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W. Edward Hammond is well-known nationally as a champion of electronic records. He's been instrumental in developing standards for electronic formats and record content. For 26 years, he's been working on computerized patient records development at Duke University. But despite substantial progress, the pioneering researcher says the field still has a ways to go before it achieves his vision of the ultimate medical record.
The results of this research have added an expanded perspective on the decision to adopt particular technologies. The perception had been that, given the current state of health care reimbursement, decisions to acquire radical and often expensive devices will center around economic or strategic considerations. However, it was discovered that technology acquisition appeared to be a physician centered activity with less consideration given to strategic or economic factors. While these data suggest that hospitals have not been listening to complaints about rising health care costs and continue to operate in a "business as usual" manner, it may because physicians continue to be the dominant players in what is for them an unrestrained free market. This trend, if continued, may ultimately lead to a reimposition of heavy handed government regulation in the adoption of even the most routine medical technology. As a result, it is vital that health care administrators begin to explore ways for moving from physician centered and tactical considerations to a more strategic focus which builds upon the needs and interests of the medical staff to serve the community in a more responsible fashion before that ability is taken away from them.
As healthcare moves from individual fee-for-services and single hospital systems to capitated contracts and integrated delivery systems (IDS), and then into Community Health Information Networks (CHINs), implementing a data warehouse is a realistic way to collect and transform data into meaningful information. However, healthcare differs from other industries because of its complexity. The software is more specialized, and many vendors have adopted proprietary operating systems that hold critical data hostage. Even when available, data is not integrated and is more convoluted than in other industries. To have a complete patient profile, there can be 750 critical data elements in a healthcare transaction, as compared to an estimated 150 data elements in a financial transaction. Historical, behavioral, and diagnostic information is needed at multiple points along the continuum of care: physician's office, rehabilitation, pharmacy, emergency room, laboratory, and hospital. Additionally, these points along the continuum must communicate with the community they serve and the purchasers of healthcare. This article looks at data warehousing and the different technologies available for consolidating and integrating information in the healthcare environment.
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The phenomenal development and growth of the information superhighway over the past few years has brought with an ever-increasing number of sites associated with health care. At the same time, community access to the Internet and multimedia technology has allowed greater access to healthcare sites by consumers wishing to find healthcare information relevant to their needs. The Internet has greater potential for improving the healthcare knowledge of the community, especially in remote areas or in parts of the community that have limited access to community health infrastructure. However, most of the current development of healthcare sites has focused on the needs of healthcare professionals rather than consumers. Indeed, with the volume of information available over the Internet, it is easy to spend hours browsing through a maze of sites with information that often is fragmented, incomplete, or only accessible with a password. Once a relevant site is located, the information often is presented as vast amounts of text with possibly some graphics. It appears little consideration is given during the development of web sites to the actual presentation of the information. For the full potential of the information superhighway to be realized in relation to health care, more consideration should be given during the development stages of web sites to how the information is presented and how to make access more streamlined.
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Healthcare systems are adapting the "browser" technology that simplified use of the Internet to weave new webs--known as "intranets"--among their provider and facility networks. Browsers eventually will be tapped to deliver information at the point of care, making them an all-purpose tool to reshape clinical practice by providing just the right data at just the right time for a diagnosis or treatment decision.
The good news is that newer, faster technology is opening up new horizons for networked applications. The bad news? Figuring out how much bandwidth to install to meet future demands, without overbuilding and suffering a poor ROI.
Technological advances are changing the way the world shares information and conducts daily business, CARING asked home care colleagues around the world to respond to a question about technology's role in home care delivery. Although the degree of technology's involvement differs from country to country, each country is aware of the possibilities and is looking toward the future.
Science is expanding the options for homebound patients. Many of the new technologies coming into the home care industry are the result of aerospace innovations. What are these new technologies, and what can the home care industry expect to see in the future.
Although there are few monoclonal antibody (MoAb) products on the market, the biotechnology industry has made considerable progress over the last decade. The industry has developed new technology to address the primary hurdles facing the development of MoAbs--including the immune response to murine-derived antibodies as well as lack of tumor specificity. As the techniques for development become more refined, more products will be approved by the Food and Drug Administration. Integrating these products into the existing healthcare system will be a challenge, given their high acquisition costs. Recent pharmacoeconomic examples outlined in this paper confirm that MoAb products will need to be supported with proven clinical and economic profiles. As long as a global clinical and economic perspective is taken and patient care benefits can be demonstrated, the place of MoAbs in the future of healthcare will be assured.
The world's current system of intellectual property rights has in recent years become unworkable and ineffective. Designed more than 100 years ago to meet the needs of an industrial era, it is inadequate to handle the ownership and distribution of intellectual property generated by the brainpower industries that have come to dominate the world's economy. The prevailing wisdom is that minor tweaking can remedy the problem. But MIT economist Lester Thurow challenges such thinking and calls instead for a new system--one redesigned from the ground up. In making his case for why the old system doesn't work anymore, Thurow lays out the challenges the new system must meet. It must offer incentives to inventors that are strong enough to offset the decline in publicly funded research. At the same time, it must protect the public interest by keeping some intellectual property--basic scientific knowledge, for example--in the public domain. The new system must be flexible enough to deal with the fact that new technologies have created new potential forms of intellectual property rights (Can pieces of a human being be patented?) and have made old rights unenforceable (When books can be downloaded from an electronic library, what does a copyright mean?). And in an increasingly global economy, a new system must meet the needs of both "catch-up" states and "keep-ahead" states. A system that ignores the lesson of history--that every country that has caught up has done so by copying--will be an unenforceable one.