Visionary Road
As we conclude our blog, Melissa and I would like to propose our ultimate vision for the health care industry. In our previous posts, we demonstrated how technology impacts the medical system. We first talked about how doctors with technology perform better than doctors without technology. Through technology itself, doctors have been able to provide better quality via x-rays, magnetic resonance image (MRI) machines, and more. However, we noticed that patients are looking for more than just technology – patients are looking for ways to use technology to reduce costs and to take more control of their health, as seen through WebMD and HelloHealth.
Unfortunately, technology itself can cause many security issues, which were also discussed in our previous blogs. Technology does provide patients with more access to medical attention, but technology itself wasn’t the solution. We discovered that information technology – technology that is used to manage information – was an area that can have great impacts on the quality, access, and costs of medicine. As we conducted our research using the ORACLE, we realized hospitals need a database management system (DBMS) to organize the information that flows into the hospitals in a centralized system. However, we wanted to develop a method that would allow both doctors and patients the ability to access the information that flows into hospitals.
This led to our vision of interactive medicine. As we looked into China and Germany, we noticed that other developed countries have made significant steps to provide information technology to support the information systems in their medical systems. This made us think, “Why is the U.S. so behind on the current medical trends?” We hypothesized that the U.S. wants to gradually introduce information technology because of the fear that information technology will become an enterprise replacement process (ERP). Thus, Melissa and I recommended that the U.S. be cautioned when introducing information technologies to the medical field because indeed, ERPs can have negative impacts on the quality given to patients. We noticed that hospitals have started to introduce electronic medical records (EMRs), but we wanted to integrate EMRs with computer kiosks that are available to patients in hospital lobbies.
Therefore, as supported by the New York Times, we want to introduce interactive medicine to the health care system. The New York Times posted an article that supported how friendships and social interactions can improve patient health. Well, we want to take that idea even further to promote more social interactions between patients and doctors through information technology. As we introduced this before, Melissa and I want to create a DBMS that will link the information that is received from hospitals in a centralized system so that doctors can access patient records, regardless of which hospital they are in. Doctors will have tablets that will allow them to electronically record new information that they receive about patients. Computer kiosks, which are currently only used to allow patients to surf the internet, will allow patients to access their information in hospitals so that they can update their medical profile (i.e. new allergies, new over-the-counter medications, etc) as they arrive to help their doctor diagnose their symptoms. These information technologies will only be located in hospitals to ensure security, and we expect this system will decrease waiting times, improve the quality of services provided, create more access for patients and doctors to update patient records, and reduce medical costs by decreasing overhead and administrative expenses.
We hope that you have enjoyed learning about this topic as much as we have, but if you have any further questions or comments, please contact us at ttt36@cornell.edu or mhm227@cornell.edu.
-Thomas
An Interactive Future- Click Here.
Over the past few months, Thomas and I have explored and argued about the trends involving the use of technology in the U.S. health care system. More specifically, we talked about implementing electronic medical records (ERM) in different facets (such as computer kiosks) to create an interactive health care system that will provide patients with better quality in care. Although I have often been the skeptic in these discussions over moving away from paper records, I cannot deny the inevitability of the adoption of EMR systems or other technologies in the health care system.
The integration of EMR systems into health care operations and information systems in the United States will greatly improve efficiency, which is why these systems are so desirable. Both space and time can be saved when files are stored electronically; but still, the option to click the print button will always exists in the event that paper records are still needed. In this blog, we have explored the present state of transition in regards to electronic medical record storage and the implications of changing to a system where medical practitioners replace their quills and ink wells with tablet pens.
Those basement storage rooms...
EMR Tablet PC
Thus, we envision that technology will be fused with health care to create an interactive environment where patients can cooperate with physicians to improve the quality of service provided to them. This vision is supported not only by the use of EMRs, but also by the innovations of web-based networking sites, like Facebook and WebMD. Recently the New York Times published an article on how friendship, i.e. social interaction, can have a positive influence on patient health. These social network sites can help enact social support systems for the ill. People will also feel more confident in medical filing systems where they hold some control over their information. Interaction encourages confidence in security; the impact of these fears will be significantly lessened by the perceived control over our own medical records. The future is interactive medicine.
