APPLICATION OF ICT IN THE HOSPITAL

CHAPTER ONE

BACKGROUND OF THE STUDY

Whether we are aware of it or not, we are surrounded by networks through which information flows constantly. Our notions of time and location are changing – the world seems to have become a ‘global village’ where distance is no longer a barrier to commercial or social contact. If we live in Britain or other parts of the westernised world, it's difficult to imagine being without all the networked infrastructure that plays a crucial part in our daily lives. This free course, ICTs in everyday life, is about how this infrastructure of information and communication technologies (ICTs) permeates our lives.

The use of information and communication technologies has become widespread in the health care sector. This is most clearly seen in the increasing use of computers in hospitals. Technology has taken over the daily schedules of hospitals, and has allowed nurses and doctors to work more efficiently with patients and each other. If you were to think of your latest visit to the hospital, or even a doctor's office, what image comes to mind? Mine includes a nurse or a doctor making small talk while speedily working on a computer mounted on the wall. This begs the question of what exactly do hospitals use these computers for? The addition of computers to the health care system was done with one goal in mind: efficiency. ICT have helped nurses and doctors keep track of various items ranging from work schedules to patient's scheduled appointments. They not only handle the logistics of hospitals, but also medical implications, such as X-rays and surgery equipment.

INFORMATION AND COMMUNICATIONS TECHNOLOGY (ICT)

Information and communications technology (ICT) is often used as an extended synonym for information technology (IT), but is a more specific term that stresses the role of unified communications and the integration of telecommunications (telephone lines and wireless signals), computers as well as necessary enterprise software, middleware, storage, and audio-visual systems, which enable users to access, store, transmit, and manipulate information.

The term ICT is also used to refer to the convergence of audio-visual and telephone networks with computer networks through a single cabling or link system. There are large economic incentives (huge cost savings due to elimination of the telephone network) to merge the telephone network with the computer network system using a single unified system of cabling, signal distribution and management.

In a landline telephone system, messages are conveyed as signals on wires. The message is conveyed electronically. Manipulation of data takes place when you speak into the phone – your words are transformed into electronic signals. The data is then conveyed through the phone system, stored briefly for further processing on the way, and transformed back into words at the other end. In a mobile phone system, messages are also stored and manipulated but in this case they are conveyed by electromagnetic means such as radio waves, which are wireless.

Examples of ICT systems include the internet, mobile phone systems, broadcast radio and TV systems, but ICTs are essential to many other day-to-day activities. Consider for example a visit to a supermarket. Checkout staff use an ICT system to scan bar codes and obtain prices. ICT systems also allow management to monitor stock levels and sales trends.

CHAPTER TWO

THE USE OF ICT IN HOSPITALS

The specific advancements that computers have brought to everyday hospital life can be seen in four different categories: clinical implication, administration, research, & community settings.

Clinical Implication

In clinical implication, computers are used for:

• Assessment
• Patient Monitoring
• Documentation
• Telemedicine
• Electronic Medical Records (EMR)

The use of computers in assessment helps in gathering and storing data about the patient. ICT are used in settings such as emergency, intensive care, ICCU, and the NICU for vital sign monitoring, calculations of cardiac output, and even pulmonary artery pressure. This allows the focus to be solely on the patient and helps in the comparison of a patient's present condition to earlier conditions. ICT are also useful in documenting nurses' observations. Computer programs either offer nurses a library of common phrases that they can pick to describe the patient's condition, or they are offered a series of questions that they answer to describe the patient's condition. There is also documentation on the computer that lists on a patient's discharge sheet all the personnel that worked on their case.

In the category of telemedicine, the internet on computers is used to transfer medical information for consultation, examinations, and even some small medical procedures. Electronic medical records (EMR) have increased the efficiency of hospitals by making patient information readily available and saving office space for the storage of records. It has also eliminated illegible handwriting, decreases on data-entry errors, and automatically connects related records. Through means of security, only authorized individuals have access to medical records. The computer even keeps track of the history of those who have visited certain records. Most significantly, EMR has dramatically reduced the need for paper and storage services.

