How does lack of information technology affect quality of Healthcare?

As healtheappointments.com writes:

As per Institute of Medicine, “healthcare quality” is defined as the extent to which health services provided to individuals and patient populations improve desired health outcomes. The quality of care which is offered by the US Health Care lags much behind its competitors at the international level, on all measurable parameters. One such field is the failure to use proper Information Technology to support the quality of care. Despite the huge amount of money being spent on healthcare by the US government, the quality of care that is delivered is poor. Several loop holes exist in making proper utilization of information technology in health care which are discussed below. There could be changes made in each aspect of quality of care to overcome such defects and make health care more accessible, affordable and convenient for everyone. For example, electronic medical records (EMR/EHR) are one of the basics in Health Information Technology. Their advantages have been highlighted in this paper. Though the nation spends a huge chunk of its GDP on healthcare, it is still not able to successfully implement the EMRs throughout the nation, in the health care system. Implementing these records in the system will affect the quality of health care delivery enormously. This paper attempts to explain few methods to implement this system for improving health care systems. Overall this entire article speaks about how the lack of information technology affects different sectors in quality of care, existing strategies in market and the goals to improve the health care.

Introduction

Institute of Medicine's Committee on Quality Health Care in America states “Information technology must play a central role in the redesign of the health care system if a substantial improvement in quality is to be achieved over the coming decade.” But, The Institute of Medicine's report on medical errors reports dangers inherent in the U.S. medical care system that might cause up to 98,000 deaths in hospitals and cost approximately $38

billion per year. U.S lags behind other countries at the international level in the usage of EMR. This is because of the failure of the primary care physicians to use EMR. The reasons for this could be due to the high costs which estimates of costs of $28 billion per year during a 10 year deployment and more 16$ billion per year after adopting the interoperable EMR systems in U.S health care. The complexities in health delivery systems pose challenges to achieve interoperability. There should be proper coordination among the health care providers like physicians, specialists and technicians to use the EMR systems effectively without any confusion. Comprehensive staff training is needed. Extensive staff training programmes and coordination and planning to train staff from all sections across the hospital are required during implementation of EMR system. As explained in the article, Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally, 2010 Update (http://www.commonwealthfund.org/Publications/Fund-Reports/2010/Jun/Mirror-Mirror-Update.aspx?page=all), the high quality care is defined in the commissions National Scorecard as care that is effective, safe, coordinated, patient-centered. Quality of care can be studied under three aspects; safe care, coordinated care and effective care. Below listed are some of the points about how does the lack of proper usage of information technology affect the three sections. Also, the existing strategies are mentioned and focus on how we can improve these strategies by using some new policies to achieve improvements in the health care quality is explained in detail. How does lack of proper information technology usage affect safe care? Safe care: Institute of Medicine describes safe care as “avoiding the injuries to the patients from the care that is intended to help them.” The safe care can be explained in simple terms as avoiding unnecessary harm to the patients due to the services which are used to improve the health. Mostly it includes the improper drug dosages, physician induced errors/iatrogenesis, improper drug titrations. Information technologies used in health care systems often are poorly coordinated among the health care providers that lead to error. The sources for these errors include lack of proper experience of prescriber and staff in usage of technology. Shortcut or default selections can override non-standard medication regimens for elderly or underweight patients, resulting in toxic doses. Irrelevant or frequent warnings of the system that can interrupt work flow of physicians. One such error due to improper IT is Technological Iatrogenesis/ e-iatrogenesis: Technological iatrogenes is describes the new category of adverse events that result from technological innovation creating system and microsystem disturbances. Technology induced errors are significant and increasingly more evident in care delivery systems. This idiosyncratic and potentially serious problems associated with HIT implementation has recently become a concern for healthcare and information technology professionals. Healthcare systems are complex and adaptive, i.e.; there are many networks and connections working simultaneously to produce certain outcomes. When these systems are under the increased stresses caused by the diffusion of new technology, unfamiliar and new process errors often result. If not recognized, over time these new errors can collectively lead to catastrophic system failures. How does the lack of proper information technology usage affect coordinated care? Coordinated care is the patient care which is provided throughout the treatment course may it be inpatient or out patient. As per the Commissions first National Scorecard report, coordinated care can be defined as “coordination of patient care throughout the course of treatment and across various sites of care helps to ensure appropriate follow-up treatment, minimize the risk of error, and prevent complication.” This type of care is typically complex and coordinated. Information is often not available to those who need it when it is needed, and as a result patients often do not get care they need, or alternatively do get care they do not need. Many lab tests are performed at "outside" laboratories, and because of this lack of integration, such results are generally unavailable via the information system, for example the unusual tests like electroencephalograms. When the images of a variety of types including radiographs and electrocardiograms can now readily be displayed, such images are typically not yet accessible to providers. More important, most hospital systems provide little or no clinical decision support to providers. Clinically decision support takes many forms that include passive display of information such as the last digoxin level and potassium in a patient receiving digoxin. Reminders for example, that a mammogram is due; alerts such as, the haematocrit is falling rapidly or that the patient has an allergy to the prescribed drug and, guidelines and suggestions about