Our Peachtree Vision
As Melissa and I consider our vision for the health care industry, we want to comment on an article that we read recently called “Too Far Ahead of the IT Curve” by John P. Glaser. In this article, Glaser talks about how Peachtree Healthcare wants to standardize systems and processes across all facilities to increase efficiency. Although this enterprise replacement process (ERP) is designed to “get the job done faster,” one of the main concerns for implementing this type of system is the cost.
This article inspired us to weigh the cost-benefit trade-offs involved with investing in health care information technology. One of the issues that we would like to address is the cost for implementing an ERP. For future developments, we believe that health care software providers will need to analyze the costs (i.e. training, administrative, etc.) that will be incurred if they implement this type of system. Therefore, we agree with the commentators of the Peachtree Healthcare case that the service-oriented approach would be the best method for implementing information technology changes into the health care industry. As noted in the article, medicine is a different business because it often involves matters of life or death.Therefore, any drastic changes in information technology could negatively impact the quality of care given, and even risk the lives of patients. Because the impact of information technologies is so significant, Melissa and I recommend that the health care industry make gradual changes to minimize the risks that are involved in the transformation process.
Currently, only a few hospitals have carefully observed the risks and have started to switch over to electronic medical files. These technologies can vastly enhance the recently popular movement toward a service-oriented approach in medicine. The need to provide good service will be the driver in the disposal of the piles of manila files trapped in storage rooms in the basements of health care facilities.
Therefore, with regards to our vision, we believe that electronic medical files will certainly be implemented in the future, as seen in the article above. Through the economic stimulus plan, we have confidence that information technology will play a more prominent role in improving the way hospitals collect and organize life-saving information at a lower cost. However, through innovations like computer kiosks in offices, we believe that doctors will be able to access updated patient records faster, but only if this innovation is implemented through the service-oriented approach. In other words, computer kiosks should be gradually introduced to hospitals to allow patients to update their personal record. Our purpose is not to eliminate receptionists who typically handle patient information; we want to propose an option that will allow patients to become more interactive with their medical records and to decrease the time and cost it takes for a patient to see a doctor without notably jeopardizing quality of care.
- Thomas
Die Führung in der Weiterentwicklung…(Taking the lead in innovation)
In our last post, Thomas discussed the developments of information technologies in China’s medical environment. Today, I will move westward to talk about the technology advancements in Germany. Germany is a forerunner of medical device technology in the world, and continues to develop new technologies that further incorporate new information systems. Germany recognizes “Sector-spanning IT interconnectivity [as] making it possible to give patients improved information, organize the health care system more efficiently, and improve multicentre clinical studies that make new medicines available to patients sooner[1].” This is where medical information use is headed. Germany proudly beams at the innovative tracks they are sowing in the field of medical technology.
Igniting Ideas! is a website that discusses the “high-tech strategy for Germany[2].” The link above will bring you to an article that displays a SWOT analysis of German medical technologies. Through the analysis, Germany has identified the need to enhance patient care information processes. In this website, Germany presents one particular opportunity that they plan to further investigate in the future:
E-health: Introduction of the electronic health data card and the electronic patient file[3].
As you can see, e-health is the future of medicine. Currently, the United States is believed to be at the forefront of medical advancements because the United States has the legal structure to protect its innovations and the financial capabilities to support new technological endeavors. Although this country sits at the top, our development of information technology will be surpassed by other countries in the future, especially with sites like Igniting Ideas, which promotes the advancement of medical technologies.
Germany has also begun to integrate medical information with on-line publications. German Medical Science is a new web compilation of medical articles of international interest. Although the site is in English, the site offers other languages to merge medical references of the world for the world to see. The development of sites like this one only further promotes the worldwide expansion and exposure of medical information. Because other countries such as China and Germany have invested in IT development in the medical industry, Thomas and I conclude that electronic medical files will have a prominent role in medicine in the future.
- Melissa
Waiting until the CIST explodes!
