Critical Thinking
There is no arguing over the pervasive role of technology, especially information technology, especially in the field of medicine and the health sciences. A major area of health information technology (HIT) is biomedical informatics, which is the interdisciplinary technology field that synthesizes biomedical data, information and knowledge and relates them to scientific inquiry, problem-solving and decision-making with the end in view to impact positively on human health (Hsu, Markey and Wang, 2013). Biomedical imaging informatics (BMII) emerged as a subfield of biomedical informatics that tackles all concerns of biomedical informatics, including the social and behavioral considerations in the design and evaluation of technical solutions, from the perspective of imaging. Imaging provides insights on the cellular and molecular aspects of disease and improves accuracy and reproducibility of image interpretation. Accordingly, BMII is one of the fastest-growing research areas due to the evolution of the techniques in molecular, anatomical and functional imaging and advancements in imaging biomarker generation (Hsu, Markey and Wang, 2013). This began with the advent of radiologic imaging systems such as CT and MRI that saw the need for a digital and film-less approach to acquiring and interpreting images. Imaging techniques span the range from microscopic and molecular to whole body visualization and applies to many areas of clinical medical practice such as radiology, pathology, dermatology, obstetrics and gynecology, and ophthalmology. It is widely touted that BMII offers great potential to effectively diagnose disease, tailor optimum treatment, track and monitor disease response and predict outcomes (AMIA, 2014).
In this paper, we focus on the role and impact of health information technology in general and biomedical imaging in particular in present-day clinical practice of physicians.
According to Deloitte in its annual Survey of U.S. Physicians (2014), health care reforms, health plans and consumers are the key market forces that speed up awareness and adoption of health information technologies (HIT) in medical practice. Technology has transformed the delivery of health care systems around the world. HIT in its many forms has proved to be the cornerstone of that transformation. Among the variety of forms of HIT are electronic health records (EHR), patient support tools, fuzzy medical technologies and mobile health technologies. According to the Deloitte Survey, physician interest in HIT especially mobile health (mHealth) technologies, Meaningful Use (MU) and EHR, is strong and the most cited benefit is access to clinical information. 9 out of 10 physicians are interested in mHealth technology and say that it has clinical value. Deloitte (2014) profiles the 1 in 10 disinterested physicians to be older, established their clinical practice the longest and are solo or independent practitioners.
Benefits of HIT
Among the chief reasons for the adoption of HIT in clinical practice is that it increases patient safety, result to better patient outcomes and decrease medical cost that leads to savings of millions of dollars. At the clinical level, decision-making in the treatment and management of patients and their diseases is greatly aided with HIT. For example, research undertaken by Per Gesteland, M.D. (2010) for the University of Utah has sought to tap a population health repository and decision support tools in order to provide timely and accessible information about the local incidence of common respiratory viruses. The research developed Germ Watch which is a reporting system for pediatric respiratory infections that imports data from all Intermountain Healthcare (affiliate of University of Utah School of Medicine) system practices. Accordingly, the reports display pathogen-specific data presented in graphs on the Web site with a user interface to select for age ranges, pathogens and regions. The idea behind the research project was to refine this system and further integrate it into clinical workflow. Clearly, there is greater push to integrate web systems and computer-based technologies and enhance HIT insofar as clinical practice is concerned. The central idea behind the use of HIT is knowledge generation and creation while the strategic goal is to develop and spread HIT evidence and evidence-based tools to improve health care decision-making through the use of integrated data and knowledge management (AHRQ, 2010).
Several arguments are in favor of EHR. EHRs, defined as electronic record of patient health information generated in any care delivery setting, contain information on patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data, and radiology reports (Menachemi and Collum, 2011). Among the basic benefits associated with EHRs include easy access to computerized records and the elimination of poor penmanship in medical charts. EHR systems have three particular functionalities viewed to hold great promise in improving the quality of care and reducing costs at the health care system level: clinical decision support (CDS) tools, computerized physician order entry (CPOE) systems, and health information exchange (HIE). These are among the requirements of the “meaningful use” criteria set forth in the HITECH Act of 2009 (Menachemi and Collum, 2011).
EHR-based tools allow practitioners access to patient information and patient care that enable them to better adapt their practice workflow in managing their patients’ conditions.
Clinical transformation and performance improvement are the key results of HIT (ONCHIT, 2013). In addition, EHR was originally conceived to improve the monitoring of patient care and patient management. Among the potential benefits of EHR include clinical outcomes (improved quality and reduced medical errors), organizational outcomes (financial and operational benefits) and societal outcomes (improved ability to conduct research, improved population health and reduced costs). In the interview with AAMC Reporter (2012), Dr. C. William Hanson observed that while technology has enhanced safety and the ability of doctors to treat patients, it has not always resulted to lower costs and ease workloads. This was especially true with the first-generation EHR which promised to ease workloads in clinical practice but failed to deliver on this metric. The evolution of technology and its role in medicine and clinical practice remains grounded on its promise to be a cost-effective system for both practitioners and patients.
Downside of EHR
As discussed earlier, the impact on costs of implementing EHR systems remain a grey area. EHR systems have been found to be associated with high acquisition costs, ongoing maintenance costs and disruptions to workflows that contribute to productivity losses that come with the learning curve syndrome. Specifically, EHR systems have potential privacy concerns among patients, even as these are addressed in the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 (Menachemi and Collum, 2011). The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, which is part of the American Recovery and Reinvestment Act (ARRA) (known as the stimulus package), was signed into law with an explicit purpose of giving incentives to providers (hospitals and physicians) to adopt EHR systems.
Deloitte Survey of Clinical Practitioners
Among the notable findings of the Deloitte Survey of Physicians (2014) are as follows:
- mHealth (HIT) is useful for accessing clinical information during patient encounters, researching specific diseases, conditions, interventions and prescription medications and engaging in continued medical education or staying current in health care.
- Physicians are not convinced that monitoring patients’ conditions is a benefit of mHealth even as consumers are interested in the technology to monitor and manage health issues. Security and privacy are a concern for both users and non-users of mHealth.
- 3 out of 4 physicians report EHRs increase costs and do not save time but 70% say they provide useful analytics and 60% maintain that EHRs support value-based care. 68% of physicians believe that Meaningful Use (MU) does not increase productivity, 58% say MU does not differentiate their practice among consumers and 48% view MU as unsupportive of care coordination.
Bibliography
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American Medical Informatics Association. 2014. Biomedical Imaging Informatics. Retrieved from http://www.amia.org/programs/working-groups/biomedical-imaging-informatics.
Association of American Medical Colleges. April 2012. Technology Meets Clinical Practice to Transform Medicine. AAMC Reporter. Washington, D.C.: AAMC. Retrieved from https://www.aamc.org/newsroom/reporter/april2012/279210/smart-medicine.html
Deloitte. 2014. Deloitte Survey of U.S. Physicians: Physician Insights on Health Reform, Health IT and the Future of Medicine. Retrieved from http://www2.deloitte.com/us/en/pages/life-sciences-and-health-care/articles/center-for-health-solutions-us-physicians-survey-health-information-technology.html.
Hsu, William, Markey, Mia K. and Wang, May D. 2013. Biomedical Imaging Informatics in the Era of Precision Medicine: Progress, Challenges and Opportunities. Journal of American Medical Information Association Volume 20, Issue 6. Retrieved from http://jamia.bmj.com/content/20/6/1010.extract.
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