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  • 1. Chapter15: Role of IT in Healthcare V 3.0, April 2010 For Associates Certificate in Healthcare and Life sciences – L1 1
  • 2. Confidentiality statement This document should not be carried outside the physical and virtual boundaries of TCS and its client work locations. The sharing of this document with any person other than TCSer would tantamount to violation of confidentiality agreement signed by you while joining TCS. 2
  • 3. Certificate in Health Care & Life Sciences – L1 TCS Business Domain Academy Chapter 15 Role of IT in HealthCare In this Chapter: The session discusses about the impact of IT in health care. It talks about the nature and scope of information power granted by IT. It also deals with the influence of IT on the design of healthcare systems. Lastly it talks about bioinformatics. Learning Objectives: After reading this session you will know about: • Impact of IT on healthcare • Impact of IT on the design of healthcare system • Nature and scope of information granted by IT • Role of IT in Life Sciences Topics Covered: Chapter 15 Role of IT in HealthCare.................................................................................3 15.1 Introduction:............................................................................................................................... 4 15.2 Impact of IT on Healthcare: .................................................................................................. 4 15.3 Hospital Information System: ............................................................................................. 7 15.4 EHR (Electronic Healthcare Records):............................................................................. 14 Deleted: 15 15.5 Nature and Scope of Present Trends in IT and Health:........................................... 18 15.5.1 IT’s role in design of healthcare products and services: .................................... 18 Deleted: 19 15.5.2 IT’s impact on design of healthcare systems .......................................................... 20 Deleted: 21 15.5.3 Nature and scope of information power granted by IT...................................... 20 Deleted: 21 15.5.4 IT’s facilitating role in strengthening public-private partnerships: ............. 21 Deleted: 22 15.5.5 IT-induced vulnerabilities and IT-aggravated risks:............................................ 23 Deleted: 24 15.6 Information Technology’s Role in Life Sciences Research & Development: . 25 Deleted: 26 15.7 Bioinformatics Assists Drug Discovery and Development:.................................. 27 Deleted: 28 15.8 The Indian Perspective:........................................................................................................ 27 Deleted: 29 Summary: ............................................................................................................................................. 29 3
  • 4. Certificate in Health Care & Life Sciences – L1 TCS Business Domain Academy 15.1 Introduction: IT investment offers an environment for a new level of care to exist. For example, IT can provide a prospect to evaluate trends that previously took much longer to identify. Enhanced information access can lead to rapid decision-making. The confirmation of better information leads to better care can be confirmed by the improvement in health outcomes. Better health outcomes include: • diagnosing patients more accurately and quickly; • act in accordance with patients’ wishes and comforting the family; • decreasing the number and severity of errors; • supporting care delivery through improved access to information. Information technology (IT) has significantly reduced the costs, improved the speed, and enhanced the efficiency of life sciences research and development (R&D). The R&D, in turn, has established new challenges and opportunities for IT applications. This cycle has added to an entire new frontier for knowledge production. For example, the union of IT and biological progresses made possible the mapping of the whole human genome and genomes of many other organisms in just over a decade. These inventions, along with the current efforts to establish gene and protein functions, have enhanced our capacity to know the root causes of human, animal and plant diseases and find new cures for the same. In addition to this, many future IT innovations will likely be stimulated by the data and analysis demands of the life sciences. 15.2 Impact of IT on Healthcare: The maximum advancements of IT will be felt on release of healthcare. Some of the futuristic happenings would include: Right now there is a clear cut difference between healthcare product manufacturers and marketers and the healthcare delivery systems. Pharmaceutical corporations belong to the previous group and hospitals/clinics are major parts of the healthcare delivery systems in society. IT will associate the two as one, leading to blurring of the boundaries. Thus, we would have a future situation where Pfizer would be concerned in storing profiles of patients in a locked web site in an electronic format, accessible via a password through internet and WAP-mobile services. Thus, Pfizer would help identify 4
  • 5. Certificate in Health Care & Life Sciences – L1 TCS Business Domain Academy cases of hyperlipidemia, store e-records, and provide access to these to authorized employees. The second impact of IT would be a new type of experts or companies – the electronic healthcare information providers or healthcare counsel providers. These healthcare and IT knowledgeable people would help incorporate the vast database of health, disease and treatment related information, including prevention and would assist therapy givers provide the best integrated therapy for an individual’s sickness condition. The third impact of IT would be in the form of Pharma companies or connected companies generating and sustaining electronic records of genetic profiles of people and helping therapy givers give the best treatment based on the hereditary tendencies of the patients. The fourth impact of IT would be societal media assisted word-of-mouth propagation of healthcare information tips and knowledge. These are very dominant influencers. Information technology presents huge potential benefits to U.S. healthcare. As per the Institute of Medicine, as many as 98,000 people pass away in hospitals every year from medical errors such as wrong medications and improper identification of diseases, many of which are preventable. A study conducted by the Healthcare Information Management Systems Society found out that approximately 49% of clinical diagnostic testing is carried out since prior test results are not available when required. Applications of IT to healthcare such as electronic healthcare records (EHRs), computerized ordering of prescriptions and tests and updated medical information for clinical decision support can save thousands of lives and billions of dollars by decreasing medical faults and miscommunication. The entry of IT into the healthcare has been slow and disorganized. Only 12% of practices with smaller number of physicians have adopted EHRs. The healthcare industry expends only 2% of revenues on information technology which is much lower than the 10% average of other information-intensive industries. The major difficulty in the adoption of a nationwide, interoperable healthcare information technology (HIT) system is the lack of vigorous, commonly accepted technical standards. In spite of the efforts at the Department of Health and Human Services (HHS) since 2004, such standards have yet to be completely developed and extensively propagated. Furthermore, there is also a need of conformance testing to 5