Administration

In the category of administration, nursing administrators use computers to define the cost of nursing services. Programs such as Excel and Quickbooks allow hospitals to calculate the total cost of the services they are providing. These programs would also help with the comparison of the net values of money coming in and going out, and ensuring balance between the two. Computers help in the calculating of paychecks, the respective salaries of all workers, and the respective taxes to be taken out of each salary. This same financial system also keeps track of the bills the hospital needs to have paid. All of these items above would assist in the administrators making sure that the medical care they are giving their patients is as cost effective and efficient as possible.

In addition to costs, computers evaluate quality assurance programs. These programs ensure that all the methods and procedures of the hospital are in proper installation. Computers additionally help to justify new roles for nursing in the health care system. This essentially means that the job of a nurse is enhanced through duties on the computer in addition to their medical duties. So, computers are facilitating the nursing process. A job that used to be strictly hands on is now branching out to the technological.

Research

In research, we can use computers for:

• Preparation of a research document
• Data gathering
• Computer assisted instruction
• Simulation
• Tutorials

The invention of computerized literary databases has extended the field of research in medicine immensely. These databases allow for a rapid search and the retrieval of countless abstracts of literature immediately. There are also tools in the computer search that limits the search to a specific topic or author. Once this information is obtained, computers help with the formatting and revision of research documents. This cuts down on the time taken in research projects significantly. Most of the journals that medical personnel's research would appear in are also online, initiating the ironic cycle that research has with computers.

Computers are also essential in research on the bases of teaching. A new form of learning is seen in online classes. This is a system in which the teacher communicates information to the student by means of the computer, without any direct contact with the student. Online classes also take advantage of computerized video systems. They can more easily convey their topic through posted videos on their prospective sites. Learning is also assisted by online tutorials and simulated real life situations, which assist with quick decision making.

Community Settings

In community settings, we use computers for: gathering statistics, patient-appointments-identification systems, home care management, and automated remote patient monitoring. The types of information that hospital computer's possess are anything from classification of diseases to the geographical location of patients treated. Computer use in gathering statistics allows for accurate documentation in a compiled, summarized, and meaningful form. The information can even be organized in graphs for deeper understanding. The patient appointments-identification system of the hospital is a means to increase efficiency in areas such as waiting rooms. The advantages include minimizing waiting time, smoothing the load of appointments, and establishing patient priority.

The computer also assists in home care management. This includes personal medical plans for the patient that are stored in computer memory banks. These plans assess the personal care the patients would do for themselves such as monitoring prescriptions and other activities. The banks on the computer can also be updated for the best possible care to the patient at the present time. The computer is helpful in the area of automated remote patient monitoring. It is most often used on patients with pacemakers or other coronary conditions. An example of this system is an electrocardiogram.

MERITS of ICT IN HOSPITALS

1. Improved Quality of Care

Automated hospital information systems can help improve quality of care because of their far-reaching capabilities. An example is the HELP system, which is a complete knowledge based hospital information system. It supports not only the routine applications of an HIS including ADT, Order Entry/Charge Capture, Pharmacy, Radiology, Nursing documentation, ICU Monitoring, but also supports a robust decision support function. Use of the HELP integrated system showed that the risk of wound infection decreased significantly when antibiotics were given in the 2 hours before surgery at LDS Hospital in Salt Lake City. Also, the HELP system detected 60 times as many adverse drug reactions in patients as the traditional method at LDS Hospital. The computer-detected reactions - 95 percent of which were moderate to severe - occurred in 648 patients over 18 months. Given this information, one can argue that decision support withing the HELP system improved:

• Data interpretation
• Patient Diagnosis
• Clinical Protocols

In addition to alerting physicians to abnormal and changing clinical values, computers can generate reminders for physicians. For complex issues, computer workstations can integrate and use patient records, knowledge databases, and research plans. Investigators have shown that Physicians reminded electronically were twice as likely to give vital shots and vaccinations like the flu vaccine to patients at a high risk during the winter in a 3-year trial by Indiana University investigators. When creatinine levels rose in patients, the computers sent an alert message to physicians, which allowed them to act quickly in the treatment of patients. Nonetheless, computers provide physicans and healthcare providers worldwide an easier method in which they can treat and care for patients.

