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Healthcare Information Management in the US

Introduction

Information management in any healthcare facility involves the management and use of information to improve healthcare and medical services. For hospitals to provide coordinated and integrated services, such information are vital, including the procedures and forms of care; patient personal information; forms of care provided and their results; and the performance capabilities (Robinson, 2001, p.69).

Information is of great importance in any institution. It’s of even greater importance to health institutions since the information exchanged is large in volume and sensitive. Information in any health care facility ranges from data collected from the patient, data from the laboratory and pharmacy units, data from the clinician/physician, and data from other supporting units e.g. social services and health insurance covers.

In his view, Robinson suggests that the large volume of information maintained and exchanged at health institutions, information needs to be safe, of high quality and reliable, if it is to meet professional standards. Different health facilities in recognizing the need for proper handling and transition of their information have put in place measures that help manage this information to improve quality, safety, and reliability of the information at health care institutions (2001, p.70).

The goal of health informatics is primarily to provide solutions for problems related to data, information, and knowledge processing; study the principle of processing data, information, and knowledge in medicine and healthcare; minimize resources use while securing maximal profit; develop structures for pooling and communicating and applying clinical evidence (Al-Shorbaji, 2001; Imhoff et al., 2000).

Healthcare centrally focuses on patients. The patients provide the data and information because the majority of communication is done to or from the patients. As such, all medical and nursing data focuses on patient care. Bearing this in mind, informatics is meant to improve the quality and efficiency with which service is delivered to the patient whether directly or indirectly.

Definitions

Health informatics which is at times referred to as medical informatics concerns cognitive, information processing, and communication tasks of medical practice, education, research including the information and science and technology that support these tasks (Greenes and Shortliffe, 1990, p. 1114). Wisegeek.com defines Healthcare informatics as a field that is widening its information scope, improving healthcare system security, and furthering the clinical work, coordinates health and information technology, in developing the appropriate systems. It has also been defined as the development and assessment of methods and systems of acquisitions, processing, and the interpretation of patient data with the help of knowledge in scientific research (Griew, and Currell, 1995).

Health information technologies such as electronic health records, computerized provider order entry have been considered as critical in transforming the healthcare industry in the US. They provide tools that control processes in healthcare, acquisition of medical knowledge, and communication between healthcare personnel and patients by adapting to better patients’ needs in a cost-effective manner and rates affordable to the majority of patients. As opposed to the negative perception of many, health informatics does not only include the use of computer technology but it covers the generation, handling, transfer, recovery, discovery, backup, examination, knowledge, and information touching on healthcare (Imhoff et al., 2000).

Different health information systems are used in healthcare. These may include the clinical and administrative health information systems, electronic health/patient record (HER/EPR), financial and clinical health information systems, decision support system (DSS), robotic and simulators, telemedicine, telematics, e-health systems, and computer simulations (McLafferty, 2003, p. 25).

The applications of informatics in a health institution may come at different levels which include; instrumentation (patient monitoring using equipment), bed-side or point of care, at ward or care units (admissions and discharges), at the hospital level, the scientific community, and the society level (Imhoff et al., 2000).

Applications and benefits of informatics Health care

The application of health informatics depends on the type of information available for use. This can be either: patient-specific, which is generated and used in the care of patients in the clinical setting, or knowledge-based, which comprises of the scientific basis of health care (Hersh, 2002, p. 1958). Its application is but not limited to Hospital administration and management, diseases surveillance, computer-based medical records, access to literature and information, knowledge-based serve, e-Health and Telemedicine, and GIS. Other areas of application include billing and accounting, Resource management, medical documentation, Diagnostics and therapy, Imaging, communication, information management, and clinical decision support (Hersh, 2002, p. 1958; Al-Shorbaji, 2001).

Management

Management in a health sector covers different aspects including; the management of healthcare institutions e.g. the lab and pharmacy or the hospital, in the management of national healthcare programs e.g. in disease control. There is a need to manage information from the different institutions in their different sectors. Informatics in the area of management covers aspects of financial management, administrative work, and logistics (Al-Shorbaji, 2001).

Disease Surveillance

In looking at disease surveillance, a large volume of data is collected on the location of disease, type of disease, demographics of the diseased population, and trend of the disease. According to Shortliffe, surveillance data is collected continuously on the disease of interest. Computers and other technology are use to store the data collected to ensure reliability, easy and quality surveillance of the information that is collected. This also ensures that data is collected at considerably low costs for the institution. Data collected from different surveillance is recorded in computers and this makes it easy for health professionals to retrieve and analyze the data as need arises. Informatics has also been used been applied in health statistics and epidemiological studies. Information from satellite-based remote sensors has made it easy to do disease surveillance (1995, p.1061).