  • 6. Certificate in Health Care & Life Sciences – L1 TCS Business Domain Academy make sure that product and systems meet the terms of the set HIT interoperability standards. Without these standards and conformance tests, healthcare providers are unwilling to spend in HIT systems as there is no guarantee that they will be able to correspond with other systems. The federal government’s lead organization for the progress and spread of technical standards, the National Institute of Standards and Technology (NIST), has been concerned with HIT standards development work since 2005. With its extensive expertise with issues of system interoperability, data security and privacy, and consensus standards development, NIST is well placed to make a larger contribution to HIT standards development work and speed the use of a national secure and interoperable HIT system. On May 21, 2007, Chairman Bart Gordon introduced H.R. 2406, a bill to sanction NIST to boost its efforts in support of the incorporation of the U.S. healthcare information project. The bill: • Directs NIST to set up an proposal for progressing HIT integration and permits it to support healthcare representatives and organizations and federal agencies in developing technical roadmaps for HIT standards; • Requires NIST to build up or take up existing technology-neutral guidelines and standards to facilitate federal agencies to efficiently choose and exercise HIT systems that are safe, interoperable and guarantee patient privacy; • Requires the Department of Commerce to start a Senior Interagency Council on Federal Healthcare Information Technology Infrastructure to synchronize the development and deployment of federal HIT systems, the related technology transfer and federal work with private HIT standards development organizations; • Requires NIST to institute a university funding program for multidisciplinary research in HIT-related fields; and • Directs the National High-Performance Computing Program to organize federal HIT R&D programs. Though the United States is the most technologically advanced nation in the world, the U.S. healthcare system persists to depend on pen and paper for the bulk of its information requirements. From patient medical histories, to prescriptions, to hospital charts, handwritten notations are the foundation for patient care information. This system is expensive, outdated and prone to risky or life-threatening medical errors. As a 6
  • 7. Certificate in Health Care & Life Sciences – L1 TCS Business Domain Academy result of broken down healthcare practices and system malfunctioning, over 98,000 Americans die and more than one million patients experience injuries every year. According to the National Academies, between 30% and 40% of the healthcare costs, which is more than half a trillion dollars annually, is used up on overuse, underused, mishandling, duplication, system failures and redundant repetition, poor communication, and inefficient healthcare practices. Information technology proposes vast potential benefits to enhance the functioning and efficiency of U.S. healthcare. A completely realized national interoperable healthcare IT (HIT) system could decrease errors, improve communication, assist in eliminating redundancy and supply many other benefits that would guard the patients and save up to tens of billions of dollars per year. The fundamental challenge to achieving such a system is interoperability—the capability of data systems, medical devices and software from different vendors based on various array of platforms to share patient electronic healthcare records (EHRs), electronic physician orders for lab tests and drug prescriptions, electronic referrals to specialists, electronic access to information about present suggested treatments and research findings and other information. An important characteristic of a practical HIT system is that it protects the privacy and confidentiality of patients’ medical information. It must also have strong data safety provisions so that medical information cannot be altered or destroyed by illegal entities. HIT standards must include privacy and security in the original standards design in order to make sure that these features will be an essential constituent of a national HIT system. 15.3 Hospital Information System: Various Hospital Information System (HIS) are being developed with the objective of organizing the treatment process of a patient and allowing doctors and other staff to perform to their maximum in an organized and efficient manner. It ensures benefits through technological advancement and is a guaranteed return for investment. It is operated in such a way that it is beneficial to both the recipients and providers of healthcare because it is modeled on a unique combination of a 'patient centric and medical staff centric' paradigm. 7
  • 8. Certificate in Health Care & Life Sciences – L1 TCS Business Domain Academy HIS uses a network of computers to gather, process, and retrieve patient care and administrative information for easy availability to the users. It helps the hospital authorities by acting as decision support system for developing comprehensive health care policies. It incorporates an integrated computerized clinical information system for improved hospital administration and patient health care. It also helps to provide updated electronic medical record of the patient. These serves as data for research undertaken by hospital authorities. HIS software is built around a highly optimized core library. Application modules are layered around this core and can be suitably customized for any user specific requirements. Advantages of maintaining electronic records are: • Reliable information storage, querying and retrieval. • Easy access to query data as the classification is based on many factors such as age, gender etc. • Instant information access • Efficient and accurate administration of all hospital activities including finance, diet, etc. • Improved monitoring Example of an effective HIS can be C-DAC’s Sushrut. A hospitals’s administration can be best explained through this example. 8
  • 9. Certificate in Health Care & Life Sciences – L1 TCS Business Domain Academy Direct Source:www.cdac.in The various modules maintenance and functionality using this HIS can be explained as: 1) Out-Patient Management: The out-patient module deals with recording the basic medical treatment details required for the patient. It consists of the following parts: a) Bay Management: This module depends on the registration module for the patient's demographic data. o Paging and Checking of patients in the bay. o Appointment scheduling of patients (normal and investigations). o Printing of investigation requisition forms. b) Patient Visit Creation and maintenance: o Creation of sessions and recording of complaints and history. o Creation of visit and recording of clinical summary, provisional diagnosis, drugs, diets and Problem Oriented Medical Records. o Raising Investigation requisition. o Viewing of reports of tests for which results have been entered. o Printing of reports (visit record, investigation reports etc.). o Allotment of beds for patients to be admitted. o Appointment Scheduling (normal and investigations). o Closing of treatment session and recording of final diagnosis. o Making OPD summary and printing it. o Printing all pending investigation reports for a patient till date. o Facility to print duplicate investigation reports. o Printing a report on the total number of old patients handled during a period. 2) Investigation: 9
