Health information technology
Encyclopedia
Health information technology (HIT) provides the umbrella framework to describe the comprehensive management of health information across computerized systems and its secure exchange between consumers, providers, government and quality entities, and insurers. Health information technology (HIT) is in general increasingly viewed as the most promising tool for improving the overall quality, safety and efficiency of the health delivery system (Chaudhry et al., 2006). Broad and consistent utilization of HIT will:
Interoperable HIT will improve individual patient care, but it will also bring many public health benefits including:
is a broad concept that deals with a species' usage and knowledge of tools and crafts, and how it affects a species' ability to control and adapt to its environment. However, a strict definition is elusive; "technology" can refer to material objects of use to humanity, such as machines, hardware or utensils, but can also encompass broader themes, including systems, methods of organization, and techniques. For HIT, technology represents computers and communications attributes that can be networked to build systems for moving health information. Informatics is yet another integral aspect of HIT.
Informatics
refers to the science of information
, the practice of information processing
, and the engineering of information systems
. Informatics underlies the academic investigation and practitioner application of computing and communications technology to healthcare, health education, and biomedical research. Health informatics
refers to the intersection of information science, computer science, and health care. Health informatics describes the use and sharing of information within the healthcare industry with contributions from computer science, mathematics, and psychology. It deals with the resources, devices, and methods required for optimizing the acquisition, storage, retrieval, and use of information in health and biomedicine. Health informatics tools
include not only computers but also clinical guidelines, formal medical terminologies, and information and communication systems. Medical informatics, nursing informatics, public health informatics
, and pharmacy informatics are subdisciplines that inform health informatics from different disciplinary perspectives. The processes and people of concern or study are the main variables.
. The most immediate barrier to widespread adoption of technology is cost: patients benefit from better health, and payers benefit from lower costs; however, hospitals pay in both higher costs for implementation and lower revenues due to reduced patient length of stay.
Although frequently cited in the literature the Electronic health record
(EHR), previously known as the Electronic medical record
(EMR), there is no consensus about the definition (Jha et al., 2008). However, there is consensus that EMRs can reduce several types of errors, including those related to prescription drugs, to preventive care, and to tests and procedures. Recurring alerts remind clinicians of intervals for preventive care and track referrals and test results. Clinical guidelines for disease management have a demonstrated benefit when accessible within the electronic record during the process of treating the patient. Advances in health informatics
and widespread adoption of interoperable electronic health records promise access to a patient's records at any health care site. A 2005 report noted that medical practices in the United States are encountering barriers to adopting an EHR system, such as training, costs and complexity, but the adoption rate continues to rise (see chart to right). Since 2002, the National Health Service
of the United Kingdom has placed emphasis on introducing computers into healthcare. As of 2005, one of the largest projects for a national EHR is by the National Health Service
(NHS) in the United Kingdom
. The goal of the NHS is to have 60,000,000 patients with a centralized electronic health record by 2010. The plan involves a gradual roll-out commencing May 2006, providing general practices in England access to the National Programme for IT (NPfIT), the NHS component of which is known as the "Connecting for Health Programme". However, recent surveys have shown physicians' deficiencies in understanding the patient safety features of the NPfIT-approved software.
Computerized provider order entry (CPOE), formerly called Computer physician order entry
, can reduce total medication error rates by 80%, and adverse (serious with harm to patient) errors by 55%. A 2004 survey by Leapfrog found that 16% of US clinics, hospitals and medical practices are expected to be utilizing CPOE within 2 years. In addition to electronic prescribing, a standardized bar code system for dispensing drugs could prevent a quarter of drug errors. Consumer information about the risks of the drugs and improved drug packaging (clear labels, avoiding similar drug names and dosage reminders) are other error-proofing measures. Despite ample evidence of the potential to reduce medication errors, competing systems of barcoding and electronic prescribing have slowed adoption of this technology by doctors and hospitals in the United States, due to concern with interoperability and compliance with future national standards. Such concerns are not inconsequential; standards for electronic prescribing
for Medicare Part D
conflict with regulations in many US states.
