Introduction to Smart eHealth and eCare Technologies

Sari Merilampi, Andrew Sirkka, Sari Merilampi, Andrew Sirkka

• Publisher: CRC Press
• Year: 2016
• Print ISBN: 9781498745659
• eBook ISBN: 9781315351780
• Topic: Business
• Subtopic: Industria dei servizi
• Index: Business

Both the demographics and lack of resources in the health and well-being industry are increasingly forcing us to find alternative solutions for individualized health and social care. In an effort to address this issue, smart technologies present enormous potential in solving this challenge. This book strives to enhance communication and collaboration between technology and health and social care sectors. The reader will receive an extensive overview of the possibilities of various technologies in care sectors (including ICT, electronics, automation, and sensor technology) written by experts from various countries. It will prove extremely useful for engineers developing well-being related systems, software, or other devices that can be used by professionals working with people with specialist needs, well-being and health service providers, educators teaching related courses, and upper level undergraduate students and graduate student studying related topics. The technology focus of the book is widespread and addresses elderly care and hospitals, in addition to solutions for various user groups, devices, and technologies. Beyond serving as a resource for nurses and people working in care sector, the book is also meant to give guidelines for engineers developing person-centered systems by exploring the integration of these technologies into service systems.

Section II

ICT-Based Service Platforms and Technology Examples

---

5 Introduction to ICT-Based Service Patient Record Systems

Madis Tiik and Indrek Ait

CONTENTS

5.1 Introduction

5.1.1 Trends and Need

5.1.2 Brief History

5.2 Service Platforms and Patient Record Systems

5.2.1 Electronic Medical Record

5.2.1.1 Hospital Information System

5.2.2 Electronic Health Records

5.2.3 Health Information Exchange

5.2.4 Personal Health Records

5.3 Services

5.3.1 Clinician Electronic Services

5.3.1.1 Computerized Provider Order Entry

5.3.1.2 Electronic Referrals

5.3.1.3 Virtual Consultation

5.3.1.4 Electronic Prescribing

5.3.2 Consumer Electronic Health Services

5.3.2.1 Remote Patient Monitoring

5.3.2.2 Remote Patient Consultation

5.3.2.3 Electronic Booking

5.3.2.4 Patient Portals

5.4 Fundamentals

5.4.1 Common IT Infrastructure

5.4.2 Robust Standards to Support Health IT

5.4.3 Unique Patient Identifiers and Authentication

5.4.4 Privacy Issues Related to Health IT Systems

5.4.5 Access Rights

5.4.6 Consent Management

5.5 Summary

Abbreviations, Terms, and Symbols

References

5.1 INTRODUCTION

To give an overview of the ICT-based service platforms and patient record systems, we have divided the chapter into three sections. First, we introduce some background information to understand why we need health informatics and technology in general, then we give a brief history of how this field has evolved during the last few decades, and finally we introduce the fundamental building blocks that are necessary to create these service platforms. Health care is a difficult field because of numerous reasons. It is more or less different in all of the countries in the world that means it is very hard to give a perfect and precise overview of everything that has happened, is happening, and will happen in this sector. The next part gives an overview of different technologies that ICT-based health care service platforms and patient records comprise. They are introduced to the reader from simple to more complex systems. To implement and use complex systems, one has to have adopted the simple systems. It is not about giving the reader a chronological order but a development order. After getting to know the fundamental systems, electronic services of clinicians and consumers are introduced to the reader. Section 5.4 is about fundamentals and the building blocks that are needed to successfully build health service platforms and patient record systems. There are no shortcuts in our opinion. Of course, nowadays one can develop and adopt the principle structures and systems much faster, but they still need to be developed and adopted starting from the ground up.

5.1.1 TRENDS AND NEED

As described in Chapter 2, there are quite many important trends that affect the health care sector enormously. Health care is very complex and quite inefficient industry. Health care and medicine specifically is an information and image-intensive field. Hospitals need to be efficient and timely in their works and this includes their information management. Information management is the critical part of decision making in medicine as it has to be timely, relevant, and reliable. As the amount of clinical knowledge has become very large, computers are of great help. Machines are able to store, process, manipulate, and retrieve huge amounts of information and images efficiently and quickly. As delivery of health care may have to deal with physical, geographical, and other barriers, the field of informatics can help here a lot to overcome these hurdles. It is important to transmit and share medical and health information across organizations and enterprises using local area networks or wide area networks including the Internet. It is also necessary to provide health care services to remote and underserved areas where regular delivery is too complicated, expensive, or low quality. Technological solutions are crucially needed for sustaining medical education by reaching out to professionals. One of the biggest areas health care is pressured to redesign its thought process is cost-efficiency and here technology is hoped to be the savior. Ultimately going paperless and filmless is meant to reduce costs and make work more efficient. Doctors usually do have not enough time for the visits and there is lack of attention as the number of doctors per patient is too small. Technology also aims to help to provide better care and services. Clinical decision support helps doctors to do better choices. It should be seen clearly now that there is a huge need for health informatics and technologies.