  • 10. Certificate in Health Care & Life Sciences – L1 TCS Business Domain Academy For daily hospital activities various types of investigations are carried out. Carrying out number of investigation tests and making the results available promptly is very crucial for assessing the patient's medical status and deciding on the further course of action. The main functions of this module are: generating investigation requisitions, accepting investigation requisitions, collection of samples for investigations, preparation of lab reports, sending samples to laboratories, entry of test results and validation of results. Salient Features: • Raising the Investigation Requisition • Sample Collection • Printing Packing List • Accepting/Rejecting the samples/Patient in the Laboratory • Entering the details of the Film used in the Investigation • Entering the Investigation Results • Validation of the Investigation Results • Printing the Investigation Reports • Viewing of the Investigation results • Quality Control Check • Keeping track of films / Slides, issue and returns • Tracking of the status of a Test • Viewing and Printing of Work-list 3) Billing: The Billing module deals in collection of money for services availed by a patient. The module works in two ways: • Money can be collected in cash for outpatient services availed. • Advance can be collected when a patient is to be admitted. In this case the billing module maintains the status of each in-patient's account. The account is finally settled when the patient is discharged. The module consists of the following sub-modules: Cash Collection, Account Maintenance and Billing Reports Salient features: 10
  • 11. Certificate in Health Care & Life Sciences – L1 TCS Business Domain Academy a) Cash Collection b) Account Maintenance 4) Appointments: This module deals in allotting appointments to patients for a visit to the hospital. It keeps track of available slots in various categories of appointments. This module also deals with cancellation of existing appointments. The module consists of: • Appointment Scheduling • Appointment Cancellation 5) Operation theatre: The Operation Theatre module contains information about the availability of all the theatres, and Equipment/Tools. Scheduling of operations is the main function of this module. Various departments give the requisition for an operation theatre. Various Functions covered by this module are as follows: • Operation Theatre Scheduling • Raising and validating an operation • Preparing an operation dossier • Entering Operation record • Entering Anesthesia record 6) Blood bank: The Blood Bank is one of the major components of a hospital, concerned with various related activities including donor registration, physical examination, blood grouping, blood infectious tests, component separation, blood requisition and cross match. The Blood Bank module provides ready information about blood reserve/stock, daily cross- matched details, total daily blood requisitions and information regarding blood and donor. 7) In-Patient Management: 11
  • 12. Certificate in Health Care & Life Sciences – L1 TCS Business Domain Academy The In-patient module commences when the patient is being allotted a bed in the ward. It deals with the complete treatment of the patient during his/her stay in the hospital. Salient Features: • Bed Allotment • Inter-departmental Consultation • Transfer of patient between wards and beds • Requisition of drugs and consumables from the pharmacy • Raising investigations and report viewing • Maintenance of billing sheets for patients • Discharge of patients 8) Registration: Registration of the patient is the foremost activity in the overall Hospital Information System. Every patient who approaches a hospital has to get registered prior to getting any consultation, treatment, and investigations done from the hospital. Input/Screen Interfaces: • Capturing Demographic Details • Visit Creation for the Old Patients • Change of Department • Duplicate Card Printing • Modification Request 9) Enquiry: This module provides information about all the enquiries received regarding the hospital and the patients admitted or registered in the hospital. The details of the utilities are outlined in the later part of the write up. E.g: In-patient enquiry, Out- patient enquiry, holiday enquiry etc. 10) Master management: The functioning of the Hospital Information System depends on a large set of data that remains static for a long period of time. The Master module is used to enter, modify and 12
  • 13. Certificate in Health Care & Life Sciences – L1 TCS Business Domain Academy validate the Master data that is used by all the other modules. It is the responsibility of the System Administrator to maintain the integrity of this data. E.g of masters maintained are: Department master, Designation master, Lab master etc. 11) Central Sterile Services: The Central Sterile Services Department's (CSSD) main function is to provide sterile items, linen, equipment to wards and OT's. The CSSD receives reusable equipment, linen from various wards and OT's for sterilization. Items are exchanged depending upon the requirements. The linen is sent for washing to the laundry directly or through CSSD. Washed linen from laundry is sent to CSSD for sterilization. These sterilized items are issued to wards/OT's as per the requisition received from their side. The CSSD also prepares linen and dressing material from the cloth in different sizes, which are standardized by hospital management. Once the dressing material and linen is prepared, new item details are entered into the system and stocks are updated accordingly. 12) Diet Kitchen: The functionality of the kitchen module is to manage the patients' meal services. Its features include: Meal scheduling, Meal cancellation, Diet requisition Slip, Diet Cancellation Report, Late admission report and Therapeutic Diet. 13) Bio-Medical Engineering Department: The Bio-Medical Engineering Department (BMED) module keeps track of the details of the Bio-medical equipment installed at SGPGI. The details include equipment code, category, department name, location, and vendor's name and purchase details. This module also handles complaints and service details of different equipment. This module interacts with the central stores module for equipment receipt. 14) Central Stores: This module deals with Hospital Equipment/Material/Inventory Purchase and Supply to different Departments. Requisitions for different items/equipment are sent to this store from different departments and accordingly the CSD issues items/equipment to various departments. The CSD also maintains records of purchases, stock, and supplier list, item/equipment/material master tables, and also takes care of the inspection details. 13