- Improve health care quality;
- Prevent medical errors;
- Reduce health care costs;
- Increase administrative efficiencies
- Decrease paperwork; and
- Expand access to affordable care.
Interoperable HIT will improve individual patient care, but it will also bring many public health benefits including:
- Early detection of infectious disease outbreaks around the country;
- Improved tracking of chronic disease management; and
- Evaluation of health care based on value enabled by the collection of de-identified price and quality information that can be compared.
Concepts and Definitions
Health information technology (HIT) is “the application of information processing involving both computer hardware and software that deals with the storage, retrieval, sharing, and use of health care information, data, and knowledge for communication and decision making” (Brailer, & Thompson, 2004). TechnologyTechnology
Technology is the making, usage, and knowledge of tools, machines, techniques, crafts, systems or methods of organization in order to solve a problem or perform a specific function. It can also refer to the collection of such tools, machinery, and procedures. The word technology comes ;...
is a broad concept that deals with a species' usage and knowledge of tools and crafts, and how it affects a species' ability to control and adapt to its environment. However, a strict definition is elusive; "technology" can refer to material objects of use to humanity, such as machines, hardware or utensils, but can also encompass broader themes, including systems, methods of organization, and techniques. For HIT, technology represents computers and communications attributes that can be networked to build systems for moving health information. Informatics is yet another integral aspect of HIT.
Informatics
Informatics (academic field)
Informatics is the science of information, the practice of information processing, and the engineering of information systems. Informatics studies the structure, algorithms, behavior, and interactions of natural and artificial systems that store, process, access and communicate information...
refers to the science of information
Information
Information in its most restricted technical sense is a message or collection of messages that consists of an ordered sequence of symbols, or it is the meaning that can be interpreted from such a message or collection of messages. Information can be recorded or transmitted. It can be recorded as...
, the practice of information processing
Information processing
Information processing is the change of information in any manner detectable by an observer. As such, it is a process which describes everything which happens in the universe, from the falling of a rock to the printing of a text file from a digital computer system...
, and the engineering of information systems
Information systems
Information Systems is an academic/professional discipline bridging the business field and the well-defined computer science field that is evolving toward a new scientific area of study...
. Informatics underlies the academic investigation and practitioner application of computing and communications technology to healthcare, health education, and biomedical research. Health informatics
Health informatics
.Health informatics is a discipline at the intersection of information science, computer science, and health care...
refers to the intersection of information science, computer science, and health care. Health informatics describes the use and sharing of information within the healthcare industry with contributions from computer science, mathematics, and psychology. It deals with the resources, devices, and methods required for optimizing the acquisition, storage, retrieval, and use of information in health and biomedicine. Health informatics tools
Health informatics tools
To provide the safe and effective delivery of medical care, virtually all clinical staff use a number of front-line Health Informatics Tools in their day-to-day operations. The need for standardization and refined development of these tools is underscored by the HITECH act and other efforts to...
include not only computers but also clinical guidelines, formal medical terminologies, and information and communication systems. Medical informatics, nursing informatics, public health informatics
Public health informatics
Public Health Informatics has been defined as the systematic application of information and computer science and technology to public health practice, research, and learning...
, and pharmacy informatics are subdisciplines that inform health informatics from different disciplinary perspectives. The processes and people of concern or study are the main variables.
Implementation of HIT
The Institute of Medicine’s (2001) call for the use of electronic prescribing systems in all healthcare organizations by 2010 heightened the urgency to accelerate United States hospitals’ adoption of CPOE systems. In 2004, President Bush signed an Executive Order titled the President’s Health Information Technology Plan, established a ten-year plan as this technology is essential to put the needs and the values of the patients first and gives patients information they need to make clinical and economic decisions. According to a study by RAND Health, the US healthcare system could save more than $81 billion annually, reduce adverse healthcare events and improve the quality of care if it were to widely adopt health information technologyHealth informatics
.Health informatics is a discipline at the intersection of information science, computer science, and health care...
