Over the last two decades, different industries have adopted the use of Information Technology in their various operations in order to enhance growth, conform to emerging standards, attract new customers, maximize profitability, and for Business Intelligence. Different sectors, however, have adopted the IT use in different capacities. The health sector, like all others, is striving to enhance the uptake of better and easier techniques available through the IT implementation. However, the average use of IT in health care has lagged behind other industry sectors for the better part of the last decade. Health care has many potential benefits of the IT implementation both in managerial operations and patient-related operations. This paper will focus on the IT implementation in health care facilities and will identify problems that could be solved through proper policies based on IT and link these problems with possible opportunities presented by current and developing IT trends in Medicare. In addition, the paper will develop a working proposal to aid in the implementation of profitable IT practices, as well as perform a cost benefit analysis of the proposed initiative.
Healthcare Problems and Opportunities for the IT Implementation
The healthcare situation in the global platform is experiencing dynamic changes in several ways. The major avenues of the change involve the following:
A significant percentage of modern care facilities are using healthcare IT systems in clinical operations. However, the majority of units are still dependent on traditionally used systems such as physical patients’ document keeping, lab reports, drug administration history, and other functions. They lack computerized drug and other substances order information and history, medical supplies catalogue, and lab test results. In addition, they lack Electronic Health Records (EHR), image and film archiving and associated communications systems, the result analysis mechanism for ordinary patient processes such as lab tests and drug prescriptions, decision support facilities in clinical systems, prescription error alert systems, as well as electronic monitoring of high care patients, especially in Intensive Care Units (ICU).
Electronic Health Records (EHRs) involve standardizing the way in which patients’ records are entered, stored, and retrieved not just within an organization, but across different hospitals, care givers, government control organs, and other interested parties. The biggest challenge regarding EHRs has been the establishment of an industry standard to use so that a working harmony may be realized, which allows seamless retrieval and the use of records for patients, even when they roam in other units other than where they were initially treated.
This kind of a data pool would imply a dedicated system with necessary checks and balances to prevent unauthorized access to and manipulation of patient records, while at the same time enabling data addition by different care units when patients make additional visits to any facility. This concept is delicate in the view of the possibility of malicious addition or manipulation of patient data by different staff in different facilities. Moreover, proper coding and categorization of prescriptions and procedures has hindered the implementation of a universal HER system in the last two decades. This problem can now sufficiently be handled by the development of very high end software applications that are being developed by individual and corporate research entities.
One such authority, the Health Information Technology for Economic and Clinical Health Act (HITECH Act), is a US government initiative to harmonize HER availability in a secure and safe manner that allows their use across the Medicare fraternity. Presently, other systems that are being pursued include the Computerized Provider Order Entry (CPOE) which may replace conventional order cataloguing and fulfillment in a manner that will enhance tracking, logistic harmony, and cost effectiveness; the Clinical Decision Support System (CDSS), which, in its basic form, will give informative guidelines to practitioners regarding medication and procedures, including warning systems relating to high risk medication and processes.
In addition, Picture Archiving and Communications System (PACS) will integrate inputs from multiple radiological and diagnostic tools to allow easy, consistent, and accurate treatment of different conditions, while Radio Frequency Identification (RFID) may help to track patients within a medical precinct, without having to restrict them to a particular location or allocate a nurse to them. Such vital signs collectable from this system may include pulse rate, temperature levels, blood pressure, and other metabolic/respiratory signals. Benefits of such a system, if properly collected, stored, and secured, integrated with other dedicated software applications, may shorten treatment time, allow more freedom, and lead to cost efficiency and better resource utilization within a hospital or other healthcare facilities. Automated Dispensing Machines (ADM) may aid in drug dispensing, while Electronic Materials Management systems (EMM) will operate like the resource planning systems used in other sectors which manage information processing regarding pharmaceuticals, new drugs development, and coding among other functions. Such a system would reduce medication errors which as of year 2000, were responsible for over 98,000 deaths in the US alone (Institute of Medicine – IOM, 2000).
Administrative and Financial services
Functions that could be gained through investment in IT in the administrative category include the following: general ledger operations including cash flows, expenses, purchases, and other day-to-day transactions. Other functions are billing, cost accounting systems, payroll, and personnel management including other integrated human resource functions, patient registration and booking, and electronic management of materials among other functions.
