technology provides reach to wider markets; helps reduce inventories and thus lead to significant cost savings. Apart from the technical factors, a host of non-technical issues such as social, economic, political, cost, organizational and individual considerations also impact the employment of IT strategies in health care sector.

From the analysis of the external and internal environment in information strategic planning and development, it is evident that the most important phase in induction of IT in health care is the design stage. It is at this stage that the IS manager will have all the flexibility and options to decide on way forward. Overlooking any of the internal or external factors could be dangerous, in the form of undesirable consequences at a later point of time. Unlike other industries, which deals with objects, the healthcare sector deals with life and any lapse in IT driven systems could lead to disastrous consequences. Therefore, strategic information system planning assumes great significance in the health care sector.

There is general consensus that the health sector has been a relative laggard in embracing IT and strategic planning information systems. While there are several approaches to information strategic, empirical studies had narrowed the areas of strategic applications to four generic types (Ward, et al., p.55):

linking the establishment through technology-based systems to customers (patients) and suppliers improved integration of internal value adding processes enabling the establishment to develop and deliver new and enhanced services management support, especially external databases.

The key for effective use of IT in health care sector is the integration of various discrete processes in the system. It is very important that the IS/IT strategy is in line with the organizational strategic objectives and support progression in the desired direction. If this does not happen, then the credibility and value of IT systems becomes uncertain. The investments made in implementing the IT strategy must be commensurate with the delivered results in terms of improved healthcare at affordable costs.

There are many issues and problems that the IS manager has to deal with in the implementation of the IT strategy. The fundamental problem is that the IT function is yet to be recognized as a part of the healthcare systems as a result of which the IS manager finds it difficult to implement the systems and procedures across the fragmented divisions within the establishment. Lack of top management commitment and involvement, failure of the management to provide adequate resources and inability to create awareness of the importance and value of IT driven systems are the major stumbling blocks to success implementation of IT. Another major point of concern is neglecting to carry out a consequence analysis before deciding on the IS/IT strategy. This is because the IT functions in healthcare sectors are led by the IS manager and usually, senior management does not take direct part in the process. From a long-term perspective, it is essential that this trend changes and top management starts taking active interest in developing IT systems in their establishments.

To sum up, information technology strategy helps health care organizations to achieve competitive advantage. It enables spread of IT to every part of the organization. There is increasing tendency for establishments to depend on IT for day-to-day and critical operations. A good IS/IT strategy supports the growth of international organizational systems and integration of communications technology with information technology. Eventually, information strategy and systems should meet the growing needs of health care by people and make available top quality services at best costs.