Use of IT in healthcare industry

Definition

Health information technology (HIT) is “the application of information

processing involving both computer hardware and software that deals with the
storage, retrieval, sharing, and use of health care information, data, and knowledge
for communication and decision making”. Technology is a broad concept that
deals with a species' usage and knowledge of tools and crafts, and how it affects a
species' ability to control and adapt to its environment. However, a strict definition
is elusive; "technology" can refer to material objects of use to humanity, such as
machines, hardware or utensils, but can also encompass broader themes, including
systems, methods of organization, and techniques. For HIT, technology represents
computers and communications attributes that can be networked to build systems
for moving health information. 

Purpose of using HIT

Health information technology (HIT) provides the umbrella framework to

describe the comprehensive management of health information across
computerized systems and its secure exchange between consumers, providers,
government and quality entities, and insurers. Health information technology (HIT)
is in general increasingly viewed as the most promising tool for improving the
overall quality, safety and efficiency of the health delivery system. Broad and
consistent utilization of HIT will:

 Improve health care quality;

 Prevent medical errors;
 Reduce health care costs;
 Increase administrative efficiencies
 Decrease paperwork; and
 Expand access to affordable care.
Interoperable HIT will improve individual patient care, but it will also bring many
public health benefits including:

 Early detection of infectious disease outbreaks around the country;

 Improved tracking of chronic disease management; and

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 Evaluation of health care based on value enabled by the collection of de-
identified price and quality information that can be compared.

Growing numbers

The global healthcare IT market is expected to grow from $99.6 billion in 2010 to
$162.2 billion in 2015, at a CAGR of 10.2% from 2010 to 2015.

The world healthcare information technology (HIT) market is one of the fastest
growing markets in healthcare industry. The industry is being impacted by the
huge government stimulus and support for the adoption of information technology
in healthcare across the globe. Need for decreasing healthcare costs and improving
revenue cycle management has attracted IT solution providers who can offer
integrated applications to improve the workflow efficiencies in hospitals. The
shifting trend from clinic centric to patient centric systems is offering huge
opportunities for healthcare information systems providers. However, the
fragmented end-user market and interoperability issue have restricted the scope of
information technology applications in healthcare. Need for applications that can
integrate the three key players i.e. healthcare providers, payors, and consumers in a
better way and need for defining better data security standards is offering
opportunities to the IT providers.

The year 2009 has been significant in the healthcare IT market, with improved
government regulations worldwide for healthcare IT development enabling
increased investments for better patient monitoring and technology developments.
Advancements in healthcare IT have also improved access to medical care, making
high-end treatment, and diagnosis services more cost-effective to patients across
hospitals globally. Radio frequency identification (RFID) implementation is
expected to drastically improve the healthcare IT scenario with access to medical
record systems and files at any given time. Development in picture archive and
communication systems (PACS) has been another essential clinical IT solution for
delivering better patient care and physician satisfaction. 

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List of countries using HIT

1. United States (U.S.)

2. Canada

3. United Kingdom (UK)

4. Germany

5. Netherlands

6. Australia

7. New Zealand

Healthcare IT scenario in India: 

As per the Springboard Research, healthcare IT spending in India is expected to

grow from $274.2 million in 2009 to $609.5 in 2013, growing at a Compounded
Annual Growth Rate (CAGR) of 22 per cent from 2009-2013.

Indian healthcare is experiencing a transformation, with the application of newer,

better IT systems and applications. Adoption of IT has become one of the top
priorities for the Indian healthcare companies. But most big healthcare
organisations allocate only two to three per cent of their annual budget to IT
expenditure. These percentages when calculated on a lower base seem insignificant
as compared to US IT spends in actual dollars.

However, by 2013, India’s healthcare sector’s total spend is projected to grow to

nearly $40 billion. This throws up a lot of opportunities for IT players as more and
more hospitals are adopting information technology apart from medical
technology. Moreover, with new and upcoming applications such as telemedicine
and e-prescriptions penetrating the healthcare vertical in India, IT investments on
software would further increase with a focus on integrated billing and online
availability of patient records across hospitals.

With increasing IT applications and insurance penetration, the demand for EMR is
anticipated to increase robustly in next few years. However, initially the scope of
the services will be limited to the metro and Tier-I cities only.

