Shalaka Samant, PhD
It is not uncommon these days for a patient with an abnormal heart rhythm to have a remote-monitored pacemaker device. Digital data from the device is relayed via a portable transmitter to a receiving station. The station faxes alerts of irregularities in cardiac rhythm to the patient’s local cardiologist in a matter of minutes, making a quick medical intervention possible if necessary.
Due to its pervasive nature, information technology (IT) has become integral to transforming health care. The application of IT in health care goes by many names—health informatics, clinical informatics, biomedical informatics, and health information systems. Conventionally, when “informatics” is used in conjunction with the name of any discipline, it denotes the application of computer science and information science to assist in the management and processing of information in that discipline. Similarly, health informatics (HI) uses information technology to maintain, organize, and analyze health records in order to improve health care outcomes. The aim of HI is to apply technology and data analytics to health care data with the goal of improving patient care.
HI has tremendous potential to improve clinical workflow by enhancing and expanding the clinician’s ability to work with patient data and information. For example, handheld scanners are used to read electronic medication records in the form of bar codes to submit and fill prescriptions. The scanners transmit information, such as medication dosage, medication type, and refill history, to a central workstation via Bluetooth technology. This enables doctors and pharmacists to make prescription and dispensing decisions based on knowledge of previous prescriptions, current medication regimens, and previous medication reactions. These e-records also significantly reduce prescription errors and allow the patients to actively participate in their medication management. Having electronic access to their own health history and recommendations empowers patients to adopt a more responsible role in their own well-being. A valuable extension of the electronic medication record is a comprehensive e-health record, which stores and shares all information, such as treatment and tests undertaken, from all providers involved in a patient’s care.
Problems of legibility, access, and transportability of paper-based, handwritten health care information are frequently reported. HI ensures that high-quality and reliable data are available when needed, and that those data can be easily shared among the dozens of caregivers that a patient typically encounters during one hospital stay. Pharmaceutical concerns, nutrition, blood chemistry, physical therapy, scans, and discharge instructions are just a few of the areas of interaction between patients and caregivers. In the absence of coordinated sharing of relevant conversations, information, and instructions, patient care might suffer. HI provides the way forward as it simplifies this necessary coordination.
Wasteful health care practices, such as repeat procedures and delays or errors in care, can often be attributed to use of traditional methods of sharing information. HI improves communication by bringing lab results to clinicians sooner and avoiding transcription errors. This improves patient care and reduces the cost of treatment. Another key issue is that paper-based patient files and data are more easily lost or misplaced. HI addresses this effectively, as computer-based records are more secure than paper-based ones, and access to such records can be controlled and monitored.
HI has the potential to greatly improve patient safety. The rapid changes in health care norms and practices make it impossible for the clinician to carry around all the relevant information available about disease type, medication, and dosage in order to make an informed decision. Electronic decision support is an HI tool that can assist by providing access to guidelines and pathways, built-in alerts, prompts for care, continued patient monitoring, drug indices, links to current health information, and journals of interest. Quick access to a detailed log of a patient’s medical history could be lifesaving, especially in a hospital setting.
A strong criticism of HI is that it increasingly leads to impersonalization of health care delivery. The situation is now shifting from one in which the caregiver or clinician knows more about the patient to one in which the database or algorithm is more knowledgeable. However, on the upside, the ability of HI to make the patients more knowledgeable helps them become active participants in their own health care decisions. A more engaged and informed patient is likely to make better health care decisions.
Health information systems are in a phase of rapid development with several questions still unresolved in terms of architecture, functionality, and management; there is a significant amount of research going on in HI to address these questions. However, the instrumental role of HI in ensuring the efficient flow of information at all stages of patient care should not be underestimated.