Informatics application in Hospital Management:
In all over the world the health problems and needs are increasing and becoming more complex. The demands and pressures on the hospitals and health care institutions are also increasing. At the same time the resources are becoming increasingly limited. Achievement of goals, efficiently, effectively, and economically is the primary responsibility of all the administrators. This can be achieved through business, medical and technical management systems in hospitals.
Decision making-Decision support system in health care:
There is a growing trend to apply computers for tasks other than tabulation. The health care providers are increasingly interested in the feasibility of applying the "expert system technology" to assist in improved health care delivery. The earliest research contribtions in the area of artificial intelligence was a program to simulate expert behaviour in the selection of an antibiotic for an infection. The trend of research in Medical Informatics is increasingly in the area called expert systems/decision support systems.
Informatics application in health system management:
The deployment and development of health services has been less influenced by the collection of specific data than by what has been referred to as "Impressionistic Planning" a process wherein information may be minimal and the basis for decision making is intuitive and political, the end results being determined by past experience, popular pressures and rough estimates and guess work. Health professionals tended to cooperate more readily and communicate more freely working and a local level and this promoted the free exchange of health activities and information. At the central level the need to coordinate and control health service development was government largely by the constraints of the resources available. The emphasis, until recent years has been that if there were enough staff, facilities, equipment and finance, the public health and health care services could be expanded and the health status of the population would automatically be improved. In the early 1960s, it became apparent to most health administrators that health expenditure was not infinite and that the emphasis in planning and development must focus on the more effective and efficient use of the limited resources available. When the time came to transmit priorities and proposed programmes into actual operation it soon became evident that there was a serious deficit in relevant information. The major areas in which health service data was lacking or not readily available were health workforce development programming, and the evaluation of service effectiveness and efficiency. Heath managers found they urgently required this information to enable them to initiate and control the progress and outcomes of the programme operation. The establishments of health information unit enable the health organization to have a single focus for the coordination and collation of any forms and sources of data available within the health systems.
International Status
Health informatics in North America
The earliest use of computation for medicine was for dental projects in the 1950s at the United States National Bureau of Standards by Robert Ledley.
The next step in the mid 1950s were the development of expert systems such as MYCIN and INTERNIST-I. In 1965, the National Library of Medicine started to use MEDLINE and MEDLARS. At this time, Neil Pappalardo, Curtis Marble, and Robert Greenes developed MUMPS (Massachusetts General Hospital Utility Multi-Programming System) in Octo Barnett's Laboratory of Computer Science at Massachusetts General Hospital in Boston. In the 1970s and 1980s it was the most commonly used programming language for clinical applications. The MUMPS operating system was used to support MUMPS language specifications. As of 2004, a descendent of this system is being used in the United States Veterans Affairs hospital system.The VA has the largest enterprise-wide health information system that includes an electronic medical record, known as the Veterans Health Information Systems and Technology Architecture or VistA. A graphical user interface known as the Computerized Patient Record System (CPRS) allows health care providers to review and update a patient’s electronic medical record at any of the VA's over 1,000 healthcare facilities.
In the United States in 1996, HIPAA regulations concerning privacy and medical record transmission created the impetus for large numbers of physicians to move towards using EMR software, primarily for the purpose of secure medical billing.
In the US, progress towards a standardized health information infrastructure is underway. In 2004, the US Department of Health and Human Services (HHS) formed the Office of the National Coordinator for Health Information Technology (ONCHIT), headed by David J. Brailer, M.D., Ph.D. The mission of this office is to achieve widespread adoption of interoperable electronic health records (EHRs) in the US within 10 years. For more information regarding federal initiatives in this area, see QIOs. Brailer, whose reputation included an appreciation of the merits of Free (Libre) and Open Source software (FLOSS) resigned from the post in April 2006.
The Certification Commission for Healthcare Information Technology (CCHIT), a private nonprofit group, was funded in 2005 by the U.S. Department of Health and Human Services to develop a set of standards for electronic health records (EHR) and supporting networks, and certify vendors who meet them. In July 2006, CCHIT released its first list of 22 certified ambulatory EHR products, in two different announcements.
European health informatics
The European Union's Member States are committed to sharing their best practices and experiences to create a European eHealth Area, thereby improving access to and quality of healthcare at the same time as stimulating growth in a promising new industrial sector. The European eHealth Action Plan plays a fundamental role in the European Union's i2010 strategy. Work on this initiative involves a collaborative approach among several parts of the Commission services.
In the United Kingdom, moves towards registration and regulation of those involved in Health Informatics have begun with the formation of the UK Council for Health Informatics Professions (UKCHIP)
The NHS in England has also contracted out to several vendors for a National Medical Informatics system that divides the country into five regions and is to be united by a central electronic medical record system nicknamed "the spine". National Programme for IT in the NHS. The project, in 2006, is well behind schedule and its scope and design are being revised in real time.
In 2006, 60% of residents in England and Wales have more or less extensive clinical records and their prescriptions generated on 4000 installations of one system (EMIS) written in 'M' (MUMPS as was). The other 40% predominantly have records stored on assorted SQL or file-based systems.
Scotland has a similar approach to central connection under way which is more advanced than the English one in some ways.