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With increasing emphasis on the implementation of hospital information system
(HIS) in the country, the market of instruments such as PACS will grow rapidly.
However, the success of these factors will largely depend upon various factors
including technology adoption and cost.

Overall, India can learn from the US experience on leveraging technology for
healthcare and benefit.

Information technology (IT) is a critical contributor to transform care delivery and

helps improve the quality, safety and efficiency of healthcare delivery. The
possibility of innovative new technology that is simple to use, cost effective and
helps data to be portable – is a phenomenal change in how care could now be
delivered. Additionally, the information could also be used to standardise the
delivery process inside the provider’s facilities.

The positive impacts on the healthcare delivery segments are:

 Enabling and improving healthcare processes

 Delivering timely information to care providers
 Integrating facilities and share information between facilities
 Enabling analytics for more effective and efficient care to each patient
 Bridge India’s rural-urban users equally

The biggest impact of good information technology systems will be on improving

upon the inefficiencies in existing procedures inside Indian hospitals. India lags
behind in terms of hospital infrastructure and manpower. The adoption of IT will
help hospitals develop innovative and efficient healthcare infrastructure necessary
for rural and urban population. IT solutions, which can help improve asset
optimisation, schedule doctors/clinicians, pharmacy orders, lab test orders etc. are
needed on priority. The growth in healthcare IT sector will also help hospitals in
enhancing the efficiency of their administrative functions thus leading to reduced
patient waiting time and increased success rate in treatment.

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How it all started?

World wide use of computer technology in medicine began in the early 1950s with
the rise of the computers. In 1949, Gustav Wagner established the first professional
organization for informatics in Germany.  Specialized university departments and
Informatics training programs began during the 1960s in France, Germany,
Belgium and The Netherlands. Medical informatics research units began to appear
during the 1970s in Poland and in the U.S. Since then the development of high-
quality health informatics research, education and infrastructure has been the goal
of the U.S. and the European Union.
Early names for health informatics included medical computing, biomedical
computing, medical computer science, computer medicine, medical electronic data
processing, medical automatic data processing, medical information processing,
medical information science, medical software engineering, and medical computer
technology.
The health informatics community is still growing, it is by no means a mature
profession, but work in the UK by the voluntary registration body, the UK Council
of Health Informatics Professions has suggested eight key constituencies within the
domain - information management, knowledge management,
portfolio/programme/project management, ICT, education and research, clinical
informatics, health records(service and business-related), health informatics service
management. These constituencies accommodate professionals in and for the NHS,
in academia and commercial service and solution providers.
Since the 1970s the most prominent international coordinating body has been
the International Medical Informatics Association (IMIA).
Germany was the first country to start developing a national HIT network (1993)
and also has the first expected completion date (2006). Germany is updating its
smart-card technology to use advanced security features to protect the stored
personal medical data. In 1997, Canada established the Advisory Council on
Health Infrastructure and in 2001 launched Canada Health Infoway, a nonprofit
organization. Canada Health Infoway expects to have EHRs for half of the
population by the end of 2009. The United Kingdom has established the National

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Programme for IT (NPfIT), the most expensive and perhaps the most
comprehensive HIT system in development worldwide. The program anticipates
creating an integrated care record service, an electronic appointment system, and
an electronic prescription transmission system and will build infrastructure and
networks that will be accessible to all of the major health care providers by 2014.
Norway and Australia have also established major HIT initiatives, and both
countries have at least a six-year head start on the United States.

Types of technology used in HIT

In a recent study about the adoption of technology in the United States, Furukawa,
and colleagues (2008) classified applications for prescribing to include:
1. Electronic medical records (EMR)
2. Clinical decision support (CDS)
3. Computerized physician order entry (CPOE)
4. Bar-coding at medication dispensing (BarD)
5. robot for medication dispensing (ROBOT)
6. Automated dispensing machines (ADM)
7. Electronic medication administration records (EMAR)
8. Bar-coding at medication administration (BarA)

Difference between health information management and health informatics

Health Informatics (HI),is not synonymous with Health Information Management
(HIM). Even though there are areas of overlap in training and job responsibilities
between the two, understanding the differences between the two disciplines is
important. OIT offers an IT degree in Health Informatics and therefore has a strong
focus and grounding in Health Informatics as an applied IT degree.

