A number of key technologies that can be used to improve healthcare services have been identified as proven catalysts to significant healthcare improvement, efficiently and effectively meeting the increasing demands of stakeholders in the healthcare environment, patients, professionals and funders.
10 of these technologies are outlined in this article.
While this list is not exhaustive, I believe any healthcare provider especially the Kenyan Health Ministry should strongly consider the benefits to patient care that these and similar technologies can provide.
1. Electronic Health Records (EHR)
Electronic Health Records aggregate patient-centric health data from the patient record systems of multiple independent healthcare organisations. An EHR is a long-term record for a patient, detailing his or her involvement with individual healthcare organisations and episodes of care.
Many EHRs include detailed clinical data such as individual lab results and prescription refill information. EHRs are commonly used to transfer a patient’s healthcare information between organisations, allowing stakeholders in the patient’s health to access this information remotely.
Access to this information allows for continuity of care between different care
delivery organisations or other organisations, such as social services, that may come in contact with the patient.
EHRs make information for decision-making available at the point of care and result in less time and effort spent capturing patient data when crossing organisational boundaries. Additionally, ensuring the interoperability of these systems, delivers increased benefit for the patient, clinician and healthcare provider.
2. Chronic Disease Management Systems
Chronic Disease Management Systems, CDMS, rely on the use of evidence-based best practices. They allow doctors to organise and use their chronic care patient information efficiently providing fast, easy access to evidence-based clinical guidelines.
It includes, for example
- What measures should be checked on each patient visit (e.g. blood pressure, weight, activity level)
- What medications the patient should be taking, which lab tests should be repeated and when
- What self-care reminders the patient should receive.
Research estimates that Up to 50% of patients with chronic conditions fail to take their medicines properly. In diabetics alone, 20% with type two diabetes forget to take their medicines at least once a week, whilst around 80% are unable to test their glucose even once a day because they have not obtained enough testing strips.
CDMS should provide tools that any member of a patient’s care team can access easily; for example, a nurse, dietician or other care provider may use a patient education report or patient flow sheet from the system to help a patient set and meet self-management goals; similarly, a medical office assistant may use recall reports from the system to proactively schedule follow-up appointments.
CDMS has the potential to reduce costs by improving health outcomes for chronic care patients. Physicians can use CDMS to generate alerts, identify subsets of patients, and track their progress toward goals. By extending this system to the home, patients can also enter their own care management information, and take relevant measurement for their condition, making the registry a complete chronic care record.
3. Computerised Practitioner Order Entry (CPOE)
Computerised practitioner/(or physician) order entry (CPOE), also known as Order Communications, is defined as the computer system that allows direct entry of medical orders by the person with the license and privileges to do so. Directly entering orders into a computer, at the point of care, has the benefit of reducing errors by minimizing the ambiguity of hand-written orders, but a much greater benefit is seen with the combination of CPOE and clinical decision support (CDS) tools.
CPOE supports decision making by improving formulary compliance; cost effective medication ordering; appropriateness of medication administration, route, dosage, duration, and interval; decrease in test redundancy and unnecessary duplication.
When combined with Electronic Transfer of Prescription, it also improves clinical processes for ordering, saving time and cost while reducing ambiguity due to illegible handwriting and incompleteness of handwritten orders.
4. Clinical Decision Support
Clinical Decision Support (CDS) can assist in the avoidance of medical errors. CDS, in conjunction with CPOE, can help clinicians make complex decisions and can trigger appropriate early notification of possible untoward events. The system can immediately raise an alert if a potential adverse drug event or prescription error could be triggered by a prescription.
It can also generate dosage adjustments based for example on advancing age or declining renal function. Similarly, decision support tools can alert a physician to reassess the need for medications such as antibiotics that appear to be used for longer than indicated.
5. Electronic Transfer of Prescription
Electronic Transfer of Prescription (ETP) makes it easier for GPs –General Practitioner to issue prescriptions and more convenient for patients to collect their medication. ETP enables prescription data to be transmitted electronically between the prescribing health professional and the pharmacy, making prescribing and dispensing safer and more convenient for patients.