orders in a patient with a suspected myocardial infarction. Asking the providers to deliver today's complex care without such assistance is like asking a commercial pilot to fly with no instruments, given the vast array of information and knowledge that providers must handle. One more situation where clinical decision support fails is improper delivery of information in today's subsystems of health care providers. For example, the laboratory and pharmacy systems, they do not have good interfaces and thus cannot readily communicate with each other when required. This lack of communication makes extracting important information and providing clinical decision support vastly more difficult. Furthermore, the inpatient and outpatient systems in most healthcare systems are disconnected. Rarely providers have access outpatient medical information from the inpatient setting, or vice versa. This information is absolutely pivotal in providing safe, efficient medical care; after all, a patient's allergies are the same both inside and outside the hospital. Covering for another physician's patient panel is vastly easier, safer and more efficient when their medical record; especially their problems, medications, and test results can be instantly accessed. Transfers from acute care to long-term care or home-care are also problematic; often little information is transferred with the patient. In general, outpatient care is much more fragmented than inpatient care, and would likely benefit even more from computerization and communication of information than inpatient care. The lack of electronic information also limits quality reporting. Most organizations report externally for both inpatients and outpatients using only claims data, as required by state and federal agencies. How does the lack of proper information technology usage affect effective care? Effective care is appropriate care given for preventing the chronic illness or treating a given condition. The Commission’s National Scorecard defines effective care as “services that are effective and appropriate for preventing or treating a given condition and controlling chronic illness”. Preventive care and chronic care lags behind because of inadequate availability and usage of information technology in the primary care. Source for such errors can be due to the lack of computerization of reminders and prevention guidelines in the health care systems, information system changes in the prevention and chronic care aspects. The patient oriented intervention programmes of educational or

supportive nature are poorly coordinated. There is lack of proper computerized tracking and reminder system usage in the preventive services for geriatrics. Looking at the three sections in the quality of health care, the health care services are affected because of improper usage of information technology. One such example is the electronic health records (EMR). By definition EMR is the digital version of patient medical record in a physician office. Electronic health record (EHR) is the electronic record of patient’s health details beyond the physician office. These two are often used interchangeably. Usage of EMR in the health care systems is not widespread even though the amount of money spent on health care is huge. How can EMR affect the quality of care? Before that, let’s discuss the advantages and disadvantages of EMR. Pros and cons of using EMR:

Electronic Medical Records are becoming widespread with the HITECH act which is passed in February of 2009. But most of primary care physicians still have not adopted the electronic health record systems in their practice. The benefits of electronic medical records, however, outweigh their disadvantages and it will be inevitable in the future that all practicing physicians have an electronic medical record for their patients.

Advantages of EMR:

Reduction in medical errors by digitizing patient records, physicians, nurses, and other care providers can freely access information. Nurses and doctors do not need to track down folders or worry about losing notes. Everything is documented in the Electronic Medical Records software. Decrease in the repeat procedures like laboratory test or blood report. A big reason for why patients pay for repeat procedures is because health care providers do not communicate information between different locations. Physicians order the same procedures because the information isn’t available for them to look at or too difficult to obtain. Finally it lowers the overall cost of health care. A decrease in repeat procedures decreases the cost of healthcare overall. Insurance companies need not pay for these procedures and thus it can help cover the other services. Disadvantages of EMR:

The existing electronic medical records are clumsy, unsecure, and expensive. Many of the proprietary systems are to use with poor user interfaces and with too many features. With the less expensive software solutions, there is a risk of unsecure information being passed. Because these EMR systems are expensive, physicians charge their patients more. The practitioners aren’t incentivized to use. Many doctors don’t feel the need to convert to digitize patient records. The government incentives are designed to give a reimbursement to doctors who already have a system in place. Many physicians are stuck in their old ways. Most of the physicians are slow adopters of technology. Private practice has their own ways of doing things and is resistant to change. Overall, in the health care systems EMRs are inevitable. EMRs represent benefit to patients who care enough to take their healthcare into their own hands. Patients can create personal health records to track their own health progress which parallels patient records that are held by your doctor. With the usage of EMR systems in health care the patients would definitely benefit as the overall cost of treatment reduces, there could be more easy access to older records, and avoid unnecessary charges. So as we could make it clear, that information technology has more made the health care systems more favourable, we will have a look at the technologies which are existing in the market for making IT usage easier, as well how we can make IT more reachable with new policies and strategies. Already existing Strategies in the Market focusing on the IT usage in quality of care: Clinical Informatics to Promote Patient Safety (CLIP) - AHRQ's FY 2001 included $50 million for initiatives to reduce medical errors and improve patient safety. Small Business Innovative Research Program (SBIR) - AHRQ devotes 2.5 percent of its extramural research budget to support SBIR to help small businesses develop innovative technology that will lead to improvements in health care quality in the United States. The Integrated Delivery System Research Network (IDSRN) was developed to capitalize on the research capacity of large integrated delivery systems in the United States. In FY 2001, sixteen IDSRN projects were funded, and 7 of these projects specifically targeted to the use of IT in health care.