Computer-based medical record

Patient-based information is being made electronic by use of computers to improve their quality, efficiency of retrieval and accessibility to medical personnel in the different areas (Al-Shorbaji, 2001). The electronic records ensure the legality and reliability of content since the entries are coded and there is less chance of making mistakes. The codes also help improve on the security of the data since every patient or condition is given a unique identity that can be traced and easily followed up. Electronic records also provide flexibility since the data stored electronically can be presented in different formats to capture the interest of the user (as table of raw data, as graphics that can be easily interpreted), Electronic patients database allows for quality checks to be incorporated in the database to ensure quality in the data entered and also to ensure that the data is complete before any other record is entered. The records also make research easy. The records are analyzed by different researchers that look at different areas. The availability of these records make their research work less costly and fast since that data has already been collected. The institutions can also share their data with others and have a platform for comparisons. The records also act as a basis of decision making for many health professionals and the organization. These records are evidence on the performance and decisions that have been made before. They show the outcome of the decisions made and the impact they experienced, for example, a physician can use records of a former patient to make decisions on how to progress in treating a patient with a similar condition. The administration can monitor the admission and discharge flow, the finances of the different departments or institutions using the same records (Imhoff et al., 2000; Al-Shorbaji, 2001).

Access to Literature and Information Services

Many healthcare institutions have information service centers where they store all information that the institution has and information from other institutions that would be of help to personnel for diagnosis and research. These data can then accessed by individuals or other institutions doing research and need reference. Healthcare information is nowadays presented in electronic form to allow easy access and sharing. Some of the forms in which literature and data is archived and presented for easy and reliable access include: CD-ROM, electronic journals, internet, electronic mail systems and discussion and news groups (Robinson, 1994, p. 72).

Knowledge-based Services

Though new, knowledge-based systems are quickly being applied in the management of information in healthcare. The systems provide expert advice on medico-scientific issues. These are systems that given a patient’s coordinates and symptoms, and it analyses the data thus provide diagnostic support, suggest additional tests or propose a treatment. The systems include literature and factual data (Al-Salqan, n.d.).

These systems help health care specialists to learn and practice the skills and experience pertinent to the patients’ care; instrumentally contribute in the medical and administration decision making processes; act as a measure and betterment for performance; and cater for the needs of researchers, while enlightening the patient’s families.

Geographic Information Systems (GIS)

Westminster College defines GIS as a computer–based tool for mapping and analyzing spatial data. It integrates common database operations of statistical analysis and use of queries, visualization and geographic analysis benefits that maps offer, GIS helps in visual presentation of health data collected. One of the areas where GIS has been used is in public health surveillance and in epidemiological studies. GIS is used for the understanding of the distribution of disease in populations and in the examining, the distribution of health facilities and their access to given populations. It has also been used in planning and evaluating service locations and in spatial decision that support the delivery of health care (McLafferty, 2003, p. 39).

Benefits of informatics in healthcare

The benefits that informatics brings to a health institution can be classified as qualitative, quantitative and strategic benefits. Quantitative benefits are measurable and can be explained by a given intervention e.g. reduction in time and cost of submitting medical claims. Qualitative benefits on the other hand are more difficult to quantify but whose outcome can directly be linked to an informatics infrastructure. These benefits can be measured in terms of the impact they have brought in areas of quality and efficiency in the different areas used. Other benefits include strategic benefits; these include those whose impacts would be seen at a future date. Data collected in a health institution may not be used immediately but may be referred to in future research. Innovations resulting from using this data through its results give rise to new interventions in the healthcare institution.

Informatics has also opened many career opportunities in teaching and training; many institutions have introduced health/medical informatics in the curricula and there is need for skilled facilitators for these courses, within the academic arena. In the development of medical/health informatics courses, institutions of learning have to bring together individuals from different disciplines if they are to deliver the course in the required standards. Many institutions that are concerned with the development of appropriate software to be used in the health institutions also have opportunities of expansion, especially in this field which combines various technologies.

Challenges facing informatics in the health care

Some of the challenges that hinder full implementation and adoption of informatics include lack of awareness. Many healthcare institutions have not yet appreciated the full impact of informatics in their institutes. Without this knowledge or evidence, the budgets do not consider informatics infrastructure as a necessity worth investing in for their institution. The health personnel’s lack of knowledge about informatics also means that the institutions have to hire other professionals with skills on informatics (Haux et al., 2000, p. 3).

Lack of vision is another challenge facing the health care. It is important to note that that informatics involves the knowledge of both health science and technology e.g. the use of computers. Many health institutions have one or the other the scientist are involved in their work and do not make time to enhance other areas e.g. information technology and computer sciences that are paramount for informatics. Such institutions resort to adopting informatics mainly when a particular intervention must be acquired.

The costs of maintaining proper informatics infrastructure is high and some of the technology used in informatics needs skilled personnel to operate. With very few health professionals having the skills required for this technology, the healthcare institution also incurs the cost of hiring external informatics professional as well as the infrastructure. With most healthcare institutions operating on tight budgets, and can only cater for the most basic of needs, the acquisition of informatics infrastructure or its upgrading is yet to be considered one of the basic needs (McLafferty, 2003, p. 42).

