Information Technology in the Healthcare sector to increase patient's quality of care
Increasing numbers of firms are thinking of using Information Technology in the healthcare sector so that patient's quality of care should be increased. This move has aroused a significant amount of change in the way the health care organization work. Some people says that information technology has the potential to improve the efficiency, time, safety and quality of health care by providing the new ways for the patient to access the heath related information at any time and at any place whereas some people argue that how to provide a secure environment in accessing or updating the health related critical information. This study focuses on the said problem. The literature review was conducted with the aim of identifying the characteristics of successfully managed health care organization. Accordingly, the findings of the literature review are in the form of a list of the key determinants of successfully managed healthcare centres. Following from that, a survey was conducted for the purpose of evaluating how the information technology impacts healthcare organization from the perspective of both patient and providers. The study's conclusions are based on both the findings of the literature review and the survey and are a set of recommendations for the more effective management of healthcare centers.
Without the continued support provided by my family and professors, I may not reach the end of this journey. During my studies there were tough times when work commitments are on sake and I was not finding this journey through. It was during that time, my family, friends and supervisor words of encouragement had gave me the confidence in my ability and the motivation to persist. Words of thanks are just limited. I would like to thanks my supervisor for their understanding, encouragement and support and above all, the prompt constructive appreciation and criticism were invaluable to the research and completion of this study. Thank you.
Chapter I: Introduction to the Study
Information System refers to the organized collection and processing of data either manually or computerized. It is the system that stores, maintains and analyses the information and these data are used for making critical management decisions. Information system development is the process in which organized and collective work is facilitated by analysis, design, implementation, maintenance and support. Information is provided to the organization by three means, which are Input, Processing and Output. Input is the collection of raw data, which is processed and transformed into more meaningful information. The processed information is called as Output. The output is then reviewed and processed by the appropriate members of the organization to evaluate and refine the input. This is called feedback.
In today's environment, information and technology have become a critical component of successful businesses and organizations (Avison, 2003). Most of the organizations are now relying upon the information systems in their day-to-day operations, management decisions and other business activities.
Information technology can improve the quality of health care by providing the new ways for the patient to access the heath related information at any time and at any place. By this chapter, we are taking the first step in increasing our understanding about IT, and how IT affects the health care industry (Glickman, 2007).
Despite putting considerable attention to the topic, there are some questions that remain unknown about the role of IT in the health care setting. What types of IT are being used and how much investment and a kind of investment have hospitals made in information technology? What steps have taken by public and private entities to encourage further diffusion of IT and what possible action are making sense?
In order to deliver quality health care, patients and providers have to integrate complex and stipulated information from many different sources so that physicians, nurses, clinical technicians, and other people have access to the right information about their patients so to improve care. If the information about the patient health is readily available, it will improve the efficiency and quality of care and also manage the condition of patient better. In today's world, healthcare system uses less IT than other industries (Herb, 2004).
While information technology has the potential to improve the efficiency and quality of patient care, but it also raises some critical ethical and social issues. Below are some of the most interesting and important questions about the use of IT in health care:
* What are the uses of information systems in healthcare and who should use these systems?
* What are the risks and benefits of using IT have for patients?
* How does the use of IT can change the relationship of physician and patient?
* How will IT help in making medical decision change and under what circumstances does diffusion of IT promote health, trade and development?
* Does diffusion of IT in healthcare mitigate disease burdens by reductions in cost per diagnosis or cost per treated/cured illness?
* What are the lessons to be learnt from the past usage experience of IT in healthcare in developed and developing countries?
Background of the Problem
IT allows the new ways of organizing the work locally, nationally and globally. IT is an important consideration in the design of public health systems in developed and less developed countries.
National ICT Institute for Healthcare in Europe provides the treatment, prevention and management of diseases and the prevention of physical or mental well being. These services are provided by medical and health experts. NICT are facing some challenging issue related to the chronic disease, illness, nurse's shortage, medical accident and rising costs. Also elderly people require the persistent medical assistance and care so that they can live independently. Furthermore chronic diseases are increasing day by day as well as their management cost. Evidence has suggested that every year hundreds and thousands of deaths worldwide are attributed because of medical accident rather than by drug. The majority of these deaths are due to insufficient communication process or due to lack of information of patient history (Karsh, 2004).