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The Pros and Cons of Health Information Technology

Advantages:
Coordination of Care - HIT enables a framework for the coordination of care
thereby encouraging patient-physician partnerships. In this environment, a team of
practitioners works together, moving beyond the paradigm of mere episodic visits.
Decision Support -Physicians currently face a myriad of clinical challenges,
including many thousands of possible diagnoses that can be treated by various
procedures and different drugs, all of which present potential adverse side effects.
Such systems serve to integrate and improve access to health and patient-related
data.
Access to Information - HIT enables users to retrieve and store vital medical and
patient information which allows patients to be notified of recalls, side effects, and
interactions associated with medications they may be using.
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Reduction of Costs - Electronic Medical Records can reduce filing and
transcription costs. By minimizing the need for paper clinical records, practices can
reduce the support staff traditionally needed to perform filing and transcription
duties. The potential savings here can be substantial.
Decreased Duplication - The implementation of information technology has been
shown to significantly prevent the duplication of imaging and laboratory tests.
Improved Coding - There is potential to substantially impact coding accuracy and
revenue capture.

Disadvantages

One reason that countries abroad did not experience the same level of
fragmentation in HIT adoption that the United States has experienced is that they
have relatively simple health insurance contract payment structures, with standard
nomenclatures that are easily operated electronically. Australia, Canada, Germany,
Norway, and the United Kingdom all began with fragmented and incremental
processes, but over time, they realized the need for national HIT standards. These
countries found that national efforts have the advantage of ensuring uniform
privacy and confidentiality standards, guiding efficient development and
implementation of technology, and providing grants and incentive programs to
encourage HIT adoption.

Lack of interoperability.

Some countries have found that one danger of a fragmented approach to HIT
implementation is a lack of interoperability among various HIT systems. This is
particularly important for the management of people with multiple chronic
conditions, whose care is often managed by multiple providers.
Germany and Norway have built their HIT programs using the standards of
interoperability and privacy set by the eEurope 2002 and eEurope 2005 Action
Plans. Their visions were to prepare their HIT systems for future levels of
interconnectivity in electronic commerce, particularly for pharmaceuticals. A
longer-term goal is to allow all clinicians in Europe to be able to access health
records from all countries.
In June 2005, the U.S. Department of Health and Human Services (HHS) formed
the American Health Information Community to develop common standards and
interoperability while ensuring privacy and confidentiality. At the request of HHS,
Health Level Seven (HL7) interoperability standards are being adopted for clinical
and administrative data on various computer systems to communicate while

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preserving meaning Canada, Germany, the United Kingdom, and to a limited
extent Norway and Australia have adopted HL7 standards to promote
interconnectivity. In addition, HHS signed a licensed agreement to standardize the
Systemized Nomenclature of Medical and Clinical Terminology (SNOMED CT).
Germany’s upgrade of its smart-card technology moves it toward the goal of
portability The technology allows authorized health professionals to access a
centralized database holding patient data within a secure network managed using
public key infrastructure (PKI) technology. The provider signs legally valid
electronic documents to store data within a chip on the smart card and then
encrypts the data to allow their secure transmission. The new smart health card
allows physicians to access networked databases that provide patients’ complete
medical histories.

Privacy and confidentiality concerns.

The public’s perception of the security of their personal health records is critical to
HIT adoption. The U.S. Health Insurance Portability and Accountability Act
(HIPAA) of 1996 has provisions establishing the privacy of health information,
mandating steps toward the creation of standards for coding and the electronic
transmission of medical claims. However, 70 percent of the U.S. population
remains concerned that sensitive personal information could be leaked because of
weak security.
Each country engaged in HIT has developed or is in the process of developing
privacy and confidentiality standards. Germany’s health initiative divides
information into two parts: an administrative part that is obligatory (for example,
copayment status and paperless transmission prescriptions) and a medical part that
is voluntary (for example, drug usage, current diagnoses, and previous surgeries).
Germany’s regulations allow patients to decide whether or not to release their
medical part and which specific medical information to make available to
whom Norway recently adopted laws regarding health professionals’ handling of
confidential and electronic health information, and laws enforcing the integrity and
security of EHRs.34 Canada developed a Pan-Canadian Health Information Privacy
and Confidentiality Framework to suggest a set of core provisions for the
collection, use, and disclosure of personal health information in both the publicly
and privately funded sectors.35 However, not all of the provinces have adopted the
full framework.