. The most immediate barrier to widespread adoption of technology is cost: patients benefit from better health, and payers benefit from lower costs; however, hospitals pay in both higher costs for implementation and lower revenues due to reduced patient length of stay.
Types of technology
In a recent study about the adoption of technology in the United States, Furukawa, and colleagues (2008) classified applications for prescribing to include electronic medical records (EMR), clinical decision support (CDS), and computerized physician order entry (CPOE). They further defined applications for dispensing to include bar-coding at medication dispensing (BarD), robot for medication dispensing (ROBOT), and automated dispensing machines (ADM). And, they defined applications for administration to include electronic medication administration records (EMAR) and bar-coding at medication administration (BarA).Electronic Health Record (EHR)
Electronic Health Record
An electronic health record is an evolving concept defined as a systematic collection of electronic health information about individual patients or populations...
(EHR), previously known as the Electronic medical record
Electronic medical record
An electronic medical record is a computerized medical record created in an organization that delivers care, such as a hospital or physician's office...
(EMR), there is no consensus about the definition (Jha et al., 2008). However, there is consensus that EMRs can reduce several types of errors, including those related to prescription drugs, to preventive care, and to tests and procedures. Recurring alerts remind clinicians of intervals for preventive care and track referrals and test results. Clinical guidelines for disease management have a demonstrated benefit when accessible within the electronic record during the process of treating the patient. Advances in health informatics
Health informatics
.Health informatics is a discipline at the intersection of information science, computer science, and health care...
and widespread adoption of interoperable electronic health records promise access to a patient's records at any health care site. A 2005 report noted that medical practices in the United States are encountering barriers to adopting an EHR system, such as training, costs and complexity, but the adoption rate continues to rise (see chart to right). Since 2002, the National Health Service
National Health Service
The National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...
of the United Kingdom has placed emphasis on introducing computers into healthcare. As of 2005, one of the largest projects for a national EHR is by the National Health Service
National Health Service
The National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...
(NHS) in the United Kingdom
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
. The goal of the NHS is to have 60,000,000 patients with a centralized electronic health record by 2010. The plan involves a gradual roll-out commencing May 2006, providing general practices in England access to the National Programme for IT (NPfIT), the NHS component of which is known as the "Connecting for Health Programme". However, recent surveys have shown physicians' deficiencies in understanding the patient safety features of the NPfIT-approved software.
Computerized Provider (Physician) Order Entry (CPOE)
Prescribing errors are the largest identified source of preventable errors in hospitals. A 2006 report by the Institute of Medicine estimated that a hospitalized patient is exposed to a medication error each day of his or her stay.Computerized provider order entry (CPOE), formerly called Computer physician order entry
Computer physician order entry
Computerized physician order entry is a process of electronic entry of medical practitioner instructions for the treatment of patients under his or her care...
, can reduce total medication error rates by 80%, and adverse (serious with harm to patient) errors by 55%. A 2004 survey by Leapfrog found that 16% of US clinics, hospitals and medical practices are expected to be utilizing CPOE within 2 years. In addition to electronic prescribing, a standardized bar code system for dispensing drugs could prevent a quarter of drug errors. Consumer information about the risks of the drugs and improved drug packaging (clear labels, avoiding similar drug names and dosage reminders) are other error-proofing measures. Despite ample evidence of the potential to reduce medication errors, competing systems of barcoding and electronic prescribing have slowed adoption of this technology by doctors and hospitals in the United States, due to concern with interoperability and compliance with future national standards. Such concerns are not inconsequential; standards for electronic prescribing
Electronic prescribing
Electronic prescribing or e-prescribing is the ability to send error-free, accurate, and understandable prescriptions electronically from the healthcare provider to the pharmacy. E-prescribing is meant to reduce the risks associated with traditional prescription script writing. It is also one of...
for Medicare Part D
Medicare Part D
Medicare Part D is a federal program to subsidize the costs of prescription drugs for Medicare beneficiaries in the United States. It was enacted as part of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 and went into effect on January 1, 2006.- Eligibility and...
conflict with regulations in many US states.