All these issues and challenges are places a strain on European National Health care system and the situation will not be sustainable unless some important action is not taken at all level to change the way how healthcare is delivered.
Nature and scope of Study
IT enable the choice and reduce the response time for making new contracts, organization structure, networks, licenses and management processes. With IT Patients, doctors, hospitals, pharmacies and health insurers can adjust, avail and get the new responses interactively and the responsibilities towards each other can be rearranged. Information power enables new ways of exercising authority, and responsibility to emerge around tradeoff and combinations of choice, costs, efficiency and effectiveness as the criteria by which performance analysis can be judged. Performance analysis also encourages the openness, accountability and raising the incentives for private and public health systems to perform better (Veazie, 2006).
New websites are developed by many hospitals, medical schools and pharmaceutical companies etc so to provide the information about any disease or problem from any place at any time. Nearly about 45 per cent of the content of the website deals with health and health-related topics covering different ways of covering common healthcare problems. Almost about 21 Millions of people around the world visit World Wide Web sites for getting the information about how to eat intelligently, different ways to exercise their bodies and to find out healthcare information which sometimes people are unable to share (Veazie, 2006). Healthcare information such as nutrition, diet, exercise, primary healthcare, ante-natal and post-natal care, hygiene and sanitation can be located easily through World Wide Web. The awareness of medicine and non allopathic medical systems is expanding rapidly due to IT. In developing countries, the majority of registered medical practitioners do not practice allopathy medicines and 3 out of 4 patients are not interested in using allopathy. There are many type of medicine available for same problem and websites are enabling people to be more aware of these new medical systems such as homeopathy, ayurveda, unani, acupuncture, herbal medicines and to know where these are available (Hersh, 2004).
Public healthcare systems can be significantly rationalized with IT. Robotics and Artificial Intelligence applications enable the positioning of automatic analyzers of biotic material such as blood, oral fluids and excretions at remote locations. Radiological scanners in rural areas enable distance consultations with organ specialists. We can network the delivery of healthcare expertise by having health centers in villages and extend the boundaries to make healthcare reach to the places where it does not exist. With the advent of IT, more efficiently emergencies can also be handled in countries which are deficient in transport infrastructure. Medical professionals such as doctors, nurses, surgeons, anesthetists, laboratory pathologists and medical technicians can pool their expertise in new forms and link in ways that save costs and time. IT also helps in making inexpensive arrangements through partnerships, branches, representation offices etc through on-line tele-services and data transfers in different part of the countries and even in different countries (Ajeet, 2003).
Aim and Objective of study
The aim of the study is to enable access to the best quality care for all European citizens by providing safer care to avoid medical accidents and to facilitate the independent living and lifestyle management addressing the elderly people and children's.
In recognition of these problems and challenges, NICT has adopted a strategy to transform the healthcare landscape in Europe. They are planning to deploy the eHealth system in Europe. The main aim of eHealth plan is to enable access to quality and reliable healthcare for all citizens at any time and at any place. This will facilitates independent living and lifestyle management addressing children and elderly people. It will slowdown some of the medical accidents and adverse events and also leads to improve the efficiency and effectiveness of healthcare systems. The constraints of NICT is to provide the consistent and reliable platform for all the patients to securely access all the information related to their health and the provision and prevention required for any disease.
In this context the main objectives of the research study could be stated as:
* To research and identify how healthcare organizations improve quality of care while cutting medical treatment costs.
* To facilitate active ageing and independent living for the ageing population
* To develop an implementation strategy on how to improve patient satisfaction and safety.
* To identify how healthcare organizations increase productivity in the midst of chronic labor shortages.
* To research and identify how to empower the citizens to become actively involved in managing their own health status.
How can eHealth provide integrated and interoperable services with full access to citizen's complete medical history and data from anywhere in Europe and enable citizens to access quality health knowledge on-line. How to provide secure environment by which patient can update their medical history and by which right to privacy is not breached.
