HIT, EHRS, and the Digitization of Medicine in the 21st Century – Georgios Ardavanis (Ph.D.)

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Medicine and innovation go hand in hand. Given the history of innovation, it is remarkable that the healthcare industry has been slow to adopt information technology. Since the turn of the century, every major business has embraced computerization, but doctors still mostly use pen and paper in much of the world. In recent years, medicine has finally caught up. In this blog post, I’ll explain how introducing electronic health records that can be converted into searchable medical databases will likely transform healthcare, creating a smart grid for medicine that will enhance clinical practice and help revive drug research. Mobile devices are already being used in developing nations to put doctors in their patients’ pockets. Digitalization of devices and diagnostics also promotes long-promised concepts like telemedicine, personal medical devices for the home, and smart medications. According to a recent MIT research, adopting information technology, new materials, imaging, nanotechnology, and sophisticated modeling and simulation has profoundly impacted physical science.

As the world gets older, sicker, and fatter, the market for medical innovations of all kinds is bound to grow. Clever technology can help solve two big problems in health care: overspending in the rich world and underprovisioning in the poor world. But this will take time and become more of a reformation than a revolution. The hidebound healthcare systems of the rich world may resist new technologies even as poor countries leapfrog ahead. There is already a backlash against genomics, which has been oversold to consumers as a deterministic science. And given soaring healthcare costs, insurers, and health systems may not want to adopt new technologies unless inventors can show conclusively that they will produce better outcomes and offer value for money.

The patient will be the biggest winner if these obstacles can be overcome. In the past, medicine has taken a paternalistic stance, with all-knowing physicians dispensing wisdom from on high, but that is becoming increasingly untenable. Digitization promises to connect doctors to everything they need to know about their patients and other doctors who have treated similar disorders.

Information technology will be at the forefront of the upcoming confluence of biology and engineering, which in medicine involves digitizing medical records and creating an intelligent network for sharing those records. Many additional significant technological advancements will be introduced thanks to that crucial reform. Patients can play a stronger role in controlling their own health if that information is made available to them as well, which is equally vital. With good reason, this is divisive. Many doctors and some patients believe they cannot make informed judgments due to a lack of knowledge. However, patients actually have a wealth of knowledge about illnesses, particularly chronic ones like diabetes and heart issues, which they frequently battle with for a long time. The easiest approach to handling things is for people to take more charge of their own health and avoid issues before they result in expensive hospital visits. That entails giving patients access to their own electronic health records.

Today’s EHRS (Electronic Health Records) are digitized versions of all the bits of paper usually kept in files by all doctors a patient sees regularly. HIT (Health Information Technology) describes all the software and other kit needed to make sense of the data. Yet although most healthcare providers have installed computer systems to deal with back-office tasks such as billing, few have modernized the bits of their business and patients. Studies have shown that fewer than one-fifth of the doctors’ offices in the USA offer EHRS. Another example is Denmark, which uses an e-health system to which nearly everyone is connected and a way to track which drugs have been prescribed to whom, by whom, and when. Other continental European countries are building HIT grids. Another example is India’s Apollo Hospital chain, which uses an advanced EHRS system built locally that integrates back-office functions with the sort of data on patients doctors need to see. Apollo Health Street, a successful offshoot, sells HIT software and services to American hospitals. Apollo’s executive team wants to build an open-source “health superhighway” in India from which everyone can benefit, not just the better-off who use his hospital.

If the health providers were to switch to EHRS integrated into a smart grid of information technologies, the future of medicine could look a lot brighter. If used properly, this bundle of technologies could give more power to patients, transform the daily practice of medicine and assist research into new pharmaceuticals.

The RAND Corporation, an American Think-Tank, examined the potential benefits of digitizing health systems and concluded that if 90% of hospitals and doctors in the USA adopt HIT over 15 years, the health system could save about $77 billion a year from efficiency gains. If health-and-safety benefits are considered, the gains could double, saving about 6% of the total amount (in the level of trillions) that could be spent on healthcare in the USA.

