Future Reform in Medical Health Records: Projections and Perspectives
Features of the form and function of medical health records in 2030
Revolutionary changes are occurring nowadays in the different areas. Medicine in this regard is also trying to keep up, in spite of its traditional conservatism. New drugs, new treatments, and new technologies are being introduced into medicine. Most of the older treatments do not do without radical changes.
The fact that we could see a couple of years ago only in books of fiction, today is discussed on the medical conferences on innovation. Much emphasis in recent years is made on computer technologies that are being introduced into surgery, and are used for therapeutic and diagnostic purposes.
In the medicine of future, an important role is played not by the treatment of the diseases; instead, their early prediction and prevention. One of the big achievements in this area is the introduction of the diagnostic devices. Prediction of diseases can be possible up to the patient's treatment. Thanks to Internet patients can be consulted remotely, saving time not only for the person under treatment, but also for the doctor.
One of the stages of improvement of the modern medicine is the personalization of data and developed communication between doctors. Easy access to the medical records allows to timely schedule effective treatment.
Keeping of medical records can gradually move into the network. “Cloud” software is used in order to store large amounts of information on the Internet. Thanks to it, doctors of different clinics have access to the patients’ data. Electronic medical records allow learning timely the health conditions of the patient in order to prescribe an effective treatment. Linking of health facilities in a network will allow receiving the survey data to portable devices of doctors. In the United States, some clinics are already working on this principle. Doctors have tablets that are receiving information about the patient: what medications are prescribed, test results, etc.
Although electronic medical records are not new to the health care industry, it is clear that to get the bonuses in accordance with the law “On the Recovery and Reinvestment Act of the U.S. economy” by 2009 (American Recovery and Reinvestment Act of 2009 - ARRA), more precisely the law HITECH, healthcare organizations must implement electronic health records and ensure their effective use. Today their effective use is one of the most important factors to increase investment in the IT infrastructure of hospitals (Borycki, eds., 2010).
The company IDC Health Insights has published market forecast, which shows that the overall increase in spending on health care organizations’ IT in the U.S. will be about 5% in 2013, while the increase in the cost of clinical technologies that require efficient use (EMR, CPOE, HIE, and analytics), is expected to be at around 12%. According to another study by IDC Health Insights, 40% of health care organizations in 2013 will accelerate the introduction of efficient use technology. In addition to the benefits of the effective use, these technologies will enable CIOs of the healthcare organizations to control costs and prepare to meet the requirements of the law “On the protection of patients and access to medical care” of 2010 (PPACA).
It should be noticed that incentive payments are not the primary motivation of medical companies in implementing electronic medical records. According to the survey conducted among physicians and radiologists at a conference RSNA in 2010, the majority of respondents reported that bonuses are the least important motivating factor in the implementation of electronic medical records. The primary motivating factors were easy access to patients’ records, safety features, and differentiation of access to electronic information, as well as the ability to access patients’ information from any department in any region, and the availability of the complete information about the patient (Shortliffe & Cimino, 2011).
The development of medical technology is going on to ensure that people can monitor their health on their own. Today, in every house we can see the tonometers. Diabetics use portable blood glucose meters. Apparatus for measuring pressure, scales, and other portable equipment is equipped with wireless transmitters that allow data being immediately transferred to another computer, so that the track of health will be kept.
Health Wear Company is developing a “smart clothes”, which collects data on the human condition: heart rate, body temperature, and respiratory rate. In such smart clothes already on the stage of development, the chips are sewed that are not only measuring, but also allow transferring of the data to a mobile phone (Jha, eds., 2008).
Japanese scientists have developed an intelligent toilet that during a morning visit to the restroom can diagnose the health of the user. This device makes it possible not only to do a urine test, but also measures the blood pressure, body temperature, and weight. This toilet is connected to the home network and can transmit health data to the computer. The man has an excellent opportunity to monitor his state of health for a long time, because all the data are stored and can be displayed in a graph form, on which the dynamics can be observed. In case of deterioration of analyzes, the system notifies the owner (Krupinski, 2008).
The company AliveCor has recently demonstrated the device that works together with an Iphone and is able to read ECG. This mobile device offers an opportunity to get a limited number of ECG leads (1-3) in all conditions, and upload them online for the doctor. AliveCor has alos developed and introduced various equipment for animals. Moreover, similar systems for people are currently in the clinical trials Device consists of a case with special sensors, which are put on the phone, the electrodes are attached to the body, and the person is able to make an analysis of the ECG.
Interesting Russian design is Cardiovisor. The device not only takes ECG (6 limb leads or 12 standard leads), but also allows to predict cardiovascular disease, according to the so called microalternations (microvibrations, which are analyzed with the use of a special algorithm). Cardiovisor today is been already widely used in many medical institutions, and was officially adopted by private physicians. Its main advantage is mobility. The unit has a cheap modification that can be used at home. With the service Kardi.ru everyone is able to monitor heart getting a clear result of examination understandable even to a non-expert, by which he/she can judge whether to go to the doctor or not. Due to the service Kardi.ru, the doctor can immediately find out about the previous surveys and advise the patient accordingly.
