ROLE OF INFORMATION TECHNOLOGY

ROLE OF INFORMATION TECHNOLOGY SUPPORT FOR HEALTH INFORMATION MANAGEMENT IN HOSPITALS

A. Preliminary

        The development of information technology is so rapidly has penetrated many sectors including health. Although the world of health (and medical) is a field that is information-intensive, but relatively low adoption of information technology. For example, when the financial transactions electronically has become one of the standard procedures in the banking world, most of the hospitals in Indonesia in the planning stages of developing a new billing system. Although the hospital is known as the capital-intensive organization-labor intensive, but the investment in information technology is still a small part. In the U.S., a relatively advanced country in terms of health and information technology budgets, hospitals average only 2% of investment for information technology.


         On the other hand, people realized that information technology is a critical tool in human civilization to overcome (most of) the problem of the rapid flow of information. Information technology (and communication) is currently an important part of information management. In the medical world, with the development of knowledge that is so fast (less than 750,000 recent article in the medical journal published annually), the doctor will quickly fall behind if you do not take advantage of a variety of tools to mengudapte latest developments. In addition to having the potential to refine and process the data into information, IT is able to save the amount of capacity far more than manual methods. The convergence of communication technology also enables health data be shared easily and quickly. In addition, the technology has the characteristics of rapid growth. Every two years, the new product will come with the capability of processing twice as fast and twice the storage capacity as well as the latest innovative applications. For all its potential, it is naive if the health information management in the hospital did not give special attention. This article will specifically address developments in information technology to support the management of medical records more effectively and efficiently. This paper will begin with examples of applications of information technology, as well as the factors that influence the success of community reflection for medical records.


B. Application of information technology to support health information management


         In general, people familiar with the product in the form of information technology hardware, software and infrastructure. Hardware includes input devices (keyboard, monitor, touch screen, scanner, mike, digital camera, video recorder, barcode reader, and other digitizing tools from analog to digital form). The hardware is intended to receive input data / information into a digital form that can be processed through a computer device. Furthermore, there is a hardware processor known as the CPU (central procesing unit) and computer memory. Hardware serves to cultivate and manage computer systems controlled by the computer's operating system. In addition, there are also data storage hardware both permanent (hard disk) and portable (removable disk). The next hardware device that displays the processed outuput computer to the user via a monitor, printer, speakers, LCD and other forms of response.
Furthermore, the differentiated software operating systems (eg Windows, Linux or Mac) tasked to manage the life and death of computer, media input and output connecting and controlling a variety of software applications and utilities on your computer. While the application is a practical program that is used to assist the implementation of specific tasks such as writing, creating spreadsheets, presentations, database management, and so forth. In addition there is also a utility program that helps the operating system in the management of certain functions such as memory management, computer security, and others.
In the infrastructure sector, we know there is a computer networking term both limited and in certain areas (eg, a building), known as Local Area Network and the wider network, it can even include one county or state, known as the Wide Area Network (WAN). Currently, the infrastructure in information technology are often lumped together with the development of communication technology. So that the term convergence of information and communication technologies. Devices PDA (personal digital assistant) that acts as a handheld computer but loaded with communication functions (either Wi-Fi, Bluetooth or GSM) is one such example.
Hardware (either input, processing, storage, and output), software and infrastructure, all three have great potential to improve the effectiveness and efficiency of health information management. Some notable examples that will be reviewed are (1) a computer-based medical record, (2) portable storage technologies such as smart cards, (3) wireless technology, and (4) handheld computer.

B.1. Computer-based medical record (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 notes that it is still little evidence of the successful implementation of computer-based medical record as a whole, comprehensive and can be used as a data model for other hospitals [1].
Definition of a 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 hospital. Computer-based medical records will gather patient clinical data both from the results of physician examination, digitization of tools diagnosisi (ECG, radiology, etc.), conversion of laboratory results and clinical interpretation. Computer-based medical record is usually accompanied by a complete facility decision support system (DSS) that enable delivery of alerts, reminders, diagnosis and therapy in order to help doctors and clinicians to adhere to clinical protocols.
Figure 1. Alert on excessive demand lab in one model of computer-based medical record applications

