Information Technology in the Future of Health Care

P1: IZO Journal of Medical Systems [joms]

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Style file version June 5th, 2002

C 2004) Journal of Medical Systems, Vol. 28, No. 6, December 2004 (

Information Technology in the Future of Health Care1 Myron Hatcher2,4 and Irene Heetebry3

Technology advances have changed the face of health care. This paradigm shift blurred the boundaries between public health, acute care, and prevention. Technology’s role in the diagnosis, treatment assignment, follow-ups, and prevention will be reviewed and future impact projected. The understanding of shift in our expectation for each aspect of health care is critical so that levels of success are understood. Technology advances in health care delivery will be discussed. Specific applications are presented and explained and future trends discussed. Four applications are defined, and related to categories of technologies and their attributes. KEY WORDS: information technology; networking; decision models; health care applications.

INTRODUCTION In 1918 the influenza epidemic was raging throughout the world. Dr Hatcher’s grandfather, Dr Drake, was a physician in rural America. Dr Drake lived in Grand Rapids Ohio, which is along the Maumee river (30 miles from Toledo, Ohio). Dr Drake had an office in his home as well as on the main street of the town. Dr Hatcher’s mother discussed how she would go out on house calls with her father during the epidemic. Normally a person would walk or come by mule to fetch Dr Drake. Telephones were available only to those who could afford them. Across the river was Providence, Ohio, that was severely hit by the epidemic. A Model T Ford would be prepared and Dr Drake and Dr Hatcher’s mother would head out. If they were going to Providence, they crossed the river via a shallow area since the bridge was washed out in 1913 and had not been replaced. The influenza epidemic of 1918 had a morbidity rate of 312 per 1000 people. The mortality rate for the population was 22.8 per 1000 people. If you got influenza 1 Presented

at the Annual Meeting of INFORMS: Institute for Operations Research and Management Sciences in Atlanta, Georgia, October 19–22, 2003. 2 Information Systems and Decision Sciences, 5245 N. Backer Avenue M/S PB7, Craig School of Business, California State University, Fresno, California 93740. 3 Kaiser Permanente, Fresno, California. 4 To whom correspondence should be addressed; e-mail: [email protected]. 673 C 2004 Springer Science+Business Media, Inc. 0148-5598/04/1200-0673/0


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or pneumonia the mortality was 75 per 1000 people. The authors calculated these figures from the cited article.(1) Dr Drake and his family had been in the area since 1912 and he knew the families and the cultures of the area. He knew who could be trusted to care for family member, and just how compliant the family member would be. The medical records were a limited paper system with much of the information in the doctor’s memory. In order to have a better feel for the era, let us discuss payment for services and training. People were very proud. There was limited insurance and people paid for their care. Family history has it that many medical bills were paid with the likes of a bag of potatoes, fresh game. The point is that people paid for their services somewhat according to what they could afford. For a perspective, the School of Medicine at The Johns Hopkins University accepted their first graduating class in 1893. There were other university’s schools of medicine as well as independent schools of medicine before this date. Hopkins transformed medical education, practice of medicine and medical research. Rigid entrance requirements for medical students, upgraded curriculum with emphasis on the scientific method, bedside teaching and laboratory research were the approach used by the School of Medicine. The integration of the School of Medicine with the Hospital through joint appointments made the hands on education possible. During this period, many physicians also learned their profession by apprenticing. Dr Drake took dissection from Ohio Medical University in Columbus, Ohio, in 1903. He then attended Toledo medical College and graduated in 1910. He did his residency at Toledo Hospital. He worked with a physician in Lima, Ohio, before he and his family moved to Grand Rapids, Ohio, in 1912 to take over a practice from a retiring physician. Information technology has made rapid advances in the last 100 years. This paper discusses some of these advances. Four applications are outlined and these applications represent what is happening in health care delivery. It is important to understand what categories of technologies and their attributes are utilized by each application. This understanding also highlights what categories of technologies have not made their way to production applications.

LITERATURE REVIEW Health care delivery has been a fertile area for technology applications and research for over 50 years. The authors had difficulty in listing a few sources to represent the history of quantitative methods and information systems in health care because of the abundance. Therefore, the authors listed researchers and suggested that each interested reader conduct his/her specific literature search. Charles Flagle, John Young, and Rogar Parker from The Johns Hopkins University; Harold Smalley from George Institute of Technology; Ralph Gram for University of Florida; and CW Churchman from Berkeley, California. Following is our attempt to provide an overview of the development of quantitative thinking in health delivery.