The goal of this research is to describe how the frequency of errors in healthcare or medical care can be reduced by the use of information technology, and how to make general and specific recommendations about reduction of errors through the use of IT (Iftikhar, 2006). In order to make healthcare sector IT enabled a lot of technologies are needed to be used, in which some of these are:
* Electronic health record.
* Clinical decision support system.
* Picture archiving and communications system.
* Radio frequency identification.
* Electronic materials management.
As information technology provides quality of services at any place and at any time but certainly there are constraints associated with its use (Ajeet, 2003). Below are the few points to be taken care while deploying the IT in healthcare sector.
* Personal data and rights to privacy can be easily breached because database of healthcare can be easily accessible for updating the old records and for initiating new records and entries. So security and confidentiality are the issues.
* IT helps in decoding of personal data using genotypes and phenotypes as identifiers and the design of novel organisms against which vaccines or antibiotics would be useless.
* The risk is extremely high when ownership or control of database of healthcare sector is lawful.
* The promotion of IT as a means to stimulate cross-border connectivity for growth and employment through trade and foreign investment cannot be easily accomplished when international networks bypass locations where doctors, IT specialists and other scientists and technologists do not already relate to each other.
In today's environment, information and technology have become a critical component of successful businesses and organizations and it has the potential to improve the efficiency, safety and quality of health care by providing the new ways for the patient to access the heath related information at any time and at any place but it also has some limitation and constraint which should be handled carefully The next chapter presents the literature reviewed for this study.
The demand of healthcare sector has sky rocketed in the recent past. The consumer as well as aging population push for an increasingly efficient healthcare delivery has fuelled this growing demand. The development of healthcare information systems takes place within the field of medical informatics. Medical informatics is the study of management and use of biomedical information and its aim is to assure that the information system is effectively used to give the greatest benefit to patients' health. It enables healthcare through improved quality of medical records and it focuses on the development of health information system that may be more easily integrated into the clinical setting for use by healthcare professionals, with attention to assured patient privacy and confidentiality (Adam, 2004).
In general, the ideal health information system gives quick access to the full medical history of the patient's health and accessibility to data which is helpful in avoiding medical accident that happen because sometimes doctors inability to understand the patient problem and the medicine which patient body doesn't handle. If the information about the patient is readily available then this improves the quality of care of patient through improved patient records. Health information system also helps in ensuring the patient data are accurate through quality assurance checks. It also allow healthcare professionals to easily track the patient record and measure changes in health status through the use of automatic summary reports which examine patient data according to disease. In this way health information system allows doctor to routinely monitor the patient state of wellness and if required quickly sent the reminder mails to patients to inform them about the preventative care measures. Reminding mails also help in ensuring the providers offer services in a timely manner. Additionally health information system can enable patients to take actively participation in making themselves aware of their medical attention and self care through self-monitoring of behavioral modifications. Generally there is no reason for any difficulty or failures in implementing health information system. Furthermore, it is agreed that certainly there are some factor which might take an important part in making IT in health care sector a failure, but there is no data by which we can measure the relative cause of failure (Walsh, 2004).
Information technology is used to store, process, output or transmit the data which gives new opportunities doctors and patients to interact and communicate in ways that were impractical few years ago. The use of information technology to monitor, diagnose and treat the patient medical conditions remotely is called telemedicine. Since in late 1990s, the use of Internet, computer software improvement and the introduction of high-speed telecommunications networks have led to a rapid increase in telemedicine. Health care organizations and entrepreneurs are taking advantage of these opportunities to make medical care easily accessible and convenient to patients, to raise quality and to reduce costs.
This literature review examines how healthcare and other information technology are providing best and innovative solutions to some of the problems which patients and health care providers faces in today's world under the traditional model of health care delivery. Firstly we will discuss what are the problems with the traditional physician care system and how information technology usage in healthcare sector will solve it. Secondly we will discuss about what are the obstacles in wider use of IT in healthcare and why public policy are needed to get changes in order to remove them.
