Abstract
Health Information system entails data storage and processing systems that assist in healthcare service delivery. The most common and widely used systems include the billing and eligibility check system for insurance and state programs. However, these systems are not medical support systems since they do not track and assess healthcare. There are numerous health information support systems that have been developed to enhance the effectiveness, efficiency, and quality of healthcare service delivery. This study explores these systems, their benefits, and the rate of their adoption in the public sector. The study also looks at the challenges faced by healthcare providers in the adoption and implementation of these systems.
Introduction
Over the recent past, the health care sector in both developed and developing countries have registered underperformance in terms of cost and quality (Porter &Teisberg, 2004, p. 4). The healthcare structure is different from other sectors of the economy because of a high degree of regulation, massive state investment, and associated low demands of effectiveness and efficiency in public hospitals, and lack of patient geared policies (Mettler et al., 2007, p. 10). As a result, the health care sector exhibits a depressed information system structure.
Nonetheless, since the introduction of e-health, many attempts have been made in the healthcare sector to eradicate these shortcomings. Therefore, the introduction of information and communication technology in the healthcare sector is not only seen as the way to enhance the effectiveness and efficiency of the healthcare services but also the quality of service delivery (World Health Organization 2005, p. 4). In the US, the adoption of information technology in the health sector is highly promoted to improve efficiency, cost-effectiveness, excellence, and safety of health care delivery. This is attributed to the rising healthcare cost and adverse healthcare events (Porter &Teisberg, 2004, p. 64).
Numerous medical reports have suggested that over half of the healthcare funds are wasted on inefficient processes (Porter &Teisberg, 2004, p. 65). As a result, the state and leaders in the health care sector have emphasized the need for the healthcare sector to borrow a leaf from the non-healthcare industries to improve their efficiency. Information communication technology in the other sectors of the economy has been significant in improving the ease of access of vital information, automating labor-intensive and incompetent processes, and reducing human mistakes (Porter &Teisberg, 2004, p.7; Wand & Wang, 1996, p. 86). The main purpose of this study is to explore the adoption and advancement of information communication technology in the healthcare sector and how it has improved healthcare service delivery. The study will also focus on some of the challenges experienced in the healthcare information system.
Data Quality in HealthCare
Data quality is characterized by a multifaceted conception of the properties and state of data (Wand & Wang, 1996, p. 87). Even though there is no conventional agreement on the definition of data quality, a number of researchers have used different approaches to define data quality criteria. These include empirical, theoretical, literature, or practitioner-based criteria. The empirical research approach relies mainly on consumer feedback to develop quality criteria and grade them into classes (Kahn et al., 2002, p.12). Practitioner-based approaches are focused on impromptu observations and experiences of the medical practitioners thus lacking rigor (Price &Shanks, 2005, p.88).
Theoretical approaches are derived from the information economics and communication theories. Theoretical approaches are often criticized because of their deficiency in relevance (Prince & Shanks, 2005, p. 90). On the other hand, literature-based approaches employ literature reviews and analysis to derive data quality criteria. However, there is a fifth approach developed after the first four. This approach took into consideration the fact that the actual use of data is often out of the designer’s control and therefore offers a designer-oriented classification of data quality that reflects the anticipated use of the information. In contrast to other approaches, the design-oriented approach has provided actual direction to system designers by assisting them to comprehend the perceived reality of the diverse stakeholders of the system, and to spot data deficiencies by comparing the state of information technology against the real world (Porter &Teisberg, 2004, p. 66).
Just like other sectors of the economy, the perception of stakeholders is very significant to the success of any form of change in the healthcare sector. As a result, many researchers recommend design-oriented approaches to organizations where data quality evaluation is hard to define in terms of relevance and scope. Designer-oriented approaches help health care system designers to understand the complex link and interrelationship between the elements required to re-engineer technical and organizational features, to enhance data quality in the health care sector (Wand & Wang, 1996, p. 87).
Health Information Systems
Health Information system refers to the data storage and processing systems that assist in healthcare service delivery. The most common and widely used systems include the billing and eligibility check system for insurance and state programs. However, these systems are not medical support system since they do not track and assess healthcare. They only keep track of the processes and costs. Health Information systems support, keep track and analyze service delivery in the healthcare organizations (Kitch & Yasnoff, 2002, p. 114).