Scotland has the GPASS system whose source code is owned by the State, and controlled and developed by NHS Scotland. It has been provided free to all GPs in Scotland but has developed poorly. Discussion of open sourcing it as a remedy is occurring.
The European Commission's preference, as exemplified in the 5th Framework, is for Free/Libre and Open Source Software (FLOSS) for healthcare.
Clinical Informatics in Asia
In Asia and Australia-New Zealand, the regional group called the APAMI Asia Pacific Association for Medical Informatics was established in 1994 and now consists of more than 15 member regions in the Asia Pacific Region.
In Hong Kong a computerized patient record system called the Clinical Management System (CMS) has been developed by the Hospital Authority since 1994. This system has been deployed at all the sites of the Authority (40 hospitals and 120 clinics), and is used by all 30,000 clinical staff on a daily basis, with a daily transaction of up to 2 millions. The comprehensive records of 7 million patients are available on-line in the Electronic Patient Record (ePR), with data integrated from all sites. Since 2004 radiology image viewing has been added to the ePR, with radiography images from any HA site being available as part of the ePR.
The Hong Kong Hospital Authority placed particular attention to the governance of clinical systems development, with input from hundreds of clinicians being incorporated through a structured process. The Health Informatics Section in Hong Kong Hospital Authority has close relationship with Information Technology Department and clinicians to develop healthcare systems for the organization to support the service to all public hospitals and clinics in the region.
The Hong Kong Society of Medical Informatics (HKSMI) was established in 1987 to promote the use of information technology in healthcare. Recently the eHealth Consortium has been formed to bring together clinicians from both the private and public sectors, medical informatics professionals and the IT industry to further promote IT in healthcare in Hong Kong.
The Indian Association for Medical Informatics (IAMI) was established in 1993. IAMI has been publishing the Indian Journal of Medical Informatics since 2004.
Health informatics in Oceania
In 2002 the Australian College of Health Informatics (ACHI) was formed as a professional association and peak health informatics professional body. It represents the interests of a broad range of clinical and non-clinical professionals working within the Health Informatics sphere through a commitment to quality, standards and ethical practice. ACHI works to enhance the national capacity in health informatics in research, education and training, policy and system implementation.
Although there are a number of health informatics organisations in Australia, the Health Informatics Society of Australia (HISA) is regarded as the major umbrella group and is a member of the International Medical Informatics Association (IMIA). Nursing informaticians were the driving force behind the formation of HISA, which is now an incorporated company. The membership comes from across the informatics spectrum that is from students to corporate affiliates. HISA has a number of branches (Queensland, New South Wales and Western Australia) as well as special interest groups such as nursing (NIA), pathology, aged and community care, industry and medical imaging (Conrick, 2006).
Health Informatics focuses on the meaning and use of this health information to:
- Support Clinical Care by suggesting ways to improve information flow
- Including the tracking and monitoring of patient health shared amongst medical and health professionals
- Providing knowledge about health care outcomes of certain clinical care practices
- Support Health Services Administration in the areas of:
- Access to care
- Effectiveness of care
- Efficiency of care, in terms of cost and benefit
- Support Health Research by:
- Linking health activities to results or outcomes
- Seeking evidence to populate a knowledge base for use as a decision
- Improving health information retrieval
- Encourage Learning by:
- Developing electronic prompting systems
- Providing feedback loops to health information stakeholders
National Status
In India, IT has been a late entrant in this field and most hospitals which forayed into this area started with small systems that were developed in-house. Till the middle 90’s no standardized solutions were available and these local innovations were the pioneers. However, they neither give the desired results nor can they be integrated with newer systems. The major demand for updated solution started with the establishment of the large corporate hospitals many of which like the Apollo group, implemented strong IT solutions in the latter half of the nineties. With the increasing demands of the market, many sturdy, standard HIS solutions were developed by the major IT companies. Today, the Healthcare segment is, in fact, going through the kind of evolution that the banking and financial services sector went through a decade ago. This is being driven by the huge annual increase in the number of hospital beds mostly in the corporate sector. However, the government still owns 66% of the Indian hospital market. The Central Government has also announced setting up of large new hospitals. The public sector hospitals have realized the direction in which the wind is blowing.
In the recent years few insurance companies are venturing into health sector. Inspite of well networked health care system access to healthcare in rural areas is far from satisfactory. In the current scenario, 75% of the qualified consulting doctors practice in urban, 23% in semi-urban (towns) and only 2% in rural areas where as the vast majority of population live in the rural areas. Hospital beds/1000 people are 0.10 in rural as compared to 2.2 in urban areas. Further, a vast proportion of north and north-eastern region of country lie in hilly terrain and some territory in remote islands making healthcare reach impossible to such far flung areas. Tele-healthcare concept is no longer new to the India. Both government and private agencies are venturing into it. Few Indian companies are being capable of providing hardware and software solution for tele-health care. Products of reputed overseas tele-health industry have their presence. Efforts are directed towards setting up standards and IT enabled healthcare infrastructure in the country. All those activities carried out by various agencies are collected and summarized below. Indian Space Research Organisation (ISRO), as part of its commitment for social sector development has been applying space technology for healthcare and education, under GRAMSAT (rural satellite) programme.
