Role of information technology on health

information technology in health and nursing

1. ROLE OF INFORMATION TECHNOLOGY ON HEALTH Submitted To: Dr. Kavita Narang Lecturer PGIMER Chandigarh Prepared By : Nisha Yadav M.Sc. Nursing 1 st Year NINE, PGIMER Chandigarh

2. Content Introduction to information technology History of IT Basics of Information Technology Benefits of Information Technology Need for IT in healthcare IT tools in healthcare Privacy and Security in Healthcare Information Technology Current Status of IT in Healthcare NDHM Future scope

3. Introduction to IT Information technology is a general term that describes any technology that helps to produce, manipulate, store, communicate and disseminate information. IT is considered to be a subset of  information and communications technology  (ICT).

4. An information technology system (IT system) is generally an  information system , a  communications system , or, more specifically speaking, a  computer system  – including all  hardware ,  software , and  peripheral  equipment.

5. History of IT

6. The Pre-mechanical Age Writing and Alphabets- communication. Paper and Pens- input technologies. Books and Libraries: Permanent Storage Devices. The First Numbering Systems. The First Calculators: The Abacus

7. The Mechanical Age: T he First Information Explosion. The first general purpose “computers” were actually used. Slide Rule, the Pascaline and Leibniz's Machine.

8. The Electromechanical Age Voltaic Battery Telegraph Telephone and Radio Electromechanical Computing

9. The Electronic Age First generation (1951- 1958) Second generation (1958- 1963) Third generation (1964- 1979) Fourth generation (1979- present)

10. Basics of Information Technology Computer Communication technology Characteristics of a computer Components of a computer system Memory Units of memory Storage devices Types of software Computer networking

11. Computer A Computer is a programmable electronic device. It takes data through input devices. It processes the data according to a sequence of instructions provided in the form of a program. The result is called the output and given through some output device.

12. Characteristics of computer Speed Accuracy Storage Versatility Diligence Automation Security

13. Memory A Computer uses several different types of memory. They are classified below :-

14. Storage devices Floppy disk Hard disk CD Pen Drive

15. Software

16. Computer networking LAN MAN WAN Internet Wired Networking Technology Wireless Networking Technology Wi-fi Technology

17. Communication technology Communication Technology is the study of Technology applications which are used in Tele- Communications.

18. Benefits of IT Education Business Research Healthcare

19. Education Audio visual sessions Interactive e- learning classes Social communication classes Simulation classes

20. Business Networking Mailing Marketing Video conferences

21. Healthcare Reduction in healthcare cost Increase in quality of healthcare services Easy communication of medical data

22. Information technology in healthcare Information Technology (IT) has the potential to improve the quality, safety, and efficiency of health care. Delivering quality health care require providers and patients to integrate complex information from many different sources. By increasing the ability of physicians, nurses, clinical technicians, and others to readily access and use the right information about their patients should improve care.

23. The ability for patients to obtain information to better manage their condition and to communicate with the health system can also improve the efficiency and quality of care. IT allows healthcare providers to collect, store, retrieve, and transfer information electronically. In comparison to traditional learning modalities, the computer based decision support tools are more likely to suggest treatments that are both new and relevant to the care of a specific patient.

24. As a result, the new information technology will have greater influence on physicians and under plausible conditions, enhance the rate of diffusion of new knowledge. Participation is a vital aspect of healthcare.

25. Need for IT in healthcare The ability of human to memorize things has remained flat, but the medical knowledge that needs to be assimilated is increasing geometrically. Rapid technology advancements and continuous increase in performance/price indexes have made information technology (IT) applicable at all levels in health care organizations and patient management.

26. In such situation IT based decision support system could help doctors to learn about new treatments. Health Information Technology (Health IT) allows comprehensive management of medical information and its secure exchange between healthcare consumers and providers.

27. IT TOOLS IN HEALTHCARE Today a number of tools exist and are being developed to help health information technology (IT) stakeholders to plan for and to evaluate health IT. Health IT programs serve to bring it to individual stakeholders such as providers, patients, hospitals, pharmacists, and others in this industry. These Health IT tools support in specific areas and promote better, more efficient healthcare through the use of today's technologies.

