ADVANCED PRACTICE THROUGH HEALTH INFORMATICS
Development of electronically linked patient records or Electronic Health Record schemes (EHRs) is a priority for governments in many countries, including Australia, as part of a vision for future health care services using call centers, web-based patient information and telehealth. Scientific knowledge and technology related to health care are rapidly increasing. Rapid advancements in science and technology, along with investor dollars, have created major advances in medical care. These emerging technologies in medicine, which were increasingly housed in hospitals and physicians’ offices laid the groundwork for the coming shift in the way health care was delivered.
The world of healthcare in Australia is increasingly reliant on information technology (IT). Information technology can contribute significantly to quality improvements in healthcare institutions. There are difficulties associated with implementing information technologies, but they are not insurmountable.
Electronic communication is widely used nowadays. The growth of electronic communication options presents both opportunities and challenges. E-mail and secure web-based portals offer patients better access both to their physician and to applications where they can review their medications and correct errors, request prescription refills, make appointments, retrieve laboratory results and view radiology images.
Nursing informatics is the vehicle that enables evidence of the effects of nursing interventions to be linked with the outcomes of care in relation to the problems identified for a specific patient or groups of patients. Nursing informatics addresses the management and processing of data, information, and knowledge to support nursing practice and the delivery of care.
Nursing informatics is defined as a combination of computer science, information science, and nursing science designed to assist in the management and processing of nursing data, information, and knowledge to support the practice of nursing and the delivery of nursing care. The integration of computer science, information science, and nursing science requires a sustainable technology infrastructure to achieve nursing goals related to quality patient care ( 2004).
Nursing science includes evidence, guidelines, research, knowledge generation, knowledge integration, decision making, and integration. Management of the outcomes of nursing care that contribute to nursing science is accomplished through the use of information systems, technology, and databases. Literacy in these areas of computer science and information science is a basic and fundamental requirement for nursing informatics competency (2004).
Information technology has dramatically changed the way health care professionals, especially the nurses, work. It is clear that advances in technology and the Internet have transformed consumer and professional access to information and have influenced changes in public policy and the public’s role in its health care. The public’s expectations are presenting both challenges and opportunities for professionals and communities addressing health issues. Patients will identify more health information online and will take more responsibility for their care. Nurses and other health professionals will assist patients to assess the quality of information (2004).
One of these advances in technology is the increasing use of electronic health records (EHR) and health informatics in health care settings. This paper will attempt to analyze and discuss the potential benefits to patient outcomes of EHR on oncology/cancer patients.
Many health care organizations around the world are using EHR in storing patient data. Based on literature, the reason for this increasing use is that it saves cost and patient data is easier to access. International standards organizations and the electronic health record (EHR) advocates recognize the need for each healthcare profession to capture its data/documentation electronically (2004). But there are also downsides to the use of EHR. The most important of which is the problem of privacy of the patients.
The original vision of the EHR encompassed a mainly virtual, computer-based medical record that would include all information, clinical and administrative, and would cover all practitioners involved in a person’s healthcare over that patient’s lifetime, including all medical specialties and even prenatal and post-mortem information. Such a vision would require standards of full interoperability consisting of complex system interoperability, terminology and architecture, in addition to a number of functional requirements (2004). The most important benefit of EHR systems is to minimize those healthcare encounters where practitioners are uninformed about a patient’s history and recent treatment.
Comprehensive electronic patient records are finally becoming reality, helping providers reduce costs, expand accessibility, and promote quality health care. Basically, data captured from medical equipment is integrated with IT systems to give health care professionals real-time access to lab results, pharmaceutical information, patient histories, test results, medical images, and all other pertinent clinical data anytime, anywhere (2001). Certainly, patients will see the efficiency of not having to give their name and date of birth five times to five different people on the same day in one hospital.
One of the great improvements in practice that an EHR enables is the ability to manage chronic illness in a proactive, organized fashion. Many physicians and health care professionals without EHRs take a passive approach: They wait for patients who are chronically ill to show up at their practice with an acute problem, and then they address any chronic disease issues at that time or reschedule the patient for another visit dedicated to the chronic illness. This approach has several disadvantages when you think of your patient population as a whole. It neglects patients who rarely visit the practice and delays chronic disease management until the patient arrives at your doorstep (2006).
In order to facilitate the international development of standards in health informatics, the electronic health record (EHR) has been defined very broadly as “a health record in computer processable form.” Despite the recognition of differences between national and regional health systems and of different healthcare contexts and disciplines the International Standards Organisation (ISO) recommends a generic electronic health record reference model for all healthcare disciplines (2004).
Benefits from the electronic record for cancer patients include increased capture of charges and improved patient care, attributed to safety checks requiring a physician’s treatment review and electronic signature before radiation commences. Plus, the system enables the radiation oncology department to analyze information and generate reports like never before (2002).
For EHR systems, a critical consideration is how to provide patient care when the EHR–or portions of the data–is unavailable to those who need to make medical decisions. If a clinician must make a decision in an emergency care situation without all the facts, how will this affect the way medicine is practiced? Certain tools can be made available in physical form or perhaps in an “offline” mode. For example, practitioners can rely on reference books if available, but they lose access to automated features that rapidly correlate drug therapies or interactions with a specific patient’s existing medications or allergies when electronic systems are down (2006).
