Computers in health care

Definition

Once used primarily as back-office record keepers and financial calculators, computers and their networks now play increasingly significant roles in patient care. They are increasingly used by health-care practitioners for patient information, record keeping, communicating with colleagues, devising strategies for patient care, interpreting lab results, and research. The fast processors and large memory capacity of today's computers, along with the Internet and other networks, have expanded the role of computers into virtually every aspect of health care.

Description

From the moment a patient walks into a hospital, doctor's office or clinic, computers are involved in his or her care. Patient information is often entered electronically to generate an electronic chart. Some organizations integrate this information with practice management software, helping staff schedule patient procedures and manage the financial matters.

Computer workstations in exam rooms can now allow clinicians to access patient information, lab results, and educational material. Electrocardiograms and other lab and radiology tests are often analyzed initially by computer programs to save staff time. Some radiology departments have begun to use digital "filmless" imaging technologies, and computers are even slowly entering the chaotic environment of the operating room, where perioperative nurses use workstations to document procedures.

Computers are being used to help avert medical errors—a critical need, since, according to an Institute of Medicine report important, an estimated 44,000 to 98,000 Americans die each year from preventable errors. Computer systems in some hospitals monitor patients in intensive-care units or operating rooms, alerting clinicians to anything abnormal, such as a sharp decrease in hemoglobin levels, for example. Instead of writing prescriptions on paper, some clinicians now use computerbased systems that not only suggest drug dosages but

check for allergies and interactions as well. Some clinicians also use handheld computers to enter patient notes and check medical references.

In addition to computerizing individual hospital departments, computers are being used to tie disjointed departments together and to standardize health care information over the entire industry. Aside from promising monetary savings and improved efficiency, such departmental integration is expected to help hospitals adhere to insurance company and government requirements. The federal Health Insurance Portability and Accountability Act (HIPAA), designed to protect confidential health care information, has pushed health care organizations to use consistent standards in their dealings with patients and insurers. Such standardization also promises to improve research by allowing scientists to track public health records more accurately and to better identify both treatments for, and causes of, disease.

The Internet has quickly become an integral part of health care. Patients can check their medical records , research drug interaction information, or find information on clinical trials and experimental medical treatment. Health care practitioners use the Internet for research, to gain continuing medical education (CME) credits, and to check patient information. To help manage this information overload, several websites provide customized health information and access to research tools such as the National Library of Medicine's Medline/PubMed, a search engine that provides access to millions of citations from research journals. The Internet can also educate people about disease prevention and help them adopt a healthy lifestyle. Specialty websites, whose topics range from mental health to infectious diseases, allow individuals to conduct disease screenings and lifestyle and quality-of-life assessments.

In addition, government health organizations, such as the Centers for Disease Control and Prevention, use the web to provide public health information to state and local health departments, health professionals, and the general public. The World Health Organization (WHO) and its member organizations have created a vast global computer network called the Library and Information Networks for Knowledge (LINK); the agency also supports an electronic database called WHOLIS. Both the library and the database support the WHO's mission to improve international public health. Once a communicable disease outbreak has been confirmed, for example, information is placed on the web for the general public.

Several Internet applications can even provide telemedical services, such as long-distance mammograms to underserved women. Other applications help patients suffering from chronic diseases such as asthma , diabetes, and heart disease to monitor their conditions. Still another computer program allows diabetics to download data from a blood glucose meter, enter information about their medications, diet, and symptoms, and transmit this data to healthcare providers.

Viewpoints

Although computers have improved patient care, administrative efficiency, and disease tracking, their increasing use also poses several challenges. Consistent, standardized data coding is one example. Maintaining patient privacy is another concern. In an electronic world of integrated departments and shared databases, patient confidentiality can be difficult to maintain unless great care is taken with sensitive patient information (like HIV status or drug-abuse history), and staff is trained to protect the confidentiality and security of patient information. Another consideration: making sure technology is reliable enough to be trusted. Poorly designed pharmaceutical software could result in drug errors, for example.

Professional implications

Nurses, who have traditionally gathered, stored, and maintained patient information, have an especial need for computer training. Even beginning nurses should have basic word processor, database, spreadsheet, and E-mail skills, according to a panel of researchers affiliated with the American Nurses Association (ANA). As computers become ever-more integrated into patient care, disease prevention, and health promotion, as well as into medicine's administrative processes, nurses need information literacy as much as they need computer literacy. This means that they must be able to recognize when information is needed and know how to track down and use it appropriately, according to the ANA panel.

Reflecting this shift, some nurses have chosen to augment their training with courses in nursing informatics, a field that was officially recognized as a specialty for registered nurses by the American Nurses Association in1992. This specialty is a combination of nursing science, information processing theory, and computer science.

Resources

BOOKS

Ball, M. and K. Hannah, eds. Nursing Informatics: Where Caring and Technology Meet. New York: Springer- Verlag, 2000.

Saba, Virginia K., Kathleen A. McCormick, eds. Essentials of Computers for Nurses: Informatics for the New Millennium. New York: McGraw-Hill, 2001.

Shortliffe, E., and L. Perreault, eds. Medical Informatics: Computer Applications in Health Care and Biomedicine. New York: Springer-Verlag, 2001.

PERIODICALS

Pravikoff, D. "On the Information Highway, Or Sitting on the Curb?" Journal of Nursing Education vol. 39, no. 3(2000): 99-100.

ORGANIZATIONS

American Association of Critical-Care Nurses (AACN), 101 Columbia, Aliso Viejo, CA 92656. (949) 362-2000. <http://www.aacn.org>.

American Association of Nurse Anesthetists (AANA), 222 South Prospect Avenue, Park Ridge, IL 60068. (847) 692-7050. <http://www.aana.com>.

The American Health Information Management Association. 233 N. Michigan Avenue, Suite 2150, Chicago, IL 60601.(312) 233-1100. <http://www.ahima.org>.

American Nurses Association (ANA), 600 Maryland Avenue, SW, Suite 100 West, Washington, DC 20024. (800) 274- 4ANA. <http://www.nursingworld.org>.

AORN, Association of Perioperative Registered Nurses, 2170 South Parker Road, Suite 300, Denver, CO 80231. (800) 755-2676. <http://www.aorn.org>.

Emergency Nurses Association (ENA), 915 Lee Street, Des Plaines, IL 60016. (800) 900-9659. <http://www.ena.org>.

National Student Nurses Association (NSNA), 555 West 57th Street, New York, NY 10019. (212) 581-2211. <http://www.nsna.org>.

OTHER

Gawande, A., and D. Bates. "The Use of Information Technology in Improving Medical Performance." Medscape General Medicine. 2000, vol. 2, no.1. <http://www.medscape.com>.

Kohn, L., J. Corrigan, and M. Donaldson, eds. To Err Is Human: Building a Safer Health System. Committee on Quality of Health Care in America, Institute of Medicine2000. <http://books.nap.edu/catalog/9728.html>.

Legal Issues for Physicians. American Medical Association, Office of General Counsel, Division of Health Law. <http://www.ama-assn.org/physlegl/legal/patient.htm>.

Scope of practice of nursing informatics and the standards of practice and professional performance for the informatics nurse specialist. American Nurses Association Expert Panel. <http://www.nursingworld.org/practice/1207fl6.doc>.

Ann Quigley