Most doctors still rely on pen and paper for medical records. Susan Tsang finds out how Today's doctors have to grapple not just with illnesses, but with information as well, and healthcare organisations must rise to the challenge of raising productivity. "The health industry is under constant pressure to ensure financial, operational and clinical efficiency while reducing expenditure," notes Adam Chee, program manager (healthcare IT), healthcare practice with Frost & Sullivan, Asia-Pacific.
"The healthcare consumer is also better-informed, and demanding more quality, choice, yet affordable healthcare services," adds Andre Greyling, Hong Kong Hospital Authority's director of IT. "Doctors and other care-givers need to stay up-to-date with advances in medicine and healthcare organisations need to adopt and implement new evidence-based protocols and treatments quicker to reduce unnecessary errors and improve quality."
Linus Tham, CIO, National Healthcare Group (NHG) in Singapore, sees a trend "towards having greater and greater access to information online by patients and their care-givers, to facilitate better integration of care between different providers as well as between visits for one provider."
One would assume that IT would play a major role in achieving these targets, but this is not the case. Greyling points out that although healthcare is an information-intensive industry, "expenditure on IT is generally only between 1 and 2 per cent of total expenditure".
Back-office support functions such as payroll, finance and supplies are reasonably well-automated, with the same to be said for clinical support departments such as diagnostics laboratories, radiology imaging and pharmacy/drug dispensing. But he says: "There has not been broad adoption of IT to automate the actual care-delivery process to date. Most doctors still are not using IT on a daily basis and therefore do not have access to a legible patient record nor advanced clinical decision support tools to assist decision-making at the point of care."
Tham agrees. "On the point of latest technologies, healthcare is actually a laggard, and many of the technologies we are rolling out, or have rolled out recently, have been around for some time, for example, RFID [radio frequency identification]. Still, it is encouraging that there is increasing innovative use of tested technologies in healthcare-such as using RFID for tracking of patients in TTSH [Tan Tock Seng Hospital in Singapore] to facilitate greater automation in the bed management process, and wireless networks in the wards to allow easy access to information by doctors at the patient's bedside. Wireless technology has enabled doctors to use IT far more extensively in their daily jobs within NHG institutions."
Worldwide, Gartner estimates the total market size of IT healthcare to be a measly US$7.5 billion in 2007, with a compound annual growth rate of 5.8 per cent from 2007 to 2010. In contrast, US$8.9 billion is spent on IT in education, and US$55.5 billion on IT in finance.
Chee puts this slow rate of IT adoption down to the "change management issue", which he feels "is probably the biggest barrier to the adoption of healthcare IT in the health industry."
Implementation of new technology, he explains, represents a change in workflow, hierarchy, authority and politics, in addition to the actual cost. Decision-makers in the healthcare facilities, he says, are usually senior physicians whose interest lies in the clinical aspect of healthcare. They may therefore resist tinkering with existing systems that work. "Their altitude is if it's not broken, don't fix it"-be it in technology, workflow or machines.
"There is also a tedious process of assessing the needs to determine the right solution to be purchased."
Figuring out the right solution is further complicated, says Tham, by the fact that "there is insufficient adoption of standards at this point in time by providers, their systems, and the vendors who develop these systems. Without industry-wide standards, it is very difficult and costly to integrate information. Some of the standards are also in the midst of being upgraded, making it even more difficult. There's also a fair amount of debate among members in the industry on what information is needed for care integration. Some push for full data, others feel a minimum data set should be defined."
But Chee notes that "investments in healthcare-related information systems have been on the rise across the Asia-Pacific as both governmental and private healthcare organisations rollout plans for achieving 'electronic hospital' status".
IT adoption is recognised as a critical enabler for successful change in health systems, and he believes "IT will propel medical sciences into a new era of advancement".
On its part, the Hong Kong Hospital Authority is one of a handful of organisations world-wide that have made great progress with an IT-based clinical management system and a single, comprehensive electronic patient records system for its 7 million patients. These systems are used daily by all 30,000 clinical workers in all its facilities.
Likewise, at the National Healthcare Group, doctors no longer write out prescriptions manually. These are electronically entered and transmitted to the pharmacies eliminating paper and errors at the same time.
Chee is impressed with the impact created by the integration of internet technologies into healthcare. "Many medical specialties can use the internet to provide virtual consultations (aka telemedicine) in areas with poor access to conventional services. The deployment of web-based electronic records also eases the access to relevant patient records needed to make an accurate diagnosis. In addition, homecare for the chronically ill and remote monitoring during pandemic outbreaks can also benefit from the use of the internet," he says.
"Telemedicine has seen tremendous growth due to internet technologies. The penetration of broadband internet technologies in remote or rural areas can mean access to healthcare where little had been available before, in situations where fast medical response time and specialty care are needed. The availability of telemedicine can mean the difference between life and death."
Greyling sees that healthcare organisations are utilising "wireless technologies and new end-user devices" to enable the largely mobile clinical workforce to extend their services from within the hospital to the network of clinics.
"This will greatly enhance the ability to capture data electronically and use it for decision support at the point of care, improving patient safety and care quality," he adds.
Chee is looking forward to Microsoft's Connected Health Framework, which "highlights some of the best practices for service-oriented health information and collaboration architecture and how to build these systems to maximise interoperability of their services and business components."
Successful adoption, he feels, "could potentially translate into the end of integration problems between the disparate information silos implemented in the real world." This would result in interoperability, regardless of what platform they use.
© Fairfax Business Media
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