A Health Care Crisis in the Making - Essay Example

Introduction Healthcare is among the most costly industries in America. Its costs are compounded by its inefficiencies. For example, the thought of waiting in line for hours to see a doctor makes one think twice before going to a hospital regardless of seriousness of the illness. This scenario occurs in all areas of healthcare, from the emergency room to routine check ups. This leads to an obvious question: despite the improved efficiencies observed in other sectors of modern business, why has the healthcare industry lagged behind in the last few decades A potential answer to this question is the slow pace of adoption of IT in the healthcare industry. In the last few decades, the benefits of IT in the manufacturing and service industries have been well demonstrated. These benefits can just as easily be implemented in the healthcare area. For example, much of current record keeping is paper based, disorganized, and often illegible. Thus, records can be easily lost or scattered, and are poorly linked together. This disorganization can cause up to 80% of errors in healthcare administration. Clearly, the information needs to be organized architecturally according to a designed framework while keeping in mind the privacy of health records. Automation and streamlining of information storage would enable the seamless flow of information and would contribute to overall cost reduction. Cost containment is one of the key drivers of this kind of change, particularly in light of the growing elderly population combined with a shortage of physicians and nurses. Scenario: A Health Care Crisis in the Making The rising proportion of healthcare costs with respect to the gross domestic product (GDP) is an important indicator of the significance of this issue. In 1960, healthcare costs amounted to 7.2% of the GDP. By 2005 they have escalated to 16% of GDP and are predicted to continue to grow to 20% by 2015. The increase in the average human lifespan has been made possible by the advancement in medical science and technologies. Despite the high cost, the availability of healthcare in America is dismal compared to other developed nations where the average healthcare cost is typically around 8% of the GDP [13]. Today, forty-four million Americans cannot afford health insurance because health-care costs have risen four times faster than wages [14]. Many hospitals and vital health care services are out of reach for needy Americans. The United States will spend 10 trillion dollars in health-care in next 10 years, which will have a significant negative impact on the economy. Worse, government programs such as Medicare do not cover the hospital costs. These unpaid expenses add to the cost private insurance for individuals and employers. To be sure, the cost of health-care must be addressed on a top priority. The inherent efficiency of the system is perhaps the leading culprit in producing these consequences. Condition of Current Practices is Critical Utilization of information technology in the healthcare industry has been minimal, and its adoption slow. Although health insurance is among the leading industries, 90% of the transactions within this $30 billion industry are performed by phone, fax or mail. Fewer than 5% of prescriptions from U.S. physicians are managed electronically. Most healthcare organizations spend only 1% to 4 % of their revenues on IT. This is half the amount that organizations in other leading industries spend on their IT infrastructures [3]. Clearly, more effort must be directed toward facilitating the implementation of IT in the healthcare field by addressing the barriers to its adoption. Some hospitals have already started to capitalize on this opportunity by using electronic medical record keeping technologies, and hospital information systems (HISs). For example, Kaiser Permanante allows its users to book and cancel appointments on-line. Such initiatives must be expanded in order to fully realize the benefits of IT for reducing the cost of healthcare. Indeed, they hold great promise for making healthcare more affordable. "There exist advanced technologies which can dramatically lower health care costs and improve quality. While capital expenditures for equipment and training are required, the cost savings associated with implementing these technologies going forward can be much greater, such that substantial net financial benefits are possible. These technologies cross a spectrum of disciplines including biotechnology, medical devices and information technology."4 IT Applications for Healthcare There are many IT applications that are suitable for the health-care sector, potentially reducing costs and improving the quality of service. Such applications can have the following positive effects, among others: Faster processing Optimizing Data Management Reducing medication errors. These applications provide an IT based strategy for the organization and can address the need for automation, improvement in efficiency, and reduction of manual errors. However, in order to have seamless functionality it is necessary to have internal integration and external integration within an organization. Two key dimensions of system integration may be used to develop this framework: (1) nternal integration: the systems and technologies integrated to facilitate services within an organization; and (2) external integration: the degree to which healthcare applications integrate with outside computer agencies and hospitals. In order to be truly valuable, IT applications must incorporate the consumer's perspective into the software. Computerized patient record (CPR) systems, Document Management Systems, Data Warehouses, and Intranet all potentially enhance the sharing of information and integration of internal systems within healthcare organizations. IT is used to help eliminate data redundancy and inconsistency while achieving the paperless sharing of data throughout an organization [5]. Client-Patient Record (CPR) Implementation Client-Patient Record (CPR) is a growing trend toward the use of common standardized data formats. These formats