7 min readThe Role of Information Systems in Today’s Healthcare
London – UK – Health care systems globally, and in the European Union in particular, have been evolving and adapting the last couple of years to the impact of an ageing population and to epidemiological changes in the context of fiscal restraints. There is an increasing trend towards integrated care with the linking up of the range of healthcare facilities including primary care and diagnostic centres, acute care hospitals and clinics. The situation is further enhanced by increased patient mobility, especially within Europe, and an increased expectation from the general public to have better services and a more customer-friendly healthcare.
In this light, healthcare organizations are constantly trying to ensure high degrees of efficiency and effectiveness in the provision of their services. An overriding priority in many EU countries remains the full implementation of Healthcare Information Systems, especially in the light of the new European environment for e-Health and the increased cooperation between EU Member States on this matter. This has created a clear interest to accelerate the transformation of clinical care so that clinicians will routinely use appropriate information systems technologies when diagnosing problems and subsequently planning and administering care to a patient.
Across Europe, stakeholders and decision-makers have now come to realise the importance of the clinical, organizational, and financial benefits directly resulting from the implementation of healthcare information technologies. Although, disparate healthcare systems, payer mechanisms, languages and clinical/treatment protocols have retarded a more uniform systems adoption, healthcare IT is increasingly being placed high on the political agenda of most European governments.
The Need for Information Systems
One of the many definitions of Healthcare information technology is “the application of information processing involving both computer hardware and software that deals with the storage, retrieval, sharing, and use of healthcare information, data, and knowledge for communication and decision-making”.Today, healthcare executives are under tremendous pressure to address a host of different challenges: medical errors, rising costs, inconsistent quality, inefficiency, declining doctor satisfaction, and mounting staff shortages. Dealing with these issues will ultimately lead to better healthcare, but the process appears as complex and overwhelming as the challenges themselves. Information – or lack of it – is a big part of today’s healthcare problems.
Accordingly, Information Technology should be a big part of the solution. In theory, the whole concept seems quite simple: we should be able to accurately record detailed and legible clinical notes; populate a comprehensive, lifetime digital record for every patient (including medication history, lab tests, and radiology images); provide access to disease management and outcomes information to help doctors make clinical decisions; prevent medical errors by having complete patient histories on hand, and so on. Yet in practice, only a small percentage of doctors are actually using such technologies daily and it’s not hard to understand why. Historically, healthcare IT systems have been too expensive and hard to implement for the average provider organization to adopt. They didn’t fit in with typical workflows and, there was very little evidence demonstrating the value of specific Healthcare IT investments. Fortunately, as the healthcare IT industry matures, this is all changing.
Investment in Information Systems
The average IT investment of a healthcare organization in Europe lies in the range of 1-2% of its annual budget which is quite low compared with around 10-15% in the Banking/Insurance or Telecommunications industries. Fortunately stakeholders are now aware of this crucial gap and according to the European Commission, up to 5% of health budgets will be invested in eHealth systems and services by 2010. According to Frost & Sullivan Research, the European Healthcare IT market has crossed the $4 billion mark in 2006, and is growing at more than 10 per cent year-on-year – one of the fastest among all industries. Major initiatives like government sponsored modernisation plans and mandates to adopt and use IT systems, even though they might face issues around funding, changing political agendas, competing interests of involved parties, public acceptance, etc, have a positive effect on the growth of the market.
Some Unique Challenges
Privacy and security is a core issue when dealing with healthcare information. One of the top concerns of all e-Health programs is how the privacy and security of personal health data can be guaranteed. The IT industry is able to provide better, safer and more reliable solutions, however, security breaches do not require just technical solutions, but also laws, detection of violations, enforcement and punishment. The European Union already is enforcing strict medical data security standards and the North American market with the health Insurance Portability and Accountability Act (HIPAA) is also demanding improved security and confidentiality for healthcare transactions.
In addition, the highly fragmented nature of the healthcare information systems market indicates that there are so many different systems (old or new, advanced or simple, integrated or stand-alone) that interconnectivity issues between them are inevitable. Even within same regions one can find enormous differences in software platforms, applications and standards in use. This creates a challenge for all stakeholders, as the move is more towards integrated healthcare networks, and interconnectivity/compatibility capabilities are of paramount importance.Finally, a growing number of patients are becoming more and more actively involved in the health care they receive. These “power patients” have some characteristics that distinguish them from more traditional patients and are an important factor in driving the use of IT in healthcare.
They usually have higher incomes that allow them to make choices about what they purchase. They can choose between a more expensive health plan and spending out-of-pocket for alternative medicine services. They are also most likely to have attended a college or higher education institution making them more probable to seek extra information about their health and health care choices. “Power patients” have access to computers, and they have experience in seeking and analyzing health information. “Power patients” are a growing share of the population and health care organizations will have to meet their needs. Free choice of doctors, control over treatments they receive, access to quality information about their care, and extremely high levels of customer service are high on the expectations of such patients.Overall, dynamics in this industry indicate that the above challenges, among others, will play a significant role in defining the role of information systems in healthcare.