As the United States continues to contemplate the effectiveness of electronic medical records, other countries, such as China, will continue to develop IT that will change the way the medical industry handles information. For the past few weeks, Melissa and I have discussed how electronic medical files will change health care. To elaborate, we mentioned the idea of utilizing computer kiosks to allow patients to update their own, personal information to increase the efficiency in medical offices. Although this idea seems long-term, some countries, such as China, have already started with the technological movement to bring IT into the medical industry.
Just recently, China has released patented software that will allow doctors from within a network can review a patient’s complete medical history. According to the Organization for Economic Cooperation and Development, the China Information Security Technology, Inc. (CIST) has developed Medical Case Software (MCS), which will facilitate the integration of medical records into a centralized system that will be accessible to doctors. As I mentioned in a previous blog, this software can closely resemble a database management system because it will allow hospitals to store their information in a central location for medical uses. For more information, visit the following website:
http://news.prnewswire.com/ViewContent.aspx?ACCT=109&STORY=/www/story/03-19-2009/0004991268&EDATE=
China’s information technology development serves as an example of how technology will impact many industries, including the medical industry. Because medical technology is still under developed, many countries, such as China, are taking advantage of the resources available. Since the United States have fallen behind on the export of information and communication technology, we expect that the United States may miss the wave of a great investment in medical technology. The most important issue to recognize is that medical information technology will continue to develop to improve efficiencies. However, in the future, Melissa and I believe that patient interaction will revolutionize the technology development to improve how information gets handled in the medical industry. Through the technological development, we believe that the information technologies will complement the information systems to provide more efficient means to obtain, store, and use patient records.
- Thomas
http://www.oecd.org/document/8/0,3343,en_2649_33757_35833096_1_1_1_1,00.html
http://www.oecd.org/document/60/0,2340,en_2649_201185_35834236_1_1_1_1,00.html
Less waiting, more caring!
While I am especially cautious about the future use of medical information technology, I believe that computer kiosks will be a part of the future of health care. As Thomas mentioned in the previous post, computer kiosks will allow patients to update their medical information, if needed, at their own convenience. Typically, patients usually wait for long periods of time to talk to a receptionist in order to update their medical information, but with computer kiosks, the waiting time will be reduced, and patients will be able to gain access to medical treatment faster. I speak from first hand experience; as a frequent visitor at medical offices, I often see patients waiting and groaning to speak to a receptionist to confirm both general and medical information. This process is especially true in offices for long-term treatment like those for oncology; however, I have often been asked to confirm my basic information at Gannett, Cornell University’s “finest” health facility. Regardless, I believe that computer kiosks will promote efficiency in the medical industry, and the kiosks can potentially hasten the time spent waiting for medical care.
A preliminary example of the usage of computer kiosks can be seen at the Hospital of the University of Pennsylvania (Figure 1). Although these computers are currently provided for recreational purposes, we can foresee an evolution of the usage of technology in the medical offices. When computer kiosks become implemented in medical offices, patients will no longer check in with a live administrative assistant. However, because some offices are not as calm as the one seen in Figure 1, hospitals may choose to reduce the number of administrative assistants and receptions so that they can cater to those who are unable to use computers. Furthermore, with computer kiosks, patients will sit down in an office chair in a semi-private kiosk to grab a mouse and simply click a few confirmation buttons to verify patient information.
Figure 1: HUP Otolaryngology Office
The future of medical care is headed toward technologies that will increase the efficiency and effectiveness of information management. Simplifying the most basic and common information management functions is obviously a huge trend, but in order to implement systems where the patients can actively interact with their own medical files, certain steps need to be taken. The example discussed in this post is one fairly, effortless step toward interactive electronic record storage. Thomas and I see this as the future of medical information storage; we see the industry evolving record storage into a efficient system, reducing the efforts of both administrative staff and patients themselves. This can all be accomplished through secure information networking and online Web 2.0 platforms like Hello Health and WebMD.
-Melissa
The heart of the matter
As Melissa and I have discussed throughout our past posts, technology has already greatly impacted the information systems in the medical industry. More specifically, we believe as information technology continues to develop, the medical industry will continue to adapt new innovative approaches improving the quality of patient care. We would like to further explore the future effects of information technology in the health care system. To do this, Melissa and I will look into the future impacts of electronic patient records.