are uniquely identified, electronically stored information about individuals. CPR technology entails the capture, storage, retrieval, transmission, and manipulation of patient-specific healthcare-related data, including clinical, administrative, and biographical details [6]. This helps in eliminating data duplication and maintenance of multiple databases. For example, an intranet-enabled CPR system installed in 1997 at Cabarrus Family Medicine in Concord, NC, a practice with approximately 26,000 patients in four clinics, achieved a substantial reduction in record keeping efforts for the physicians. It also enabled access by consumers to personal health data via standard browsers. Previously, physicians had spent 40% of their time going through paper based patient records to meet HMO requirements. Such a smart card system can store patients' records, enabling data to be carried just like a credit card or driver's license card. Regular updates to the smart card application database can help deliver access to healthcare regardless of location. This application is very portable and facilitates personal mobility. For example, in 1995, the West Palm Beach Veteran's Administration Medical Center in West Palm Beach, FL, began to pare down all its medical records and associated paperwork to approximately 200 clinical and 1,000 administrative electronic forms accessible through computers in screening rooms and nursing stations [7]. These forms enable physicians to point and click to enter the results of any type of examination or to issue prescriptions, making it possible to substantially reduce the Medical Center's physical file storage costs. Prescriptions Another application of IT in healthcare is in the area of prescriptions. Prescription-writing mistakes constitute a leading cause of over-medication errors, the cost of which can be reduced by implementing a more advanced electronic procedure for sending prescriptions. This can be done with a hand held device or personal computer that goes over the patients records and drug history. The physician can generate safe, formulate-compliant prescriptions and then transmit them via secure network electronically to a patient's pharmacy.[4] Thus, electronic prescription is one of the important and vital elements in reducing paper based work in the healthcare industry. Document Management and Data Warehouse Systems The need to reduce cost has contributed to document management systems as well as data warehousing systems to collect and administer clinical and financial data online. Document management technology includes document imaging, work flow, electronic forms processing, mass storage, and computer output to laser disk. Data warehouses are large stores of data kept for strategic decision support. For example, an analysis of patient data can reveal patterns of symptoms related to specific diseases. Data mining can also readily provide information for the diagnosis of disease. Many hospitals strongly advocate self care with the aid of information, knowledge, and documentation, utilizing these tools. For example, in 1992 the San Jose Medical Center in California began to address the challenge of accessing medical records quickly and making record management more efficient by using a LAN to link its document management software, relational databases, and imaging equipment. Management reported dramatic results, allowing the center to reduce its staff and increase revenue by handling external record requests directly. Web Technologies The internet has driven change in every industry; and healthcare has started utilizing web technologies to facilitate real time data. The internet plays a crucial role in bridging the gap between healthcare providers and consumers by making valuable information available. For example, the advice of a physician is available at any time, appointments can be made quickly, patients do not have to stand in long lines and can get their diagnoses, as well their prescribed medication, all on line. Stand-alone kiosks also provide telephony links to customer-service representatives and other member services. One aim is to significantly reduce the cost of in-house insurance support and education by directing employees and customers to online support. Many HMOs also provide access to insurance and health data via the worldwide web. For example, a service called Tel-a-Nurse allows patients to call in medical questions to be answered by nurses accessing relevant information via their intranet. People are able to use worldwide web to ask questions as well as to interact with people who have similar health problems and diagnostic procedures. They can use forums to discuss symptoms, and access their own health records anywhere and anytime. Further, online shopping for health products can be extremely easy and cost effective. Physicians can be consulted, issues discussed, and appointments made all online. Regional Data Sharing The benefit of the technologies discussed previously can be augmented strategically through electronic and digital networking-a logical next step for health services delivery. Clustering health information in one network and providing integrated heath services along the entire care of continuum can be extremely valuable. For example, the Orlando Regional Healthcare System in Orlando, FL, began in 1996 to build an integrated delivery network, a form of one-stop shopping for all types of health services in response to its need to reduce costs while continuing to market its services. In most cases, the information needed resides with some specialist within the network. Thus, it makes sense for physicians to invest in distributed, client/server networks and OO technology to deliver the necessary links to best serve their patients. Speech Recognition Technology Nuance has developed a very smart solution with the help of Speech Recognition Technologies. One example is speech-to-text transcription-pathology, radiology, and cardiology. Error rates from the automated systems still are high enough that some human intervention is necessary before the copy is of good enough quality for a medical chart. Once