Advances in computer technology are having a significant effect on all areas of service provision. The healthcare industry is one of the beneficiaries of information technology. The combined advances in computing power and the increasing dynamism of software design underlie the recent availability of information systems that are making it easier for health facilities to take care of patients (Deloitte, 2011). The creation of management information systems specific to the health industry is ongoing. Many departments in healthcare facilities have customized software solutions designed to improve service provision. This paper reviews the contribution of computer technology to patient care. It looks at the existing information systems and their impact on the provision of health care.
Background
The discussion of health information systems must take place in the context of several factors that are shaping human life in general. The factors with the most relevance to this discussion include globalization, rapid expansion of Information technology systems, cyber concerns, and increasing legal and regulatory bottlenecks in the delivery of medical services.
There is little debate regarding the power and impact of globalization on all human activities. Increasingly, people are demanding services and products produced in different geographic jurisdictions. International trade is not a new phenomenon. What is new is the volume and scale of trade taking place between different countries. The rise of multinationals is the result of consumers in different parts of the world demanding services and products from other parts of the world. In the medical field, people travel to other parts of the world to access health care (DiMatteo, 1998). When they do this, they expect to find their records in the overseas hospitals. At the very least, they expect to find familiar procedures in the overseas health facilities.
The second factor shaping the provision of health care comes from Moore’s Law (Dixon, 1999). According to Moore’s law, the processing capacity of transistors doubles every eighteen months. This means that every two years or so, the computing power of computers doubles. The implication is that new services that require high computing power become accessible and affordable as time moves on. In the medical services industry, the number of computers available for use in health facilities is on the increase. Every medical facility relies on computers to process some of the workflow.
On the legal front, there are more regulations governing the practice of medicine that at any other time in history (Zanaboni & Wootton, 2012). Doctors are liable to prosecution if patients feel that they received wrong treatment. The question of motive does not always arise. The law expects doctors to understand all the risks associated with the treatments they offer. There is no place for honest mistakes. Many doctors have lost their practicing licenses over issues that were beyond their control. In such an environment, decision support systems can help to reduce the chances of making certain mistakes such as wrong diagnosis, or issuing of wrong prescriptions.
In the discussion of computer based patient records (CPRs), the main concern that patients have is their privacy. The collection and storage of personal information in the magnitude that health facilities require carries several risks. If unauthorized people access the information, they can use it to defraud, blackmail, or malign individuals. This concern is consistent with the fears people have regarding online commerce.
Significance
The significance of this review stems from the increasing pressure to computerize the provision of healthcare. It also comes from the need to appreciate the bottlenecks that face the implementation of software solutions, and the need to develop integrated solutions.
Computer based tools promise to eliminate several major concerns that relate to healthcare provision. For instance, when a person moves from one state to another, lack of records can hamper their treatment when they fall ill. In addition, an increasing number of people travel across the world for studies, work and for tourism. These people need access to their medical records from any point where they land. In addition to these, there is a need to eliminate problems associated with wrong prescriptions, issuance of wrong diagnosis and other dangers associated with medical negligence.
The second significance of this review comes from the need to explore solutions to the current bottlenecks facing the implementation of software solutions. The most significant challenge is the lack of enforceable software standards by players in the health sector. So far, software developers use market demand as the basis of the solutions that they develop. The healthcare industry does not have a strong voice in the matter. Secondly, there is no consensus relating to the extent of the software solutions needed by health care institutions. Some institutions are lagging behind in the implementation of software solutions because of costs, and insufficient reassurance from vendors and regulators about the security of these systems. The institutions do not want to expose themselves to cyber attacks and the risk of litigation in case of data breaches.
Thirdly, the current model of software deployment is limiting the benefits that institutions can attain from the use of computer based decision support systems. Systems used by pharmacists vary from those created for physicians. Integration is costly unless an institution chooses to install an enterprise-wide solution. Such solutions tend to work well for some departments and poorly for others. The needs of different departments vary to the extent that universal solutions cannot fit.
Description
The article under review covers several patient care applications used in the healthcare industry. The first application is computer based patient records (CPRs). This refers to a centralized repository of medical information about patients accessible from multiple points. These systems allow caregivers to provide health services to patients based on historical records (Hersh, 1995). They are growing in popularity in many countries. However, data security concerns limit their universal application. Some patients and hospitals are unwilling to utilize them because of the risks associated with data security. Their use also depends on the goodwill of medical practitioners, some of whom are reluctant to adopt new technologies. Lack of standards also hampers their universal appeal.
Several computer applications exist to provide support for clinical services. Clinical services applications include laboratory information systems, pharmacy information systems and medical imaging and radiology information systems. Pharmacy information systems are useful for controlling the flow of drugs in health facilities. They serve as an administrative tool that assists in tracking usage of drugs. They are useful for detecting drugs that are running low on supplies for the purposes of reordering. They are also important for determining the cost of care for patients. The cost of medicine dispensed forms part of the medical bill that the patients need to pay. Apart from these administrative and business functions, pharmacy information systems can warn pharmacists before dispensing drugs that have negative interactions. It also helps the pharmacist to avoid overdosing, or under dosing the patient.
Laboratory information systems are a critical part of patient care. These systems allow physicians to access laboratory results quickly and efficiently. They serve as a repository of test results. Once the results enter the system, they remain there for immediate and future reference. Laboratories that use laboratory information systems can serve as sentinel sites for epidemiological initiatives because of their capacity to detect and flag increases in certain types of infections.
