Information technology (IT) has the potential to improve the quality, safety, and efficiency of health care. Diffusion of IT in health care is generally low (varying, however, with the application and setting) but surveys indicate that providers plan to increase their investments. Drivers of investment in IT include the promise of quality and efficiency gains. Barriers include the cost and complexity of IT implementation, which often necessitates significant work process and cultural changes. Certain characteristics of the health care market—including payment policies that reward volume rather than quality, and a fragmented delivery system – can also pose barriers to IT adoption. Given IT’s potential, both the private and public sectors have engaged in numerous efforts to promote its use within and across health care settings. Additional steps could include financial incentives (e.g., payment policy or loans) and expanded efforts to standardize records formats, nomenclature, and communication protocols to enhance interoperability. However, any policy to stimulate further investment must be carefully considered because of the possibility of unintended consequences.
What is health information technology?
In general, IT allows health care providers to collect, store, retrieve, and transfer information electronically. However, more specific discussion of IT in health care is challenging due to the lack of precise definitions, the volume of applications, and a rapid pace of change in technology. Similar terms can be used to define different products, and the exact functions of a system will depend on the specifics of its implementation in a given setting. Both the terms and the functions also change over time. For example, computerized provider order entry (CPOE), which can minimize handwriting or other communication errors by having physicians or other providers enter orders into a computer system, can apply only to prescription drugs, or may also include additional physician orders, such as x-rays or other images, consultations, and transfers. For electronic health records (EHRs, also known as electronic medical records, automated medical records, and computer-based patient records, among other names), multiple definitions exist, depending on the constellation of functions that are included. They can be used simply as a passive tool to store patient information or can include multiple decision support functions, such as individualized patient reminders and prescribing alerts.
Linking health care providers through information technology
For information technology to become widespread, individual providers must adopt it. Once that happens, connecting them electronically could bring additional benefits. Health care today involves considerable sharing of information among providers such as physicians’ offices, hospitals, imaging centers, and clinical laboratories, as well as among providers and payers. A health care information infrastructure would provide the networks and standards to allow providers within a community to share information electronically. In addition, patients could use it to access their medical records or other health care information from all providers.
A primary focus of those advocating a health care information infrastructure is development of standards for messaging so that one IT system can communicate with another. Few systems allow communication among providers today, although some cities are sharing information across emergency departments. Two communities have moved to have a more comprehensive ability to share information. Some see a health care information infrastructure as a key building block to encourage investment by providers and increase its value. The goal is interoperability—the ability for information to flow among settings of care.
The information infrastructure would consist of standards and networks that allow electronic communication among providers, so that, for example, the electronic record created during a hospital stay is accessible to the primary care physician, or even becomes part of the electronic record maintained by the primary care physician. Interoperability could increase the usefulness of implementing IT and decrease the risk of investing in a system that might quickly become obsolete. The healthcare information infrastructure has been a major focus of the Department of Health and Human Services (HHS) and a number of private initiatives, such as the eHealth Initiative and projects at the Markle Foundation.
HCIT 2000 and beyond
The era of HIT – 2000 has evolved the following way:
- Voice recognition rebounds
- Bar coding and RFID
- PDAs and multipurpose cell phones
- PHRs and consumers maintaining Web-based records
- Web 2.0 technologies
- National call for EHR adoption – Meaningful Use
- Infusion of HIT funding
- Implementation of point of care clinical systems
- Health 2.0 – Participatory Health Care; Types of Web 2.0 – RSS, Podcasts, Google, Sharing data for Clinical Trials
- Farmville of Health – From gaming to Health
Mindbloom[i] is about spending two minutes every day looking at images that mean something to you, and that motivate you. One step every day is the key to enduring change. The key is sustained engagement. Many of the tools that exist today are not engaging. The core goal is to make life change fun, and engaging. As a gamer, Hewett wants to make behavior change appealling. And it needs to be authentic. I think that he is trying to make Mindbloom into the Farmville of health – a pervasive and widely appealing game, but one that happens to have a positive effect on people’s health and life. People use Mindbloom to discover what’s most important to them. A key differentiator is to take a view of the entire life. The key reason why most people want to be healthy is to spend more time with their relationships. Mindbloom just finished their public beta with 15,000 users.
The central visual image to Mindbloom is a tree, with each of the leaves representing an area of life that means something to you (such as spirituality). The sun represents inspiration, and rain represents the steps that you are going to take today to nourish what is important to you. Users in communities can upload their favorite images (in addition to the ones provided by MindBloom), and sayings and songs that inspire them. You earn points by setting it up, and as you apply it, there is a visual response (the tree grows a bit and the sun glows). The rain is simple steps that you can take to improve your life. You again get positive feedback to improve your life. If you keep your tree green, you produce ore “seeds” and the seeds can then unlock features and content, as well as action-packs for different areas of your life. Game items include the ability to purchase sun and rain for your friends’ trees. The social element is a crucial part of personal growth. It is supported here by the ability to add friends, as well as the ability to encourage people who may not be doing so well. The worst that happens to the tree is that the leaves turn brown-ish (they don’t fall off). Coaches are also able to invite in their clients, and can see how they are doing. Mindbloom’s beta showed that people were, on average visiting three times a week and spending 15 minutes at the site.
- Mobile Technology
GlucoPack, a glucose meter that fits onto regular cell phones.
Heart rate monitors that utilize accelerometers and bluetooth.
Softwares allowing to photograph the package(food, cosmetics, cleaning etc) and receive full info how ingredients in food affects on health.
- HealthHiway – interoperable, standards based healthcare network
- SOLOMO(SOcial, LOcal, MObile) communication
- Epidemiologists track outbreaks of flu and food-borne illnesses using Tweets.
- Recorded puffs on asthma inhalers (equipped with GPS) now provide useful indications about air quality .
- ‘First Life’ gathers real-life side-effects or complications from medications reported informally by millions of patients on tweets, blogs, and virtual community sites, revealing far more diversity and detail than any formal clinical .
What’s in ahead?
- Patients will have the same access to knowledge as professionals
- Self-care or “rolled back care” will become steadily more important
- Professionals and patients will become much more equal partners
- Evidence will become steadily more important
- Health care systems will increasingly be concerned with chronic not acute disease
- Health will increasingly be at the centre not the edge of politics