Health Care Informatics

LESSON 14 Paper vs. Electronic LECTURE NOTES ______________________________________________________________________________________

Evolution of Information Systems in Health Care

The health care profession has used paper-based record systems since the early 1900s, first by

the health care professions as a mandate for professional standards and then by the organizations

paying for care and by governmental entities. Since that time, health information systems have

evolved to become highly sophisticated and specialized record-keeping systems. However, it

took nearly 90 years to develop this level of effectiveness. While there are limitations and issues

with paper-based systems, they certainly have been tools that allowed for the timely and accurate

recording of the care and condition of patients.

The development of computers began in the 1940s and were simple systems that used vacuum

tubes and were housed in boxes the size of a living room. With the invention of the transistor,

the computer began to shrink in physical size. As electronic engineers experimented with this

new technology, computer systems began to evolve rapidly with the ability to put a transistor on

a micro basis in the silicon chip.

The physical size of the computer continued to be reduced, but the cost of the hardware was still

too high for smaller organizations. Most of the software that was available required high levels

of expertise and special knowledge. It was the creation of the micro-computer that drove the

cost of the units down and allowed for wide-area adoption of the technology.

Hospitals and other health care organizations began to more widely adopt electronic technology,

primarily in the accounting and finance departments as a solution to the information needs of the

organization. Financial software became widely available for business purposes and was readily

adopted by health care entities since numbers are just numbers. Little or limited specialized

software was developed and used by health care entities. Using the technology for health records

was probably considered and even used in some settings, but only if the software was available.

However, most of the software was customized for the organization and was very expensive to

develop.

As the size of the hardware was reduced and software evolved to become more user friendly, the

value of computers began to be seen by many organizations and professions. It was the

development of software that pushed the expansion of computers into the public mainstream.

Computers started to become a tool to manage large amounts of data in a small space and

manipulate that data in ways that had never been done so quickly.

The development of the Internet and broad access to that system by the general public created the

tipping point for the further explosion of computing. The Internet was developed as a tool for

large government and academic entities so they could transmit information between each other.

As it became available to the general public, it was readily adopted for home and small business

use. Access to information, e-mail, games, personal software, etc., all came into use, and the

high demand for Internet access expanded rapidly. Connection to the Internet transformed into a

necessity of daily life.

Use of Computerized Systems in Health Care

In the early 1990s, the Institute of Medicine (IOM), a research and think-tank organization,

evaluated the current paper-based health record with the potential of using electronic technology

to record, compare, and manipulate patient data. The IOM report suggested that an electronic

health record could create a number of functions that would enhance the care and outcomes

delivered to a patient.

The IOM report created the potential for eight core functions that the technology could perform

that would be an enhancement to the health care delivery system. They saw the ability to create

a defined data set of information that would give researchers the ability to assess treatment

outcomes and create evidence-based practices. They also saw the potential for error reduction

and enhanced productivity in recording information by using a computerized provider order

entry (CPOE) system and a decision support system that would provide access to best practices

(Dick & Steen, 1991).

This IOM report started three decades of research by the IOM and other research-based

organizations on the value of the electronic health record, including the 2009 health care reform

legislation (H.R.1, 2009) that mandates the adoption of this technology as a means to reduce both

errors and costs. Much of the strategy to “bend the cost” curve of health care is being driven by

the expanded adoption of electronic health information systems.

There are a number of key items that the technology will need to consider to allow the reduction

of errors, provide enhanced productivity, and lower the costs of health care. These functional

issues are factors that will determine how information systems are developed.

First, a standardized and mandated protocol for the format of patient information needs to be

created and adopted. If every health care provider is left to determine how the information will

be recorded and saved, the ability to compile information for separate systems will be

compromised. While it is the decision of the provider on how the data might be used internally,

the ability to share information from provider to provider on a patient is essential if duplicate

services are to be eliminated and conflicting treatments are to be prevented. A number of

organizations and entities are creating standards, including HL7 and CCHIT.

Another area similar to the protocol for transmitting information is the adoption of a standardized

coding system, which is referred to as nomenclatures. This assures that the terminology used is

the same from location to location, which again provides the ability to conduct comparisons.

The systems used include SNOWMED-CT and MEDCIN.

The adoption of both of these key standards provides for consistent inputting of health

information by each entity, which is a critical factor for quality improvement purposes and to

achieve reduced costs. This consistency allows for the accurate transmission of health

information to other providers, third-party payers, and governmental entities.

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WORKS CITED

Dick, R. S., & Steen, E. B. (1991). The computer-based patient record: An essential technology

for health care. Washington, DC: Institute of Medicine, National Academy Press. (Revised

1997, 2000).

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Congress. (2009-2010). H.R.1: American recovery and reinvestment act of 2009. Title XIII

Health Information Technology for Economic and Clinical Health, February 17, 2009.