The Role of Information Technology to Support Health Information Management in the Hospital

The development of information technology has penetrated so rapidly into a variety of sectors including health. Although the world of health (and medical) is a field that is information-intensive, but the adoption of information technology is relatively lagged. For example, when financial transactions electronically has become one of the standard procedures in the banking world, the majority of hospitals in Indonesia in the planning stage development of new billing system. Although the hospital is known as an organization-intensive, capital-intensive, but the investment in information technology is still a small part. In the U.S., both countries are relatively advanced in terms of health budget as well as information technology, hospital menginvestasinya average only 2% for information technology. On the other hand, people realize that information technology is one important tool in human civilization to overcome (in part) the problem of rapid flow of information. Information technology (and communication) is currently an important part in information management. In the medical world, with the development of knowledge that is so fast (less than 750,000 the latest articles published in medical journals every year), the doctor will quickly left behind if it does not make use of various tools for mengudapte latest developments. Besides having the potential of the filter and process data into information, IT can save it with a number of far more capacity than manual methods. Convergence in communications technology also allows health data to be shared easily and quickly. In addition, the technology has the characteristics of very rapid development. Every two years, will emerge a new product with a processing capability that is twice as fast and twice the storage capacity greater as well as various new innovative applications. With all its potential, it is naive if the health information management in hospitals do not provide special attention. This article will specifically address the development of information technology to support the management of medical records more effectively and efficiently. This paper will begin with various examples of applications of information technology, factors that influence success and reflection for the community medical record.
B. Application of information technology to support health information managementIn general, people familiar with information technology products in the form of hardware, software and infrastructure. The hardware includes an input device (keyboard, monitor, touch screen, scanner, microphone, digital camera, video recorder, barcode reader, or other means of digitization of analog to digital form). The hardware is intended to receive input data / information into digital form to be processed through a computer device. Furthermore, there are more processors the hardware known as a CPU (central procesing unit) and computer memory. This hardware serves to cultivate and manage computer systems controlled by a computer operating system. In addition, there is also a data storage hardware both fixed (hard disk) or portable (removable disk). The next hardware is a device that displays the processed outuput computer to the user via the monitor, printer, speakers, LCD or any other form of response.Furthermore, in differentiated software operating system (eg Windows, Linux or Mac) is tasked to manage the living death of the computer, connecting the input and output media and controlling the various software applications and utilities on the computer. While the application is a practical program that is used to assist the implementation of specific tasks such as writing, creating spreadsheets, create presentations, manage databases and so forth. In addition there is also utility programs that help the operating system in the management of certain functions such as memory management, computer security and others.In the aspect of infrastructure, we know there are good computer networking term which is limited and in certain areas (eg a building) is known as the Local Area Network and the wider network, it can even include a single county or a state or what is known as the Wide Area Network (WAN). Currently, the infrastructure in information technology are often lumped together with the development of communication technology. Thus the term convergence of information and communication technologies. PDAs (personal digital assistant) that acts as a handheld computer, but loaded with communication functions (both Wi-Fi, Bluetooth and GSM) is one such example.Hardware (either the input, processing, storage, and output), software and infrastructure, all three have great potential to improve the effectiveness and efficiency of health information management. Some important examples to be examined are (1) computer-based medical records, (2) portable storage technologies such as smart cards, (3) wireless technology, and (4) handheld computer.B.1. Computer-based medical records (Computer-based patient record)One of the major challenges in the application of information and communication technology in hospitals is the application of computer-based medical records. In his official report, Intitute of Medicine noted that it is still little evidence to demonstrate the successful application of computer-based medical records intact, comprehensive data and can serve as a model for other hospitals.Understanding of computer-based medical records vary, but, in principle, is the use of a database to record all medical data, demographic and every event in the management of patients in the hospital. Computer-based medical record will collect a variety of clinical patient data both derived from the results of the examination the doctor, digitization of diagnosisi tools (ECG, radiology, etc.), conversion of laboratory results and clinical interpretation. Medical records are a complete computer-based facilities are usually accompanied with decision support systems (DSS) which allows the provision of alerts, reminders, diagnosis and therapy in order to help physicians and clinicians can adhere to clinical protocols.Figure 1. Alert lab of excessive demand in one model of computer-based medical record applicationB.2. Portable data storage technologyOne important aspect of health care that uses the approach of reference (referral system) is the continuity of care. In this concept, health services at primary level have a high level of connectivity with the referral on it. One prerequisite is the existence of medical data communications easily and effectively. Some approaches made use of information technology is the use of smart cards (smart card that allows storage