Information Technology may find many basic as well as advanced applications in administrative and financial services. Firstly, human resource management has experienced radical changes in the form and operational methods as a result of the IT implementation. Systems for employee management, role definition, reward and recognition support, as well as performance development, have successfully been automated thanks to dedicated software such as Oracle HR. Such systems allow easy, timely, and accurate workflow management in Human Resource mobilization and development, saving time and costs that would be allocated for additional staff. Other functions such as payroll, budgeting, budget implementation, and internal audit have also been made easier, more precise, and tailor-made for specific analytical objectives, without incurring additional monthly or yearly charges due to the use of IT systems. Patient registration and tracking can become more enhanced and efficient; online statistics accessibility of every facility within an area may be useful in referrals and in discharges notification enabling time saving and better emergency handling.
Infrastructure is a broad category that incorporates various equipment with diverse applications in modern facilities—both general and specific application tools. Firstly, current security standards have shifted towards bio-metric sensors for movement and access control in most major private and public buildings and premises. These security standards enhance accountability in systems’ access and support user logging which enhances safety and responsibility among authorized personnel. The healthcare sector could, perhaps, benefit the most from such systems, given the delicate nature of confidentiality requirements involved in patients’ records access and dissemination. Bio-metric sensors typically used include finger-print scanners, voice recognition systems, and eye scanners among others. Such systems have become so common that they are available in private homes of modest incomes. Other more dedicated systems include bar coding systems for medication grouping, ordering, cataloguing, and stock control. Security infrastructure may also include CCTV cameras and night infrared cameras.
Since Information Technology relates to healthcare security, it may find many uses, some of which may not be achieved in other ways. Firstly, the patient documents/information access logging is important in ensuring confidentiality and professionalism in the way clients are treated. It would restore patients’ confidence in the practitioner and boost the trust level. In addition, the use of bio-metric systems will eliminate to a large extent ambiguity in accountability in delicate cases due to their high precision levels and extremely low chances of identity theft or manipulation, unlike conventional securitization protocols when any person with forced access to pass codes may steal information. In addition, healthcare research facilities may hold expensive machinery which, if it falls in wrong hands, may be used in ways detrimental to society. For instance, ultra-modern DNA synthesis machines, if used by experts, may find applications in the terrorist underworld. Other chemicals and drugs in healthcare facilities may also be abused or sold to unsuspecting people as legitimate prescriptions with catastrophic consequences. Such security measures cannot be overlooked, and government control is restricting accessibility of certain machinery and equipment used in medical practice to high security facilities, limiting the range of services that a healthcare unit may offer to its security level capabilities.
Another broad category of infrastructure has to do with network development and all associated controls. Medicare is a field that processes huge amounts of information internally, not to mention external linkage requirements associated with referrals and national accountability reports that must be processed and sent to government control and data collection organs and other industry regulatory bodies. The baseline network infrastructure includes servers, end user computer stations, switches, network access points, all associated cabling, and external access infrastructure. While very elaborate high level applications have been incorporated in network infrastructures in a significant number of health facilities, the majority of care units are using their network support equipment for slightly more than just the baseline uses such as record keeping and document sharing.
Needs Analysis in Healthcare Facilities
In order to develop a proper proposal for sustainable IT supplementation in the core processes of the healthcare sector, it is important to identify the main challenges in the healthcare sector and specifically those needs that can be sufficiently met by the implementation of sustainable, secure, and cost efficient IT practices. This section will give a detailed need analysis to lay a foundation for the paper. The needs may be sectioned into operational, administrative, and industry.
