COMPUTERS AND INFORMATION TECHNOLOGIES IN HEALTH CARE

Dr. Snehal J. Mehta

Oral free paper

The utility of computers & communication tools to enhance and improve medical practice, education and research has increased exponentially in the past 30 years. Recent years have seen an explosive growth in biological data and to cope with that, a new scientific discipline has emerged which is known as Bioinformatics, Biocomputing or Computational Biology. It combines the tools and techniques of mathematics, computer science and biology in order to understand the biological significance of a variety of data. Bioinformatics is located at intersection of information technology and the different disciplines of medicine & healthcare. It is considered as the essential & pervasive element in all healthcare activity. Modern information system offers the promise of unprecedented quality, innovation and efficiency in the delivery of health care.

HEALTH WEB SITES :

Over the past few years, organizations providing health information have identified the Computer & Internet as an effective medium for reaching large numbers of health consumers. It resulted in explosion of consumer-oriented health web sites, which are dedicated to diagnosis and management of diseases, the suggestion for healthy lifestyle, and prevention of disease. Very popular of them are :

Other websites like cnnhealth.com, mdconsult.com and emedicine.com allow clinicians to review useful information such as clinical knowledge and therapeutic evaluations. Security requirements are minimal because personal health information are generally not exchanged on these sites. A major issue is the need for tools to help consumers find information of interest and evaluate its quality according to their needs and capabilities and present it in a form that they can be understood, regardless of educational and cultural background of consumer.

ONLINE HEALTH RECORDS :

The Computer and Internet is an emerging medium for giving direct access to consumers for their personal health records. A number of new websites like personalmd.com allow consumers to store, update & retrieve their own health record online. These records are well organized and easily accessible compared to historical voluminous paper work. This can create comprehensive chronological record that carry information about care received from different organizations over an extended period of time, which can be used anytime from anywhere to monitor and evaluate their health status. Organisations that store online health record will need to develop policies that balance the need for privacy and security against the need for ready access to record by patients and eventually by care providers and perhaps insurance companies, researchers and others. Methods to ensure security of electronic patient information are authentication, access control, audit trails, encryption and sessions.

HEALTH EDUCATION :

The emergence of the Internet and Internet-based technologies has the potential to transform health professional education at all levels. Educational systems that were once teacher-centered and geographically limited can now become learner-centered and unconstrained by geography. Very large amount of database like abstracts, journals, books, reports, seminars, conferences, dictionaries, directories etc. can be stored, retrieved and transported efficiently. These databases are available in various forms like floppy, CD, softwares, magnetic tapes or internet. The advent of online textbooks, journals, and interactive courseware could accelerate the trend so that students spend less time reading books and attending lectures and more time researching topics online.

Evidence Based Medicine (EBM) is useful for making decisions about care of individual patient, in a scientific and systematic manner. EBM is the best tool that allows students and clinicians to search and retrieve the latest medical literature over the Internet and use the evidence retrieved to guide clinical decisions. The process of incorporating knowledge from the medical literature into patient care decisions is referred to as evidence-based practice. It provides an effective and efficient frame work for post-graduate education and also supplies a model of worldwide applicability when coupled with virtual libraries and distance learning programmes. In addition to learning in virtual conferences, clinicians will do much of their learning of new diagnostic and therapeutic measures in the context of daily patient ca

BIOMEDICAL RESEARCH :

Biomedical research ranges from basic investigations of the molecular details of biological systems to the study of clinical implications of new scientific findings. Progress in biomedical research has recently been fueled by an explosion of biological data available for analysis. The Internet has been widely accepted within the biomedical community and greatly facilitates the research enterprise by helping integrate disparate databases for improved analysis, allowing linked simulations, and enabling remote control of biomedical research apparatus. Each of these applications poses a range of technological challenges. The most important reason for the adoption of Internet technologies within the biomedical community has been the development of publicly available databases containing biological information. Many major biological databases are available at no charge on the Web and offer rapid access and query capability like medline, genbank, swiss-prot, omim etc.

TELEMEDICINE AND REMOTE CONSULTATION :

It is the delivery of healthcare services where 'distance' is a critical factor, by all healthcare professionals using electronic information & communication technologies. 'Store and Forward Telemedicine' has become more commonplace using multimedia e-mail and web technology to forward medical images, audios, medical records, and laboratory results. By combining these data with real-time synchronous consultations, consultants can now provide comprehensive evaluations from anywhere in the world. The next generation of telemedicine applications will expand the remote clinician's capabilities beyond diagnosis to therapeutic interventions. Telesurgery, Remote psychotherapy and virtual 'home visits' to manage chronic medical problems are all in early development. Examples of current telemedicine applications are in-flight emergency resuscitation guidance; home fetal monitoring during complicated pregnancies; remote dermatologic, pathologic or radiographic consultations; tele-laparoscopic surgery; and providing specialty care to incarcerated violent criminals.