This improves audit trails for medication and reduces errors that can arise from illegible paper based prescriptions.
6. Electronic Appointment Booking
Electronic Appointment Booking Systems allow patients to choose the place, date and time of their first outpatient hospital appointment and automates the process by which a GP refers a patient for specialist care. It allows patients to book appointments on site at the surgery, over the phone or over the internet in the way that is most convenient for them.
Electronic appointment booking systems can exist as standalone applications but
in highly integrated environment can often be found embedded in systems such as Patient Portals, Self Service Applications and Personal Health Records.
With an Electronic Appointment Booking system, the referral process in which the GP’s surgery contacts the specialist’s practice who then gets in touch with the patient via post to schedule an appointment is cut down to a single step.
Some Electronic Appointment Booking Systems also allow for triage and e-consultations where a clinician in primary care can confirm the need or the specialty to which a patient ought to be referred
7. Personal Health Record
The Personal Health Record (PHR) is an Internet-based patient owned and patient controlled set of tools that allow people to access and coordinate their lifelong health information and make appropriate parts of it available to those who need it. PHR systems can allow patients to manage their own health and the health of others (dependents) through education and monitoring as well as enable the exchange of data with others regarding their health.
This technology differs from others in the Healthcare space in that its use and adoption is largely dependent on the patient. In the case of chronic conditions, for example, a patient could update their PHR with their latest readings and make them available online to a clinician or a nurse.
PHRs can enable other transactional self service interactions such as booking appointments or requesting a refill of a prescription. Equally, through a PHR, a patient can communicate with their clinician for advice, guidance or e consultations.
Finally, a PHR can help a patient access medical information and best practices for the better management of certain conditions.
Telemedicine consists of a series of technologies that enable care services to be
provided remotely. Telemedicine and other care-at-a-distance technologies can enable the sharing of information in the form or records, images, and audio. Telemedicine can be applied in scenarios where the physical presence of a healthcare professional is restricted, by distance or time.
Whether it is for analysis, diagnosis, consultation or treatment, Telemedicine represents a convenient way for patients to gain access to medical skills in a suitable and timely manner. Home health monitoring has contributed to the reduction of unnecessary visits and clinician appointments as well as the
identification of potentially serious situations that would require attention of a clinician.
9. RFID and Bar-coding
Radio Frequency Identification (RFID) is a technology that allows traceable chips, called RFID tags, carrying a set of predetermined information to be embedded in objects. RFID readers can pick up radio signals which provide particular information related to the carrier such as identification number, name, and medication requirements.
These technologies can be used in a number of ways in a medical setting. For example, Patients can be provided with identification wristbands carrying an RFID tag or a barcode that will be used throughout the patient’s stay in hospital. The tag or barcode would allow caregivers to positively identify and match patients to their care – for example to ensure that the right medicines are going to the right patient.
This technology also allows patients to be tracked within the hospital, facilitating bed and service management and timely release of outpatients. Bar-coding/RFID can also be used for inventory management and equipment tracking which allows for improved utilisation of expensive diagnostic equipment by providing real-time location information.
Some hospitals are already using it to track levels of medications and other supplies.
10. Business Intelligence (BI) for Real Time Detection of Hospital Infection Patterns
Through the collection, storage, analysis and interpretation of data, business Intelligence systems can generate valuable actionable knowledge for tactical and strategic decision support, trend recognition, forecast, predictive modelling and strategic analysis.
Additional capabilities include the ability to distinguish previously unrecognised disease patterns, identify at-risk patients, and review the performance of individual physicians. Business Intelligence and in particular Data Mining are useful tools in the detection of outbreaks when used for the real time detection of infection trends within hospitals.
Trend recognition in wards and hospitals can lead to the reduction of outbreaks such as Hospital Acquired Infections (HAIs) if detected at an early stage. These tools are being used to analyse vast amount of data in real time and to help distinguish patterns that could indicate abnormal situations that would require further attention or action from healthcare professionals.