Health Care & Information Technology
One of the greatest forces of change in the twenty-first century is the impact of information technology, which impacts our communications, entertainment, personal finances, and our ability to know about the world around us. Ironically, this technology has not impacted us at a most personal level: how we find and receive health care. This article looks at the development and application of information technology to health care delivery and will provide a brief analysis of why health care technology has lagged behind other industries as well as at some of the new technologies that are transforming the delivery of health care in the US.
Keywords Decision Support Systems; Electronic Health Records; Health Care Delivery; Information Technology; Physician Practice
Health Care Management: Health CareOverview
The application of information technology has been an uphill climb hampered by a variety of cultural, organizational, and financial factors. Early efforts at clinical applications in health care began in the late 1960s. One of the first hospitals to embrace the potential of emerging computer technologies was El Camino Hospital in Mt. View, California. Designed by the Lockheed Missiles and Space Company, the system installed at El Camino was an extension of its computer applications developed for the space industry. Technicon Corporation provided management for the project. The system had two functions: Computerized physician order entry and documentation of nursing activities. Despite the promising start represented by El Camion, there was a general reluctance on the part of health care providers to adopt emerging technologies. As a result, information systems and other technological advances in health care have significantly lagged behind other industries such as manufacturing, finance, and telecommunications.
Although many stakeholders in the health care industry have recognized the potential importance of computers, initial applications were limited to a handful of researchers, hospitals, and forward thinking physicians. The National Library of Medicine (NLM) emerged as an early leader in the field of medical informatics. Driven by the need to computerize the Index Medicus, the nation's leading reference for biomedical research journals, NLM designed and built MEDLINE in the 1990s, an interactive searchable, networked database that linked academic and research institutions to NLM's central computers in Bethesda, Maryland.
The earliest successes in adapting technology to the health care industry were primarily addressed business functions, first in hospitals and later in private physician practices. The applications consisted of financial management information systems encompassing accounting functions (collection of revenue and expenditure data) and financial functions (planning and decision support). Data was used for reporting purposes and in financial planning to construct simple what-if scenarios (Smith, 2000). Other applications included routine operational procedures such as scheduling and patient information databases. As computing technology and capabilities increased, networking systems were developed that allowed providers to link with payors and automate claims processing and accounts payable.
The nonbusiness side of information technology continued to lag considerably behind the development of financial and administrative computing functions until the 1990s. Increasing pressure from payors (government, employers, and insurance companies), rising costs, and increasing technological capabilities have combined to propel health information systems forward. The result is the development of applications beyond routine processing of administrative functions and a shift to what Tan and Modrow (1999) call a "new paradigm" in health care information technology. This new paradigm is the application of technology for building computer models and knowledge based systems to support clinical decision-making (Tan & Sheps, 1998).
Despite the acceleration of technology adoption in health care, there still exist barriers to full integration. In this essay, we will look at the obstacles that continue to hinder adoption of information technology in health care and then will consider two specific applications that have the potential to transform the art, science and practice of medicine: Decision support systems and electronic health records.Obstacles to Information Technology (IT) in Health Care
The obstacles to full adoption of technology in health care can be categorized into three areas: cultural, organizational, and financial.Cultural
The organizational culture of health care is one that is dominated by physicians. Physicians assumed their central role of authority since the movement out of family based medical care and into the scientific era of modern medical practice beginning in the early 1920s and 1930s. This role has been maintained through the apprentice-based training model, the tight network of collegial relationships, and the trust and status that society has granted the profession of medicine.
The advent of computers in the early 1960s saw two types of responses by physicians in relation to technology and their position of authority in the delivery of health care. The responses are almost diametrically imposed. The first is the assumption that integrating computers into medicine would have no effect on the physician practice of medicine. Information technology (IT) was perceived to be remote from the clinical care much like business or maintenance operations — necessary and important functions but ancillary, not integral, to their work, i.e. caring for patients (Shortliffe, 2005). The opposite view was the perception that computers might eventually limit or even diminish their role in patient care and thus were viewed as a threat to physician autonomy (Bernstein, 2007). Many physicians as well as other patient care providers were also concerned about issues of confidentiality.Organizational
Unlike many other industries, health care is characterized by fragmentation — many players, little coordination (DePhillips, 2007; Shortliffe, 2005). Even physicians in their pivotal role in patient care can get lost in the tangle of various and diverse service providers, technicians, office staff, administrators, and so on. Middleton (2005) observes that the failure of...
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