The basic fundamental healthcare system is the Electronic Medical Record (EMR) on which everything else is built on. EMR includes patient’s history, examinations, test results, prescriptions, and comments of the physicians among other medical details. The major difference between EMR and other conventional paper records is that the records can easily be shared and analyzed. In the simplest form, EMRs are normally restricted to single healthcare organizations. Electronic Health Records (EHR) was a term used to refer to all the patients’ medical information across various healthcare organizations, but is now used interchangeably with Electronic Medical Records (EMR) (Ammenwerth et al., 2003, p. 126).
Personal Health Records (PHR) is being considered by the healthcare sector to counter the slow adoption of health information systems by healthcare organizations to enable patients to directly access their health records. In this case, the patient will choose a third party who will assist in organizing and maintaining the personal records. However, the main challenges of this system will be on data quality, privacy and lack of cover by the Health Insurance Portability and Accountability Act. This Act only covers healthcare plans, healthcare providers, and healthcare clearinghouses (Kitch & Yasnoff, 2002, p. 33; Ammenwerth et al., 2003, p. 125).
Given the fact that most Electronic Health Records are limited to single organizations, health care sector in the industrialized nations are coming up with healthcare information networks to allow sharing of information among the healthcare organizations. These networks are subject to security and privacy laws to protect patients and only allow disclosure of information on patient’s approval. The privacy and security systems used are sophisticated and can trace those who have accessed the records or information (Mettler et al., 2007, p. 15; Kitch & Yasnoff, 2002, p. 34).
The most sophisticated Electronic Health Records system allows and supports additional medical support applications. These systems are common among hospitals and large healthcare organizations. Nearly a third of the hospitals in the industrialized nations have adopted Computerized Physician Order Entry systems. However, a half of this number has fully functioning Computerized Physician Order Entry systems. These systems enable physicians to organize procedures electronically. Other systems currently in use include Electronic Pharmacy Systems and Clinical Decision Support Systems (Kitch & Yasnoff, 2002, p. 34).
Clinical pharmacies Support Systems are based on medical principles and scientific studies and help physicians to suggest diagnoses and treatments to patients. Electronic Pharmacy Systems on the other hand enable physicians to enter prescriptions electronically and is used to assess drug interaction with other medication. This system also assists hospitals to reduce confusion and errors caused by illegible prescriptions. Health Information Systems advocates explain that these systems are not meant take over care or make decisions on behalf of the physicians but only help them to improve on their service delivery (Kitch & Yasnoff, 2002, p. 34; Porter &Teisberg, 2004, p.67).
Health Information System in the public health
For many years, public health organizations and institutions have used information communication technology to facilitate management of data. Public health information systems were developed to support specific healthcare programs such as: immunization, surveillance of diseases, school health, among others. These systems have varying data and are integrated among government healthcare organizations, thus provide vital information for public health decision support and medical research. However, these systems lack the capability of offering first hand data bank to healthcare providers for healthcare coordination and disease prevention (Ammenwerth et al., 2003, p. 125).
In US, public health information systems are jammed with data reported by healthcare providers. Healthcare regulation makes it compulsory for every healthcare practitioner to report to the Central Disease Control (CDC) unit found in all the state. However, this is not done directly. Local clinicians report to their departments which in turn transfer these data to the CDC. Additionally, different authorities require clinicians to make regular reports for particular jurisdictions. Besides, communicable disease reporting, numerous public health programs also receive data from the health practitioners, for instance, those dealing with chronic conditions (Mettler et al., 2007, p. 11; Ammenwerth et al., 2003, p. 127).
In some regions, data is still being reported using paper forms sent through fax or mail service. For instance, in some states, primary emergency physicians report in Adobe Acrobat generated paper forms required by the state infectious disease surveillance system and the state health department. Lack of integration and interoperability of the public health information system have resulted into too much duplication and frustrations among healthcare practitioners and consumers. These additional costs are not incurred by the insurance companies (Ammenwerth et al., 2003, p. 126-127).
Reasons for Slow Adoption of Health Information Systems
Even though many health information systems are developed by large healthcare organizations, some of the medium sized and small organizations use their own systems and applications. The availability of certified commercial, off- the- shelf systems have minimized overhead cost of implementation and adoption by healthcare providers and organizations. Although the government has put a lot effort in encouraging healthcare sector to implement and use these systems, the rate of adoption is relatively slow. One of the factors attributed to this is the natural resistance of people to change to new ideas. However, the new generation of medical practitioners understands the significance of health information systems and greatly values their influence on healthcare service quality (Porter &Teisberg, 2004, p.67).
