Renovation in Health Care and Information Technology


By

Dr. Vijay Pithadia
Assistant Professor & Kidevices Chair
School of Management Studies
Shri Leuva Patel Trust College For Women
Amreli–365 601
&
Dr. Vandana Parmar
Associate Professor
Department of Anaesthesiology
PDDU Government Medical College
Civil Hospital Campus, Rajkot-360 001
 


Summary:

In a knowledge-based society, information is the skeleton around which organizations are designed. Information Technology (IT) is increasingly playing an important role in the society and helps in the information exchange with higher efficiencies. IT models are developed of all the varieties which empower in bringing up the under privileged section on the same platform to other accessible sections. The government should identify and support programs which, being IT-enabled, can bring greater good to greater number of people.

Modern healthcare has moved away from seeing disease in isolation, to understanding that illness occurs at a complex system level. These systems produce our knowledge, tools, languages and methods. Thus, a new treatment is never created and tested in intellectual isolation.

Introduction:

In a knowledge-based society, information is the skeleton around which organizations are designed. Health informatics is thus as much about computers as cardiology is about stethoscopes. Rather than drugs, X-ray machines or surgical instruments, the tools of informatics are more likely to be clinical guidelines, formal health languages, information systems, or communication systems like the Internet. Although the name 'health informatics' only came into use around 1973 (Protti, 1995), it is a study that is as old as healthcare itself. It was born the day that a clinician first wrote down some impressions about a patient's illness, and used these to learn how to treat their next patient.

Informatics has grown considerably as a clinical discipline in recent years fuelled, in part no doubt, by the advances in computer technology. We build up rich communication systems to support the process of healthcare.  Health informatics is particularly focused on:

[1] Understanding the fundamental nature of these information and communication systems
[2] Developing interventions which can improve upon existing   information and communication systems
[3] Developing methods and principles which allow such interventions to be designed
[4] Evaluating the impact of these interventions on the way individuals or organizations work, or on the outcome of the work.

Words like quality and safety, clinical audit, outcome measures, healthcare rationing and evidence-based practice now define the new intellectual battleground. While the advance of science pushes clinical knowledge down to a fine-grained molecular and genetic level, it is events at the other end of the scale are forcing us to change. 

We have to put together rational structures for the way clinical evidence is pooled, communicated and applied to routine care. We have to develop organisational processes and structures that minimise the resources we use and maximise the benefits delivered. And finally the tools and methods are available to achieve these aims in a manner that is practicable, testable and in keeping with the fundamental goal of healthcare - the relief from disease.

Informatics has both theoretical and applied aspects to its study, like health care. Health care informatics should content every clinical action, every treatment choice and investigation, is shaped by the available information and how effectively that information is communicated The various roles that computer-based protocol systems can play in clinical practice are outlined.

We have to explore the special character of information systems in healthcare. The clinical record is given many names and is discussed in many different ways its role and scope should understand. Information systems like the electronic medical record are shown to manage a wide variety of activities. Ultimately, the way that these activities are modelled, measured and then managed is determined by information system design.

Sometimes, leaving things unsaid or informal is more productive than encoding them in a formal computer system. Consequently, the important concept of system formality is also introduced, since it is not always appropriate to build information systems. Indeed it can often be counterproductive. Understanding the role of formality helps principled decisions to be made before information systems are introduced. The concept of formality also helps us to understand the different roles that communication and information systems play in healthcare. With knowledge of foundational ideas in health care system, we have to focus on two information problems that are specific to healthcare - protocol-based care, and clinical coding.

The protocol based system cover both traditional 'passive' support where protocols are kept as a reference, and 'active' systems in which the computer uses the protocol to assist in the delivery of care. For example, protocols incorporated into the electronic record can generate clinical alerts or make treatment recommendations.

Communication system in health care is very important; interpersonal communication skills are fundamental to patient care, the process of communication has, for a long time, not been well supported technologically. Now, with the widespread availability of communication systems supporting mobility, voice mail, electronic mail and video-conferencing, Information systems are starting to become indistinguishable from communication ones, and this convergence is perhaps nowhere more apparent than with the Internet.

Now days for better use of advance technology Medical Information Sciences (MIS) training program is an interdepartmental program offering instruction and research opportunities leading to an MS or a PhD degree in medical informatics. The program is administratively based in the School of Medicine but is overseen by the Graduate Studies Committee of Stanford University and is viewed by the Graduate Division as a free-standing department for purposes of granting degrees.

Areas of investigation are diverse and include topics such as decision-support systems, integrated workstations, knowledge acquisition, speech input, mobile computing, medical records, computational biology, medical imaging, reasoning under uncertainty, information retrieval, medical terminology and vocabularies, technology assessment, and health-services research. Some of the areas where IT play critical role in relation to health care industry are:

[A] Telemedicine:

Dr. Ben G. Raimer said that" Telemedicine means that no distance can prevent a patient from top notch medical care."