Kardi.Ru project is successfully developed and a mobile diagnostic device that records patients’ surveys without using a PC is already developed. The survey is sent to the server and to the doctor through the Internet channel of cellular operator, SIM card of which is inserted into each device. The device is cheap and affordable for a wide range of people suffering from cardiovascular diseases (Jha, eds., 2008).
For cardiologists it is very important to see the big picture of the cardiovascular disease, so it is important to get regular checkups. Accumulation of data related to the work of the heart allows doctors to accurately diagnose and monitor the course of the disease and the effectiveness of drug treatment. In this regard, cardiac diagnostic devices that monitor the work of the heart not only in the health facilities, but also outside, are very important.
Doctors are studying the possibility of storage of medical data in the body of patients in the electronic chips. These chips, which are of a size of a grain of rice, implanted with a needle, could in case of emergency provide physicians with all the necessary medical information about chronic diseases that plague the patient. Implantation of these chips “can improve coordination and continuity of care, will reduce the risk of medical errors” (Jha, eds., 2008).
Nowadays, the introduction of new technologies called IBM Content and Predictive Analytics for Healthcare is widely beginning. This solution will enable healthcare organizations to extract important clinical information from a vast array of medical patient data to better analyze the past, understand the present, and predict the future outcomes of the patient. Combining technology with IBM Watson with the offers of industry-specific solutions, Seton Company intends to apply a new solution for the content analysis and predictive analysis to identify the main causes of hospital readmissions and finding ways to reduce the incidence of many visits to hospital patients. For example, since 2012, hospitals are penalized for high readmission rates by reducing payments to cover the costs.
In the basis of modern technology, Data Mining (discovery-driven data mining) is the concept of templates (patterns), reflecting fragments of multidimensional relationships in the data. These templates are regularities inherent in subsamples of data that can be compactly expressed in human readable form. Finding of patterns is produced by methods not confined by a priori assumptions about the structure of the sample and a distribution of values of the analyzed parameters. Important provision of Data Mining is non-triviality of wanted templates. This means that the discovered patterns should reflect the non-obvious, unexpected regularity in the data, making up the so-called hidden knowledge (Ho, 2008).
Finally, a fantastic data carrier is created by the specialists from the Harvard Medical School. This is a kind of a “Hard Disk”, which writes the data with DNA (Butler & Lathram, 2005).
Extensive data, structuring and distribution, and the requirements for reliability and availability require the use of GRID technologies in electronic medical records. It is obvious that these technologies can provide a good solution in the short-term perspectives. Grid infrastructure allows achieving geographical distribution, warranty, and access speed. In a distributed system, the predetermined level of redundancy is provided that allows to recover data in case of the fall of any of the nodes and to increase the speed of data access.
The most likely impediments to health care information access in 2030 and possible solutions of the problems
The radiologist of Consulting Radiologists, LTD. (Minneapolis, MN), who uses a system of electronic medical record, said that the most difficult challenge to the use of electronic medical records was idleness of the system. “If there is a critical server failure, which can last several hours, it can literally lead to despair” (Smelcer, Miller-Jacobs, Kantrovich, 2009).
Another difficulty is caused by the need to test applications, which are scheduled for connection to electronic health records, before integration. “Do not add new features to your system of electronic medical records without first testing - once we have done so and regret about it”, - said a nurse from the Kettering Health. “We tested the entire system, everything worked, and then we added 20 beds in the intensive care unit and 20 beds in the operating room that caused the crash in the entire integrated system. We abandoned the practice. Now we are making these changes after the fact. This served as a good lesson for us” (Smelcer, Miller-Jacobs, Kantrovich, 2009).
Education also plays a key role in the implementation of electronic medical records. “Training of staff - is one of the problems in the implementation of electronic medical records”, - said the chief physician of the hospital in the Veterans Affairs Hospital in Albuquerque, New Mexico. “Suppliers of electronic medical records need to be offered intensive training to work with their systems, the duration of the course should be one or two weeks” (Smelcer, Miller-Jacobs, Kantrovich, 2009).
According to the radiologist of the hospital in the town of Nyack, New York, “the big gains can be made by optimization of training to work with electronic medical records. When implementing a new system of electronic medical records, mechanism of the entire hospital is changed, and at the same time”. To make the introduction of electronic medical records successful, the training of all health care providers should be coordinated (Smelcer, Miller-Jacobs, Kantrovich, 2009).
A great problem in the implementation of electronic health care records is privacy. The largest number of fixed public safety incidents in 2011 occurred in the health sector. According to the analytical report of Zecurion, 20.4% of leaks of confidential information come from the medical institutions. This is explained by the fact that health care institutions are paying little attention to the protection of personal data of patients. On the second place are the state organizations. Total damage from leaks reported in 2011, according to Zecurion Analytics, was $20.582 billion, on average, each leak cost 25.13 million of the US dollars. The total number of the compromised records of personal data was over 350 million.