5.1.2 BRIEF HISTORY

Between the 1960s and 1970s, hospitals started to have computers. Together with computers came the first administrative applications. The adoption of these applications was driven by the need to process large volumes of hospital data, which was much easier and better to do with computers rather than by hand. First, the applications were mainly for billing and health insurance claims.

Throughout the 1970s to 1980s, administrative systems started to be replaced by hospital information systems (HISs). During this period, the attempts of integration of clinical components into the administrative and financial systems were starting. Early examples of these information systems include the HELP system that was developed at Latter-Day Saints Hospital in Utah, USA (Collen & Ball, 2015) and the DIOGENE system that was developed in Geneva, Switzerland (Borst et al., 1999).

The 1970s brought along the early developments of digital medical records systems. The aim was to automate the entry, storage, and retrieval of patient data. Examples of these systems are PRoblem-Oriented Medical Information System (PROMIS) from University of Vermont Medical Center (Goldberg, 1988) and TMR from Duke University (Collen & Ball, 2015). PROMIS featured Problem-Oriented Medical Record, which is thought to be one of the earliest medical record systems. It was the first system to link patient and patient care by using hypertext.

During the 1980s, medical informatics was formalized as a scientific discipline. During this decade, professional groups such as the International Medical Informatics Association, the American Medical Informatics Association, and the European Federation for Medical Informatics were formed and medical informatics departments grew in North America, Asia, and Europe.

From 1990 to 2000, technology including Internet was rapidly evolving and gaining mainstream popularity. In medicine, this trend manifested in fast and pervasive adoption of networked and client–server technology. This was the time of growth for Internet and PC-based clinical information systems and knowledge bases. The field of medical informatics development accelerated.

During the change of millennium, several nations started to plan for a countrywide integration platform that would cover all the different health care stakeholders. Denmark, Finland, and Estonia were the first pioneers in this field. Estonia launched its nationwide health information exchange (HIE) platform in January 2009. At the same time, Estonia was the first country to show all collected health data to the patients. For that, a patient portal service was developed, where people could look up health information that was collected about them, give permissions (organ donation permission, prohibition of resuscitation, and blood transfusion), and designate trustees and close own health data (OECD, 2010; Sabes-Figuera & Maghiros, 2013).

5.2 SERVICE PLATFORMS AND PATIENT RECORD SYSTEMS

The first step is the transformation from analog to digital, where main element is that hospitals start to gather and use digital data. Historically, it was first mostly used for making insurance and billing tasks easier. Later digital patient data enabled doctors to start communicating better with each other and to do more informed medical decisions. Digital health records adoption by health care service providers forms the base and need for integrations. Data exchange systems and document standards have to be in place to move from local networks to broad networks. The central parts of it are integrations and data sharing between different stakeholders. As increasing number of health-related technologies and services are in the hands of the people themselves, patient empowerment is starting to take place, and it is not all about the health care service providers anymore.

5.2.1 ELECTRONIC MEDICAL RECORD

As introduced in Chapter 1, the widely deployed and popular computer applications such as electronic medical record (EMR), sometimes also called as electronic patient record, is in basic version, a digitalized version of the regular traditional paper-based medical chart for each individual. It contains all of the patient’s medical and clinical data history created in a single facility, such as a hospital, clinic, or general practitioner (GP) office. EMR includes patient demographics, medical and treatment histories, vital signs, progress and problems notes, laboratory and test results, medications, treatment plans, immunization and allergies information, radiology images, and behavioral and environmental data. Health care providers use it to monitor and manage care delivery within the facility. EMRs have developed a lot over time and nowadays EMR itself comprises a lot of different modules. In our approach of understanding, one example of a modern EMR is an HIS that we will introduce next. The other example of an EMR might be a GP information system. Later we expand on electronic health records (EHRs).

5.2.1.1 Hospital Information System

The main aim of an HIS is to manage the information for health professionals so they can perform their jobs effectively and efficiently. The core system elements are retrieving and submitting patient information, scheduling, admission, discharge, and transfer of patients. The business and financial systems deal with payroll and accounts receivable. Communications and networking systems integrate different parts of HIS and have order entry and result reporting. Departmental management systems focus on the needs of individual depart...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Preface
• Series Editor
• Editors
• Contributors
• Section I Opportunities and Barriers of Smart Technology in Care
• SECTION II ICT-Based Platforms and Technology Examples
• SECTION III Case Studies and Field Trials
• Index