Any consideration presented in the last 20 years toward “Electronic Medicine” is hard. One stumbling block has been privacy, but the technical tools to safeguard it, such as encryption software, have improved so much that this should no longer be a problem. Another massive obstacle has been resistance from doctors, some of which stems from failed previous efforts to introduce HIT. Doctors and nurses have too often been required to learn how to use new software but have rarely been compensated for their time or seen tangible medical benefits. That is why much of the health money in the American stimulus package will go into providing financial incentives to encourage doctors to go digital. The success of the digitization of Medicine requires governmental and financial planning and commitment instead of fancy kits and pots of money and promises alone. Such an approach is rather bothersome and agonizing.

At one point, the information department at the Harvard Medical School suggested a bottom-up approach design by listening to doctors and patients. Yet, there are a lot of reformers that believe that patient control works better. Other experts support that a top-down approach makes setting common security standards and data-sharing protocols for small countries easier. For example, Denmark is doing well with its modest top-down HIT system. But it will work less well in a large and heterogeneous system like a National Health System.

The American HIT reforms are planned to unfold in three phases: The first will involve health-information exchanges to ensure that systems work together. The second phase – which may run concurrently with the first – will be the adoption of EHRS. The third phase involves the analysis of patient data to improve medical practice and drug research. One concern is that big software vendors or health providers with expensive legacy systems mqt try to slow things down so that they can milk their existing businesses. The best way to ensure that the first phase does not get captured by interest groups may be to push ahead with phase two simultaneously by putting EHRS in the hands of patients. Further, there is fear that a debate about standards could run into an excuse for inaction. Let’s remember HIT is unlike railways, where the gauges must match perfectly for interoperability.

Medical errors can be decreased by smart software. A study published in the British Medical Journal 2007 estimated that 30,000 hospital patients in the Netherlands suffered avoidable harm yearly because of such mistakes, and 1,700 died. According to another study by the Institute of Medicine, more Americans die from hospital-acquired illnesses and drug errors than from breast cancer or AIDS. Up to 100,000 Americans are thought to die each year due to preventable accidents like these. Sometimes, preventing such errors doesn’t require cutting-edge technology. Another striking study in the New England Journal of Medicine has shown that surgical errors and complications fall by one-third if hospitals use a simple safety checklist before, during, and after surgery.

HIT may also benefit drug development, administration, and dosage. There is currently a lack of knowledge regarding how pharmaceuticals are utilized and how they interact. According to some experts, half of all medications are consumed at the incorrect frequency and dosage. Perhaps a smart grid for medicine could change that.

There is a category of medical doctors who readily admit to being very skeptical of HIT and EHRS. For example, some doctors insist that medicine is a performing art; thus, nobody can end variance. Many concede that they used to see HIT as more of a nuisance than a help. However, in the last few years, patient-centric EHRS, clinical decision support systems, and hospital analytics software have become so user-friendly and useful that they are now enthusiastic converts.

Regarding mobile phones, health technology, or mHealth, enables multidirectional information flows even in the most remote parts of the world, and they have the power to transform health care. For now, the most promising applications of mHealth are public-health messaging, stitching together smart medical grids, extending the reach of scarce health workers, and establishing surveillance networks for infectious diseases. Another promising mHealth application involves integrating mobiles into EHRS and software for clinical decision support. One lesson emerging from these various experiments is that the visible face of any mHealth scheme, regardless of where it operates, needs to be as simple and user-friendly as possible. In contrast, the remote backends should use sophisticated software and hardware.

Indeed digitized medicine will take off as people live longer and spend an ever larger proportion of their income on health. Yet, doctors quickly point out that transistors are not the same as transplants. Medicine is more complex than electronics, and several things about an established medical practice must be cherished and not recklessly cast aside in the name of change. That is why it may make more sense to see the move to digital medicine as a reformation rather than a revolution. The reformation had irreversible consequences for Western society; the implications of the healthcare reformation could also be profound. As bottom-up digital medicine arrives in full force, it will, at last, provide reformers with the tools they need to tackle the great healthcare challenges of this century, dealing with the cost of chronic care for the aging populations of the rich world and helping the weak health systems in poor countries tackle deadly diseases. Thus, digitization of Medicine will succeed only if coupled with the empowerment that the patient has lived with his medical problem and often knows he is better than the doctor. Countries should pass a giant fiscal-stimulus package to create a national health information network, including incentives for hospitals and doctors to adopt EHRS. Medical information must be free on rival software systems. It must be decided whether the patient records are legally the property of the government or the hospital or put the patient back in charge of his own care.


Georgios Ardavanis – 23/05/2023

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