Information Technology in Health and Medicine

Sheetal Shaji

MBA (IB), Roll no: 20

School of Management Studies
CUSAT, Kochi – 22
E – mail:sheetalshaji@yahoo.com

Abstract: This report is on the applications of Information System in the field of Health and
medicine. In its enthusiastic embrace of information and communications technology in the
health care sector

Key Words: Health care, HIS, Multimedia, Telemedicine

1.0 INTRODUCTION

Computer-based information and communication technologies continue to transform the delivery of

health care and the conception and scientific understanding of the human body and the diseases
that afflict it. While information technology has the potential to improve the quality and efficiency of
patient care, it also raises important ethical and social issues.

1.1. General Information

Although the health sciences will benefit from many of the advances in information technology that
are applied to a wide variety of research areas, information technology is of particular importance to
health care delivery. Developments of computerized patient records will enhance the efficiency,
effectiveness, and distribution of health care. As managed care programs develop, population-
based information will be of increasing importance to health care providers and to the public health
community. The capacity to transmit this information through telecommunication linkages, including
telemedicine, will revolutionize the accessibility of health care to underserved areas, including both
rural and urban populations. These developments will raise substantial concerns regarding
confidentiality and privacy because information on health may be very relevant to employment and
insurability. Efficient, effective, reliable information systems could, in fact, enhance the human
quality of patient/doctor interactions by focusing on clinical decision making and patient preferences
rather than routine data collection. In this regard, information technology might, in fact, enhance the
quality of that interaction. However, there are also major risks that information systems will be
substituted for the human touch. This risk should be clearly understood and avoided.

2.0 FUNCTIONAL AREAS

2.1 Hospital Information System

A hospital information system (HIS), variously also called clinical information system (CIS) is a
comprehensive, integrated information system designed to manage the administrative, financial
and clinical aspects of a hospital. This encompasses paper-based information processing as well
as data processing machines. It can be composed of one or a few software components with
specialty-specific extensions as well as of a large variety of sub-systems in medical specialties (e.g.
Laboratory Information System, Radiology Information System). CISs are sometimes separated
from HISs in that the former concentrate on patient-related and clinical-state-related data
(electronic patient record) whereas the latter keeps track of administrative issues. The distinction is
not always clear and there is contradictory evidence against a consistent use of both terms.

2.1.1 Implementation of HIS

(HIS) has always been a challenge. This scenario is not only true for hospitals in India but also in
the West. The implementation challenges in Indian hospitals are multifold and broadly fall in the
following categories:

• Setting up right expectations from the management and users in the hospital
• Availability of accurate and exhaustive master data
• User training
• Acceptance and appreciation of computerization by medical, paramedical and other
healthcare specialists
• Quantifying Return on Investment(ROI) and Key performance indicators (KPI)

Implementation of HIS in hospitals is not mere computerization of the hospital, it is just not about
automation of existing paper trail. This approach, if followed will not only lead to failure of the
implementation but also transfer the inefficiencies of the manual system to the computerized
environment. Proper business processes, re-engineering and accurate definition of workflows
incorporating global best practices will improve the effectiveness and efficiency of the hospital and
in turn provide better patient care.

A good HIS product should not only cover the functionality of all the business processes in a typical
hospital but more importantly have the flexibility of customization to the specific needs of the
hospital through parameterization and the ability to configure alternative workflows. There will be
resistance from users (for instance, from nurses, phlebotomists other paramedical staff, etc) who
may feel that feeding information into the computerized system is additional work and not their
primary responsibility or core competence.

Rigorous and continuous training, user friendly screens, hand-held devices for data input and most
importantly showing tangible benefits are the answers to overcome this initial resistance. Enough
cannot be said about the extensive preparation required to collect the initial master data. These
master data parameters are the ultimate drivers of your system and please remember the old
computer adage Garbage in, Garbage out.