28. Commonly used health IT tools are

29. Electronic Medical Records (EMR) The EMR provides a clinician with real-time access to patient information, such as patients medical condition, visits to health providers, images and reports of diagnostic procedures, schedule of services, allergies and contact information to caregivers and a complete longitudinal record of care evidence based on decision support tools that can be used to aid clinicians in decision making.

30. A fully integrated EMR enables a physician to update clinical and other information about a patient on a continuous basis. The EMR can automate and streamline a clinician's workflow, ensuring that all clinical information is communicated .

31. The EMR can support the collection of data for uses such as billing, quality management, outcome reporting, public health disease surveillance and reporting.

32. A total of 223 providers completed all 3 surveys of which 85.6% had outpatient practices, 56.5% were >45 Years old and 23.8% were primary care providers. The percentage of providers with positive perceptions significantly increased from baseline to long term follow up for patients communication, hospital transition access to clinical information, preventive lab prompt, satisfaction with system reliability and sharing medical information.

33. Clinical Decision Support (CDS) CDS encompasses computerized alerts and reminders to care providers and patients, clinical guidelines, condition-focused order sets, patient data reports and summaries, diagnostic support, and other tools that enhance decision making in clinical workflow. CDS provide clinicians, staff and patients with knowledge and person-specific information, presented at appropriate times to enhance health and health care.

34. CDS has the potential to increase adherence to clinical guidelines, protocols and best practices which helps to avoid medication errors, and to prevent complications. CDS requires computable biomedical knowledge, person-specific data, and a reasoning or inferencing mechanism that combines knowledge and data to generate “advice” to clinicians.

35. Computerized Physician Order Entry (CPOE) CPOE is used by physicians for ordering medications, orders for x-rays and other diagnostic procedures, referrals, discharges, and transfers. One important higher-level application in CPOE is that providers write orders including prescriptions using computers. Computerization of ordering is important because most actions in health care follows an order.

36. Electronic Prescribing (E-prescribing ) E-prescribing is the transmission, using electronic media of prescription between a prescriber, dispenser, pharmacy manager, either directly or through an intermediary, including an e-prescribing network. E-prescribing includes, two-way transmissions between the point of care and the dispenser.

37. It is recommended that electronic prescription applications should be robust enough to include safety checks for allergies, drug- to- drug interaction warning, dose appropriateness, drug-clinical condition warning, and drug-laboratory alerts.

38. Findings revealed that nurses adjust their routine in response to providers’ preferential behavior about EHR with e-Rx systems yet retained focus on the patient and care coordination. Although perceived as more efficient, EHR with e-Rx adoption increased workload and introduced safety risks.

39. Health Information Exchange It is the electronic connectivity via internet and other networks that enables health care providers to exchange patient health information.

40. It is necessary that the networks that permit electronic communication among providers must be secure in order to safeguard the information from unauthorized access, use and disclosure. It requires to develop data and messaging standards to establish the critical goal of interoperability to communicate with one another.

41. Personal Health Record (PHR) PHR is an electronic application through which individuals can maintain and manage their health information in a private, secure, and confidential environment. The most salient feature of PHR, and the one that distinguishes it from the EMR and EHR, is that information it contains is under the control of individual.

42. The individual is distinctively the guardian of information stored who can decide what volume of information to include, how it is maintained and ordered, and who to read them or “check them out.” It is necessary to decide standards and policy to determine how individuals can delete or modify information in a PHR that originated from an EHR and how these modifications are communicated to other providers with whom the data in the PHR are shared.

43. Significant sources may include health care providers, medical devices, individuals, health insurers, research institutes etc.

44. Remote Monitoring Remote monitoring is the electronic transmission of health care data either entered directly by a patient (or his/her caregiver) or through a medical device to a clinician’s Electronic Health Record (EHR) or a Patient’s Personal Health Record (PHR).