Implementing information systems in healthcare organizations poses a series of challenges. These include complexity, human acceptance of IT, data security, and data quality and standards. In light of these challenges, some argue that no other industry invests as little in IT as the healthcare industry. Most hospitals and physicians still rely on outmoded paper records organized by visual color codes, alphabet and number (1998).
The increasing use of IT in the healthcare systems also has drawbacks. Ensuring the integrity and confidentiality of patient-related data is a major requirement of healthcare information networking strategies. The availability of easy and rapid electronic transmission of patient information to various organizations at different locations increases the risk of violating confidentiality. Because of convenience and efficiency, staff may forget to consider the privacy implications. Rather than improving healthcare quality, IT could reduce patient satisfaction and the quality of care. Confidentiality is especially problematic in the management of suspected child abuse cases, psychiatric cases and for patients with AIDS (1998).
The problem of sharing information is one that the use of EHR faces. The problem of confidentiality and privacy could also be applied to cancer patients. Taking into consideration that cancer patients are in a difficult time, they would of course want to keep things in private. Don’t all patients wish that?
Patient records constitute an essential building block for health care’s information management capabilities. Unfortunately, patient records vary widely in form and availability, offer varying degrees of quality, and have not yet reached their full potential. Although genuine progress is being made, most patient records do not meet the current information needs of health care professionals. In this era of health care reform and in this information age, the inadequacies of current patient records (both paper and electronic) are all the more pronounced, as even greater information management demands loom on the horizon and better technologies are within our grasp (1994).
patient record systems will support the information needs of the full range of legitimate users (including physicians, nurses, and other caregivers; patients; administrators; third-party payers; and researchers) and will become the core of health information systems both within and beyond health care organizations (e.g., regional health databases or information systems). If patient records and record systems cannot meet the needs of all users in terms of content and function through direct access or linkages to other information systems, we will continue to experience expensive proliferation of redundant information systems and wasteful duplication of data gathering and entry. Connectivity, data format, and data content standards must be met for systems to meet the needs of all users. Moreover, users must understand that the patient record is a resource for improving the effectiveness and efficiency of clinical processes and procedures, that complete and accurate data offers benefits well beyond the individual patient, and that information management (including record-keeping) is a critical component of the health care delivery process (1994).
There are currently a number of initiatives in Australia and internationally that are aimed at sharing patient data among healthcare providers, as well as other third parties. In the mental health context, without proper clinical documentation the patient is denied rights to a full and accurate record of diagnosis and treatment, and the therapist has no evidence of the diagnosis and treatment given for both immediate and future uses (2004).
Electronic health records, and in particular those that are shared outside their creation boundary, need to be retained for the lifetime, and possibly beyond the life of the patient to provide healthcare continuity and accountability. In fact, current electronic health record models refer to the “longitudinal” record that can be either a single encounter or any length of time. Any loss of accessibility to, and intelligibility of, the records and the loss of the original functionality of the data during transfer to a new technology or accidental loss due to media failure affects the integrity of the records and must be minimized (2004).
There are a number of initiatives in Australia and internationally that are aimed at sharing patient data between health service providers, as well as other third parties including researchers and health administrators (2002). Federal health initiatives share patient clinical data via summaries (if not the actual records of clinicians) from the health service providers’ source records on the basis of “demographics” such as names, addresses and other personal details of the patient, medical practitioner and health facility. The shared record is created from a point of care source system to which patients must consent and which is accessed by authorized persons (I2004).
Technology standards like electronic information and other tools have significantly increased healthcare costs. Strongly associated with technological advances is also the issue of how quickly new treatments are made available to the general public (1993). Although of course this is beneficial for the consumer, this would mean increased healthcare cost on their parts. Indeed all these advances have helped improve health care services for the consumers, but it also added extra payment or cost on their part. The choice should be the optimal combination of inputs to produce a specified level of output at the lowest cost.
Quality improvement data must be reliable and valid in order to measure performance and change within a healthcare system or to make comparisons with other organizations. The electronic transfer of health-related information inter-departmentally and, in particular, interorganizationally has been hampered by the slow development of standard clinical guide, lines and nomenclature. Electronic sharing of information is difficult. In some hospitals a 24-hour stay is classified as an inpatient episode while other hospitals classify it as outpatient care (1998).
The Benefits of Electronic Health Records Electronic health records, or EHRs, are appealing for a number of reasons, including convenience, availability, and portability. The most compelling reason to use information technology in health care is that it helps us provide better, safer, more consistent care to all patients.
Reviews of statistics consistently have pointed out that medical practice can be improved by reducing the medical errors that occur during treatment. Errors may be based on incomplete medical records, transcription mistakes, or failure to correlate medical histories with current treatment decisions. The effective use of automation can allow practitioners at every level to make decisions and treat patients to the best of their abilities (2006).