B.2. Portable data storage technology
One important aspect of health care that uses the approach of referral (referral system) is the continuity of care. In this concept, health services at the primary level have a high level of connectivity with the referral on it. One of the conditions is the communication of medical data easily and effectively. Some of the approaches made use of information technology is the use of smart cards (smart cards that allow temporary data storage). Smart cards are already used in some European countries and the United States making it easier for patients, doctors and health insurers. In the smart card, in addition to demographic data, some data will also be recorded diagnosisi last. Other portable storage technology is a model of web-based electronic health records allow patients to store their health data while on the Internet. The data can then be accessed by a doctor or hospital as authorized by the patient. This technology is one of the models of telemedicine applications that do not run in real time.
Application is a simple portable storage bar code (or bar code). Bar code is already available in the industry as a marker of a particular brand's unique to come. It is obviously easier supermarkets and retail warehouses and inventory management. Food and Drug Administration (FDA) in the U.S. have required all drug manufacturers in the U.S. to use the barcode as a marker drug. The use of bar code will also benefit the pharmacy and hospital pharmacy in speeding up the inventory process. In addition, the use of barcodes can also be used as a unique identifier on the card and the patient's medical record.
Unique marker technology is now increasingly popular is the RFID (radio frequency identifier) ​​that allows pengidentifikasikan identity through radio frequency. If using barcode, hospitals still require barcode reader, the use of RFID would eliminate the use of these tools. Each item (eg drug or medical record file), along with RFID will send a continuous signal into a computer database. So identification will run automatically.

B. 3. Wireless Technology
The use of computer networks in the medical world has actually been initiated since almost 40 years ago. In 1976/1977, University of Vermont Hospital and Walter Reed Army Hospital to develop a 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 is still a koaxial cable. Currently, the network Hairdryer be excellent because the user stays connected to the network without wires hampered by mobility. Through the non-cable networks, the doctor can always connect to the database without having terganggun patient mobility.
B. 4. Handheld computers (Personal Digital Assistant)
Currently, the use of handheld computers (PDAs) become more and more commonplace in the medical community. In Canada, fifty percent of physicians who are under 35 years old using a PDA. PDAs can be used to store a variety of patient clinical data, drug information, and guide therapy / treatment specific clinical. Some sites on the Internet provide examples of clinical applications are used in PDA dapta as Epocrates. Use of PDAs that have been accompanied by a fixed telephone network allows physicians to have access to a database of patients in rumahs Akit through the Internet network. One example of the application of telemedicine technology is patient radiological data transmission that can be sent directly through the GSM network. Furthermore, doctors can provide direct interpretation PDA and provide feedback to hospitals.

C. What are the factors the successful implementation of computer-based medical record? Indeed, to date there is not one hospital in the world to apply the concept of an ideal electronic medical record. However, several studies have reported the characteristics and experiences of hospitals in implementing electronic medical records. Doolan, Bates and James [2] published a study on the successful implementation of five major hospitals in the U.S. are implementing a 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 1995
2. Wishard Memorial Hospital, Indianapolis (WMH) in 1997
3. Brigham and Women's Hospital, Boston (BWH) in 1996
4. Queen's Medical Center, Honolulu (QMC) in1999
5. Veteran's Affairs Puget Sound Healthcare System, Seattle and Tacoma (VAPS) of 2000
The five hospital is a teaching hospital with a number of beds varies (from TT 246-712). Based on the ownership, 3 of whom are non-profit private hospital (No. 1, 3 and 4), 1 is a regional hospital (number 2) and 1 military hospital (number 5).
Electronic medical records has been applied to support inpatient care, outpatient and emergency department. Various laboratory test results in the form of text, numbers and images (such as pathology, radiology, nuclear medicine, cardiology to neurology are available in electronic format. Addition, patients' clinical records were found by doctors and nurses have also been incorporated into the computer realm either directly (in the form of free text or coded) and using dictation system. Meanwhile, in an 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 and clinical protocols comply. electronics with complete facilities, doctors routinely use the computer to find the patient, seek clinical data and provide clinical instruction. however, does not mean that the paper is not used. Doctors still use it to print a summary of the data clinical patient while doing visit. At the outpatient clinical summaries were scored by the administrative staff first.
Despite the approach, type of application and experience different, but in general there is a common factor that determines their success factors in implementing a computer-based medical records, namely:
Leadership, commitment and vision of the organization
Leadership from the head of the hospital is an important factor. It is characterized by long-term commitment and vision is very clear. Often senior clinician who became leader in computing and informatics experts cooperating with. Furthermore, the commitment is realized financial and human resources.
Aiming to improve clinical processes and patient care.
The key to the success of both the development of the system is an investment to improve and enhance clinical processes and patient care. Today, along with the issue of medical errors and patient safety, the need for the development of IT is becoming increasingly dominant.
Involving clinicians in the design and modification of the 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 very much part of the effort. "
Maintain and enhance clinical productivity
Although it is recognized that the use of computers increase the burden for the doctor, but the hospital provides excellent facilities support. Hairdryer Network provided so that clinicians can still access mobile data. Likewise, Internet facilities enabling them to monitor the patient's progress from home. Computers are also available in a fair, for outpatient care bed with a computer comparison between 1:3-5, even in the LDS 1:1. While in the outpatient unit 1 room 1 computer.
Maintain momentum and support for the clinician.
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 the computer to record patient progress. However, to maintain the momentum so the doctor can use the computer directly varied, from 3-year to a decade.
Experience in the application of IT to reveal that the medical record is an extraordinary effort that is reflected from leadership management, financial and human resource commitment, organizational goals, the grueling process of designing, networking among medical, non-medical and Informatik to maintain the momentum.

