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Friday, August 13, 2010

Computers in Patient Care: The Promise and the Challenge

"Why is it that in terms of automating medical information, we are
still attempting to implement concepts that are decades old? With all
of the computerization of so many aspects of our daily lives, medical
informatics has had limited impact on day-to-day patient care. We have
witnessed slow progress in using technology to gather, process, and
disseminate patient information, to guide medical practitioners in
their provision of care and to couple them to appropriate medical
information for their patients' care...

The first challenge in applying medical informatics to the daily
practice of care is to decide how computerization can help patient care
and to determine the necessary steps to achieve that goal. Several
other early attempts were made to apply computerization to health
care. Most were mainframe-based, driving 'dumb' terminals. Many dealt
only with the low-hanging fruit of patient order entry and results
reporting, with little or no additional clinical data entry. Also,
many systems did not attempt to interface with the information
originator (e.g., physician) but rather delegated the system use to
a hospital ward clerk or nurse, thereby negating the possibility of
providing medical guidance to the physician, such as a warning about
the dangers of using a specific drug.

We have made significant technological advances that solve many of
these early shortcomings. Availability of mass storage is no longer a
significant issue. Starting with a 7-MB-per-freezer-size-disk drive
(which was not very reliable), we now have enterprise storage systems
providing extremely large amounts of storage for less than $1 per
gigabyte, and they don't take up an entire room. This advance in
storage has been accompanied by a concomitant series of advances in
file structures, database design, and database maintenance utilities,
greatly simplifying and accelerating data access and maintenance.
[But] if we truly want to develop an information utility for
health-care delivery in an acute care setting (such as an intensive
care unit or emergency department), we need to strive for overall
system reliability at least on the order of our electric power grid...

One significant issue is the balkanization of medical computerization.
Historically, there has been little appreciation of the need for an
overall system. Instead we have a proliferation of systems that do
not integrate well with each other. For example, a patient who is
cared for in my emergency department may have his/her data spread
across nine different systems during a single visit, with varying
degrees of integration and communication among these systems: EDIS
(emergency department information system), prehospital care (ambulance)
documentation system, the hospital ADT (admission/discharge/transfer)
system, computerized clinical laboratory system, electronic data
management (medical records) imaging system, hospital pharmacy system,
vital-signs monitoring system, hospital radiology ordering system,
and PACS system...." More Info See also XML in Clinical Research and Healthcare Industries:

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