Technological Innovations, Opportunities, and Challenges
Handwritten reports or notes, manual order entry, non-standard abbreviations and poor legibility lead to substantial errors and injuries, according to the Institute of Medicine (2000) report. The follow-up IOM (2004) report, Crossing the quality chasm: A new health system for the 21st century, advised rapid adoption of electronic patient records, electronic medication ordering, with computer- and internet-based information systems to support clinical decisions. However, many system implementations have experienced costly failures (Ammenwerth et al., 2006). Furthermore, there is evidence that CPOE may actually contribute to some types of adverse events and other medical errors.(Campbell et al., 2007) For example, the period immediately following CPOE implementation resulted in significant increases in reported adverse drug events in at least one study (Bradley, Steltenkamp, & Hite, 2006) and evidence of other errors have been reported.(Bates, 2005a; Bates, Leape, Cullen, & Laird, 1998; Bates; 2005b) Collectively, these reported adverse events describe phenomena related to the disruption of the complex adaptive system resulting from poorly implemented or inadequately planned technological innovation.Technological Iatrogenesis
Technology may introduce new sources of error Technologically induced errors are significant and increasingly more evident in care delivery systems. Terms to describe this new area of error production include the label technological iatrogenesis for the process and e-iatrogenic for the individual error. The sources for these errors include:- Prescriber and staff inexperience may lead to a false sense of security; that when technology suggests a course of action, errors are avoided.
- Shortcut or default selections can override non-standard medication regimens for elderly or underweight patients, resulting in toxic doses.
- CPOE and automated drug dispensing was identified as a cause of error by 84% of over 500 health care facilities participating in a surveillance system by the United States Pharmacopoeia.
- Irrelevant or frequent warnings can interrupt work flow.
See also
- BioinformaticsBioinformaticsBioinformatics is the application of computer science and information technology to the field of biology and medicine. Bioinformatics deals with algorithms, databases and information systems, web technologies, artificial intelligence and soft computing, information and computation theory, software...
- Biomedical informatics
- Clinical informatics
- Clinical research informatics
- Consumer health informaticsConsumer health informaticsConsumer Health Informatics helps bridge the gap between patients and health resources. The Kaiser model is an example of allowing patients to remotely communicate with their physicians or other healthcare professionals....
- Dental informatics
- eHealthEHealtheHealth is a relatively recent term for healthcare practice supported by electronic processes and communication, dating back to at least 1999...
- Health care informatics
- Health informaticsHealth informatics.Health informatics is a discipline at the intersection of information science, computer science, and health care...
- Imaging informaticsImaging informatics-Introduction:Imaging Informatics, also known as Radiology Informatics or Medical Imaging Informatics, is a subspecialty of Biomedical Informatics that aims to improve the efficiency, accuracy, usability and reliability of medical imaging services within the healthcare enterprise...
- mHealthMHealthmHealth is a term used for the practice of medicine and public health, supported by mobile devices. The term is most commonly used in reference to using mobile communication devices, such as mobile phones and PDAs, for health services and information...
- Nursing informatics
- Pharmacy informatics
- Public health informaticsPublic health informaticsPublic Health Informatics has been defined as the systematic application of information and computer science and technology to public health practice, research, and learning...
- Veterinary informatics
- Patient SafetyPatient safetyPatient safety is a new healthcare discipline that emphasizes the reporting, analysis, and prevention of medical error that often leads to adverse healthcare events. The frequency and magnitude of avoidable adverse patient events was not well known until the 1990s, when multiple countries reported...
Further reading
- Ammenwerth, E., Talmon, J., Ash, J. S., Bates, D. W., Beuscart-Zephir, M. C., Duhamel, A., Elkin, P. L., Gardner, R. M., & Geissbuhler, A. (2006). Impact of CPOE on mortality rates – contradictory findings, important messages.” Methods Inf Med, 45(6): 586-593.