D. Barriers and constraints
However, there is no doubt that there are many obstacles in the application of information technology for health management in hospitals. If you are still in the early stages of development of information system transaction (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 issue of human resource readiness is often a booster. Understanding of health workers in the hospital for potential IT sometimes becomes weak because of a misunderstanding. Therefore, strengthening the aspects of knowledge and skills is one of the keys. Besides that, of course, is the financial issue. Without the assistance of experts accompanied by the good, sometimes the IT investment will only provide waste without lebihnya value. The latter is a prejudice against the weaker aspects of security, confidentiality and privacy of medical data.
E. Applying aplikasiBagaimana selecting and applying information technology applications for health management in the hospital?
This is a crucial question that must 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 the bandwagon or are already contained in the strategic plan of the hospital? Furthermore, the implication of costs and human resources? How to establish cooperation between the various components in the hospital, both medical and non medical?
If that question is answered, we can choose the appropriate application with the capability of the organization. The most important step is the development of transactional information systems (simple clinical and administrative data). Furthermore, the development of the second level, the management information systems and systems executive information systems (decision support systems) can be done later. Application SMS as a reminder for pregnant women to check in a timely manner is also meruapakan one SPK models for patients. Likewise, a similar model that immunization schedule for infants is not too late. The investment required is quite a computer that has been filled with the patient's clinical database, mobile phone number as well as the rule of the immunization schedule. Application of the current wireless networks are also not expensive investment. And still seabreg another innovation that can be developed.
From the context of information and communication technology, it can be said that the various potential applications once applied in the medical world. However, we should note that to date the cultural, medical world, including an infrastructure already implemented the most sophisticated electronic clinical information is still running transactions face to face [3]. So it is not wrong if someone says that the success of information systems at the hospital 90% are socio-cultural issues and only 10% which is a problem informatics.

F. Afterword: reflections for the community medical records Given the rapid development of information and communication technology is quite rapid, community medical records need to understand the various concepts and medical informatics applications (medical informatics). Medical informatics (sometimes called health informatics) is a discipline closely involved with computers and communications and their use in environmental medicine known as medical informatics (medical informatics) [4]. In a more detailed, Shortliffe defines medical informatics as follows: "Discipline rapidly evolving science that deals with the storage, withdrawal and use of data, information, and knowledge (knowledge) is optimal for the purpose of biomedical problem solving and decision making. Therefore, medical informatics in touch with all the basic and applied science in medicine and related very closely to the modern information technology, ie 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 method (paper-based methods). "[5]. The scope of medical informatics studies include theoretical and applied [6]. Thus, it can be said that medical informatics is a discipline in itself.
In applied science, medical informatics applications include electronic medical records, medical decision support systems, information retrieval systems of medicine, to the use of internet and intranet for the health sector, including linking two clinical information systems with Internet-based bibliographic search [7]. Thus, community medical record will have extensive knowledge about the prospects for information technology and bridging the clinician (user and the main provider of health information) to computer experts (informatics) that aims at designing applications and systems in order to produce products in the health information management application hospitals are more effective and efficient.


Reference:

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