For the past few blogs, Melissa and I have argued over the security and access issues of electronic medical files. Because electronic patient records are becoming more ubiquitous, we believe that all hospitals will have electronic patient records in the future. As you have read, electronic patient records have their advantages and disadvantages, but ultimately, electronic patient records were introduced to provide hospitals with an efficient method to store patient information. Doctors who need access to these records will have a more efficient means of obtaining the information they need, especially during the life-threatening moments faced on a daily basis.
Although the medical field is becoming more technologically dependent, we believe that hospitals will begin to implement more security precautions to prevent unwanted access to confidential medical files. Since we believe that all hospitals will have electronic medical files, we propose that hospitals – profit, nonprofit, and government-owned – join together to keep patient records secure within specific networks. Because many patients go to multiple facilities for their medical needs, we believe that hospitals need to share information about their patients with each other so that the doctors can perform their job more efficiently. For example, when patient A is admitted to Hospital 1 for a bypass surgery, patient A will have this operation filed into the network of medical records, which will allow hospitals 1-10 to access this information. In the event that patient A gets a heart attack while shopping in an area near hospital 5, doctors at hospital 5 will have instant access to patient A’s information, which will allow them to better treat any heart issues because they have access to more information.
Melissa and I believe this will be the future of electronic medical records. We propose that hospitals build computer kiosks that will allow patients to verify their medical records in reception areas. These computer kiosks will be available at every hospital so patients can update their information when receiving treatment. By creating this checks and balances system, doctors can provide faster care to patients and patients will be better satisfied with the efficiency of the services received. For more of our perspectives on the future of medical information , come back and check out our future posts.
- Thomas
Let’s trust the ORACLE.
Although access to electronic medical files will be an issue for the health care industry, I believe that a database management system will provide adequate security. A database management system is more secure than a flat-file approach to data because users can set up securities that will allow only certain users to change the data. In addition, information that is altered in a database management system (DBMS) will be seen by all users that use the database; therefore, enhancing the data storage efficiency lacking in the flat-files approach. Although I would like to talk more about the efficiency of electronic medical files, I want to specifically address the security issues of allowing this type of access to information.
As I mentioned previously, any database management system will be more secure than any flat-files approach because the DBMS will offer more security. Although this scenario primarily refers to electronic files, I like to think paper medical records as flat files. For example, every hospital is broken down into departments. Each department has their own filing system, which consists of patient information for those who actually enter into that department. For instance, John Doe will have an outpatient file if he has outpatient surgery, but the oncology department will also have a file for John Doe if he goes to that department for cancer treatment. Therefore, one patient can have multiple, redundant files within a hospital.
Although these patient records can be securely locked in their respective filing rooms, many people have access to these rooms, including doctors, nurses, administrators, volunteers, etc. In addition, paper files can easily get lost if filed incorrectly, and information can be hard to find if an organizational method is not consistent. Furthermore, even if the patient information is “secure” in the filing cabinets, the amount of time it takes a doctor to find this information can result in patient deaths. According to Medical News Today, there were about 98,000 deaths caused from medical errors in 2007. Because this amount was so high, Medical News Today deemed this as the fifth-leading cause of death in America. The amount of death due to medical errors in one year is equivalent to a plane, carrying 270 people, crashing every day. According to Dave Plow, a Senior Analyst at Millennium Research Group, “Medical errors in the health care system arise from miscommunication, physician order transcription errors, adverse drug events, or incomplete patient medical records.” The usage of paper files is not always the most secure approach for hospitals.
However, in terms of a DBMS, hospitals have started to use PeopleSoft, a DBMS that Cornell University also uses to store confidential student information, to store patient medical files. Although Melissa worries about the security of these electronic platforms, Oracle, a leader in data security innovation, has discovered the Oracle Advanced Security Transparent Data Encryption (TDE) to safeguard sensitive information in patient records. For more information please click here for more information about the electronic security developments in hospitals. Although I can talk more about the strong need for security in electronic files, I want to emphasize that IT has begun to complement the information system requirements for hospitals. Through technology, we can save lives that are lost due to medical errors. Would you want to be this parent who loses his one-year-old daughter from the fifth-leading cause of death in America?
