Governing Medicine: Theory And Practice (National Health Informatics Collection)

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Get to Know Us. English Choose a language for shopping. Electronic records present information on past problems as well as the current complaints, some relevant data may not be as easily identified on the summary sheet as they will be on a screen. Today in the United Kingdom, the quality and outcomes framework of the general medical service relies heavily on the electronic processing of coded health data.

If information needed is not available in the right time and format, they will be costly or useless. Complete and accurate data recording becomes more important when a different member of healthcare team needs to know what information is already known or deduced about the patient. The sharing of electronic medical records between different healthcare providers is essential for reading and updating them. The digital nature of these records enables them to be shared early, easily and cheaply.

In the United Kingdom, general practitioners tend to have the most comprehensive record including information sent from hospital records. The long term intention of current work is to provide a single EHR. Effective integration of EHR depends on establishing a workable unique personal identification system such as the community health index number CHN o [ 6 ][ 16 ] and the National security number used in the United Kingdom. What data to enter, for how long should it be kept, with whom should it be shared, how and when? Such issues and more have to be clear in dealing with EHR.

This is covered by strict security protocols and predefined access levels according to a list of rules and restrictions. The presence of an electronic version of medical records enables the physicians to regulate their working times, schedules and self-prepare for patient contact, for example by reading his medical record, searching for more data or read about a new drug.

The presence of a computer and internet access in the clinical environment facilitates, with some regulations, access to online medical literature, e-journals [ 17 ], clinical guidelines and patient education materials. EHR are valuable sources of information; applying statistical studies on them is very cost-effective, as they are already collected.

Their digital format enables them being easily analyzed and computed. The disadvantages of retrospective studies bias, archiving errors, lost data and those of prospective studies time, effort and cost consumption are brought to minimum, allowing wider scale studies to be performed with more accurate and reliable results. Evidence based medicine is the integration of clinical expertise with the best available external clinical evidence from systematic research.

Undergraduate education, postgraduate training and continuing professional development are traditional routes of knowledge. Unfortunately, these traditional sources are relatively inefficient. Prompts and reminders at the point of health care are useful aids to an overworked human brain for certain tasks. Intelligent systems, using either artificial intelligence, or sometimes simple rules, can monitor, analyze, and prompt doctors in their decision-making. Future advances in artificial intelligence will allow such systems to support almost all levels of medical practice, from clinical work, establishing diagnosis computer aided diagnosis CAD [ 22 ] to health administration guidelines and decision-making.

Some health professionals are worried that using such electronic aids may reduce patient's trust in physicians, but research evidence is to the contrary. As the internet culture invaded the public consciousness during the s, the internet, being an unprecedented source of information has been used as a health-education and knowledgedissemination tool. People who have health-related concerns have the motivation to seek knowledge related to their concerns, if they are satisfied, they could even avoid a consultation.

Today, searching for a disease on Google for example would return in a few million pages in less than half a second. Health-related internet public services provide a wide range of services that include Consumer information services, online support groups and online medical advice and diagnostic services. These provide general health and wellness information for general or targeted population e. They are expected to provide well-chosen, scientific, patientoriented up to date data.

The American Cancer Society website [ 25 ] is an example, provides a wide range of contents for cancer patients. Some physicians provide explanatory materials in their personal websites.

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Explanations in the form of diagrams, images, and videos are often simple and appreciated by patients. Other more detailed [anatomical and pathological] explanations can be also provided. Online support groups are community websites providing a virtual lodge for psychological support, shared patients' experiences and open discussions. These are very popular but only a few are moderated by health professionals. These provide a more interactive service, under health professionals' supervision.

Answering specific questions submitted by site visitors, dealing with individual cases, booking for a consultation etc. A lot of practitioners now provide this service from their personal homepages or over e-mails. Some websites provide contract-health services for specific patient [or set of patients] that are covered by an insurance plan or are employer for a covered institution.

These services can take any form that the online and computer technology can provide. Telemedicine is thus, from definition, covered by the term e-health, but it has a special category because of its semi-dependence and high costs. The above definition theoretically includes simple telephone calls between two physicians, medical TV show, or an interactive medical website. In asynchronous or store-and-forward system, the information is captured and stored in one side, then forwarded via telecommunications to another site; a good example is the e-mailing system.