45. The ability for a clinician to monitor patient information about diagnostic, medication tracking, and activities of daily living (ADL) measurements, captured remotely is a key enabler for the management of chronic health problems and management of new conditions. Remote monitoring could include physiologic measurements diagnostic measurements, medication tracking ,device information, and activities of daily living measurements

46. Telehealth/Telemedicine Telehealth is the use of telecommunication technologies to deliver health-related services and information that support patient care, administrative activities, health education, health services and information over distances. It is a new method of delivering health care by sharing/exchanging the patient related data and medical opinion between medical specialist and a doctor in a remote location through telecommunication networks.

47. The technology is a means to improve access to care, while reducing cost of transportation and increasing convenience to patients care. Tele-homecare, video-conferencing and electronic health records are all components of telehealth and use information technology in delivering their service. It can source expertise within seconds any where and effectively mediates the diagnostic shortages and surplus.

48. Home monitoring of Patients Due to the institutional healthcare costs escalating worldwide, IT can be applied to home monitoring of patients particularly the chronic sick aged patients. In one project, a system which is linked to the home telephone can measure ,collect and record information about ECG, blood pressure and body temperature of the patient with cardiovascular problems at home.

49. The telephone is modified to hold an IC memory card and multifunction such as simple character and picture processing functions. The collected information is sent from the patient’s home to the medical facilities by using online facility to the physician.

50. Clinical Data Processing (CDP) Clinical data processing is used for patient monitoring. Often patients have to be monitored continuously (for ECG monitoring) or periodically(monitoring of vital signs). These monitoring processes may be done for diagnostic purposes in emergency room, for therapeutic purposes in the operating theatre or for surveillance purposes in the ICU.

51. By automating the monitoring process , manpower cost can be saved as more nursing time can be freed from recording observations for patient care activities.

52. Computer in nursing- nursing informatics Specialty that integrates nursing science, computer science and information science to manage and communicate data, information, and knowledge in nursing practice. Any use of information technology by nurses in relation to: The care of their patients Administration of healthcare facilities Education preparation of individuals

53. Nursing practice Admission, discharge and transfer Health reporting/ documenting

54. Nursing education When computer is used as an aid to teaching the method of instruction it is called as computer assisted instructions.

55. Nursing administration Computers are used in the administrative areas of nursing for basic tasks that once were done on paper. Staffing and scheduling are used to construct daily, weekly or monthly schedules. Budgeting and financial tracking are another way in which computers are used in nursing administration.

56. Nursing research Applying technology and informatics to the nursing research process Research problem, purpose, main question or hypotheses Literature review Conceptual framework Research design Sample size calculation Research instruments and data collection Data analysis using spss , excel, etc. References

57. Privacy and Security in Healthcare Information Technology In health care, accurate and complete information about individuals is critical to provide high quality and coordinated care. When physician adopt new health IT to enhance the quality and efficiency of care in his practice, it is necessary to reassess health information security policies.

58. Information security is achieved by ensuring the confidentiality, integrity, and availability of information. When physician assess health IT environment, then there may be situations that may lead to unauthorized access, use, disclosure, disruption, modification or destruction of electronic health information

59. To mitigate each risk , physician should implement the important steps in his practice such as : Review existing health information security policies and develop new policy statements to address new risks to electronic health information. Refine who is authorized to view and administer electronic health information, or clarify and improve how and when electronic health information is provided to patients or other health care entities.

60. Apply updated health information security policies into the practice to mitigate new risks to electronic health information. Follow administrative, physical and technical safeguards in the practice.

61. Quality and Health Information Technology A New Health Care System for the 21st Century, emphasized the need for improvement in six key areas: Safety Effectiveness Responsiveness to patients Timeliness Efficiency Equity

62. Clinical decision support systems(CDSS) have been shown to improve efficiency by reducing redundant lab tests. IT can also improve the effectiveness of care by promoting compliance with clinical practice guidelines. The secure transmission of patient information among physicians will significantly improve the coordination of care.

63. Current Status of IT in Healthcare The degree of use of IT in healthcare varies by health care setting. IT and the internet had a significant impact on consumers. Numerous websites have made health information available to patients, thereby strengthening their role in care decisions.