There are many patients who are facing difficulty in finding a physician or taking some time from work to get an appointment. It is sometimes difficult for a patient to contact physician even after working hours, by e-mail or by telephone. Some of the patients do not have knowledge about the after hour clinic or a local urgent care near them. People don't know How to handle the immediate medical related problems including how to reach to a physician. Often, what is only possible is to make your way to hospital emergency room which is costly and also time consuming. Access to healthcare outside of the office or personal setting is particularly important and is equally problematic for patients who are facing multiple chronic medical problems.
Previously patients are facing some serious problems and issues. Some of them are described below:
* Doctors are hard to see. A study of medical access is being conducted between 1997 and 2001 (Allison and Joy, 2006) found that doctor is becoming increasingly difficult to see. Nearly one-quarter of the patients had raised an issue to get a time after working hour to reach to a physician.
* Patients facing problem in contacting physicians by email or telephone. Doctors are very difficult to contact outside of the office or the clinic. Instead if we talk about lawyers or some other professionals who routinely communicate with their clients by the mean of telephone or e-mail; but very few doctors, almost 1% communicates with patients electronically. A Harris Interactive poll (Harris, 2002) shows that most of the patients are having Internet access (approx 90 percent) and they would like to consult their physician online. But they have to make an office visit for a regular prescription and even for the simplest medical advice. The questions arises here why doctors or physician avoid picking up the phone or email consulting. The reason is simple that it will not reimburse their consultation.
* Too few doctors in rural areas. Comparing to the metropolitan areas, there are very fewer physicians and doctors who serves rural patients. More than a million European live in areas which are underserved by physicians, according to government estimates. The European Medical Association has estimated that around 15,000 more physicians are needed to cover the gap. Although there are 2.4 doctors per 900 residents in the Europe, and even they are not equally distributed among states (Chris, 2007).
·Patients overuse emergency rooms. Sixty-five percent of the 114 million people visits to hospital emergency rooms (ER) in a given year. Even some of the patients judged their conditions themselves as non-urgent. A survey in California in 2006 has found that nearly half of emergency rooms has acquired by patients whose problems are not resolved with a visit to their doctor. Patients who seek non-urgent care are wasting significant resources by taking the emergency room because emergency room is a costly ways to get a regular treatment. Overall, the unnecessary cost of visiting physician and acquiring emergency room is just under $41 billion annually. Now the question comes why patient with health coverage forcesibly do acquire emergency room for non-urgent care? Because they can't easily obtain care from their physician outside office hours. According to the California survey, the percentage of emergency room taken by patients is depicted in following figure:
* Doctors not providing all the necessary information during office visits. The average time spend by the physicians with each and every patient has not fallen but the needed information physicians need to convey to individual patients about their disease has grown. The proportion of doctors or physicians saying that they don't have enough time to spend with patients is approx 23 percent between 1997 to 2001, from 28 % to 34 % of doctor surveyed (Sally, 2003). According to an article in the Journal of the American Medical Association, every patient want to know more information about their disease and medical condition but they receive less assistance from their doctors. For example: During a 20 min of official visit, physicians or doctor spend not more than one minute on average planning treatment.
* Treating chronically ill patient is difficult. The estimated cost of chronic diseases in Europe and United States, including treatment is $3.3 trillion per year (Ross and Armen, 2007). Unless this trend is reverting back the assumed cost will increase to $4.2 trillion. Almost more than 126 million Americans have chronic medical conditions. Most of the patients are not getting needed care from their physicians. Take an instance, less than one quarter of patients are suffering high blood pressure control it adequately. 20 percent of diabetic patients aren't seeing a doctor annually. Twice of the number doesn't regularly test their blood sugar level. One reason for this kind of poor compliance might be a lack of integrated system which monitors their patient's chronic conditions. Person who is suffering from diabetes which often results in heart disease is complex and time consuming. Proper time should be given to patient to get him/her out of the danger of health diseases.