of temporary data). Smart cards are already used in several European countries and the U.S. making it easier for patients, physicians and health insurers. In smart cards, in addition to demographic data, some data will also be recorded last diagnosisi. Other portable storage technology is web-based model of electronic health records allow patients to store their health data while on the Internet. The data can then be accessed by doctors or hospitals after authorized by the patient. This technology is one model of telemedicine applications that do not run in real time.Simple portable data storage applications is a bar code (or bar code). Bar code is already available in the industry as a marker of a particular brand's unique coming. It is obviously easier for supermarkets and warehouses in retail and inventory management. Food and Drug Administration (FDA) in the U.S. has required all manufacturers of drugs in the U.S. to use the barcode as a marker drug. The use of bar code will also be beneficial to the pharmacy and pharmaceutical installations in hospitals in accelerating the process of inventory. In addition, the use of barcodes can also be used as a unique marker on the card and the patient's medical record.Unique marker technologies are now increasingly popular is RFID (radio frequency identifier) ​​that allows pengidentifikasikan identity via radio frequency. If using a barcode, the hospital still requires a barcode reader, the use of RFID will eliminate the use of these tools. Each item (eg drugs or medical record file) with RFID will transmit a continuous signal into a computer database. So that identification will run automatically.B. 3. Wireless TechnologyUtilization of computer networks in the medical world has actually been initiated since almost 40 years ago. In 1976/1977, the University of Vermon Hospital and Walter Reed Army Hospital to develop local area network (LAN) that allows users to log on to multiple computers from a single terminal in the nursing station. At that time, the medium used was either wired koaxial. Currently, wireless network cables to be excellent because the user remains connected to the network without mobility hampered by wires. Through a wireless network cables, the doctor can always connect to the database without having to terganggun patient mobility.B. 4. Handheld computers (Personal Digital Assistant)Currently, the use of handheld computers (PDAs) become an increasingly commonplace in the medical community. In Canada, fifty percent of physicians under the age of 35 years using a PDA. PDAs can be used to store a variety of clinical data of patients, drug information, and guide therapy / treatment of certain clinical. Some sites on the Internet provides an example of clinical application of dapta used in PDAs such as Epocrates. Utilization of PDAs that have been accompanied by a fixed telephone network enabling physicians can have access to a database of patients in rumahs akit through the Internet network. One example of the application of telemedicine technology is the delivery of patient radiological data that can be passed directly through the GSM network. Furthermore, physicians can provide direct interpretation PDAs and feed it back to the hospital.C. What is the factor of the successful application of computer-based medical records? Indeed, to date no one facility in the world who can apply the concept of an ideal electronic medical records. Nevertheless, several studies have reported the characteristics and hospital experience in implementing an electronic medical record. Doolan, Bates and James published a study of successful implementation of the five major hospitals in the U.S. who apply computer-based medical records and was awarded the Computer-Based Patient Record Institute Davies' Award. The five are:1. LDS Hospital, Salt Lake City (LDSH) in 19952. Wishard Memorial Hospital, Indianapolis (WMH) in 19973. Brigham and Women's Hospital, Boston (BWH) in 19964. Queen's Medical Center, Honolulu (QMC) in19995. Veteran's Affairs Puget Sound Healthcare System, Seattle and Tacoma (VAPS) of 2000The fifth hospital was a teaching hospital with a varied number of beds (from TT 246-712). Based on ownership, three of whom are non-profit private hospitals (no 1, 3 and 4), 1 is a regional hospital (number 2) and a military hospital (number 5).Electronic medical records has been applied to support inpatient services, outpatient and emergency care. Various results of laboratory examination either in the form of text, numbers or images (such as pathology, radiology, nuclear medicine, cardiology to neurology is already available in electronic format. In addition, clinical records of patients identified by doctors and nurses have also been incorporated into the computer either natural directly (in the form of free text or coded) using a dictation system as well. While in the intensive care unit, the computer will capture data directly from various monitors and electronic equipment. Decision support system (DSS) has also been applied to assist doctors and nurses in determining the diagnosis , notice of a history of allergy, drug selection as well as comply with clinic protocols. With the completeness of electronic facilities, doctors routinely use computers to find patients, look for clinical data and provide clinical instruction. However, it does not mean the paper is not used. Doctors still use it to print a summary of the data clinical inpatients when do visit. In an outpatient, clinical summaries were printed by the administrative staff in advance.Although using the approach, type of application and experience vary, but generally there is a common factor that factors that determine their success in implementing computer-based medical records, namely:Leadership, commitment and vision of the organizationLeadership from the head of the hospital is an important factor. It is characterized by long-term commitment and vision is very clear. Often a senior clinician who became leader in computerized and establish cooperation with informatics experts. Further commitment is realized in financial and human resources.Aiming to improve clinical processes and patient care.The key to the success of both systems development is an investment to improve and enhance clinical processes and patient care. Today, along with medical issues and patient safety errors, IT development needs are becoming increasingly dominant.Involving clinicians in the design and modification system.On the fifth hospital, efforts were made, both formal and non formal to involve physicians and in the design and modification of the system. Doctors, nurses and other health professionals who have experience Informatik involved as a liaison between clinicians and information