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The impact of ICT on healthcare and on health information management.

Moore's law states that the size or price for a given amount of computing power halves about every two years. While this explains the reason your mobile phone is getting faster and cheaper, there are further implications. One is that, similar to 'the magic of compound interest', the trends are exponential, advancing ever faster.

There are many reasons for this, but one of them is that information and communications technology (ICT) is information based; advances build one upon another, with little to impede growth. This trend is infectious; more and more fields are becoming information based, for example biotechnology and nanotechnology. More importantly to health information managers (HIMs), healthcare also is becoming information based. Kurzweil (2001) argues that this exponential growth rate is characteristic of all information-based sciences.

While the adjectives faster and cheaper apply to mobile phones, and ICT in general, healthcare has not yet seen this sort of benefit. In fact, in health, we have the opposite experience; due to the increased information, files are proliferating, becoming cumbersome at best. I would venture to say that every HIM in Australia has (at the very least) a storage problem.

HIMs are not in the only clinical domain with too much information. Pubmed, the USA peak health research website, indexes 677 health-related journals (Pubmed 2009); if a journal publishes an average of four times a year, a clinician would have to read more than seven journals per day, every day of the year, just to keep up with current research. Unaided, it is very difficult to keep up with current best practice knowledge.

While such increases in health information (including both patient data and clinical knowledge) pose current difficulties, they also portend massive changes in healthcare. I believe that these changes will be, for the most part, improvements. Increases in health information quality, quantity and access will bring both increased healthcare efficiency and quality. One of the key components of such a vision is the increasing use of ICT in the health arena, for example, an ubiquitous electronic health record (EHR). This vision has been with us since the inception of ICT, but only now is it coming to fruition.

This issue of Health Information Management Journal characterises the transition to this new era, with respect to the profiles, the reports and the research. The profiles show that health information management workers have a range of relationships to the new technology: Smalley (2009) writes an engaging piece about her UK centred life, where she details a career full of ICT related work. This is understandable; ICT and health are well integrated in the UK. Jordan (2009) details a more standard HIM experience, with little mention of technology. Thus the range of HIM jobs is expanding, now spreading from traditional to cutting edge information wranglers.

This range is also reflected in the professional practice pieces. For example, we have another clear and well written article from Judith Mair (2009) containing absolutely no ICT content. It relates a tale of privacy and disclosure, concerning the balance and choices duty to patient and duty to others. These issues will not go away with increased technology; in fact, we will have to make many more decisions, as new situations arise.

The remaining professional practice articles are ICT related, detailing both the work, and the accrued benefits. The HIM's role in ICT related projects also ranges from traditional to exotic. In a traditional role in a very useful project, Hopgood (2009) works with improved cancer data collection in the Barwon Southwest region, collecting information on cancer staging and treatment, as well as information regarding recurrence and metastases (in addition to the traditional cancer registry data). This project would have been less feasible, and the data less useful, without improved ICT support.

Boulter (2009) writes about an innovative automated physical letter system, developed in partnership between the Royal Hobart hospital and Australia Post. There were many benefits, including 20% cost savings. Freyne (2009) is also doing things that were not taught in health information management school, working to develop multimedia patient and clinical information applications.

At a more general level, Goodenough (2009) shows how e-health will help statistical data collection, but to do so, will need consistent semantics. On a more global level, Peter Fleming (2009), CEO of NEHTA, discusses the responses of the federal government to the coming transition, including both infrastructure projects (terminologies, provider registry and identification, patient identification, authentication) and specific implementation partnerships. In her report from the Connecting Healthcare conference, Grace (2009) focuses on the difficulty of integrating the disparate parts of the current health record into an electronic form.

This latter point is addressed by the first research article. Wollersheim, Sari and Rahayu (2009) outline the usefulness of the archetype paradigm for such interoperability woes. The other articles detail various effects of the ongoing ICT transition. Lee et al. (2009) discuss disaster preparedness of Victorian hospitals, noting that most disasters are due to ICT failure. Vartak et al. (2009) observe that EHR implementation in an emergency department leads to increased length of stay, but they note that this statistic may be flawed, and criticise their use of a single statistic to measure change in a complex system. Al-Azmi et al. (2009) show that this transition is not just happening in the English speaking world, providing results from a survey of Kuwaiti ICT user satisfaction amongst medical receptionists. They indicate that better typing ability, younger age, and less exposure to system errors makes for more satisfied users.

The effect of ICT in healthcare will be substantial, due mostly to its interaction with information. These effects will impact upon the health information management role. This issue of Health Information Management Journal shows some of these impacts, both theoretical and practical.

References

Al-Azmi, S. F., Al-Enezi, N. and Chowdhury, R. I. (2009). Users' attitudes to an electronic medical record system and its correlates: a multivariate analysis. Health Information Management Journal 38(2): 33-40.

Boulter, R. (2009). Post eLetter Solutions--healthy results for improving patient communication processes at the Royal Hobart Hospital. Health Information Management Journal 38(2): 58-61.

Fleming, P. (2009). A new era in clinical communications: a report on the past year's work at NEHTA. Health Information Management Journal 38(2):46-48.

Freyne, A. (2009). The role of the Health Information Manager in a research-based information technology project. Health Information Management Journal 38(2): 65-66.

Goodenough, S. (2009). Semantic interoperability, e-health and Australian health statistics. Health Information Management Journal 38(2): 41-45.

Grace, S. (2009). Connecting Healthcare. Sydney 11-12 February 2009. The Health Information Management Journal 38(2): 62-64.

Hopgood, N. (2009). A world first in cancer data collection trial. Health Information Management Journal 38(2): 55-57.

Jordan, C. (2009). Cassandra Jordan: NSW State Liaison Officer, HIMJ Health Information Management Journal 38(2): 67-69.

Kurzweil, R. (2001). The Law of Accelerating Returns. KurzweilAI.net. Available at: http://www.kurzweilai.net/ articles/art0134.html?printable=1 (accessed 2001).

Lee, C., Robinson, K. M., Wendt, K. and Williamson, D. (2009). The preparedness of hospital Health Information Services for system failures due to internal disasters. Health Information Management Journal 38(2): 18-26.

Mair, J. (2009). Duty of confidentiality and HIV/AIDS: PD v Harvey. Health Information Management Journal 38(2): 49-54.

Pubmed (2009). PMC Journal List. Available at: http://www.pubmedcentral.nih.gov/fprender.fcgi#csvfile (accessed 2009).

Smalley, J. (2009). Julie Smalley: Adventures of a Health Information Manager in the United Kingdom. Health Information Management Journal 38(2): 70-72.

Vartak, S., Crandall, D. K., Brokel, J. M., Wakefield, D. S. and Ward, M. M. (2009). Transformation of Emergency Department processes of care with EHR, CPOE, and ER event tracking systems. Health Information Management Journal 38(2): 27-32.

Wollersheim, D., Sari, A. K. and Rahayu, W. (2009). Archetype-based electronic health records: a literature review and evaluation of their applicability to health data interoperability and access. Health Information Management Journal 38(2): 7-17.
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Title Annotation:information and communications technology
Author:Wollersheim, Dennis
Publication:Health Information Management Journal
Article Type:Editorial
Geographic Code:8AUST
Date:Jun 1, 2009
Words:1315
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