In Synchronous or real-time systems, ideally both the physician and patient [in telemedical language, the healthcare service provider and the costumer] can hear and see each other video conference , the physician can also access the patient's health file and can deal with a wide range of devices starting from electronic stethoscope, ECG monitors, up to controlling MRI radiograph systems.

This technology has been tested in ICUs and emergency medicine departments too. Recently, telesurgery enables surgeons to operate remotely through robotic systems. Telemedicine thus consists of four components; [ 32 ] technology peripheral devices, computers…etc… , connection internet, satellite…etc… , people physician, technicians, patient and protocols under which they work medical, medicolegal and technical. The success of the process depends on the implementation of all the four components in the right manner.

The tele-exchange of health information can take many forms according to who is using and how is the usage of this information; Figure 7. This typically involves a consultant or a specialist assisting a GP in rendering a diagnosis or treatment. Recent surveys showed a rapid increase in specialties and subspecialties that have successfully implemented the telemedicine in its practice.

Other specialties include teledermatology, teleophthalmology, telepsychiatry, telecardiology and telepathology. Almost another 40 telespecialties are already established. This is telecommunication between the patient himself and a healthcare provider; it is suitable for answering simple questions, follow up treatment etc. This is not used widely but has been successful in telepsychiatry and telenursing. This includes the usage of electro-medical devices to collect and send patient's health status data to the health care provider.

Home telemonitoring can improve the follow up of chronic diseases like heart diseases, liver disease and diabetes. Medical education Particularly continuous medical education CME has benefited greatly from advances in telecommunication systems, now seminars, conferences, lectures and discussion groups can be made in real-time with members all around the world.

Through the integration of the above applications of e-health and telemedicine, a great change can be made in health practice, with a lot of advantages towards directly and indirectly a better and more reliable health care system;. The system provides a more professional work environment, scheduling time and regulating the work. The staff will have easy access to medical sources and records, easy search and adequate informations about their patients; this provides a better physician-patient relationship and a more specific management.

Physicians will be able to recognize the pattern of their work, [ 18 ] the reliability of drug regimes they prescribe, risk prediction and disease prognosis for particular patients. The standardization of guidelines and the usage of clinical prediction rules [derived from the patient case] assist the physician to improve the expected outcomes.

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Teleconsultation, CME, virtual conferences, up-to-date materials will all be a matter of minutes. The staff will also have more secure medicolegal coverage, through predefined working protocols. There is a long list of difficulties that face establishing e-health systems, the following represent the main issues;. Health administrators will not be the only decisionmakers and they will have to discuss all details with the new partner.

This can be inconvenient or even annoying. Adoption of e-health appears to be limited by cultural and attitudinal inertia, and resistance to behaviour changes within the healthcare system. Depending on a third partner also, increases the risks of whole system malfunction, computer breakdowns, software bugs, networking troubles, security issues and compatibility are few troubles that could result in disasters if not managed before they occur. While the cost of technology continues to plunge, it is still beyond the reach of many.

Infrastructure, hardware, software, installation and maintenance of the system on one side and operating, training, and hiring staff on the other, contribute to high costs that may be unaffordable for the limited funding provided for health sectors. Implementing these technologies in a health system with no or poor guidelines is just like driving a car in streets with no traffic lights.

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Electronic health services are backboned by minds not by computers. Extensive implementation of computer technology in the health field needs trained staff. Apart from technicians and operators, all medical and paramedical staff should have minimally a basic level of knowledge so that they are not prevented from using the service. Education empowers physicians and the public to start using the electronic services provided for them. This is one of the complicated issues; time, effort, and money are to be spent, but the compliance of the staff remains a tough barrier on many occasions.

Shifting from paper to paperless work and electronic recordings in medical field requires a similar change in the medicolegal laws and practice. The issues of insurance, malpractice, medical responsibility and work-threatening technical error should be all supervised and regulated by e-health law. Licensing the telemedical practitioners is needed too. This is further complicated by the need for regulatory technical standards security, access, identification and policies.