It is equally important that the right infrastructure in terms of right sizing, the servers and PCs, with
good bandwidth network connectivity and clean power supply will go a long way in ensuring smooth
and satisfactory implementation .The return on investment of a HIS implementation can be looked
at with both tangible and intangible benefits in mind. A well controlled inventory system can bring in
savings of 10 to 15 per cent in the first year itself, thereby justifying the investment for a HIS
product in big hospitals. The benefits include improved bed turnover ratio, on line billing to capture
all transactions across all departments, drug expiry management, accurate and reliable laboratory
test results due to on line interfaces to laboratory equipment, leading to accountability and higher
profitability in hospitals .Having the entire patient medical records and history with all attendant
details at a click of a button helps doctors to provide better diagnosis and treatment and avoid
clinical errors. With our rising costs of qualified manpower and reduction in the prices of computer
hardware, we are in a position to quantify the return on investment better in future.

In conclusion, articulating and communicating the right vision and mission for HIS implementation
project, committed involvement of the top management of a hospital and assiduous training of the
actual end users are a few key critical success factors to ensure success of any implementation of
HIS in any hospital. The project duration can vary anywhere between 9 and 12 months to
implement an integrated HIS solution in a typical 200 bed hospital.

2.2 Medical Multimedia

On June 12th 1995 a specialist group of the Software Publishers Association announced the
Multimedia Personal Computer Level 3 (MPC3) standard, which in time could lead to exciting
applications in medicine for education and clinical decision support tools. Although current
multimedia applications promise much they often actually deliver disappointingly little. This in part is
due to the limitations of the level of hardware configuration for which there was an agreed standard
supported by the computer industry. Developers of multimedia applications were confined to
developing to an agreed standard and this was particularly apparent with the size and quality of
video presented in the applications.

It should not be considered that hardware is the only limitation or even the major limitation in
developing high quality medical multimedia applications. To date, the market for these applications
has been too small to encourage developers to make major investments in this area, although
there have been some very impressive products. Regrettably many applications have concentrated
more on style than content providing little obvious advantage beyond color leaflets, which are
cheaper to produce and easier to carry. Often these systems are designed to promote a
commercial product and encourage inappropriate skepticism of the potential for medical multimedia
applications. In order to develop the market for medical multimedia there is a need for high quality
applications to justify the purchase of the necessary hardware. However, in order to develop very
high quality multimedia applications it is necessary to have an agreed standard so that the market
place is not confused by incompatible systems supplied by different companies.

The first international standard for multimedia on personal computers (MPC1) was introduced in
1991 to provide a base for developers to introduce multimedia applications to a large market. It was
not long before developments in this field lead to the need for a higher level specification (MPC2)
which was introduced in 1993. At present MPC2 provides the hardware specification that many
users currently have to run the current wide range of multimedia applications available on CD-
ROM. It is suggested that MPC3 will not replace MPC2, but rather will provide the opportunity to
develop new multimedia applications with greatly enhanced capabilities. Software titles that run on
MPC1 and MPC2 compliant hardware will also run on MPC3 compliant hardware. To consider the
possible impact of MPC3 on medical multimedia it is necessary to appreciate the possibilities
provided by this new standard.

A key element of impressive multimedia presentations is high quality video which on MPC2
systems has tended to be restricted both in terms of the size of images and the smoothness of
movement. In order to improve the quality of video display on computer systems dedicated
hardware has been developed to a standard agreed by the Multimedia Player Expert Group
(MPEG1). The MPC3 specification includes MPEG1 thereby providing the ability to display full
screen, full motion video in a display superior to television pictures. It is thus becomes possible to
fill the computer screen with a video of an operation or the stages in tying a surgical knot, which
may be paused, fast forwarded or replayed at will. A large amount of information must be stored by
a computer system to display any significant length of video. Optical storage devices using
Compact Disc Read Only Memory (CD-ROM) provide a convenient means of storing large data
volumes, and the performance of CD-ROM players has been steadily improving. The MPC3
standard requires at least a quad speed CD-ROM player, which is able to transfer data at twice the
rate of the dual speed CD-ROM players required by MPC2. This improved rate of data transfer
significantly speeds up the performance of MPC3 systems, so that large medical bibliographies or
series of medical images may be browsed with little delay.