  • 14. Certificate in Health Care & Life Sciences – L1 TCS Business Domain Academy 15) Pharmacy management: The Pharmacy Module deal with the maintenance of drugs and consumables in the hospital. The functions of this module include, online drug prescription, inventory management of drugs, consumables and sutures. This module optionally handles the billing of drugs, consumables and sutures, if required. The Pharmacy module ensures that there is a round the clock availability of a sufficient quantity of drugs and consumable material for the patients in a mode that neither hinders efficient clinical work, nor it becomes a threat to the survival of the Pharmacy. 12) Patient Medical Records: The Patient Record Management Module is crucial in the overall integrated hospital management system. The rationale behind computerization of PMR is to maximize the usage of the patients' medical information. This improves patient care as it functions as a central source of information for communication between health care providers, covering the patient's history, observation, diagnosis and therapeutic conclusions and a wide variety of unstructured documents and information. Moreover, it facilitates external linkage possibilities with health care providers and identification of clinical events that need attention. It can solve many of the logistics problems of archiving, retrieving, tracing and finding out paper based medical records. Various reports like discharge summary, diagnostic classification as per international classification of diseases, statistical report according to diagnosis, age, sex, geographical area and other parameters of the patient, surgeon index wise, reporting hospital statistics, and analysis of cases for research purpose are generated. PMR updates the patients' file with the information like diagnosis details and test results and final patient status. 15.4 EHR (Electronic Healthcare Records): An EHR is the clinical component that records the credentials of patients’, medical histories, symptoms, diagnoses, treatments, etc. Thus, EHRs contains the financial, administrative, research and educational characteristics of patient care. As represented in the figure below, the end users of HER includes hospitals, ambulatory care clinics, primary care offices, physicians, nurses, etc., ancillary departments like radiology, laboratory, pharmacies, etc., patients through a Personal Health Record (PHR) portal, public health departments and payers (insurance companies). Moreover, 14
  • 15. Certificate in Health Care & Life Sciences – L1 TCS Business Domain Academy Pharmaceutical companies may even be involved in evaluating data from EHRs. However, the users have access to only those aspects of the EHR for which they are approved. EHRs from different hospitals and physician offices need to be interoperable to encourage local, regional, national and global sharing of information. Just as an ATM card can be read in New York and New Delhi, EHRs should be able to connect globally, have the capacity to access and share data as needed and enhance the quality of patient care. Source: Datamonitor EHRs will assist in changing the healthcare industry from current reactive to more proactive, up to date and leverages planned workflows. The quality of care patients obtain within conventional healthcare settings will progress, the information available to clinicians will increase and the pace at which association for patient care, public health examination and medical research occurs will be immediate. The following factors are leading the implement EHRs in the market: • Improving the quality of care is a main concern for healthcare organizations: 15
  • 16. Certificate in Health Care & Life Sciences – L1 TCS Business Domain Academy EHRs are part of the explanation to improving patient security in the healthcare system. For example, medication errors, in particular, accounted for a considerable proportion of the number of avoidable errors that take place on a day to day basis in healthcare settings. EHRs deal with many of the areas where medication errors are likely to happen. At the most fundamental level, an electronic system reduces the problems of illegibility. A carefully typed drug prescription is expected to be filled appropriately than one that is hurriedly scribbled. With the addition of decision-support tools, doctors are capable to now check for likely complications with other prescriptions while recommending medication or rapidly confirm the distinction between two medications that have like names. These are only a few of the various benefits EHRs can provide that current paper based systems cannot offer. In addition to reducing medical errors, EHRs raise the value of care by varying the way in which care is distributed and improving the general patient experience. At present, with paper charts, only one doctor can use a patient’s record at one point. Moreover, at the point of cure, patient files are often incomplete; a part of the record may be in the lab, the radiology department or another physician’s office pending certification. As a result of this lack of management, diagnoses and treatment plans are made on incomplete information. Various medical tests have to be repeated because the results have been lost. With EHRs, several providers are capable to interpret and modify patient records, improving communication between clinicians. Files are no longer misplaced, misfiled or left behind. EHRs permit providers to expend less time searching for fresh lab tests or documentation from other physicians and spend more time with the patients themselves. Increased access to information, with physician notes, lab results, x-rays and prescriptions all at the reach of the doctors, aids them in making better, appropriate clinical decisions and improve patient care. EHRs also improve the scheduling and billing processes. Tasks like recovering patient files become less time consuming, leading to faster admission of patients. Regardless of the costs and risks of breakdown, the skill to improve patient care is motivating healthcare organizations to employ EHRs. • Government initiatives are increasing: As a result of the impact EHRs have on improving the quality of care, governments all over the world are supporting the implementation of EHRs. UK’s National Health Service (NHS) formed an organization within the Department of Health known as the Connecting for Health in 2005. Its objective is to convey the National Programme for IT 16
  • 17. Certificate in Health Care & Life Sciences – L1 TCS Business Domain Academy (NPfIT). NPfIT proposal consist of the Care Records Service, arrangement, prescribing, infrastructure, email, picture archiving and communications systems (PACS) as well as the Quality Management and Analysis System. As the NHS is supporting all these projects, these IT systems have and are being put into practice. No other country has so far achieved a countrywide EHR system than the UK because no other government has spent as compared to UK. In the US, government support has been mainly through improved consideration to healthcare technology to encourage awareness. In 2004, President Bush issued an Executive Order to set up the National Health Information Technology Coordinator in the Department of Health and Human Services and lay down an aim for every American to have right to use to an EHR by 2014. To aid rural hospitals execute EHRs, the Office of Rural Health Policy at the federal Health Resources and Services Administration awarded $1.6m to the Minnesota Health Department. Similarly, the state of California will offer $25m in grants to healthcare technology projects (EHRs as well as other healthcare technology solutions) in underserved areas of the state. • Other healthcare players will encourage late adopters to implement EHRs: The numbers of providers who have not yet implemented EHRs are decreasing, but, there are still a group of late adopters. These late adopters badly influence the efficiencies and return on investments (ROI) of EHRs for those who have already implemented EHRs. The full advantages of EHRs will not be recognized until every provider is linked. Having an EHR that is not interoperable is like being the only person with a phone and thus, not being able to call anyone. Increased competition and the possibility of decreasing damages will drive providers to adopt EHRs and regard them as very important to their practice as their stethoscopes. Competition plays an additional role in the organizations with an efficient EHR solution and will catch the attention of younger providers and increase employee satisfaction and retention. The fact that everyone else has an EHR should persuade the late adopters that they must have one as well. Furthermore, recommendation to hospitals with better EHR systems will increase. Employers and patients will promote EHR implementation, if they choose which doctors and hospitals to go to based on the technologies in use. 17