- Ash, J. S., Sittig, D. F., Poon, E. G., Guappone, K., Campbell, E., & Dykstra, R. H. (2007). The extent and importance of unintended consequences related to computerized provider order entry.” Journal of the American Medical Informatics Association, 14(4): 415-423.
- Bates, D. (2005a). Computerized Physician Order entry and medication errors: finding a balance. Journal of Biomedical Informatics, 38(4): 250-261.
- Bates, D.W. (2005b). Physicians and ambulatory electronic health records. Health Affairs, 24(5): 1180-1189.
- Bates, D. W., Leape, L. L., Cullen, D. J., & Laird, N. (1998). Effect of computerized physician order entry and a team intervention on prevention of serious medical errors. Journal of the American Medical Association, 280: 1311-1316.
- Bradley, V. M., Steltenkamp, C. L., & Hite, K. B. (2006). Evaluation of reported medication errors before and after implementation of computerized practitioner order entry. Journal Healthc Inf Manag, 20(4): 46-53.
- Brailer, D., & Thompson, T. (2004). Health IT strategic framework. Washington, DC: Department of Health and Human Services.
- Chaudhry, B. Wang , J., & Wu, S. et al., (2006). Systematic review: Impact of health information technology on quality, efficiency, and costs of medical care, Annals of Internal Medicine, 144(10), 742–752.
- Campbell, E. M., Sittig, D. F., Ash, J. S., Guappone, K. P., & Dykstra, R. H. (2007). In reply to: “e-Iatrogenesis: The most critical consequence of CPOE and other HIT. Journal of the American Medical Informatics Association.
- Edmunds MMargo EdmundsMargo Edmunds is an American health policy researcher, strategy consultant, educator, and writer who began her clinical career in disease management at Johns Hopkins Hospital...
, Peddicord D, Detmer DEDon E. DetmerDon E. Detmer, MD, MA, FACS, is Medical Director for Advocacy and Health Policy of the American College of Surgeons. He is also Professor Emeritus and Professor of Medical Education at the University of Virginia and Visiting Professor at CHIME, University College of London.-Biography and...
, Shortliffe E. Health IT Policy and Politics: A Primer on Moving Policy Into Action. Featured Session, American Medical Informatics Association Annual Symposium (2009). Available as a webinar at https://www.amia.org/amia-policy-101. - Furukawa, M. F., Raghu, T. S., Spaulding, T. J., & Vinze, A. (2008). Health Affairs, 27, (3), 865-875.
- Institute of Medicine (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, D.C: National Academies Press.
- Jha, A. K., Doolan, D., Grandt, D., Scott, T. & Bates, D. W. (2008). The use of health information technology in seven nations. International Journal of Medical Informatics, corrected proof in-press.
- Kawamoto, K. H., Caitlin, A., Balas, E. A., & Lobach, D. F. (2005). “Improving clinical practice using clinical decision support systems: A systematic review of trials to identify features critical to success.” British Journal of Medicine, 330(7494): 765-774.
- Sidrov, J. (2006). It ain’t necessarily so: The electronic health record and the unlikely prospect of reducing healthcare costs. Health Affairs, 25(4): 1079-1085.
External links
- Health Resources and Services Administration (HRSA)
- Health Information Technology at US Department of Health & Human Services
- Healthcare Information Technology from American National Standards InstituteAmerican National Standards InstituteThe American National Standards Institute is a private non-profit organization that oversees the development of voluntary consensus standards for products, services, processes, systems, and personnel in the United States. The organization also coordinates U.S. standards with international...
(ANSI) - Certification Commission for Healthcare Information Technology (CCHIT)
- Health Information Technology Videos
- Health IT Discussion Forum
- Hospital Management Information System from Center for Development of Advanced Computing (C-DAC)
- American Society of Health Informatics Managers
- Patient Safety Initiatives in India Using Health IT