Healthcare facilities need to streamline their core administrative and financial operations with the current global standards in order to foster inter-operability in record keeping and analysis with other stake holders, investors, and business partners. Currently, healthcare as an industry is behind the average industry standards in the IT uptake. Such processes as payment processing, e-bill systems, human resource systems, stock taking, auditing, and other similar functions can be sufficiently harmonized with the use of developing software. In order for this uptake to be sustainable and standard, it is necessary to select a universally accepted platform for data storage and analysis in which organizations may pool data relating to logistics and facilities. Financial as well as private human resource information does not need to be pooled in a central storage facility, but adopting software dedicated to easing these functions on a private level is necessary in order to reduce costs, enhance operational efficiency, and increase profitability. This section may be broken down into:
Staff Productivity and Satisfaction
The use of Information Technology may reduce time wasted by operational staff performing administrative work and enhance patient attendance time, which is the key need for patients. It will also reduce unnecessary routines in patient care and reduce work of clinical staff due to rigorous, non-work related duties. It will also improve employee satisfaction and reduce fatigue due to extensive overtime schedules. Better productivity will invariably lead to more patient volumes.
Revenue Increase and Cost Optimization
Increased visitor capacity per unit may boost revenues for a care unit due to a larger number of admissions and discharges turns per month following a shortened length of stay, reduced unit costs, owing to bulk purchases by the healthcare facilities, and improved capability to meet overhead expenses. Cost optimization needs to be realized through bulk purchases, efficient stock control, and reduced cost per day for each patient. In this regard, IT practices will save cost implications for the unit, as well as daily treatment and accommodation charges on the customer.
A significant number of deaths and serious medical malpractice cases are reported each year due to errors in treatment, procedures or prescriptions. The major cases involve Adverse Drug Effects (ADE) due to wrong prescriptions which affect patients negatively, admissions following adverse drug effect incidences (AADE), errors in surgical procedures and blood transfusion, as well as malpractice expenses such as corrective procedures, court litigations, and compensations. There is an urgent need to reduce such occurrences, many of which can be satisfactorily handled by the application of proper IT processes.
Quality of Care
Patient quality of care deals with the satisfaction that patients get from the care’s efforts to resolve their problems. It may involve turn of delay, time of treatment, appropriateness of procedures used and drugs administered, and the level of professionalism and confidentiality and courtesy of the staff. Moreover, it may involve specific professional services such as recognition of accreditations, complication management, physician or nurse time with patients, as well as reduced length of stay.
Patient Services Access
Apart from the length of stay, patients are concerned with delay time for such processes as lab reports, billing, online services such as viewing and scheduling, preventive care management, and outpatient care appointment bookings. There is a need to avail systems which can be automated to handle most of the routine work not requiring case specific diagnosis, such as remote patient appointment bookings and all associated alerts on scheduling, integrated lab linkage with other hospital systems that eliminate the need for extended physical queues at facilities and electronic bill settlement procedures for alternative bill settlement by customers. If proper systems are established to meet the outlined objectives, other compound needs relating to healthcare that cannot be quantized but lie in the core of healthcare provision will also be realized. Such benefits include non-monetary benefits such as good patient- physician relationships and boosted society’s health.
The foregoing discussion highlights the need for an all-around IT supplementation to help healthcare catch up with other sectors in terms of modernization and integration. In essence, what is required is a project plan to implement safe, sustainable, and cost effective IT practices to help healthcare in administrative, operational, and patient-related and industry-related functions. There is a need for a seamless backbone IT platform which integrates the four needs listed above, as well as sustainable controls for the IT implementation to ensure it remains secure, serves the maximum purpose possible, and is practical for universal adaptability in order to satisfy the core contention within various healthcare institutions, which is the harmony in policy implementation.
While all the needs listed above are urgent and important, there are certain ones which must be prioritized in order for the entire IT uptake in healthcare to stand. These processes are the backbone of healthcare, and all other requirements are built on them. For instance, patient security and safety is a core driving factor for any practitioner, and it surpasses the need for good book keeping or profit optimization. Without proper observance of fundamental safety concerns, healthcare units are likely to face legal implications that could de-license them, rendering futile any advancement they may have in their other operations. This section will therefore seek to address the need for prioritization of the IT uptake for healthcare facilities based on the hierarchy of the need model. The primary priority from an individual facility’s perspective is patient safety, followed by profitability, then ease of processes, and, lastly, industry standardization. From the health industry’s perspective, the priorities are likely to be patient safety and security, professionalism, standardization, profitability, and ease of processes. Obviously, the ease of processes is in most cases tied with profitability. The project must therefore address IT implementation issues from both perspectives and attempt to strike a balance.