The clarity of the sound produced by medical multimedia systems is particularly important in
specific areas such as cardiac auscultation, and adds greatly to any commentary to accompany a
video, animation or picture. The MPC3 specification defines a need for high quality wave table
sound, which sounds at least as good as a high quality audio compact disc. The outstanding
advantages of multimedia applications over conventional forms of presenting information stem from
the possibilities of dynamic interaction. The information presented by a multimedia system may not
only be diverse, but also it does not need to follow a linear pathway. With no more than a click on a
button or highlighted text the user may jump to another page of information, a video clip or a
computer program. Any computer program may be incorporated into a multimedia application thus
text and pictures may be transferred into a word processor to produce an individualized report of a
medical topic. In order to seek specific information within a large medical multimedia resource
another computer program may be employed to perform a search using keywords, topic areas or
even a fuzzy logic search engine, which translates a typed question into a sophisticated search
strategy. In order to provide sufficient speed for demanding interactive multimedia applications the
MPC3 standard specifies the system must have at least a 75 m Hz Pentium TM processor.

The adoption of an international standard for very high quality multimedia will allow sufficiently large
volume sales to reduce the costs of both the computer systems and software. As the price of MPC3
compliant computer systems falls they will become more commonplace not only in organizations
but also at home. As the potential market for MPC3 applications in medicine develops the quality
and quantity of appropriate products may well increase exponentially to provide an invaluable
resource for medical practice and education.

2.3 Telemedicine

The two major components necessary for successful telemedicine are the idea and the technology.
Undoubtedly, ideas abound, as the number of technologies available for application in the health
care sector is increasing rapidly. Meanwhile, current technologies are becoming cheaper and thus
more widely applicable.4 Nevertheless, they are still costly and this, together with many unresolved
issues such as State versus national licensure and charging structures for tele consultation,
currently limits the application of telemedicine largely to the public sector. Indeed, the Department
of Defense in the United States remains a prime mover and fund of telemedicine in that country.

Confined largely to the public sector, most telemedicine applications to date have been applied in
giving rural communities better access to health care. Current activity in telemedicine applications
in Australia -- at present predominantly rural -- leads to the conclusion by Yellow lees and
Kennedy4 that telemedicine is here to stay.

Already we are witnessing the application of the personal computer and the Internet and other
broadband mechanisms in "medical informatics" to transmit patient data in community-based care.
Importantly, telemedicine will probably move from being used mostly in its current rural settings into
more widespread use. By early in the next century, health care delivery will emphasis the
importance of bringing care to patients rather than bringing patients to the health care system and
tertiary hospitals, regardless of where patients live.

"Multimedia e-mail" are current buzzwords in telemedicine. They refer to the development of store-
and-forward electronic mail, allowing transmission of not just text, but also audio, still images and
video. In the future we will have more sophisticated and affordable real-time video consultation, and
the luxury of multimedia consultation, to be accessed when convenient. Concomitantly, if the vision
of such projects as the APEC (Asia-Pacific Economic Cooperation Forum)-endorsed "Interactive
Medical Curriculum" project of Health On Line in South Australia becomes a reality (see the
website at http://www.hol.com.au), the ongoing education of practitioners in the community (and of
their patients) will be vastly different and delivered "online" to their homes.

The implications of such changes inspired by information and communications technology are
difficult to appreciate, but health care delivery in the 21st century will certainly apply such
technology more effectively and, hopefully, less expensively. We will witness a significant change in
the role of the tertiary teaching hospital, and increasingly empowered family practitioners with their
better-informed patients will enforce a new role on the specialist practitioners. For better or for
worse, communication in medicine will be different.

3.0 CONCLUSION

Information technology has widespread applications in the field of health and medicines. With the
help of new technologies such as hospital information system, Medical multimedia, Telemedicine
etc information technology has proved its applicability’s in this field. With the installation of these
facilities, doctors and nurses are able to effectively carry out there work.

4.0 REFERENCES

1. IT in health and medicine - www.wikipedia.org

2. Hospital information system- www.wipro.in
3. Application of Telemedicine - www.jama.ama-assn.org
4. Health technologies - www.fiercehealthit.com
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