The lack of patient-specific physical records during any automation failure will severely impact a practitioner’s ability to deliver high quality care. Many procedures require the physician to consult radiological studies during the procedure. The absence of this capability to check the studies mid-procedure changes how a physician or surgeon may need to complete the procedure. Many treatments involve frequent monitoring of laboratory results to adjust medication levels, something that is hindered if the automated systems are unavailable ( 2006).
EHR systems make it far easier for users to review the digital information in real-time and to take advantage of automated diagnostic tools that help practitioners to quickly pinpoint irregularities. When planning for disasters or failures, those charged with this responsibility need to consider those who electronically access medical histories and test results and the levels of efficiency, productivity and the quality of patient care they need to provide ( 2006).
Many elements will contribute to the success of national EHR standards, including acceptance by multiple commercial vendors, efficient automated system interfaces to populate the records and maintain data integrity, and support and compliance with all applicable healthcare regulations. When planning for disasters in the age of EHRs, organizations need to consider external and internal authorized users of the electronic health records and their requirements for accessing data.
Vigilant security officers and others need to prepare for the very real possibility of unauthorized users breaking into systems and creating havoc. Organizational leaders must realize that EHRs will inevitably fail, and determine how to maintain access to critical data and systems. Finally, organizations must decide how practitioners can provide patient care when the EHR is not available for making clinical decisions (2006).
Literature specific to the relationship between the use of EHR and outcomes in cancer patients is scarce. Based on existing literature by far, there is no evidence that points out directly that the use of EHR can improve the lives and health outcomes of cancer patients. Perhaps it can speed up things but it does not necessarily mean that patient outcome will be better. Perhaps the quality of care could be better too but the health of the cancer patient would still not improve depending on the EHR. It would still be dependent on the drugs and therapy suited for the cancer of the patient.
Electronic information systems can help ensure that patient safety is being considered in the development of new drugs and this would include the drugs that are used for the treatment of cancer. The initiative involves using electronic information systems to analyze vast amounts of data that can then be made available to the medical community (2004). In this way, the use of technology can also help cancer patients.
The use of EHR can also help in the provision of services like support groups to cancer patients. This would allow for a more continuous flow of processes. One study has utilized the help of EHR in conducting online support groups for breast cancer patients.
If the oncology department of a hospital would utilize the latest technology at its disposal, then it would be much better not only for the health care professionals but also for the cancer patients themselves. Treatment options could be done with the use of EHR. Chemotherapy, radiation therapy and radiation surgery could be chosen based on data available and provided by the electronic records.
The fact that using EHR can reduce medical errors can also be beneficial to cancer patients. Who would want to be prescribed with the wrong drug or advised the wrong treatment? No one would like that, most especially those who have a terminal illness. There is no room for errors, most especially in the treatment and care of cancer patients.
By using EHR, cancer patients will soon have full and continuous access to all notes in their personal, electronic medical record offering them the opportunity to suggest amendments, to disagree with their doctors’ views, and to point out and correct errors.
All in all, the use of electronic health records and health informatics can help the cancer patients in some ways, but this does not necessarily mean that their health will be restored. Perhaps, the use of EHR can help chose specific treatments and drugs suited and can make it easier for both the health care professionals and the patient. The potential effect of EHR therefore only constitutes better and improved quality of care for the cancer patient, not necessarily improved health status.
An EHR will give health care professionals direct access to a person’s medical history. It would allow the provider to electronically manage all aspects of patient care, enabling the provider to retrieve/capture data for treatments in an effort to support provider-patient activities such as review, encounter, and follow-up. In addition, EHRs allow patient data to be accessible at multiple locations. Possible benefits of an EHR include improved health maintenance, disease management, and error reduction in clinical decision support.
An electronic cancer record can support patient care across organizational boundaries and could be used as the means for quality control of cancer care by clinical audit and monitoring of national standards.
The observed changes have many potential explanations. Efficiencyof outpatient care may have been increased by the readily available comprehensive clinical information. This conclusion is supportedby the shifting frequency distribution of visits, the increaseduse of phone contact in lieu of a visit, and doctors’ consistent observations across the two regions that electronic health records enabled them to identify and resolve patients’ health issuesin the first contact or with fewer contacts.
Despite perceptions of improved quality of care after electronic health records were introduced, we found generally stable andonly occasionally improved performance on selected measures.Both regions are high performing, which may make it more difficultto identify marginal quality improvements. At a minimum, wecan assert that electronic health records and the resultingeffects on usage do not reduce the quality of care and may infact increase appropriate use of healthcare services.
The use of EHR helps facilitate the cancer patient’s care process during what can be a very traumatic time for patients and their families. It somehow helps as a safety net during the traumatic experience. The use of EHR simplifies the patient care, audit and reporting process.
The use of health informatics in the care of a cancer patient provides timely and reliable clinical information to facilitate continuity of care and offers evidence to support service in order to ensure that consistent quality of cancer services are being offered. Information systems could provide benefits to health care professionals by improving the information flow and supporting communication between health care professionals.
Today efficiency, productivity, and quality of health care depend very much on the information technology which is applied in the patient care process. Providing people with cancer timely access to their health records and information can enhance their ability to understand their condition and engage in shared medical decision making with their health care provider.
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