Imaging and radiology information systems are the third type of clinical information systems. Radiology and imaging systems refer to those that support magnetic resonance imaging, X-ray systems, and ultrasound systems. The imaging component requires the use of computers to scan and store patient data in visual form. In addition to this function, some imaging and radiology information systems also provide support for scheduling, billing, and preparing activity reports for management review.
Increasingly, many people receive medical care in ambulatory care settings and through outpatient services. This is increasing the need for ambulatory care information systems. These systems can allow paramedics to refer to patient’s medical history as they offer emergency services in the case of accidents. Information such as blood group, allergies, current treatments, and recent medical activity by the patient can improve the quality of care possible in ambulatory settings. In addition, health professionals in emergency rooms can prepare better to receive a patient if the records of the patient’s medical history and updates of ongoing condition are available. These activities can save the lives of some patients, and limit ongoing damage to their health.
In-patient services can benefit a lot from nursing information systems. Nurses provide dedicated care to patients. Nursing information systems can improve their performance by providing them with vital statistics on a patient’s care and response. These services are more significant for pediatric and geriatric facilities because of the sensitivity of the patients to treatment. Nursing information systems reduce the need for nurses to go to the nursing station to record observations. The systems can help to improve the recording of patient information because there is no delay between observation and recording or events.
Physicians can benefit from the use of clinical decision support systems. Physicians are very vulnerable to litigation based on claims of negligence. This usually arises from the treatment options and care decisions made by physicians. It is not always possible for a physician to diagnose diseases correctly without the support of other professionals such as lab technicians and specialists. However, a physician still carries the responsibility of making a diagnosis and prescribing appropriate care (DiMatteo, 1998). In this sense, clinical decision support systems come in handy to ensure that a physician is aware of all the diagnostic possibilities based on the symptoms of the patient. In addition, the physician can have a well-reasoned position when prescribing treatment. Some of the clinical decision support systems rely on pre-installed expert opinions on the diagnosis and treatment of diseases, while other use statistical models to indicate to the physician common treatment options for a specified diagnosis.
An important area of computer based patient records is the use of computer assisted medical instrumentation. This refers to the increasing use of computers to support data collection in the healthcare setting. Instruments such as X-ray viewers are no longer stand-alone equipment. They come as software packages, which allow a medical doctor to zoom and view the X-ray in ways that are more convenient. Computer systems in intensive care units provide better environmental control and provide better monitoring of patient vitals. It is no longer necessary to have several individual instruments to monitor a patient. One computer, armed with several detectors, can keep track of a patient’s condition at all times. Computers are also becoming a vital part of operating theatres, working both as monitors, and as decision support systems. Robot assisted surgical procedures are becoming more common (Zanaboni & Wootton, 2012). These robots rely on computer programs to function.
Some of the emerging areas of patient care applications include telemedicine and long-term care and home care information systems. Telemedicine is an attractive concept in clinical care because of its potential to facilitate expert care irrespective of geographical separation between doctor and patient (Zanaboni & Wootton, 2012). There are still issues to do with the jurisdiction and licensing of doctors practicing telemedicine. The license to practice in one state does not allow a doctor to practice in another hence it limits the capacity of the doctor to participate in telemedicine beyond state boundaries. Telemedicine is proving to be important in rural areas and other remote locations where specialists are not available. The specialist provides local medical workers with the insight and direction needed to care for patients.
Long-term care refers to patients with terminal illnesses requiring constant support. It is easier to use patient care applications to schedule checks, and interventions. Similarly, some patients do not need hospitalization, but require low intensity medical intervention. Such patients include people with diabetes. Home care information systems can help to detect any deviations from routine, and any sudden changes in the health of the patient. With such a system, the primary care institution can call a patient for care based on data collected using the homecare information as soon as a deviation from planned care becomes apparent.
Conclusions
The trend in the use of computer based patient care applications is irreversible. The trend in the world (based on Moore’s law) points to increasing use of computer based systems in all spheres of life. The reluctance by some health institutions to deploy information systems to support their clinical work is ill advised.
There is need to hasten development of standards for patient care applications. The reliance on software companies to develop solutions for the healthcare applications is creating a bottleneck in the development and absorption of patient care systems. The health care industry needs to take initiative to control the direction of the development of patient care applications.
More research is necessary in the use of patient care applications to help optimize on existing systems. In the last twenty years, very many researchers have sought to answer various questions regarding the roles IT should play in society. The research must continue in order to find ways of improving user experience, and the reliability of IT systems. The research should involve all professionals such as social scientists, engineers, and medical professionals among others. However, it needs to focus on the medical industry.
The issue of data security is proving to be a significant bottleneck in the uptake of IT services. This means that regulators need to commit resources to handle issues to do with data security in order to defuse concerns arising from cyber attacks.
Finally, there is a need for more support for physicians embracing IT as part of their health care delivery system. Physicians are the most influential stakeholders in the uptake and widespread use of information systems because of their role as primary caregivers.
References
Deloitte. (2011). 2011 Survey of the UAE Healthcare Sector Opportunities and Challenges for Private Providers. London: Deloitte.
DiMatteo, R. M. (1998). The Role of the Physician in the Emerging Healthcare Environment. Western Journal of Medicine , 168 (5), 328–333.
Dixon, D. R. (1999). The Behavioral Side of Information Technology. International Journal of Medical Informatics , 56 (10), 117-123.
Hersh, W. R. (1995). The Electronic Medical Record: Promises and Problems. Journal of the American Society on Information Science , 772-776.
Zanaboni, P., & Wootton, R. (2012). Adoption of Telemedicine: From Pilot Stage to Routine Delivery. Medical Information Decision Making , 12 (1), 1.