It is a new method of delivering health care by sharing/exchanging the patient related data and medical opinion between medical specialist and a doctor in a remote location through telecommunication networks. Telemedicine applied in medical practice helps in;

* Reduction in need to transfer patients for expert opinion
* Decrease hospital stay
* Decrease in relocation of medical specialist
* Better diagnostic and therapeutic quality helps in effective use of medical and technological resources.
* Enhanced diagnostic and therapeutic quality of care.

These clinics work the same as the other programs, using t-carts to link the providers with presenter help, provide direct clinical care.

So telemedicine solution serves the following functions:

* Second/Special opinion
* Confirm diagnosis
* Plan treatment
* Provide acute interventional plan in case of medical emergency
* Remote consultation

[B] Complex Interpretations:

Complex medical cases often need more than one specialist opinion to ensure accurate diagnosis. In these cases, specialist at the remote site can easily approachable for interactions. This involves more than one input i.e. Tele-Radiology, Tele-Pathology, Tele-Cardiology etc., to arrive final diagnosis.

[C] Education:

Transmitting community development programmes and also for knowledge of medical/paramedical staff involved in enhancing and updating the delivery of health care services the tools like video conferencing system is the best updated help.

[D] Disaster Management:

The Tele-medicine stations can utilised to coordinate relief efforts aimed at the affected population; in natural calamities and disasters,

[E] Home Care:

Home care will benefit the patient by the way of remote monitoring and remote diagnosis. Trans–Telephonic ECG is the advance medical peripherals with its help connecting home to the Telemedicine centre will enable users to cut down travel costs and to avoid risky strenuous journeys.

[F] Telemonitored Procedure/Surgery:

In case of emergency when the surgeon is not available with the help of telemonitored assistance the general practitioner can perform surgical procedure.This is especially true when general surgeon needs specialist surgeon mentoring.

There are two categories of needs that can be met with Tele-medicine:                                      

[1] Operational Requirements
[2]Organizational and Structural Requirements

Operational requirement in form of Telediagnosis, Tele-assistance, Tele=monitoring.

Organizational and structural requirements Tele medicine offers access to a network of health care information, technology, and medical expertise, on demand, on a local, regional, national or worldwide basis.

Tele medicine eliminates geographical boundaries. It can source expertise within seconds any where it may be required and effectively mediates the diagnostic shortages and surplus that exists in health care today.

The structure of a telemedicine network depends on the following parameters;

* The objectives of network
* The geographical area that served by network
* Users of network: local clinics, regional hospitals, medical practitioners and speciality service

Telemedicine can provide a structural solution to meeting the following objectives:

* Regional management: telemedicine provide regional and international network linking medical participants.
* Legal and security: assurance can be given by medical practitioner to patients about confidentiality and security of the data transmitted via telemedicine network.
* Social Acceptability: Both medical practitioner and patients should accept this new dimension of health care.
* Methodology: Standard terms, protocols and procedures are used to communicate with in Telemedicine.
* Economic and Financial:  Due high and increasing cost of health care and populations which are living longer and competing for the same medical resources, traditional health care methods must change. Telemedicine can provide a cost effective means of access to health care.

Conclusion:

The scope of informatics is thus enormous. It finds application in the design of clinical decision support systems for practitioners, in the development of computer tools for research, and in the study of the very essence of medicine - its corpus of knowledge. The goal of present a unifying set of basic informatics principles which influence everything from the delivery of care to an individual patient through to the design of whole healthcare systems.

The role of health informatics is to develop a systems science for healthcare that provides and create the tools to achieve these goals.

Overall, telemedicine and other IT tools optimise the organisation and delivery of medical and professional resources; reduce the need for patiens to travel and allow local health authorities to purchase afar wider range of health care than might be possible within any geographic region or medical infrastructure.

Telemedicine  is telecommunication technology is following path of doing more and more with weaker and weaker signals—exactly what will enable bandwidths in  space travel to be sufficient for live video links for medical care. This is why live video telemedicine is already commonly done from the International Space Station, and will likely continue with future missions. 

References: 

1. Ducker PF.  Managing in a time of great change. Truman Talley Books, New York, 1995
2. Enrico Coiera  Guide to Health Informatics 2nd Edition 
3. Sangeeta Reddy Information Technology in Health Care Journal of Electronics and Information Planning
4. Leslie Friesen Health care Renovation in Texas Technology
    


Dr. Vijay Pithadia
Assistant Professor & Kidevices Chair
School of Management Studies
Shri Leuva Patel Trust College For Women
Amreli–365 601
&
Dr. Vandana Parmar
Associate Professor
Department of Anaesthesiology
PDDU Government Medical College
Civil Hospital Campus, Rajkot-360 001
 

Source: E-mail March 25, 2006

    

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