Trends in Medical Informatics and Health Care Delivery

ICT1 pixMedical or Health Informatics is an interdisciplinary field of scholarship and activity that applies computer, information, and cognitive sciences to enhance the delivery of healthcare, support biomedical research, and foster education of health professionals and the public.  It is at the crossroads where data, information, and knowledge meet be they focused on a gene, cell, organ, individual or group.

Health Informatics is also an applied field that effectively broadens the skills and career potential of healthcare professionals in medicine, nursing, dentistry, pharmacy and veterinary medicine as well as those with strong backgrounds in computer and information sciences.

The study of health informatics leads to new problem solving techniques, analytic methods, system thinking, and familiarity with technology tools that can be creatively applied to build and evaluate systems and tools that address the needs of healthcare delivery, biomedical research and education.

The World Health Organization (WHO) acknowledges the fact that all countries at all levels of development are faced with the problem of generating, analyzing, summarizing, reporting and communicating health information.

While the trend in most advanced countries is in the direction of electronic record keeping, most health institutions in Africa continue to adhere to a manual health records keeping systems. Studies conducted on the manual record system reveals that it is not a satisfactory way of keeping medical records. It has been found that patients’ records were often misfiled, misplaced or lost.

Other challenges with the manual records system as noted by the WHO include the failure to retrieve the relevant medical record information; physicians’ failure to locate required information due to misinterpretation of codes, terms and format; illegibility of handwritten requests; failure to update records promptly; complaints from frustrated doctors; lost/missing records, and inability to access information on specialized media.

Because one of the aims of a health care information system is to provide effective patient care, the management of medical records is crucial in the delivery of health services. Both Hippocrates and Florence Nightingale recognised this fact in their days. Nightingale, for example, lamented on the absence of reliable medical information on the causes of death in the Crimean War and its impact on proper diagnosis.

Society has come far since the days of Hippocrates and Nightingale. Today, the impact of the information revolution has affected all segments of society. This has led to the emergence of a division in medical record keeping, medical informatics, the science that deals with information management in the health care sector.

How do we facilitate the incorporation of medical informatics in our health care system? The importance of electronic record keeping in the health care sector was highlighted by the first international conference on Health Informatics in Africa (JELINA) organised by the International Medical Informatics Association in 1993 at Ile-Ife, Nigeria. HELINA 93 established an electronic bulletin board (for the African health informatics community.

A second HELINA conference was organized in Johannesburg, South Africa in 1996 to further explore the role of medical informatics in health care delivery in Africa. The conference highlighted on the need to acquire knowledge and skills to enable medical practitioners employ new tools in medical informatics in their practice.

In spite of this initial attempt to create awareness and sensitivity around the importance of electronic record keeping, research, and training in the health care sector, few initiatives have been implemented to bridge the digital divide in the health care sector.

The World Bank Information for Development program (Info Dev) is playing an advisory role to encourage effective infrastructure development in healthcare in developing countries. A Regional Information Technology Training Center (RITTC) has been set up in Kenya by SatelLife and HealthNet.

This goal is to assist African countries to develop their health care information systems. SatelLife is now using handheld computers for a variety of purposes in diverse environments. Also, known as Personal Digital Assistants (PDAs), their use is very widespread in most Western hospitals.

African governments have a major role to play in assisting African medical institutions modernize their healthcare systems by introducing information technology to replace the manual-type system.

The cost of the technological infrastructure needed to make the conversion is huge. Governments should dedicate a portion of the health budget to addressing the medical infrastructure gap. Already, African governments have committed a sizable percentage of their budget to health care. But, there is the need to do more.

One of the key innovations brought about by the information society is the notion of intermediation, the process of creating a new or online middleman, and disintermediation, the process of eliminating the middleman from the supply chain. Intermediation has brought about the creation of new titles.

One is the office of the Chief Information Officer (CIO), the person responsible for managing all the information in an organization. There was no title with this description before the advent of the information society. Given contemporary trends in medical informatics, the time has come for medical establishments across the continent to set up another executive desk, the title of the Chief Medical Information Officer (CMIO).

While persons with information technology background could be recruited to fill this position, the ideal candidate for this position would be a physician with expertise in medical informatics. The office should be directly involved in planning, implementation, and operation of electronic medical records (EMRs), and other medical databases.

The CMIO could assist their medical institutions to achieving a fully automated paperless health information system that seeks to provide instant accessibility to the patient’s medical record from birth to death.

Could we move in the direction of having every citizen on the continent have an electronic medical record. Having a database of this nature will improve upon patient care and ensure the timely availability of medical data.

We should all be strong advocates of the spread of IT throughout the health care industry.

Dr. Osei K. Darkwa

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