Main Application Areas
In a general sense, the care of a patient comes together through the focus of many clinical disciplines—medicine, nursing, pharmacy, etc. Although the work of the various disciplines sometimes overlaps, each has its own primary focus, emphasis, and methods of care delivery. Each discipline’s work is complex in and of itself, and collaboration among disciplines adds another level of complexity.
In all disciplines, the quality of clinical decisions depends in part on the quality of information available to the decision-maker. The emergence of the electronic medical record (EMR) as the key system for providing clinicians with an integrated view of clinical information in hospitals creates the requirement for ancillary systems, such as those of laboratories, radiology and pharmacy to accept orders from the EMR and replicate clinical data to it as components of an integrated clinical database. With the goal of creating a single view of a patient’s health information, hospitals are investing heavily in technologies to pull together their various departmental systems into an integrated electronic health record. For large hospital systems, this integration might even include multiple acute care facilities, physician offices, local clinics, and outpatient labs.
On the clinical side, some of the processes and functions that are managed by information systems include patient management systems; electronic medical records; imaging information management systems for radiology, cardiology, orthopaedics and ophthalmology; laboratory information systems; pharmacy information systems with decision support; treatment and operation modules for operating room management, emergency services and critical care; and care management modules including care schemes, nursing documentation, care protocols and care pathways.
Although public attention tends to focus more on installing and implementing clinical information systems because such systems are directly connected with improvements in quality of care, equally important are the administrative/business information systems. Modern administrative systems can aid in patient management, offering features such as patient scheduling, recording of consultation and treatment records, online prescribing, formulary management, tracking of patient’s current location, providing access to past inpatient as well as outpatient encounters including notes, orders, diagnostics results and medications. In addition, a combination of sub-systems can facilitate all business activity within a hospital that includes financial management, materials management, supply chain management, human resource management, payroll, strategic enterprise management, business analytics, and business support.
On top of specific clinical or administrative modules, we also have the emergence of multi-module platforms – software solutions that have the capability of supporting a wide range of clinical, administrative and business functions. As healthcare becomes more and more integrated we will see even more hospitals following that route.
Main Project Types
Looking at the implementation side, in Europe, there are four main project types:Infrastructure projects: These projects aim to connect primary care, secondary care, pharmacies, and homecare to exchange administrative, procurement, prescription, medical and other information. Related to this infrastructure are also portal projects, which allow online access to medical, administrative or epidemiological information.
Electronic Card projects: Most issued cards are currently used for administrative and insurance status validation purposes only. In the next stage they also can be used to transfer prescriptions, store emergency data (allergies, blood group, etc.) and pointers to detailed clinical data. E-Card projects require a relatively expensive and complex infrastructure with card readers, millions of cards, card issue logistics and card access management regulations.
Electronic Health Record (EHR) projects: Major components of an integrated eHealth model are local, regional or national EHRs. This term is used in a broad context beginning with high-level summaries (e.g. cancer registries) up to personal, life-long document-based or – even better – structured health records containing all clinical information for each citizen. Partial implementations of EHRs can also be used to support Medication Management or Chronic Disease Management. There is also a wide range of storage philosophy (completely central to completely decentralized) and approach to access management (access by all necessary persons concerned; only by those who need access; only those who have been directly authorized by the patient).
Telehealth/Telecare projects: They include implementations in areas such as vital signs monitoring, mobile disease monitoring, remote diagnosis and treatment or home care support tools. A broad usage of these technologies can support significant cost savings and quality improvements and a lot of focus is going into this area currently.
It will not be an Easy Ride
Used to their full range, IT systems allow providers to monitor patients with electronic medical charts; support clinical decisions with evidence-based guidelines; expedite referrals to other specialists; computerize ordering of prescription drugs, laboratory tests, and images; and store and retrieve medical records from different locations, while also supporting various administrative processes.Of course, an ideal information system is far different from most systems currently in use. Use of IT varies significantly and while adoption rates for health information technology are slowly climbing across Europe, we are seeing a widening gap between larger hospitals and physician groups and their smaller counterparts. Physicians and smaller providers face many barriers to adopting health information tools in an industry already dealing with serious fiscal and organizational upheaval.What is important to remember is that Information systems implementation is not about information technology alone; it is about transforming clinical and business practices. Healthcare IT systems are an enabling foundation for healthcare—and organizational—reform. The technology does not, in and of itself, cause the reform.
Overall, we are standing at the forefront of exciting times. Healthcare systems worldwide try to balance resources and improve business processes and workflows and there is a growing consensus that a more intelligent, innovative healthcare system is within reach. What is definite is that Information Technology is set to revolutionise healthcare delivery and to significantly impact healthcare systems and processes. We have a timely opportunity and an urgent need to build a 21st-century health care system – a comprehensive, modern system capable of providing information to all members of the healthcare team who need to make decisions about our health. Patients, healthcare providers, public health professionals, employers, policymakers, and others recognize that ready access to relevant, reliable information would greatly improve everyone’s ability to address personal and community health concerns. It is the role information systems are waiting to perform.