Closely related to the provision of remote medical consultation is the use of communication networks to transfer still medical images like X-rays, CT scans etc. Picture Archiving and Communication System (PACS) is used to retrieve digital images like Cineo-angiography, Echocardiograms and Gait analysis from online repository and send them to specialists for interpretations. Advantages of PACS in medical imaging are improved management and use of images, expert interpretation for better quality of care and cost reduction.

India, a large rural based populated country separated by large distances is faced with many preventable life threatening diseases, which can easily be avoided by the application of telemedicine. Remote consultations could give consumers greater access to skilled health professionals regardless of geographic proximity. Even where clinical expertise is available, but inconvenience for the patient or the provider, remote consultation may be a cost effective alternative.

PATIENT MONITORING AND HOME CARE :

Information technologies offer the opportunity for improved monitoring of consumer health and potentially provision of in home care through video-based consultations with care providers and control of medical equipment (e.g. pacemakers) deployed in the home. The goals of such activities are to assist in the early detection of potential health problems, ranging from heart attack to diabetes, and to reduce the need for clinical intervention and costly hospital stay. It can result in fewer office visits and hospitalizations, thereby lowering costs while improving patients monitoring and care. Continued advances in computing and information technologies could enable more widespread availability of health monitoring systems. Medical devices such as stethoscope, glucometers and electrocardiogram monitors can be equipped to support Internet connections and made available to consumers at low costs.

Clinical/Diagnostic Decision Support Systems (CDSS) are interactive computer programs which directly assist physicians & other health professionals with decision making tasks. These application offer an adjunct to the traditional patient care model as it incorporate individual patient characteristics into a computerized knowledge base to generate patient-specific assessment or recommendations. Clinical judgment is dependent on information gathering, accurate assessment of probabilities and problem-solving skills. They save lives & reduce costs.

Advanced modalities of diagnostics like Computerized Tomographic Scanning, Magnetic Resonance Imaging, Echocardiography, Automated biochemical analyzers can not exist without innovation of computer science. Future will definitely show advances in microelectromechanical systems (MEMS) devices, combined with those forecasts in microelectronic, biosensors and biomaterials, could lead to revolutionary changes in therapies, delivery of medication, and monitoring and alerting systems for elderly and those with chronic conditions. Very truly, 'the scissors are replaced by joysticks and scalpels by lasers' which is evident by various forms of Cybersurgery, Micro-robotic surgery and 3-D image modeling.

E-COMMUNICATION BETWEEN PATIENTS AND CARE PROVIDER / CLINICIANS :

E-mail is more permanent than oral communication and more spontaneous than letters and other text documents. Clinicians and care providers have been communicating with their patients by E-mail for several years. E-communication can extend and complement personal encounters, improve compliance and increase the involvement of patients in their own care. It is an effective mechanism for improving care and reducing costs because more frequent communications might enable better tracking of a patient's progress and eliminate the need for office visit. Most of these e-mail exchanges between patients and providers involve discussions of personal health information, which must be suitably protected from leakage of confidentiality and alterations. E-communication is well suited for communicating administrative informations, medication or nursing instructions, patient education materials, lab results, appointments reminders and prescription refills. Secure Sockets Layer (SSL) encryption and user authentication can largely improve the security of e-mail exchanges. The policies that can address issues of confidentiality, data integrity, authentication, timeliness and the appropriateness of safe and effective use of e-mail for clinical discussions are highly required.

PUBLIC HEALTH :

Public health workers promote health and the quality of life by preventing and controlling the spread of diseases, injury and disability. A number of public health activities could be enhanced by an internet that is better attuned to public health needs, that provides sufficient security to protect sensitive medical records, that is accessible to all public health workers and the public at large and that remains operational even in times of natural or man-made disasters. Public health surveillance can be benefited from internet based transactions to assist in collecting data about the health of individuals, personal risk factors and medical treatment as well as data about potential sources of disease and injury in the environment and resources that can be used to take effective action.

Integrating Data Sources for improved decision making : There are dozens of systems that support individual diseases (such as AIDS) or disease groups (e.g., hospital-acquired-nosocomial-infections). The result is massive duplication, and a patient's clinical information could reside in several different systems that do not interconnect. The Internet could be a powerful technical tool (and political motivator) to realign these programs and allow better integration of data for monitoring public health.

HEALTH RELATED FINANCIAL AND ADMINISTRATIVE TRANSACTIONS :

The internet is being evaluated as a medium for streamlining financial and administrative transactions in health care systems. Now health care in India is financed largely by a network of so-called third-party payers- entities that insure and pay for health services but are not directly engaged in providing care. Internet can be used by providers to submit claims for payment or by individuals to enroll, disenroll, and change their coverage. Advantages are accelerated transactions, reduced misunderstanding & disputes, fasten the payments from both sides and reduce administrative cost.

" In the future many biological scientists and health providers will have to be well educated in both biology and computer science, one sided education will not work. "

Medical College & S.S.G. Hospital, Baroda, Gujarat

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