accuracy improves, more cost savings through reducing medical transcription staff will be possible. Speech recognition will provide an easy-to-use, intuitive interface for data entry into, and complex querying of, medical records. Such tight integration, probably mediated through XML (an Internet standard that describes how data elements are encoded), will give physicians better access to critical information about their patients. Factors driving such development are the reduced cost of call center staff and the promise of potential revenue growth. The continuous discovery of health care processes along with solutions that could improve overall performance as well as continue to do more analysis of all required data without a resultant increase in manpower holds great promise for IT in the healthcare industry. Barriers to Adoption Resistance to change is natural. Nevertheless, a clear vision of advantages and effective solutions can overcome such resistance. Overcoming these hurdles requires substantial time and money. Some of the barriers of information technology have been identified as: The healthcare system is demanding as far as IT performance; Lack of system wide focus on improvement of outcomes; Lack of funding and necessary resources; Cultural resistance and lack of support from medical staff; The perceived liability, security and patient privacy issues associated with electronic communication; Difficulty moving from paper to electronic records; and Lack of industry standards. To Spur Adoption: Implementing bonus incentives for physicians who implement e-visits; Offer low- or no-cost revolving loans to physician practices that implement e-prescribing solutions Because use of home monitoring tools is still relatively early, a pilot project on these tools would make an ideal candidate for special grant funding. High-speed Internet access is a key technology required to support this solution. Incentives that would lower the ongoing cost of high-speed Internet access would also speed up adoption [4]. The government promoting the use of Health IT with some incentives Government contribution: The President has proposed nationwide standards in the healthcare industry, such as: Accelerating patients' access to electronic health records; Developing web based health records. Using electronic medication history and lab test results Using health information tools to monitor diseases A report by the Administration's Department of Health and Human Services suggests that expenses related to legal liability (including malpractice insurance) add $60 - $108 billion to the annual $1.6 trillion health-care bill. That translates to 3.75 - 6.75 percent of total costs. [2] Conclusion Technology is helping patients take care of their health. IT is a fundamental asset for improving the quality of healthcare and an important tool for reducing healthcare cost. The quality of patient care can be improved through reduction of errors and costs. Reducing loads of paper work and manual interaction which yields 80% of miscommunication errors can go a long way toward enhancing efficiency. .Most errors can be reduced healthcare technologies such as CPR and document management systems, data warehouses, point-of-care applications, distributed networks, and telematics, to provide information at any time and any place upon demand. The demand for information technology in the healthcare industry has motivated a large number of entrepreneurs such as Interplast, the first international humanitarian organization to provide free reconstructive plastic surgery in developing countries [16]. Artificial intelligence, intelligent networks, and robotics integrating with health applications in clinical and administrative support applications holds great promise. Physicians can provide real time data to patients at a lower cost than ever before because of technology. IT health management applications can help physicians and hospitals track and analyze patient care history, lab test results and cost information. This helps to analyze trends in healthcare. Most of these applications combine data warehousing, electronic data entry, messaging , and GUI tools. The strategic use of intelligent networks to automate patient recordkeeping and provide integrated patient care, timely decision support, and remote consultation, as well as regional data sharing of expert knowledge in specific domain areas, leads to a very low cost service, while improving the quality of the care actually delivered with care[5]. References Heng, K. J., Khoong, C. M., Radjou, N., Dhaliwal, J. S., Ramlochan, R., "An Integrative Program on Enterprise Modeling in the Framework of Business Process Reengineering", Proc. Information and Process Integration Conference (IPIC) 1996, Nov. 14-15, 1996. Http://uspolitics.about.com/ Connecting for Health: Facts and Stats. June 2003 Advanced Technologies to Lower Health Care Costs and Improve Quality Mitchell Adams - Executive Director, Massachusetts Technology Collaborative Strategic IT Applications in Healthcare -By Wullianallur Raghupathi and Joseph Tan Raghupathi, W. Towards a global healthcare system. Siliconindia (Oct.1997), 28-30. Hamblen, M. Pentagon to deploy huge medical data warehouse. Computerworld(Aug. 3, 1998), 25; see www.computerworld.com/databasetopics/data/datawarehouse/story/0,10801,32043,00.html. Greenes, R. and Shortliffe, E. Medical informatics: An emerging academic discipline and institutional priority. J. Amer. Med. Assoc. 263, 8 (Feb. 23, 1990), 1114. National Research Council. For the Record: Protecting Electronic Health Information. National Academy Press, Washington, DC, 199 http://www.rfidjournal.com/article/articleview/2154/1/1/ -RFID journal Thomas C. RindfleischPrivacy,InformationTechnology, andHealth Care Three researchers -- Uwe E. Reinhardt of Princeton and Peter S. Hussey and Gerard F. Anderson of Johns Hopkins http://www.ihealthbeat.org/index.cfmaction=lookupID&id=25464, TECHNOLOGY FORESIGHT: Speech Recognition by Robert Mittman , Facilitation, Foresight, Strategy July 30, 2003 http://www.nbc11.com/technowarchive/10310922/detail.html NBC11's Scott Budman reported. Read More