2. Decrease in Costs

When a healthcare provider orders a test by computer, it can automatically display information that promotes cost-effective treatment and testing.

          Computers also allow the use of a paperless, electronic system. Not having to print out test results, test information, appointment information, etc. could significantly decrease paper waste and, in turn, save trees and money. Also, with computers comes electronic mail. E-mail is a great tool when sending out information. In a healthcare setting, it could benefit patients and healthcare providers alike by keeping appointment dates organized and easy to access. If a patient communicates with a physician through the Internet, it could reduce the percentage of in-office visits. People will reduce instances of having to go for an actual visit to the clinic, saving time and money.

3. Patient Knowledge

          Computers allow patients to grasp a visual perspective on their health. Radiographs, x-rays, and several other visual representations could aid in patient knowledge of their own health. These systems create a more advanced way of recording, analyzing, and understanding a patient's situation. Without the advanced technologies that a computer creates, both patients and health care providers are not as informed as they could be with a computer's help. Along with visual representations, patients can use the Internet to help inform themselves of certain things going on in health care. Not only can users look up general information about their personal situation, but they can find answers to frequently asked questions for specific things that they are interested in finding information about.

          Computers provide an easier way to look up a patient's information if they ask for it. The alternative to that would be having to rummage through papers that could have gotten lost or misplaced. Clearly, that is not the ideal scenario. Patient portals make it easier for individuals and caregivers to address individual health and healthcare because they can enhance the quality and the frequency of health-related communications. Computers can help patients become more informed about certain prescribed drugs and treatments, as well. Patient knowledge is a very important thing and, without computers, patients would be much more ill-informed.

4. The Internet

          The availability of the Internet has brought significant changes to health services. The fact that the number of elderly people in the U.S. and other industrialized nations is rising is beginning to put pressure on health services. There are not enough resources to take care of the elderly without the Internet. This increase in the elderly is one reason for the increase in home care. With "Internet access available to everyone and the advent of wireless technologies, advanced telehomecare is a possibility for a large proportion of the population" (Herzoga, 2003). New developments, such as "network technologies that connect sensors and input devices in the patient home to a home health care provider" made home care for even gravely ill patients a possibility.

          In one study, it was found that it's possible to hook monitors in the patient's home to the health care provider via the Internet. Because this is possible, health care for the elderly has improved.

          The data that the monitors gather reflects the patient's condition. Then, that must be transmitted quickly and accurately to the health care provider. The only way it can be done is via the Internet.

5. Patient Accessibility

          Through the use of computers in healthcare, patients are able to be more pro-active in their lifestyle choices. Using applications to track their daily activities and improve healthy decisions, computers help patients navigate their lives in a beneficial manner. For example, the current app "Fitbit" allows users to track their sleep and physical activity throughout the day with suggestions on how to improve themselves. Additionally, social networking is involved in which users can be motivated to interact with other users as inspiration or encouragement. Other apps allow consumers to count the calories consumed throughout the day or look up nutrition content for nearby restaurants. By taking advantage of these computer applications, patients are taking the steps to a safer and healthier lifestyle.

          Without computers utilization for doctor and patient communication, all interaction must take place in the office or over the telephone. Computer usage allows doctors to be able to stay in contact with their patients more often and thoroughly by communicating through technology. Not only can doctors check up on patients, but they can also provide them with suggested material to access. This material can be used during surgery recoveries or treatment processes. Furthermore, taking advantage of computers provides another option to patients for contacting hospitals and doctors' offices with important questions instead of having to go to the ER. Communication is expedited as well as expanded upon between doctors and patients when computers come into play.