Another factor resulting to slow implementation of health information system is the cost/benefit analysis. Since these systems are still new and people are still resistance to adopt them, their benefits have not been fully exploited thus proving costly to the users. In many instances, the healthcare providers who pay for these systems are not the ones benefiting from them. For example healthcare providers who have put in place Personal Record System in most cases lose massive revenue from tests not conducted. On the other hand, the patient does not notice the economic benefit of this system if the test expenses are covered by the health insurance. The Insurance company also does not see the benefit since it pays for a few of them (Mettler et al., 2007, p. 22).
Generally, the health care sector can not feel the benefit of the system unless the insurance rates go down as a result of increased efficiency in the healthcare service delivery. In a nut shell, healthcare delivery is organized into isolated entities where cost and benefits are realized by different organizations. In addition, health information systems are adopted at a different rate by different organizations thus results into additional disparity in the quality of the healthcare service delivery. Even though, cost/benefit analysis impacts the rate of adoption, there is little evidence to support slow adoption of these technologies in the poor and disadvantaged regions (Ammenwerth et al., 2003, p. 126).
Benefits of Health Information System
One of the distinct benefits of health Information system is sharing of information among different healthcare providers and organizations. This is particularly significant for patients with numerous chronic conditions who are seeing different specialized physicians with little or no knowledge of the treatment and prescriptions provided by other physicians. Health information system can automatically assess the possible adverse drug interactions, recommended prescription guidelines and allergic reactions to specific drugs. This is very significant since adverse drug events is one of the most common medical error in hospitals and usually results in prolonged patient stay in the hospital (World Health Organization 2005, p. 10).
The most applicable system in this case is the Computerized Physician Order Entry systems which monitors adherence to medical rules and regulations based on modern research results and the available hospital results to come up with the most effective and efficient procedures. Finally, automated system analysis of therapeutic images allows for more advanced analysis and better diagnoses. A combination of computerized analysis and telemedicine can also allow for the development of long distance diagnoses and treatment strategies particularly for those people living in the remote regions or rural areas (Kitch & Yasnoff, 2002, p. 33).
Health information system has helped in minimizing effects of human errors in the field of medicine. Health information system has made a significant stride on the quality and safety of healthcare by incorporating automated decision making and learning tools into medical practice. This has minimized errors that might results from gaps in practitioner’s knowledge or failure to digest and apply knowledge in actual performance. Health information system enhances decision making ability of the healthcare providers and applies analytic tests and treatment regimes (Ammenwerth et al., 2003, p. 127).
In the mobile healthcare environment, the use of health information system provides a range of benefits. First and foremost, many healthcare offices have embraced computerized scheduling and financial system to rationalize organizational processes by tracking service quality and automating payment processes. Ambulatory health records also provide an opportunity to screen and enhance clinical quality by developing accessibility to information and minimizing duplication of documents. Extensive adoption of health information system has allowed the achievement of system interconnectivity and exchange of information among healthcare providers within and without the borders (Kitch & Yasnoff, 2002, p. 33; World Health Organization 2005, p. 11).
In the sub-Saharan Africa health information system has been used to track up patients under the Antiretroviral therapy so as to provide more specialized care. The information gathered through these systems is used by the government to come up with national health policies and strategies. The government uses information from the wider health information system network to tackle the challenges facing the healthcare sector and the healthcare practitioners. First hand information relating to a disease outbreak in remote areas can easily be accessed by specialists in different regions and therefore enhances collaboration in the treatment of such diseases. However, in most developing countries health information systems are not integrated as such and there is minimal exchange of information (World Health Organization 2005, p. 12; Ammenwerth et al., 2003, p. 128).
Conclusion
Introduction of information and communication technology in the healthcare sector has not only improved effectiveness and efficiency of the healthcare services but also the quality of service delivery. Over the last two decades a lot of funds in the healthcare have been wasted because of inefficient processes. This is the main reason why the US government has been investing massively on information communication technology in the health sector to minimize such inefficiencies. However, the implementation and adoption of health information systems has been quite slow to due numerous factors including the cost/benefit analysis, conservative nature of most clinicians among others. Public health organizations and institutions have used information communication technology to facilitate data and information management. Public health information systems were developed to support specific healthcare programs such immunization, surveillance of diseases, school health among others. However, health information systems in the public sector still lack integration and interoperability and therefore has resulted into too much duplication and frustrations among healthcare practitioners and consumers.
References
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