systems. This is particularly important in clinical decision support systems merancangn. One IT manager said that "We had over 530 people INVOLVED, and doctors hired to help us design screens and everything. The doctors were the resource persons very much part of the effort. "Maintain and improve clinical productivityAlthough it is recognized that the use of computers increase the burden on doctors, but hospital facilities are very supportive. Wireless network cables are provided so that clinicians can access mobile data. Likewise, Internet facilities enabling them to monitor the patient's progress from home. Computers are also available equitably, for outpatient care beds with a computer comparison between 1:3-5, 1:1 even in the LDS. While in an outpatient unit of a computer room.Maintain momentum and support for clinicians.One doctor said that ".. We demonstrated and talked about it and evangelized the clinical staff That this was something good, something sexy, high tech and innovative and it was going to be expected to be utilized." Because all of which is a teaching hospital , each resident is required to use computers to record patient progress. However, maintaining the momentum so the doctor can use the computer directly varies, from 3 years up to a decade.Experience in the above reveals that the application of IT to medical records is an incredible effort from the leadership that reflected the leadership, financial and human resource commitments, organizational goals, the grueling process of designing, networking among medical workers, non-medical and Informatik to maintain the momentum.D. Barriers and constraintsHowever, it is undeniable that there are still many obstacles in the application of information technology for health management in hospitals. If still in early stages of the transaction information system development (eg administrative data, financial and demographic) sosiokltural problem is not too obvious. However, if it is up to the clinical aspects, the challenge will be even greater. On the other hand, the readiness of human resources issues often become a booster. Understanding of health personnel in hospitals of the potential of IT sometimes becomes weak because of a mistaken understanding. Therefore, strengthening the aspects of knowledge and skills is one of the key. In addition, of course, is financial problems. Without the help of experts accompanied by a good, sometimes just the IT investment will provide more shall waste no value. The latter is a suspicion of the weak aspects of security, confidentiality and privacy of medical data.E. Applying aplikasiBagaimana select and implement information technology applications for health management in the hospital?This is a crucial question to be answered. Looking at the experience of the above, we must return to the commitment, vision and leadership of the organization. Is this just because of me-too or already contained in the strategic plan of the hospital? In addition, how the cost implications and human resources? How to establish cooperation between the various components in the hospital, both medical and non medical?If this question has been answered, we can choose the appropriate application with the ability of the organization. The most important step is the development of transactional information systems (administrative and clinical data is simple). Furthermore, the development of the second level, the system of management information systems and executive information systems (decision support systems) can be done later. Applications SMS as a reminder for pregnant women to check in a timely manner meruapakan also one of the SPK model for the patient. Likewise, a similar model to the immunization schedule for infants is not too late. The investment required is quite a computer that has been filled with a clinical database of patients, as well as rules regarding the number HP immunization scheduling. Application of the current wireless network is also not an expensive investment. And still seabreg other innovations that can be developed.From the context of information and communication technology, it can be said that various potential applications in the medical world once applied. But we should note that until recently culturally, the medical world, including those that already apply sophisticated electronic infrastructure in most of the clinical information transactions still running face to face. So it is not wrong if someone says that the success of information systems in hospitals 90% is a cultural social issues and only 10% that is the problem of informatics.F. Afterword: reflections for the community medical record Given the rapid development of information and communication technology is quite rapid, community medical records need to understand the various concepts and application of medical informatics (medical informatics). Medical informatics (sometimes also called health informatics) is a discipline which is closely involved with computers and communications as well as their utilization in environmental medicine known as medical informatics (medical informatics). In a more detailed, Shortliffe defines medical informatics as follows: "Discipline is rapidly expanding science that deals with the storage, withdrawal and use of data, information, and knowledge (knowledge) is optimal for the purposes of biomedical problem solving and decision making. Therefore, medical informatics in contact with all the basic science and applied research in medicine and related very closely to modern information technology, namely computers and communications. The presence of medical informatics as a new discipline which is mainly caused by the rapid advances in communications technology and computers, raises awareness that medical knowledge is essentially not be able to managed (unmanageable) by paper-based methods (paper-based methods). ". The scope of medical informatics studies include theoretical and applied. Thus, it can be said that medical informatics is a discipline in itself.In applied research, medical informatics applications include electronic medical records, medical decision support systems, medical information withdrawal systems, to the use of internet and intranet for the health sector, including the couple the clinical information systems with Internet-based bibliographic search. Thus, community medical records will have extensive knowledge about the prospects for bridging the information technology as well as clinicians (users and a major provider of health information) with computer experts (informatics) that aims to design applications and system design in order to produce products in the health information management application hospitals are more effective and efficient.