DEMERITS OF ICT IN HOSPITALS

1. Digital Divide among Patients

          Hospitals need to be accessible to all types of patients regardless of one’s socio-economic status. There are still individuals who do not have a smartphone or even a computer to contact through e-mails on updates on a faster pace. According to research of Hospitals and Health Networks (2009), hospitals with high percentage of poor patients that lag behind in developing digital technology than hospitals with low percentage of poor patients that it is difficult for administrators to change their system to become more digital. This issue of the digital divide could potentially lead to health care disparities.

2. Security Issues

          On the internet, there is just about anyone who could be reading any documents that is being put on there. It is important for hospitals to respect and reserve their patients’ privacy. Adesina (2011) states that securing data over a mobile network is challenging that the medical information is not stored in a private software drive. Anyone could potentially tap the information of a mobile phone, especially with the Patriot Act, which could potentially turn into potential controversey. The Patriot Act is an act that allows the government to tap phone calls when there is suspicion of terrorism. If an individual accidentially get involved in an issue that could possibly relate to terrorism the government could easily look into your medical records or just about any information that an individual put on the internet. Also, there are certain individuals that could potentially take advantage of individuals who are sick that are technical savvy enough to tap into phone lines.

3. Lack of Information Control

          There have been many complaints and concerns from hospitals that there are lack of control of how an individual could get access to certain information and who could potentially get a hold of other people’s information.  According to Heron (2010), technology have gotten advanced to a point where anyone could possibly collect large amounts of information without people’s knowledge. This issue has lead to many concerns over confidentiality of one’s private information. Heron (2010) has stated that confidentiality information on mobile technology is limited by requiring passwords. Anyone can potentially tap into one’s phone on accident which could potentially lead to many problems

4. Safety

          Hospitals have to abide by laws to protect patients from giving their patient’s personal information to the wrong people. There are many ways people could potentially get access to one’s information if anyone in the hospital takes pictures, texting to other people about patient’s information, or any other individual could potentially tap into any hospital employee phone. If everyone has all their information on-line, if a computer system shutdown occurs on a hospital’s computer, it would be difficult for administrators to get a hold of the information needed for their doctors. If a computer system shutdown occurs it would be difficult for individuals to trust technology and to keep track of everything that has occured medically especially if the patient goes to the hospital consistently.

5. Privacy

           The main issue with mobile technology is that it is challenging for health administrators to use mobile technology taht the hospital requires many privacy laws. Knox (2007) states that about 65% of companies are using software to block sites. However 35% of companies is a lot of companies that are not being strict on medical privacy which could lead to many problems for patients and their families. Patients may want their certain individuals in their lives like their boss to not know about their health conditions which could be a disadvantage on their jobs or family members that could take advantage of the information that the patient does not wish to share with. According to Avancha (2012), hospitals have strong regluations like the Health Insurance Portability Accountability Act (HIPAA) that requires confidentiality between patients and their doctors. HIPAA also emphasizes protecting personal health information from health care providers and requires to protect health information in electronic forming protecting, monitoring, and controlling organizational access

CHAPTER THREE

CONCLUSION

It is impossible for a hospital to function without technology computer. Icts helps in various fields and sectors of the Hospital- functioning, patient management, Doctors scheduling etc. Every day, hospitals and clinics churn out enormous volumes of data, comprising the details of the patients such as ailments, prescriptions, medications, medical billing details, etc. Thanks to computers, such medical records are nowadays recorded using the medical billing software, and stored into databases known as Electronic Medical Records (EMR) and Electronic Health Records (EHR) .

RECOMMENDATION

I recommend that medical schools include training on basic computing skills in the curricula; hospitals and health authorities should support the acquisition of personal computers by employees and more research should be done into factors that play an important role in computer use among doctors in developing societies.

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