  • 18. Certificate in Health Care & Life Sciences – L1 TCS Business Domain Academy 15.5 Nature and Scope of Present Trends in IT and Health: Healthcare needs and desires cannot be met in most of the countries because of the size of the world’s population and the prevailing structures of resource distribution. There are numerous disagreements between various countries for making and observing policies of global trade in healthcare goods and services. Information and communication technologies can transform healthcare system. Through the accurate policy choices, IT enables the support of new entry of human connectivity and is a powerful means of global union through cross-border supply of services. IT enables new opportunities for production of knowledge and trade in it for direct economic benefits. IT is the only factor of production which is not subject to the economic laws of diminishing returns. The international distribution of new knowledge and best practices establishes new ways of enhancing the performance of health systems. The most important aspect of IT is its ability to permit reliable storage, recovery and immediate transfer of text, sounds, images and numbers as audio, visual and data communications. This substitutes the face-to-face contact and transportation. As a result of this, the resources and needs connect easily and add new links to productive capacity in all aspects of healthcare-development, delivery and administration. IT touches all aspects of healthcare and at many different points of contact. These are: (1) IT’s role in design of healthcare products and services (2) IT’s impact on design of healthcare systems (3) Information power effects (4) Its facilitating role in strengthening public-private partnerships (5) IT-induced vulnerabilities and IT-aggravated risks, and 15.5.1 IT’s role in design of healthcare products and services: IT has formed prospects for optimizing connections between domestic markets and exports/imports which is represented in the design of healthcare products and services. The idea of Telemedicine, thus, came out as the practice of using audio, visual and data communications for medical consultations, diagnosis, cure, nursing care, medical education and transmission of medical data with a broader model of ‘TeleHealth’ which contains Telemedicine and healthcare management, examination, literature and access 18
  • 19. Certificate in Health Care & Life Sciences – L1 TCS Business Domain Academy to information from a distance. The concept of E-health has slowly emerged to illustrate the joint use of electronic communication and information technology to facilitate transfers and interactivity. The latest requirements of speed, economies of scale, standards, simulation and safety have quickly changed healthcare into an information- based science driven by IT. New medicines and treatments develop more rapidly and enhanced with cross-border distribution of work across time-zones and instantaneous clinical testing in trials covering a wider geographical area, all of which is IT enabled. On-line discussion by patients and doctors through websites and email, distance recommendations, urgent evacuations and advance broadcast of images and data of patients from ambulances can decrease lead times of involvement in emergency wards of hospitals. Treatments managed in a joint mode, distance examination of recovering patients, risk estimation by insurers, distance consultations on indications revealed by patients and comments noted by doctors with the help of transferable data from image scanning machines, processing of medico-legal documents and cross-border networking for TeleEducation are some of the ways in which IT’s involvement to new products and services is growing quickly. Applications like TeleEducation for medical degrees of well-known universities in collaboration with local institutions and for continuing medical education of professionals in hospitals, medical colleges and healthcare centers have immense demand in developing countries. Outsourced healthcare management operations include medical transcriptions, invoicing, collections, purchases and inventory management, accounting, payroll management, continuing education networks linking hospitals and medical schools, surveys, and research networks currently are a higher section of domestic business and trade where IT’s function is important and rising. These opportunities symbolize possible services exports not only amongst developed countries like among Norway and Sweden for prenatal checkups and nursing care in Lapland or between Australia and Canada for TeleConsultations between doctors, but also from developed to developing countries, as, Japan to Thailand, U.S.A to Mexico, U.K. to Kenya, France to Ivory Coast and Singapore to Indonesia for TeleDiagnostics and TeleRadiology), from developing countries to developed countries such as Srilanka/India to U.K., U.S.A, Australia and New Zealand for healthcare organization services which could in future be extended to TeleDiagnostics when professional qualifications are jointly documented or coordinated and among developing countries 19
  • 20. Certificate in Health Care & Life Sciences – L1 TCS Business Domain Academy such as Bhutan, Thailand, Argentina, Nigeria, India, Brazil, China, Nepal, Bangladesh, Tanzania for a range of telemedicine applications. In Japan and Finland, initial warning signalling of communicable disease plague is done from database searches of physicians trying to identify from signs at the time of the occurrence of disease. This type of IT application could be transferred to any developing country allowing faster involvement when epidemics break out though protection would be required to guarantee it does not cause panics or false alarms. 15.5.2 IT’s impact on design of healthcare systems IT facilitated new ways of working and managing work locally, nationwide and worldwide. IT is an essential concern in the design of public health systems in less developed countries where governments require to concurrently following schedule associated to healthcare, development, and trade. Declining budgets and rising expenses of healthcare support these innovations also in developed countries. This has considerably improved trade potential. Medical expenses in OECD countries have risen to over 10 per cent of GDP and could reach 15 per cent in the next decade. High cost medical procedures, increased long life, ageing populations, and expensive medicines are the chief cause patients, national public health systems and health safeguarding organizations seek cross-border supplies offering more beneficial price/quality ratios. Within household economies of U.S.A., Canada and Japan, TeleMedicine services halved conventional expenses and improved the efficiency of medical professionals. 15.5.3 Nature and scope of information power granted by IT New networks, contracts and licenses, organization structures, control systems and administration processes facilitated by IT increase choices and decrease response times for all concerned. Patients, doctors, hospitals, pharmacies, statutory health authorities and health insurers can quickly benefit, regulate to and propose new responses interactively and reorganize their tasks towards each other. Information power encourages new ways of exercising power, power, and accountability to appear approximately combinations and tradeoffs involving choice, costs, effectiveness as the criteria by which performance is judged. Performance comparisons promoted during 20