The main reason of the compromise of sensitive data is negligence of health care providers. The experts conducted a study, which showed that 41% of the protected health information leaks were caused by the human error. The problem is compounded by the fact that half of the organizations, where the studies were done, do nothing to protect mobile devices that are used in 80% of the health facilities.
According to statistics from Ponemon Institute, data breaches cost the U.S. healthcare industry an average of 6.5 billion of the US dollars a year. Such funds would allow to hire 81 thousand skilled nurses or to buy 216 million of the flu vaccines.
Ponemon Institute study found that 55% of the health facilities cannot detect security incidents. In 61% of organizations they could not specify exactly, where the patient data were (Grady, 2012).
Many promising projects are aimed at solving this problem. For example, virtual desktop infrastructure is a version of the client-server model, where individual jobs are located in a single data center, with the result that simplifies the process of managing multiple applications on a large number of jobs, as well as the process of end-user support. As part of the infrastructure of medical institutions VDI supports single sign-on (SSO) and the ability to transfer the user's session as a clinician move from one device to another, which makes it easy to secure access to patients’ data for those clinicians, who are highly mobile. Since the data are stored on servers with centralized control and not on the local devices, it significantly reduces the risk of a breach of confidentiality of the medical information from loss or theft of a laptop, tablet, or other mobile device. With EMC VDI solutions for the health care organizations, health-care providers will be able to access virtual desktops from the post of a nurse and a variety of devices that use clinical software, including applications for electronic medical records. VDI also allows uploading images of operating systems for desktop computers to a central hospital’s server to simplify IT support and to increases the level of privacy and data protection.
Another possible problem is the presence in the health care institutions of the minimum several critical information systems solving seemingly different problems, but in terms of functions that are almost completely overlapping.
Some of these systems are bought by the management of health care institution for a particular purpose, and a part is down from the “top” in the interest of public health authorities, fund of obligatory medical insurance, etc. Moreover, while the purchase of next program or system vendor does not always - or rather, almost never, does not receive a task of information coupling with the other automation facilities already available in hospitals.
Thus instead of a clear structure absolutely not clear design is built
It happens not only in individual health facilities, but at the district, regional, and federal levels - almost any head of regional health care institution can say at least a dozen or more of the various information systems implemented at the regional level, but almost no exchanging of information between each other.
Most information systems working in hospitals also do not interact together and served by different suppliers or are not maintained at all. But any such system requires certain costs, and often is an additional burden, not making easier, but complicating the “life” of personnel.
In health care institutions, there are almost no specialists on the design and development of complex information systems and there is nobody who can make a truly expert comprehensive assessments. Likely, in 2030 such situation could remain, especially due to the growing trend toward more specialization of professionals.
The only option in this situation, in our opinion, is the inclusion of work on the analysis of automation objects and the creation of a working draft as a mandatory first step in the creation of any quite heavy information system. Namely a working draft but not a “concept”, “strategy”, etc.
Integration of medical health records IT-technologies into organizational workflows
It is very important to build sophisticated IT strategy, in which electronic health records are a factor in the development of the organization. Despite the fact that the implementation of electronic medical records can be scheduled for some groups or units, in the end, this process will affect all those involved in the delivery of the medical services. The transition to electronic medical records is a key factor in improving the quality of patient care.
To support the deployment of clinical applications used by highly mobile workers, the movement of which is not limited to the walls of a hospital or clinic, specific tools are required, such as virtualization and cloud computing. Among the advantages of creating an IT platform and the judicious use of virtualization and cloud computing are cost savings, which can distribute IT resources, and also increase of the efficiency of health care services and IT staff, which helps to ease the transition to computer support clinical processes to meet the requirements of the law ARRA and health reform in general.
Also of interest is the integration of forecasting of IT solutions in the field of health care in the business processes of companies. Caring of the company for its employees - is one of the showing of high-level of its corporate culture, which is a major factor in shaping the image of the organization, both in the eyes of its business partners and the general public. From a practical point of view, the costs of disease prevention and treatment of employees not only shape their loyalty to the employer, but also help to increase productivity and reduce the loss of skilled workers. For companies in the service sector, whose employees, respectively, daily contact with customers, the integration of health care IT solutions in wok-flow will allow to rapidly track the health of employees. It should be noted that in the first case, integration of health IT solutions can have a direct positive impact on KPI (Key performance Indicators).
With the solutions in a service-oriented architecture (SOA) and integration can combine disparate enterprise systems and connect them to the systems of suppliers and customers. IT staff can quickly meet the needs of business and commercial department employees can use the basic data to make accurate decisions based on the “single version”. Obviously, these solutions should include:
- Business process analysis (BPA)
- Business Process Management (BPM)
- A process analysis (PI)
- Risk Management and Compliance (GRC)
- Enterprise Architecture (EA)
With these solutions the company can expand its capacity, improve efficiency and business agility, which will allow to adapt the business model in a few days.