Experts in the area of healthcare-related informatics are still few. Though medical/health informatics has now been introduced in many institutions of higher learning and training on the same on professional levels, there remains many institutions without this kind of expertise to take lead in the sector. Most institutions have computer scientist with little training on health matters doing the role of the health informatics technician. However, a health professional may act as informatics technician e.g. a doctor or nurse who has undergone basic training in informatics for this role.

Health informatics is also faced with the challenge of security and confidentiality. Most information and records on patient need to be privately handed with great integrity and security. Many Institutions are yet to develop policies which look at ensuring the security, confidentiality and integrity of the personal information they hold on patients and other research work. Different staff members get access to the record at the health institutions, the institutions have to come up with codes of ethics that will govern the staff on issues concerning information especially when the patient’s records are involved (Al-Shorbaji, 2001; Griew & Currell, 1995).

With increased need for health informatics professionals, many institutions have introduced courses aimed at providing this skill. Learning institutions are faced with the challenge of providing training programs that will cover informatics in all the health areas. Because many institutions have different curriculum for these courses, they have the challenge of producing professionals that will be able to bridge the gap between the health and informatics field.

Health institutions also have to create awareness among their staff about embracing informatics in their day to day activities at the health institution and their need to advance their knowledge on the same.

The future of informatics in healthcare

Haux et al., (2000, p. 21) has outlined three major factors that will greatly influence the further development of information processing in health care within the near future as being: the development of the population, medical advances, and advances in informatics.

Many assumptions on the future of use of information systems in the health sector have been made. Some of these assumptions include; that health care will increasingly be an information-driven service; that information is a major resource, vitally crucial to the individual health; that health information system should be continuum, beginning with patient-specific data; an that the effectiveness and efficiency of the information systems will be ensured through the transformation of the collected data into information (Al-Shorbaji, 2001).

Since health informatics is not yet a mature discipline, different paths are taken by different individuals to make progress in this area. Roberts (2007), outlines some of the paths which include; cadetship and apprenticeship, learning in the workplace, continuing professional development, academic courses and professional qualification and registration.

The great need for professionals in health informatics has enabled institutions of higher learning to develop courses geared to providing the skills need for health informatics at the institutions. Many medical universities in the United States are now making use of computers to assist in learning curriculums (Shortliffe, 1995, p.1121).This will encourage students in the medical field to have some basis of computer processing and use of database for health information management. Education in this field will change attitudes and expectation of information system technology among the health personnel and thus increase their assimilation in the day to day work of health care.

Conclusion

Informatics in health care is no longer a luxury that the institutions must consider after taking attending to their basic needs. For health professionals to make the right decisions, health institutions need to step up and embrace informatics to improve their services and to assist in research in the institutions. Budgeting boards at health institutions need to include informatics infrastructure as one of the basic needs of the institutions. Having some of the members on board with knowledge about informatics and its impact at increasing quality and efficiency of service delivery at the institution will help in convincing the board to prioritize the issue of informatics.

Awareness campaigns should also be conducted especially in the vicinity surrounding the health institution to get the ever-busy health professionals up to date with what is happening in their areas with relation to informatics. The health institutions also need to encourage their staff to train in information systems. Informatics would only bring positive results if all the relevant stakeholders are involved in its planning and implementation. It is vital that the benefits accruing to the institution in terms of improving quality and efficiency at reduced cost should be well explained to them. Institutions of higher learning also need to take up the opportunity to train professionals in this area, to nurture the skills and importance of informatics for the future developments in the field.

References

Al-Salqan, Y. Y. (n.d.). Security and Confidentiality in Healthcare Informatics, Sun Microsystems. Web.

Al-Shorbaji, N. (2001). Technical Paper Health and Medical Informatics: Technical paper: health informatics and telematics. Agenda item 8(d), Document EM/RC44/8, Resolution EM/RC44/R.4.

Greenes, R. A., & Shortliffe, E. H. (1990). Medical Informatics: An Emerging Discipline with Academic and Institutional Perspectives. Journal of the American Medical Association, 263(8), 1114-1120.

Griew, A., & Currell, R., (1995). A Strategy for Security of the Electronic Patient Record”, Institute of Health Informatics, University ofWales, Aberystwyth,UK.

Haux, R., Ammenwerth, E., Herzog, W. & Knaup, P. (2002). Health care in the information society, a prognosis for the year 2013. International Journal of Medicine and Information, 66(1-3): 3-21.

Hersh, W. R. (2002). Medical informatics: improving health care through information. Journal of American Medical Association, 288: 1955-8.

Imhoff, M., Webb, A. & Goldschmidt, A. (2000). Health informatics. Berlin: Springer-Verlag.

McLafferty, S. L. (2003). GIS and health care. Annual Review of Public Health, 24: 25-42.

Roberts, J. (2007). Health informatics: An emerging area of emerging opportunities. Lancashrine School of health and post graduate medicine. Web.

Robinson, E. N. Jr, (1994). Editorial. M.D. Computing, 11(2): 69-73.

Shortliffe, H. E. (1995). Medical informatics meets Medical Education. Journal of American Medical Association, 237: 1061-1121.

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