  • 21. Certificate in Health Care & Life Sciences – L1 TCS Business Domain Academy honesty and responsibility elevates the incentives for private and public health systems to participate and execute better. Hospitals, medical schools, pharmaceutical companies, related enterprises as well as local health authorities and health journals and advisory services have all developed and sustain web pages available during internet. About 25 per cent of the content of the World Wide Web tackles with health and health-related topics covering traditional and interchange healthcare possibilities which have extended choice to a great deal. 21 Millions of individuals visit world wide web sites for information which would facilitate them eat intelligently, discover to implement their bodies and to find out other healthcare information. IT enables links to nutrition, diet, exercise, primary healthcare, ante-natal and post-natal care, hygiene and sanitation to be located in the proximity of other healthcare and medical information with obvious synergies. 15.5.4 IT’s facilitating role in strengthening public-private partnerships: Private sector participation in financing, production and delivery of healthcare products and services is a welcome addition to the resource-starved healthcare sector but also a challenge to the regulation of public health and in ensuring equitable access to the poor and needy. The sharing of information about facilities, performance, resources, costs and prices among health authorities, planners, contributors, governments, service providers and patients is an important aid to promoting better management of healthcare systems with shared perspectives developed through interactive communications. This reduces the chance of missing opportunities of trade promotion in healthcare that require businesses and governments to act in concert. The capacity of different people and organizations to work together across complex networks is an important element in novel and experimental advances. If communities of expertise can be connected and resources mobilized together with public interest, political energies and accountability, IT diffusion could play an important role in public-private partnerships in managed healthcare. Success in any form of accountable and responsible public-private partnership is based on ongoing reviews, feedbacks and consultations where informed participation is the key to success. IT connectivity provides an interactive platform to exchange ideas and information at low cost which encourages participation and acts against exclusion. By this process, IT facilitates participation in collaborations by spawning communications networks with strong incentives to move away from isolated systems towards risk syndications and risk exchanges, harvesting value through designs of communications networks. Aided by IT, 21
  • 22. Certificate in Health Care & Life Sciences – L1 TCS Business Domain Academy the success of Merck's Ivermectin drug donation for curing river blindness enabled a hundred million people to be treated in 31 countries with credibility of the programme based on communications networks which enabled wide participation and lots of feedback. This success later spawned one of the biggest public-private partnerships when Merck joined hands with the Gates Foundation for more such initiatives. In contrast, Glaxo-Wellcome's anti-MalariaM alarone drug donation programme in Kenya suffered from inadequate communication and participation and lack of sufficient information to conduct a reasoned discourse. Failures experienced in drug donation programmes due to communication gaps could be easily remedied by IT. IT connectivity would have enabled facts of the Malarone case to be known at the time it happened with scope for timely intervention by all concerned instead of the public remaining unaware for four years until details were published by scholarly journals like Lancet. Electronic archiving accessible through internet could simplify dissemination of new knowledge published by scientific journals. The core role of IT in healthcare may be understood from the way designs of healthcare development and delivery enabled and supported by IT include or exclude people and encourage or discourage their participation in influencing decisions about allocation of healthcare resources. Participation is a vital aspect of healthcare because health consumption requires participation in its production at every level starting from individual persons (diet, hygiene, lifestyle, belief and trust in one or more medical systems) to communities (safety, pollution control, sanitation, public hygiene), and nations (healthcare standards, budgetary allocations, medical education, support to research and innovation in diagnosis and treatment, and availability of medicines) rendering it uniquely amenable to communicative technologies, horizontally and vertically in and between these aggregations. Public-private partnerships are also required to cope with trading in bioinformatics and clinical databases. Significant transactions costs arise when contributions are sourced from a wide range of value creators using different platforms of data transfers and with multiple claims to proprietary rights over fragments of a whole process before a marketable product arise. This creates incentives for venture capital, pharmaceutical firms, biotech start-ups and the State (and its marketwise counterparts such as health maintenance organizations) to make new forms of partnerships in predictive medicine and treatments. Alliances of universities and research centers with drug developing and clinical trial enterprises are being established within developed and developing 22
