This is a text written by Jon Berg <jon.berg|a|turtlemeat.com> spring 2005 in the Computer Science course Medical Informatics at Tromsø University, Norway.
Current and future possibilities of Medical Informatics
2. Background and motivation for Medical Informatics
The development of the microprocessors and the common use of PC’s in the late 1970s in made it possible to begin to employ these technologies in the health care sector. In the beginning of 1990 the Internet started to become available for common use outside the military and educational institutions.
It was obvious that there was a need for moving away from traditional paper journal and on to an electronic health record. This need was realized in 1991 (Dick. Steen (1991, Revised 1997). The Computer-Based Patient Record: An Essential Technology for Health Care. Washington, DC: Institute of Medicine, National Academy Press), but even today in 2005 the health care sector in Norway is still working on rolling out a 100% digital health record. In the study (Lærum. Ellingsen. Faxvaag. (2002). "Elektronisk pasientjournal ved somatiske sykehus - utbredelse og klinisk bruk". Tidsskrift for Den norske lægeforening; 2002, 122;2540-3.) done in 2001 the doctors say that they only use the EHR system for 2 to 7 of the 23 task given in survey, and the primary use is to read patient information. It also points out that the paper journal is still the most complete source of information.
Important issues that must be addressed in the construction of EHR and other medical informatics systems are;
The health care process involves many types of branches, from laboratory, patient monitoring, personnel systems like planning of work schedules, economy systems like billion and cost analysis. These systems are all information generators and it would be useful to be able to integrate this information in a smart way in all the other applications. Some information is useful in other settings, but not all. Lab results are useful in any setting that involves a doctor getting information about the patient, but it would not be relevant for a person planning work schedules. Integration of lab results in the patient journal is an example of beneficial use of integration of data between different data sources.
Integration of systems inside one single institution is useful. It would also be desirable to be able to integrate data between different health institutions. There is a trend for more free flow of patients between different hospitals and it would be desirable for the health workers to have the same view of the patient no matter what hospital the patient would come to. Without this capability the patient would have to do examinations over again, and the health workers would need to ask the same questions over again to get the status of the patient. This is inefficient use of time for the health workers, and it is frustrating for the patient.
The medical informatics field is a very broad and complex topic. This is what makes it a non trivial task to get all the pieces together. The great motivator behind the work is that the benefits for solving these problems are great in terms of better health care for the patient and also in the way it will make the health care sector more effective. A more effective health is wanted to be able to serve more patients while keeping the increased cost under control. The reality today is that the health organizations are not saving any money on the new technology (Hallvard Lærum. Powerpoint presentation: ”Den aktuelle situasjon i Norge”. Summit 2002). The hospitals have had to spend large amounts of money in upgrading the infrastructure and education of the staff. The real cost saving functions are not in place, except for functions for control of price rates. Even if these investments are not proving themselves at the moment, they hopefully will in time. During the introduction phase of these new technologies it is likely that the benefits of the technology will not be visible. As long as not everything is in place it will be difficulties, but in the long run the problems will likely be solved. It is not a plausible thought that the future health sector will be conducted on paper instead of in a digital way. There are also improvements in the how medical treatments and diagnostics are done; some of processes are dependent of computerized medical systems to be done. For example CT and MRI scans produce digital information. It may seem like the adoption to new technology is impossible to avoid. If there is a need for modernization the modernization phase has to start at some point, and it is a tradeoff of taking the problems now or postponing them.
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