Healthcare Information System (HIS) and Challenges in Healthcare
The system used to process data, knowledge and information in the healthcare environment is known as healthcare information system. It is a branch of health informatics that controls the administration needs of the hospitals. So, HIS is an integrated, comprehensive Information system that has been designed to control and manage all the hospital’s operations like financial, administrative, medical, and legal issues and provide corresponding services. Healthcare Information system can save a lot of money in the long run and the major benefits for hospitals are cost effectiveness, the efficiency of the system and safety of medical deliveries.
Though HIS provides huge potential and opportunities to transform healthcare sector, there are many challenges currently being faced that are evident. Firstly, the adoption of the Information technology in healthcare has really been very slow and lags behind major industries of IT by almost 10-15 years. The resistance to use information technology by healthcare professionals and failure in HIS implementation is also one of the major challenges in healthcare. The challenges may vary from technical issues, issues in healthcare settings, regulatory environment, and system users’ settings. Some of the barriers to the adoption of IT in healthcare in U.S as provided by Blumenthal (2009) are: the adoption rate by doctors and hospitals is very less, issues with privacy and security, medical errors committed.
Computerized provider order entry (CPOE) system in health care
Computerized Provider Order Entry (CPOE) refers to a system where clinicians enter medications orders (medicines and tests and procedures) directly into the computer system, from where it is then transferred to the pharmacy directly. It decreases the delay in order completion, the errors related to transcription and handwriting is reduced, error-checking for incorrect tests or duplicate doses can be provided. CPOE is thus patient management software.
Healthcare quality and errors in medical are the major concerns in healthcare these days. CPOE systems can reduce the medication error rates. The errors can be reduced by the use of information technology –computerization in all ordering, pharmacy systems, use of bar coding and event monitoring. Since the order is directly entered into the computer, it has fewer transcription errors, increased accuracy and the order can be entered into multiple locations at a time.
Early implementation of CPOE system had some adverse consequences which led to failure in providing medications in emergencies. But, with the experience in CPOE implementation, careful planning, maximizing the system’s use, all these adverse events have been averted. With the use of CPOE, the decision support can be provided by the physician at the time of care. The decision maker has to interact with the computer directly. Decision support helps in reducing the medication error rate and thus helps in ordering clinically cost-effective and appropriate medications and tests for the patients. The basic functions CPOE can provide are: Order creation, modification, dictionary management of orders, patient’s order profile management, routing orders to various departments, reporting, and summarization. Overall care process can be shown as:
Software Engineering of Decision Support Systems
The decision support system in healthcare helps in supporting decision-making activities. Health information system consists of a large number of networking technologies, electronic health records, databases for clinics, and other financial and administrative technologies that are used to store and generate healthcare information. The software development life cycle of the DSS utilizes the waterfall model. CPOE systems are generally coupled with one or the other type of decision support system. The figure below shows the software engineering of DSS.
Information System Software Model for health care
Electronic health record (EHR) systems are generally adopted in all hospitals for information system. Generally, the practice that is followed is, all the information from healthcare providers (clinics, doctors, hospitals, emergency rooms etc.) is entered into the electronic health record (EHR). Through the electronic exchange, the information is then sent to local, regional and national databases. The data that flows from these databases is then used for Decision support and decision making. Healthcare information system has the following model for information flow.
Clinical Decision Support Systems implementation approaches
Knowledge-based CDSS: The rules and compiled data are associated with IF-THEN rules in knowledge-based CDSSs. For example for determining drug interactions, the rule applied can be, IF medicine Y is taken and then medicine X is taken THEN alert the user.
Non-knowledge based CDSS: In this rules are not applied and computers have to find patterns from clinical data or learn from past experiences. Doctors use them for post-diagnosis systems as they suggest patterns for clinicians to look into in more depth.
CDS systems, when well implemented and designed, helps a lot in improving healthcare quality, reducing errors, increasing efficiency and reducing health care costs. When CDS alerts and recommendations are not attended properly, it poses challenges for all those who are developing, using and implementing CDSS.
The EMR system includes the CPOE screens and the CDSS are used for prescriptions and preventive care. One such example of how CPEO screen along with CDSS works is shown below:
In this sample above, CDSS screenshot is shown. Active reminder is indicted by the red “PP” flag in the important information screen. On clicking on red marker section, recommendation is shown. If physician agrees with recommendation, he would order that. Reason should be mentioned in case of non-acceptance of the recommendation.
Healthcare information system provides high reliability, increased readability, reduction in medical costs and increases the overall quality of the healthcare. The government should invest in technology in healthcare to help achieve desired outcomes. The implementation of CPOE surely ensures the safety of the patients. CPOE is also recommended as one of the 30 “Safe practices for better healthcare” by the National Quality Forum.
ahrq.gov. (2014, Dec). Computerized Provider Order Entry. Retrieved Jan 2016, from psnet.ahrq.gov: https://psnet.ahrq.gov/primers/primer/6/computerized-provider-order-entry
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