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.
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