Building the Next Generation Health Information Systems

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Home » Exclusive Features , Health Innovation » healthcare , IT infrastructure » Building the next generation health information systems

Building the next generation health information systems

e-health record system health information systems Healthcare industry IT healthcare

By Eden Estopace | Feb 14, 2011

SINGAPORE -- From digital devices to mobile apps to electronic health records and advance hospital systems to sensors and predictive

tools for containing disease outbreaks, technology in healthcare has gone a long way. Experts, however, hold the opinion that there is more

to come and what is currently available has barely scratched the surface of the full potential of IT in improving service delivery.

"Because of the rising prevalence of chronic diseases, I think it’s time we actually synergize to improve the way we actually deliver," says Dr.

Steve Boyages, Chief Executive Officer of Clinical Education and Training Institute (CETI) Sydney, Australia, in a recent Microsoft forum that

gathered health experts in Singapore.

IT in healthcare, he says, was where banking was 25 years ago. Every time people visit a hospital or health environment, it's like opening a

new bank account. They need to deliver the same set of information to different people and that information may already exist in the system.

Another key challenge is the complexity of the hospital or healthcare environment. "The hospital is a very fragmented environment," he says.

"It's really a complex workflow and a lot of the tools that we tried to apply through health IT have not really addressed that complexity or

understood the nature of the clinicians or the needs of the patients."

Connecting disparate systems within one environment is challenging enough but connecting to multiple interfaces from across different

areas from primary care to community-based care is another thing.

Then there is the issue on agility and flexibility. In the healthcare environment as in any other industry, you have people who are early

adopters of technology and you have a lot more people who don't want to know about computers.

"What I'm really worried about is the generation that is coming who are connected all the time. When they work in the hospital environment,

they'll feel so disconnected so we have this whole paradox of disconnectedness," he adds.

In building the next-generation health information systems, the primary issues of interconnectedness and interoperability need to be

addressed, as well as other factors unique to the healthcare industry.

Standardization

"If you want to connect systems together, technically it's very easy," discloses Dr. Brian Cohen, Chief Technology Officer, iSoft. "We've had

the technology for many years to send data from one system to another. The problem is what exactly is the format or the structure of the

data."

Cohen emphasized that in healthcare it is very important to ensure that what one doctor says in one clinic means exactly the same thing to

another doctor in another hospital. "What we've been struggling with is coming up with standards like coding standards or instruction

standards so that when we send information from one system to another they can be merged sensibly to give a complete picture," he

explains.

When you have data coming from all points -- from the primary health care physician, from the specialist, from regional or community

hospitals, or from polyclinics -- you have different structures and systems that need to talk to one another in a language that everyone in the

ecosystem are familiar with. So meaning and the contextual setting of the information is extremely important.

"Over the last five six years, common solutions or agreed solutions among countries and organizations have emerged. By the force of

momentum of these different standards, those things start to fall into place, particularly around things like classification of coding for

diseases and treatment codes," Dr. Cohen shares.

Dr. Michael Bainbridge, professor at the University of Victoria, British Columbia, Canada, affirms that if computers are to be used at the point

of care, then definitions would have to be put in place. Standards for professional record keeping are necessary as the industry moves into a

new era of person-based care.

"What has held us back is the failure to actually bring out what is the real user requirement because a lot of us in medicine still believe it's

another science, while the interoperability question, which is fundamental to person-based 21st century medicine, has to do with standards

and definitions," he explains.

Dr. Bainbridge also shares the opinion that technically has already everything it needs today to deliver personalized care or to demand from

a health system provider.

"How do you give me 21st century affordable system that is available anytime, anyplace, anywhere to suit me and to make me better? We

already have all those components," he says, adding that it is just a matter of knowing how to fit those pieces together and knowing whose

responsibility it is.



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Home » Exclusive Features , Health Innovation » healthcare , IT infrastructure » Building the next generation health information systems

Building the next generation health information systems

e-health record system health information systems Healthcare industry IT healthcare

By Eden Estopace | Feb 14, 2011

Integration and simplification

Dr. Gamaliel Tan, Chief Medical Informatics Office, Alexandra Hospital Singapore, affirms that hospitals are now working on many of these

standardization issues as well as the need for integration.

"Integration, joining the dots, painting picture about one patient so that we don't end up prescribing the same medication, repeating the same

tests, and increasing the cost for the patient - there's a lot of work to be done," he says.

But first, a plan or a kind of enterprise architecture of what we want to be in five or 10 year's time is needed," he adds. "We need to ask what

are the outcomes from this electronic medical record (EMR) system or healthcare IT that we are going to draw up. A lot of times

management changes and doctors move in and the out. It needs to be driven from the top and the system must survive change in any

management.

The biggest roadblock so far in doing these things, according to Dr. Cohen, is the lack of a real consensual view of what clinicians and

health professionals want.

"It dawned on us (from a vendor's point of view) that what we really need is a system that users themselves would have a reasonable

flexibility to customize to particular requirements," he says.

He cited a recent report in the US that the main reason IT was not picked up within the healthcare industry was that the IT systems

themselves weren't flexible enough. Just as the nature of healthcare delivery changes so rapidly, the business process models also changes

fast and IT systems must be kept up to date.

"The requirement is to have very flexible models, but are the users willing to devote time to configuring the systems to do what they want

them to do?" he asks.

Dr. Tan agrees that there must be a lot of input from clinicians before a system is designed, though he admits it is quite hard to get clinician

input.

"When IT people do call for user acceptance test it is very hard to pull clinicians out from their busy schedules and even if you can manage

to pull one or two, their way of thinking do not necessarily translate to the way the whole hospital thinks," he says.

The challenge is how to make the system adaptive to the whole hospital when you have inputs and information coming from all sides - the

nursing input, the therapist input, the doctor's input, the medical officer input and the social worker input.

"How do we really connect all these things?" he asks.

Dr. Boyages, who chaired an electronic health record implementation group 10 years ago in New South Wales, says clinicians have to trust

the system, but the issues being addressed may be too big a task.

"We tried to boil the ocean and it is too big a task," he says.

The key to facilitating learning and implementing new systems using new technologies is to keep it simple, pragmatic and achievable rather

than trying to implement too big a task. If everyone could agree, for example, to simply have a single database for medication management

across various interfaces, it would save a lot of time for clinicians and make more things more efficient at the point of care.

It is also clear, adds Dr. Cohen that most healthcare professionals want to spend as little time touching keyboards or screens.

"When we actually go to a hospital or clinic and we see what users want and not what the IT department wants, it’s actually less

sophisticated and complex than what we are thinking of. We have to make sure that we don't go overboard building something which may

not be used most of the time," he says.

Moving forward

The next-generation health information system, says Dr. Tan, must also address the issue of cost, quality and accessibility.

Who pays for the cost of the infrastructure and software when the benefits are dispersed and the beneficiary is really the society at large?

Other questions to ask include: Is the project feasible? how much does it really cost to run an EMR system? Is it accessible to the public, to

the doctors and to the healthcare users and will it translate to expected outcomes?

"I think it (next-generation health information system) is painful and it takes courage to implement," Dr. Tan says. "When you want to effect

changes, you have to have perseverance because it takes more than one cycle to implement. Philosophically, we will never get to a perfect

system; there will always be changes to be made. Twenty years from now we may still be chasing that nirvana of the perfect health record



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Building the Next Generation Health Information Systems