Information technology has the potential for re-structuring the healthcare in ways which can solve many of above problems, often while making improvement in the quality of care and reduction of cost to the organization. Often we called the term telemedicine which is using IT in healthcare sector. Telemedicine is relatively new concept, and still developing rapidly. Numerous studies have already point to the benefits of using telecommunications and internet technologies in innovative and new ways to increase care for patients.
Solution: Non-traditional physician practices. There are many medical conditions which do not require physician to present there or the time and expense of an official visit. In order to meet this demand, organizations are creating non-traditional medical services by which patient care is available via telephone or through Internet. They are staffed by doctors and physicians who can initiates therapies, treatments and order tests. There are some healthcare providers who have started integrating the web based healthcare services into their practices. Some of the physicians are becoming more flexible by providing the timely manner services to the patients.
Case Study: Flexible Physician Practices. Doctokr.com is the website by which patient can schedule an appointment or email the doctor their problems. Dr. Alan Dappen is the physician who practices medicine and provides assistance mostly by telephone and e-mail contact. In fact, Doctor Dappen's waiting room is a Web page. He always encourages most of the patients who are aware of computer to consult him by e-mail. Now if we talk about the fees of the doctor than Dr. Dappen charges his consultation fees based on the time spend. There is a prepaid card provided and by simple call and patient can renew online. Asking for a prescription or a question generally costs near about $20. Patient records are kept electronically.
Solution: Pay doctors for the consultation through e-mail and telephone. E-mail is a convenient, efficient and time effective method to consult with a physician anytime anywhere. One recent study has investigated that an electronic messaging system such as e-mail has reduced physician office visits and its associated cost of maintaining laboratory. When members of the health plan e-mail their doctor, the cost of office visits and laboratory were approx $21 less per member per year as compared to those who haven't taken this service (Laurance, 2005).
E-mail consultations. First Health Group in year 2000 became the first major health insurers. It reimburses the medical consultations fees paid by the patient to the physician over the Internet. It agreed to pay $25 for each email exchange between patients and doctors. It encourages physicians or doctors to interact with patient regularly who are chronically ill. The goal of the insurer is to reduce the hospitalizations that often result of symptoms being ignored (Abrar, 2006).
Solution: Patient-directed healthcare to increase access in rural areas. The use of IT in healthcare began around 40 years ago as an attempt to provide medical services to geographically isolated patients. There is a need of a specialist to provide medical advice to the people living in remote rural locations. One study was conducted few years ago in Australia remote area, has found that providing remote medical assistance by satellite will increase access to medical care, health status will improve and cost will be reduced.
Solution: Internet-based medical information. Another way to provide patient with all medical information is by internet based mechanism. Patients need not to rely upon their doctor for all queries and wait for the answers to every question. Health related information will become available outside doctors clinic through numbers of Web sites on the Internet. Information and knowledge is easily available on the Internet about different disease and their probable symptoms and this has led to dramatic changes in how patient can obtain information about health and medicine. Instead of visiting doctor clinic for answer to the medical questions, people can directly access internet and can visit any of the trusted website to the get the necessary information. There are almost 20,000 healthcare websites available to assist the patient.
Solution: Electronic medical records. Patient record can be kept electronically, each record containing an individual patient's medical history, their health status, test results, disease they have and prescription information. Right now there is very small percentage of healthcare organization are utilizing EMRs, but as of now growing number of healthcare organization are offering to patients the ability to manage and validate their own medical records online securely, so that the records can be accessible by the individual as well as by the physician. There are many patients who not see physicians over time and hard copy of the prescription and problem often lost by the time, if medical records can be accessible remotely then it will allow better coordination among different providers to provide better healthcare service. Electronic medical records are essential for a rapidly increasing area of telemedicine. In fact, telemedicine is the best way for the doctors to monitor and manage patient chronic conditions. Furthermore, remote access to EMRs anytime anywhere by the physicians or doctor makes telephone and email consultations with patients more useful.
Microsoft recently introduces an online personal healthcare record management service, called HealthVault. It is designed to store personal health related information securely over the Internet, and to control access to the information by healthcare providers and to ensure the reliability and accuracy of data. Health history of the patient is kept password-protected; any attempt to illegally retrieve the records of any patient will be recorded. Even addition, deletion or modification of any record is easily tracked.