  • 23. Certificate in Health Care & Life Sciences – L1 TCS Business Domain Academy countries and also between organizations in developed and developing country locations. IT-intensity sustains such networks contributing to efficiency and equity through rationalization of financial constraints as well as non-financial constraints. 15.5.5 IT-induced vulnerabilities and IT-aggravated risks: IT is distinguishable from other technologies because it is process oriented and transformative in its effects on production, consumption and organization. Connection speeds are constrained by availability of bandwidth spectra and the risk of data loss from contamination by viruses and bugs can only be minimized but not altogether eliminated. While information that IT produces is easily commoditized, much of the knowledge that IT driven biotechnology incubates is tacit and not easily reducible as information. This is the reason that biotech requires science parks and trustful networking anchored in a location. Placing information on the web poses risks to ownership of intellectual property. Nor can all information belong to everyone being unsustainable even in its elements, without being hosted or sponsored. IT products are excludable, divisible and own able through introduction of filters, but cyberspace does not create a domain governed from within itself insulated from other jurisdictions. The reliance on IT obliges adaptation to ever-changing new technical norms and to new rules introduced by regulators or censors. Policies and safeguards need to be envisaged to harmonize private and public interest so that IT is not used as a tool to propagate harmful substances and drugs. There could be four different ways in which IT as a media channel could be protected from undesirable traffic: 1. International legal agreements on e-commerce prohibiting certain products and services as “global public bads” from the purview of e-commerce. 2. Introduction of rules by regulators with enforceable penalties. 3. The use of IT itself to neutralize the canvassing of “sins and bads” with counter- campaigns disclosing more information on health hazards. 4. Censorship of cyberspace through filters IT has enabled certain kinds of abuses that would have previously not been possible to execute on a large scale. Pharmaceutical firms provide incentives to pharmacies to sell prescription drugs over the counter without prescriptions in less developed countries. IT has made it possible for chemists, pharmacies, and extension counters of clinics and hospitals to build databases and push products using retail store models of incentives - 23
  • 24. Certificate in Health Care & Life Sciences – L1 TCS Business Domain Academy something that would be impossible in developed countries where firms target doctors, not individual chemists or pharmacies. New vulnerabilities point to the need for policy safeguards to deal with the following problems: (a) Rights to privacy and personal data protection are easily breached because healthcare databases have to be kept open for updating old records and for initiating new records and entries. So confidentiality cannot be secured by coding the data or disconnecting the data from personally identifiable features. Patients could lose trust in the confidentiality of their conversations with their doctors unless this problem is solved. Demands of payment for parting with bio-information could arise. (b) Medical databases are easily linkable to databases of genealogy, castes, tribes, clans, ethnicity, and genetics. The principle that such data be stored only at its place of origin and used only for the original purpose for which it is collected is difficult to enforce. Personal data on whole nations and ethnic groups could be exploited in ways that endanger public health (Mathur, 2002). Without enforceable international agreements, no individual or social institution is in any position to supervise the use of healthcare databases. In the hands of mercenaries and rogue states, healthcare databases could be misused to trigger complex humanitarian emergencies or for fostering permanent dependencies using biopower as a means of disruption. (c) The scientific and commercial value of health databases is limited to those who have the means to maintain and update these databases and link them to other databases in their possession. This could accentuate the information and technology gaps between developed and less developed countries. (d) IT enables decoding of personal data using genotypes and phenotypes as personal identifiers and the design of novel organisms against which vaccines or antibiotics would be useless. When private information held in public databases is commercially traded by privatising public domains, rights of natural persons get transposed with rights of artificial juridical entities. Since intellectual property rights are private rights, international regimes for e- commerce in healthcare and consumer protection are needed for what remains outside the public domain. (e) If it is known that normal data protection controls can be easily bypassed by powerful interests in a vital area like health in any particular country, it would also have consequences for trade and development in other sectors due to loss 24
  • 25. Certificate in Health Care & Life Sciences – L1 TCS Business Domain Academy of confidence in that country’s capacity to provide adequate data protection for business secrets and intellectual property rights. Doctors and patients benefit from the way IT enables records to be safely stored, efficiently retrieved easily updated and quickly transferred. IT promotes awareness. People easily obtain information concerning diseases, treatments and facilities. Discerning consumers get to understand their own responsibility as co-producers of their health, and to evaluate choices. Studies have established that small inputs of TeleHealth resources contributed to huge gains in access to healthcare for consumers in Bhutan, Ethiopia, Sri Lanka, South Africa, Argentina, Mozambique, Taiwan, Saudi Arabia, Thailand and Jordan. 15.6 Information Technology’s Role in Life Sciences Research & Development: In recent years, innovations where IT and the life sciences converge have created vast quantities of data. The development of automated DNA sequencing and other innovative methods have reduced the costs and time needed to discover the genetic makeup of various organisms. Additionally, innovations such as high-throughput screening and micro-arrays are enabling studies of gene and protein functions (i.e., genomics and proteomics). The expanding complexity and diversity of information also pose new challenges. For example, data produced from studies of protein and gene function and interaction can require the consolidation of information in various formats and from diverse sources. Additionally, data may not be in a standard or readily usable format, particularly if they are not available electronically or are text-based information from scientific literature, patents and clinical trials. Critical biological information also is found throughout various scientific disciplines, such as the chemical sciences. The ability of researchers to manage and analyze these diverse and extensive data is critical to the future success of life sciences R&D. The needs described above have spawned the research field “bioinformatics,” which focuses on the use of IT to collect, organize, store, interpret, share, and analyze biological data. Developments in bioinformatics will be critical for facilitating R&D in areas such as human and animal health, agriculture, industrial processing, natural resource recovery, and environmental remediation. Figure 6.1 illustrates the IT and life sciences components of bioinformatics. 25