Sharing electronic health records for epidemiological research, statistics or studies needs the patients' agreement [and maybe consent on who and how will use it. This should be performed under strict regulations and supervision. Developing countries are facing dire health crises due to lack of basic health services. Major threats to public health stem from a shortage of health professionals, health education and out of date clinical practice. Although information and communication technologies cannot solve these problems single-handedly, they have the potential to improve the healthcare status of these countries by delivering informations and services from developing countries over political boundaries to developing countries.

Trials involving teleconsultations [ 51 ] and remote education [ 53 ] showed promising results. These technologies also create an internal infrastructure that ensures maximum benefit from these imported informations. It may come to a point where there is a globalized health system based on the dissemination of health knowledge everywhere equally and effectively using the information and communication technologies. Delivering ehealth to developing countries faces different health and socio-economic challenges to developed countries. What is the value of up-to-date health informations in the absence of abilities to implement them?

And are information and communication technologies efficient means of improving public health knowledge and wellness when infrastructure, literacy, language [ 56 ] and other factors limit effective access these technologies? Ready answers are beyond the scope of this article, and probably not ready anywhere soon,[ 56 ] but it is to state that some established projects aiming for health information delivery from developed countries are being developed, a good example is the Euro-Mediterranean Internet-Satellite Platform for Health medical Education and Research EMISHER.

Changing the way of medical practice, introducing a new partner in the health sector and modifying the laws under which it works, with a high cost of money, time and effort seems a tough equation versus performance, while the main goal of e-health is increasing the performance. On the other hand, worldwide experience in these projects proves that the right way of implementation gives promising, outstanding results.

Better information management in the health field can dramatically upgrade the process and improve the outcome. E-health is an already established field with a lot of applications worldwide. It is the future of health practice and, sooner or later, it will become a mandatory partner in the health systems all over the world. Advances in ideas and inventions in this field are making very good progress and a lot of useful applications are being added every year.

Public health education and assisting them using these technologies is another key for improving the community health status with low costs. Despite the critical status of health services in developing countries, electronic health services can participate in raising the quality and availability of health care services.

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Apart from the high initial costs and tough obstacles implementing these systems, outcomes are satisfactory and rewarding, provided the system is implemented in the right way. National Center for Biotechnology Information , U. Journal List Libyan J Med v. Published online Dec 1. Mounir M Khalil 1 and Ray Jones 2.

This article has been cited by other articles in PMC. Abstract Information and communication technologies have made dramatic changes in our lives. Introduction Information plays a major role in the practice of health at all levels. Open in a separate window. Methods and Materials The data were collected from medical literature about health informatics, electronic health services and telemedicine; theories, researches and trails. Hospital Information System HIS The integration of electronic patient records with other databases like pharmaceutical work, administration informations, schedules, financials, peripheral services in a hospital is part of the Hospital Information System HIS.

Data feeding While human brains are able to analyze and extract informations from free text comprehensive data , computerized devices have limited ability. Data interpretation The digital nature of the electronic medical records enables a wide range of presentation formats and a wider range of usage. Data sharing If information needed is not available in the right time and format, they will be costly or useless. Side services The presence of an electronic version of medical records enables the physicians to regulate their working times, schedules and self-prepare for patient contact, for example by reading his medical record, searching for more data or read about a new drug.

Evidence based Medicine EBM EHR are valuable sources of information; applying statistical studies on them is very cost-effective, as they are already collected. EHR make most of the service automated, and most information is ready-on-demand. Intelligent support systems Undergraduate education, postgraduate training and continuing professional development are traditional routes of knowledge. Public services As the internet culture invaded the public consciousness during the s, the internet, being an unprecedented source of information has been used as a health-education and knowledgedissemination tool.

Consumer information services These provide general health and wellness information for general or targeted population e. Medical advice and diagnosis services These provide a more interactive service, under health professionals' supervision. Forms of telemedical services The tele-exchange of health information can take many forms according to who is using and how is the usage of this information; Figure 7.