Direct and indirect costs.

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The cost of HIT adoption is a major concern in all of the countries. This is also the
most difficult component to compare because of the various scopes and types of
programs and funding mechanisms. In addition, cost estimates are often revised as
a project progresses.
Rainu Kaushal and colleagues estimate that to establish a national HIT network in
the United States within five years, the largest costs will be $103 billion in capital
costs and $53 billion in interoperability costs. U.S. hospitals are expected to incur
the highest functionality costs ($51 billion), followed by skilled nursing facilities
($31 billion) and office practices ($18 billion). Kaushal and colleagues advise
public and private insurers to revise their payment policies to promote HIT
adoption.

Australia’s HealthConnect found that the largest costs over the first five years were
for infrastructure deployment, change-management programs, and system
integration. Ongoing costs were shared among jurisdictions and private-sector
partners. Nevertheless, Australia does not envision a substantial role for the private
sector as an investor in the first few years.39 With an undefined completion date,
Australia is aware that further efforts and funds will be necessary to fully establish
a national HIT program.
The Canadian government shares costs with provinces and territories through a
matching-funds program to support implementation. Canada funds up to 80 percent
of ground-breaking projects because of the high risk and high initial
investment. The funding is scaled downward to 20 percent as the project becomes
less risky. Canada funds only those programs that also meet federally agreed-upon
standards.
Often, initial estimates of the total cost for HIT implementation have been too low.
For example, the Canadian government originally provided funds of $420 million
to Canada Health Infoway but now expects to spend to $1.2 billion. The original
plan included only funds for researching solutions for IT use in health and did not
incorporate the implementation phase. When the decision was made to implement,
each of the provinces signed on to receive funds from the Canadian government.
The United Kingdom originally announced in 2002 that the NPfIT program would
cost $4.3 billion over three years but later more than doubled its estimate and time
frame to $10.8 billion over ten years. The National Health Service (NHS) hopes to
achieve a steady-state annual funding level of 4 percent of its total budget to go
toward HIT programs, up from the current 1.5 percent. The head of NPfIT, Richard
Granger, insists that the money will come from already committed funds for HIT

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programs and that no extra money needs to be allocated, assuming that the overall
NHS budget grows as projected.
The Australian government has more than doubled its current investment in the
development of EHRs. Although the current total spending level is less than $100
million, $1.1 billion in HIT-related projects are “on the drawing board.”Hospitals
in Australia are struggling with operational issues that are forcing the federal
government to keep funding minimal for HealthConnect until these issues are
resolved. In addition, Australia works in partnership with states and territories,
which will be investing sizable funds in HealthConnect. Norway and Germany
have remained close to their original budgets.

Who Pays, And Who Benefits?

In all of the countries, the cost of implementing an HIT program is borne by the
government or health insurers, or both. It is recognized in these countries that the
benefits and cost savings accrue primarily to patients and insurers, not to providers.
Economists recognize that use of IT in health care has a strong public-goods
component, which means that a particular stakeholder often does not reap the full
social benefits produced by new HIT investment. Consequently, according to
economic theory, the private sector will under invest in IT relative to its social
benefits, which leads economists to recommend that public subsidies be used for
the development of HIT systems, even though they will be used by private
stakeholders. Also, the value of a particular HIT system installed by one
stakeholder tends to increase with the number of other HIT systems installed
elsewhere with which that stakeholder’s HIT system can communicate. For these
reasons, many industrialized countries have subsidized the application of HIT with
public funds, albeit it on the condition that those HIT systems can interconnect.
The United States has begun to do so in recent years as well, although so far on a
much more modest scale.
THE UNITED STATES STILL HAS THE HIGHEST LEVEL of health spending
in the world—currently almost two and a half times the level in the median OECD
country. One suggestion for lowering health spending and improving health
outcomes is the adoption of HIT. However, in all countries, we found no evidence
that the savings from these initiatives have been rigorously evaluated.
Nevertheless, many industrialized countries are proceeding to implement HIT
because they are convinced that it both saves costs and improves quality.
A comparison with other industrialized countries suggests that the United States is
beginning the implementation process as much as a dozen years behind these
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countries. The United States might be able to shorten the implementation phase if
it can learn from these countries’ experiences.

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