Role of IT in Medicine

Dwi Agustian Dept. Epidemiology & Biostatistics

Information

Information is knowledge for the purposes of taking effective action Elements of communication system:

Source Transmitter Channel Receiver Destination

Information Technology

Computers Telecommunications Networks Document reproduction Artificial intelligence

The Internet Computer-based group system Data capturing Data storage and retrieval Information management Information system

Medical Informatics

The acquisition, analysis, and dissemination of information in healthcare delivery process (Levy, 1977) The theoretical and practical aspect of information processing and communication, based on knowledge and experience derived from process in medicine and health care (van Bemmel, 1984)

Example
EMD (Electronic Medical Record) CPOE (computerized physician order entry)

Box. Advantages of CPOE Systems Compared With Paper-Based Systems1,2,6-9,11,13-15 Free of handwriting identification problems Faster to reach the pharmacy Less subject to error associated with similar drug names More easily integrated into medical records and decision-support systems Less subject to errors caused by use of apothecary measures Easily linked to drug-drug interaction warnings More likely to identify the prescribing physician Able to link to ADE reporting systems Able to avoid specification errors, such as trailing zeros Available and appropriate for training and education Available for immediate data analysis, including postmarketing reporting Claimed to generate significant economic savings With online prompts, CPOE systems can link to algorithms to emphasize cost-effective medications Reduce underprescribing and overprescribing Reduce incorrect drug choices Abbreviations: ADE, adverse drug event; CPOE, computerized physician order entry.

In his 2005 "State of the Union" message, President George Bush stated: "By computerizing health-care records, we can avoid dangerous medical mistakes, reduce costs, and improve care." Juxtaposed with this statement are the following findings from the survey of American Hospitals in 2002: of all US hospitals, only 9.6% of them (60 hospitals) have the computerized physician order entry (CPOE) component of the EMR completely available for use. In about half of these hospitals, > 90% of orders are entered with CPOE by physicians; in about another third of the hospitals, 90% of the orders are entered with CPOE by nonphysician staff.

The causes that contribute to the low rate of EMR implementation and usage include the following: Complexity of the EMR; Cost of change; Time commitment; Clinician expectations; Interoperability (including standards and controlled medical terminology); Understanding clinical workflow; and Competing agendas in American health care today.

Simplicity is complex Complexity is simple