A father who loses his daughter from a preventable medical error
- Thomas
http://www.medicalnewstoday.com/articles/75042.php
http://www.oracle.com/database/docs/advanced-security-whitepaper.pdf
http://www.oracle.com/customers/snapshots/american_medical_04_0405.pdf
http://www.capecodonline.com/apps/pbcs.dll/article?AID=/20080619/LIFE/806190301
The Inevitable Liability of Access
Alright, Thomas. I think the Hello Health concept introduces far too many scary issues to address, but I will address one key issue, which is access. What will happen when patient medical records and prescription histories are uploaded onto the “secure” internet? I understand that there are secure platforms available to protect patient information, but allowing multi-user access to patient information is a ridiculous risk to patient privacy and physician accountability.
According to Business Wire, there have been numerous uprisings in the health care industry “concerned about the growing use of electronic communications between physicians and patients, citing the need for legal, ethical and professional etiquette to govern this new, non-traditional patient care tool. Although health plans and patients may achieve savings, physicians may experience increased costs due to medical liability issues.”[1] Besides the apparent increase in short-term costs, online consultations and digitalized medical records will cause massive issues involving security and confidentiality liabilities.
This shift in the information systems sector of health care will inevitably hinder the efficiency of the system. Many people believe that converting paper files to electronic files and maintaining these digital systems will be more cost effective, but the money that you save from using electronic databases does not come close to covering the costs of a security issue. Physicians and hospitals already suffer from high costs due endless malpractice claims; therefore, liability issues with regards to online services would only cause more financial deficits for the health care industry. As a result, less time would be spent focusing on patient care and services – two areas that have higher priority over online services.
In addition, the switch to online databases will cause health care providers to become hesitant about using instable platforms because virtually anyone can gain access to patient information, if they tried hard enough. Because electronic medical records have more access points, hospitals will put themselves at greater risks if they choose to switch from paper to electronic. My point is that digital and online medical records will face major issues with patient consent, interpreting tone of discussion board doctors, security and confidentiality. If hospitals allow this kind of access, they will take a dangerous step toward the eradication of patient and physician privacy.
- Melissa
[1] “Medical Liability risks Increase as Online Consultations Grow.” Business Wire. 2 December 2002. http://www.allbusiness.com/company-activities-management/management-risk-management/5971418-1.html. Last Visited: 1 March 2009.
Excuse me sir, but there are other patients who were in line before you?
This phrase is one of many that you will hear when you enter any public hospital. Of course, you could go to private hospitals for “faster” service, but we all know that private hospitals only try to mask their waiting times with better customer service. However, many users have been able bypass the long lines and rude nurses by using the internet to get instant medical attention.
While Melissa can argue this problem, I want to help you understand that online medical websites, such as WebMD can help save your life. As Melissa mentioned in the previous blog, WebMD has its disadvantages when people abuse it, but the purpose of this technology is to help patients conveniently store information in a database so that WebMD can help provide diagnoses that might be relevant to them. Just like any other technology, WebMD is not invulnerable to improper usage, but people should recognize that WebMD can help them find answers to questions about minor medical concerns.
As I talk about how web 2.0 affects the health industry, I want to discuss an article I read for my Information Systems course called, “What’s Up, Doc?” by Steven Leckart. In this article, you can see that the health care industry is using technology to reach out to those who need instant medical attention, especially to the uninsured. Through the web, Jay Parkinson, the founder of Hello Health, has created a website that allows doctors to tap into every form of communication to reach out to patients. Through his services, he electronically records patient information and uses that information to offer medical consultation. His services include:
As you can see, health individuals are taking a step towards building a stronger eHealth system that will make health care more accessible to the public. As we continue to spend 17% of our Gross Domestic Product (GDP) on health care, please keep in mind how much money this country could save by using online health services, such as Hello Health.
-Thomas
https://www.hellohealth.com/main/index.html
http://www.good.is/?p=12779
http://www.nchc.org/facts/cost.shtml