  • 26. Certificate in Health Care & Life Sciences – L1 TCS Business Domain Academy Bioinformatics Use Information Technology to Manage and Analyse Information Generated by the Life Sciences Researchers are exploring strategies to increase computing capabilities for diverse life sciences purposes, such as computer-based drug design. One strategy is to expand the potential of supercomputers. Another is to unify computing resources through development of global, or grid, computing networks. These networks link the power of individual PCs or supercomputers. Researchers have achieved teraflop speeds (a trillion floating point operations per second) using these grid networks. In the future they hope to achieve petaflop speeds (a thousand trillion floating point operations per second). The Internet is a particularly valuable tool for life sciences researchers, especially for those with limited resources. It enables researchers to tap into data, software, and computing power. New software developments also promise life sciences researchers’ the ability to acquire, format, search, and analyze disparate data sources and types. Data mining and visualization software are improving scientists’ ability to screen data and identify important relationships. One software analysis tool, 3-D molecular modelling, facilitates studies of the function and relationships between biological molecules. These analysis tools are enabling scientists to conduct some research at the computer instead of at the lab bench, reducing the time and costs of life sciences R&D. 26
  • 27. Certificate in Health Care & Life Sciences – L1 TCS Business Domain Academy Standardization enables researchers to link different databases and software programs, thereby making the discovery process more efficient. Standardizing scientific nomenclature, databases and software helps researchers exchange and analyze information more easily. Researchers also benefit from the development of technical and computational standards for hardware and software. Given the diversity of and rapid developments in life sciences databases and software, standardization is too difficult and costly for any organization to undertake alone. To overcome this obstacle, the Interoperable Informatics Infrastructure Consortium (I3C) was founded in 2001 to collectively address some standardization problems. I3C is an international consortium that includes life science and IT participants from private industry, government institutions, academia and other research organizations. They develop and promote “global, vendor-neutral informatics solutions that improve data quality and accelerate the development of life science products.” I3C’s accomplishments include standards developed to identify and access biologically significant data and a method that simplifies data retrieval from multiple databases. 15.7 Bioinformatics Assists Drug Discovery and Development: Bioinformatics is improving the R&D process in drug discovery and development. IT tools have become important for managing and screening genetics data and for modelling outcomes in drug development. New developments in bioinformatics and genetics, such as pharmacogenetics (i.e., the study of the relationships between diseases, genes, proteins, and pharmaceuticals), will enable researchers to identify quickly a patient’s genetic predisposition to contract certain diseases as well as their potential drug response. Costs of drug discovery have been escalating. It now costs $900 million and takes 15 years on average to develop a new drug. Clinical trials constitute most of these costs. Additionally, about 75 percent of drug development costs can be attributed to failures. Analysts anticipate that advances in IT and the biological sciences—such as the computer-enabled ability to quickly screen drug candidates and predict drug responses—could lower failure rates substantially, reducing costs by as much as one- third and time by as much as two years. 15.8 The Indian Perspective: The Indian healthcare sector is today lagging behind in IT adoption. The reports show that the rural sector is the most affected as Indian healthcare is not spread onto small 27
  • 28. Certificate in Health Care & Life Sciences – L1 TCS Business Domain Academy hospitals though the rate of expansion is very rapid. The main reason for slow adoption of I.T in health industry is due to lack of regulations and standardization and the lack of professionalism. Another major reason is the fragmented nature of the Indian healthcare. Today, however, the Indian healthcare landscape is changing in the urban cities and IT is poised to revolutionize healthcare in India. The technology adoption is very rapid due to severe competition. The big Indian hospitals like Apollo, Fortis, Wockhardt, Manipal, earlier believed that I.T can only help in automation of the medical industry but now they believe that I.T can help in cost reduction and increase return on investments. Healthcare has realized the value of I.T due to the changing regulations and framework. India spends about 30 million $ on healthcare industry and the cost is expected to increase more than double fold in next ten years. 28
  • 29. Certificate in Health Care & Life Sciences – L1 TCS Business Domain Academy Summary: • IT investment offers an environment for a new level of care to exist. • Information technology (IT) has significantly reduced the costs, improved the speed, and enhanced the efficiency of life sciences research and development (R&D). • The maximum advancements of IT will be felt on release of healthcare. • Information technology presents huge potential benefits to U.S. healthcare. • The major difficulty in the adoption of a nationwide, interoperable healthcare information technology (HIT) system is the lack of vigorous, commonly accepted technical standards. • Though the United States is the most technologically advanced nation in the world, the U.S. healthcare system persists to depend on pen and paper for the bulk of its information requirements. • Information technology proposes vast potential benefits to enhance the functioning and efficiency of U.S. healthcare. • An important characteristic of a practical HIT system is that it protects the privacy and confidentiality of patients’ medical information. • An EHR is the clinical component that records the credentials of patients’, medical histories, symptoms, diagnoses, treatments, etc. • EHRs will assist in changing the healthcare industry from current reactive to more proactive, up to date and leverages planned workflows. • As a result of the impact EHRs have on improving the quality of care, governments all over the world are supporting the implementation of EHRs. • In the US, government support has been mainly through improved consideration to healthcare technology to encourage awareness. • IT has formed prospects for optimizing connections between domestic markets and exports/imports which is represented in the design of healthcare products and services. • IT enables new ways of working and organizing work locally, nationally and globally. • Public healthcare systems can be significantly rationalized with IT. • The drug discovery process in the new biotechnologies is IT-intensive. 29
  • 30. Certificate in Health Care & Life Sciences – L1 TCS Business Domain Academy • According to the National Human Genome Resource Institute in U.S.A., genes contain codes for more than 50,000 proteins in the human body and drugs on the market presently target only 10 per cent of these. • Private sector participation in financing, production and delivery of healthcare products and services is a welcome addition to the resource-starved healthcare sector but also a challenge to the regulation of public health and in ensuring equitable access to the poor and needy. • IT is distinguishable from other technologies because it is process oriented and transformative in its effects on production, consumption and organization. • IT has enabled certain kinds of abuses that would have previously not been possible to execute on a large scale. • In recent years, innovations where IT and the life sciences converge have created vast quantities of data. • Bioinformatics is improving the R&D process in drug discovery and development. 30
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