Although use of IT has the potential to lower the cost and increase competition in many areas of health care, but it also faces numerous obstacles, primarily because it is new concept and have different dimension in healthcare. Some of the barriers are related to the payment for online support taken by patient. Some arise from the efforts of entrenched interest groups, and some from the federal and state licensing laws and regulations.
Obstacle: Third-party payment.The main reason why doctors, physician and hospitals do not want to communicate electronically with patients is because patient rarely pays their own health care bills. Instead third party pays for them. Third party includes private insurers, employers or government will pay for them. Below is the figure depicting the proportion of healthcare service directly paid by consumers has been falling for decades.
Obstacle: Medical culture. Historically, face to face consultation is the most preferred way to care for patients. This may explore why the American Medical Association (AMA) came out against prescribing the medical advice on the Internet prior to a patient physical examination. Some of the medical organization finds it unethical to entertain such practices. Or they imply that quality might be compromised. In some cases, patient can be wrongly prescribed over the internet and because of that serious implication can happen; in these scenarios some serious action can be taken against the healthcare such as denial of hospital privileges and even the loss of the license to practice medicine.
Obstacle: Physician adoption of telemedicine. The adoption of telemedicine is studied so many times in the past. A study is conducted in the past which attempt to understand the physician thinking behind the concept of telemedicine. The study shows that some of the physicians are reluctant to adopt new technology for a varied variety of reasons such as reimbursement, liability, training etc.
Obstacle: State licensing laws.Unfortunately, the laws of the country are old and outdated. It does not conform to the today's information age. Recent advances in information technology allow a European radiologist to read X-rays just as easily as an American or some other country radiologist. However, state medical boards regulate the practice of medicine, which require a physician to have a license in the state to operate patient. Thus, the licensing law of state doesn't allow medical tasks from being performed by the physician living in other states or country. Physicians from other countries lack the authority to order and take certain tests, to initiate therapies and to prescribe drugs that Australian or American pharmacies can legally dispense. These laws make it difficult for the European patient to seek consultation from physician of other states via telephone or by email, and for doctors to employ foreign physicians.
As the previous section indicates that the biggest barriers to innovation and competition in health care are government laws, rules and regulations. Several evidence has suggested that wherever markets have the competition, entrepreneurial providers create innovative and best services for the consumer.
Needed Reform: Need of removing tax penalties on self-insurance. Traditionally, third party insurers are favored by the tax law over individual self-insurance. Every euro an employee gets from employer toward employee health insurance premiums avoids income tax. For an employee who is not earning much, this tax subsidy means government is paying half the cost of health insurance. Recently, the government taxed on almost half of amount that employers put into savings accounts from which employees could pay their medical expenses directly. The result was a tax law penalized the self insurance and subsidized third-party insurance. This has encourages to use the third parties insurer to pay every medical bill, even though consumers can manage their discretionary expenses themselves. Tax laws should be change to make it easier for people to self-insure rather than relying on third-party payers. Currently, the organization named Health Savings Accounts are allowing thousand of people to partly self-insure.
Needed Reform: Greater patient autonomy. State and federal policymakers are needed to understand that the introduction of telemedicine will provide benefit to the European consumers by reducing cost to the organization and improve the quality through greater access to medical records online. As of now information technology has tremendously increase the productivity in every other area of the economy, it will also increase the productivity of healthcare. Physicians should also need to understand that introduction of telemedicine also benefit providers as it is not limiting to treating patients in the office.
Needed Reform: To Modernize state licensing laws. Research is also conducted and it suggests that telemedicine is not only reliable but it also save money on unnecessary clinic visits and increase the vacancy of emergency room visits. Moreover, the satisfaction level of the patient will be on the upper side. However, outdated licensing laws increase the cost saving potential of telemedicine. Reforms also needed to recognize the providers from other countries as alternative resources. For instance, many of the Indian physicians are licensed in the US, Australia, Britain and Canada. Physicians who meet the international standards and are from different countries must be allowed to provide telemedicine services to Europe citizens.
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