64. Now a days some technologies are emerging in healthcare such as Clinical Data Warehouse, Clinical Decision Support Systems (CDS), Data-mining Techniques, Online Analytical Processing (OLAP) and Online Transactional Processing (OLTP). These technologies are used to maintain and utilize patient data intelligently , based on the user’s requirements. Information systems are used to educate patients about the latest developments in medical science through the internet and specially configured kiosks in hospitals and clinics

65. National Digital Health Mission PM Narendra Modi announced the establishment of NDHM on Independence day 2020. This program would provide an identification number for everyone in the country, and that the system would manage everyone’s government health records.

66. The National Digital Health Mission (NDHM) aims to develop the backbone necessary to support the integrated digital health infrastructure of the country. It will bridge the existing gap amongst different stakeholders of Healthcare ecosystem through digital highways.

67. Vision Universal Health Coverage NDHM shall create a seamless online platform “ through the provision of a wide-range of data, information and infrastructure services, duly leveraging open, interoperable, standards-based digital systems” while ensuring the security, confidentiality and privacy of health-related personal information.

68. Objectives

69. Benefits The implementation of NDHM is expected to significantly improve the efficiency, effectiveness, and transparency of health service delivery overall. Patients will be able to securely store and access their medical records (such as prescriptions, diagnostic reports and discharge summaries), and share them with health care providers to ensure appropriate treatment and follow-up. They will also have access to more accurate information on health facilities and service providers. Further, they will have the option to access health services remotely through tele-consultation and e-pharmacy.

70. NDHM will empower individuals with accurate information to enable informed decision making and increase accountability of healthcare providers. NDHM will provide choice to individuals to access both public and private health services, facilitate compliance with laid down guidelines and protocols, and ensure transparency in pricing of services and accountability for the health services being rendered.

71. Similarly, health care professionals across disciplines will have better access to patient’s medical history (with the necessary informed consent) for prescribing more appropriate and effective health interventions. The integrated ecosystem will also enable better continuum of care. NDHM will help digitize the claims process and enable faster reimbursement. This will enhance the overall ease of providing services amongst the health care providers. At the same time, policy makers and programme managers will have better access to data, enabling more informed decision making by the Government.

72. Future Scope Information technology has the potential to substantially improve healthcare by bringing decision support to the point of care, by providing vital links and by allowing routine quality measurement to become reality. Health IT may be especially beneficial for inner-city and rural populations and other medically underserved areas.

73. It is necessary that latest IT technologies in healthcare center that are available in urban population to be made available to rural areas of India. Rural users can access information by connecting block headquarters to fiber optic network, using wireless technology to achieve last mile connectivity.

74. CONCLUSION With the help of IT, it is possible to transform health care and improve patient safety by better leveraging information technology to improve the efficiency, accuracy, and effectiveness of health care system. Implementing and supporting IT applications require skills, hence physicians must make significant changes to both office and physician workflow and take time away to learn how to use IT. Health care administrators and planners should take a long term view because the benefits will not be immediately tangible. Hospitals are slowly moving towards clinical information systems, which helps them to lower their cost, to raise the quality and to improve their cash flow.

75. References https://en.wikipedia.org/wiki/Information_technology Gulavani SS, Kulkarni RV. Role of Information Technology in Health Care. 2010. Available from: (PDF) Role of Information Technology in Health Care (researchgate.net) Abbott AA, Fuji KT, Galt KA. A Qualitative Case Study Exploring Nurse Engagement With Electronic Health Records and E-Prescribing. Western Journal of Nursing Research. 2015; 1-17. Available from: (PDF) A Qualitative Case Study Exploring Nurse Engagement With Electronic Health Records and E-Prescribing (researchgate.net) Shaikh SM, Furniss S, Blandford A, McLeod M, Ma T, Beykloo MY, Franklin MD. The impact of electronic prescribing systems on healthcare professionals’ working practices in the hospital setting: a systematic review and narrative synthesis. 2019. 19(742); 1-8. Available from: https://doi.org/10.1186/s12913-019-4554-7

76. Thankyou