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History of Decision Making Technology Decision making technologies have developed and been applied in health care. These include decision making, group decision systems, expert systems, video conferencing, etc. The primarily purposes of these decision systems are planning and decision making.(2−4) Given that few, if any hospitals, have used group decision support systems, the approach used is to determine the reason why face-to-face meetings are used for decision making.(5−7) Reasons for using face-to-face meetings in decision making include enhancing participation, encouraging acceptance, increasing the quality and quantity of ideas generated, promoting cooperation among participants, and preventing domination of the group by special members. Various articles explore using information systems in decision making. Hatcher and Connelly present a decision support system (DSS) for negotiating hospital rates.(8) Within the DSS, the decision-maker and the computer system form one closed loop system and a decision is reached in an iterative manner. Martin and Harrison used an expert system for health care cost management.(9) Jeang developed a staffing model that meets patient needs efficiency economically and remained flexible to meet changing patient demands.(10) The model considered both full- and part-time staff and provided administration with a budget management tool. Turban does an excellent review of DSS in health care.(11) Hatcher, Green, Levine, and Flagle present a model for triaging hypertensive patients into health education treatments based upon a psychological profile.(12) Shao and Grams designed a computer diagnostic system for Malignant Melanoma.(13) The information system’s model components are described in detail. Grams, Zhang, and Yue provide an excellent overview of medical diagnostic in their discussion of MDX—A Medical Diagnostic Decision Support System.(14) Sear develops a model for determining medical eligibility of Medicaid patients.(15) This article demonstrates the contributions of a through system study and understanding the parameters and dynamics of the system. Once the medical eligibility system is understood, it became clear why consumers behaved in certain ways. Martin and Harrison used an expert system for health care cost management.(16)

History of Techniques Stevens and Rasmussen discuss remote medical diagnosis and its impact on access to health care.(17) The area of remote assistance has not developed for various reasons. First the improvement in microcomputers has allowed complex diagnostic systems to be at any location. Second, the liability to the practitioner is extensive and for a provider to diagnose a patent without physically being together has not been resolved. Gram was a pioneer in this area, and extended the field via work with NASA.(18−20) Artificial intelligent (AI) software improves the ability to identify medical disorders as Strong, MacPherson, Schultz, and Hanchak developed a software program that can identify women with carcinoma of the breast from prior claims in a health maintenance organization (HMO) database.(21) The prediction rate was approximately 84%. Kaspari, Michaelis, and Gademann used neural network in


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radiotherapy to predict the target volume of detected tumors.(22) Walczak and Nowack developed an application for diagnosing epilepsy using neural networks.(23) They review the application of neural networks to medical diagnosis in great detail. The process of the system learning and validation provide insight into the utilization barriers. Aleynikov and Micheli-Tzanakou developed a system to classify retinal hemorrhage based upon images.(24) This neural network system achieved a training performance of over 95% and a 79% operational performance. Papaconstantinou and associates utilized an expert system based upon Bayesian networks for assigning patients into clinical protocols.(25) As is more common with decision support systems, the system directed the physician interactively in the process. Zelic, Kononenko, Lavrac, and Vuga used a Bayesain classification method for diagnosis of sport injuries.(26) Knowledge was extracted from medical databases to develop the rules for identification of sport injuries. Expert-defined diagnosis rules were added because of limitations of the medical database. Unique information was obtained from each individual in the classification process. Another extension of diagnosis and treatment assignment is patient management. Austin, Iliffe, Leaning, and Modell developed a prototype DSS that manages asthma patients.(27) The system is based upon rules of thumb and is applied in the primary care setting. Modai, Israel, Mendal, Hines, and Weizman developed a patient management system for psychiatric disorders.(28) A neural network, which is an AI system, employed the system theory adaptive resonance. Results were favorable when compared with senior psychiatrists’ recommendations. An important problem in health care is prioritizing alternatives that impact resource allocation decisions. Hatcher discussed this issue in-depth and placed it in the context of a group DSS.(29) The analytic hierarchy process (AHP) is used to prioritize alternatives where both qualitative and quantitative data can be used. Kwak and Lee developed a goal programming (GP) model for resource allocation within health care organizations.(30) Specifically, employees are assigned to shifts based upon criteria. Kwak, McCarthy, and Parker applied AHP to laboratory personnel assignments.(31) They believe that their model assists in understanding perceptions, insights, and general realization of health care decision making and strategic human resource planning. Vitiello and Levary developed a simulation model that forecast the appropriate mix of physicians in a health maintenance organization (HMO).(32) Changes in population demographics and lifestyle can be studied with the model and their impacts determined. Another important field in medical decision making is simulation or uncertainty inclusion. Potential applications are varying demands and policy analysis. Simulation modeling is difficult and often is combined with decision support systems design.(33) Hatcher and Rao reviewed decision support systems and simulation in planning a health promotion center. This approach allows staffing and rate setting questions to be answered before implementations.(34) Hatcher applied uncertainty to staffing and rate setting in a health promotion center.(35) Bulter analyzed patent care policies using simulation.(36) Shuman, Wolfe, and Gunter applied simulation to emergency medical systems.(37) Lilienthal discusses more advanced uses of the Internet and decision making applications.(38) Defense Simulation Internet (DSI) are sites that


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allow decisions such as emergency medical needs to be evaluated. Access is limited and secure; therefore, sensitive management topics can be evaluated. The Internet The current growth of the Internet where Internet is concerned is the search for knowledge. This search includes a wide array of purposed from simple information, diagnosis, chat sites, ratings of health care systems, and providers. Craan and Oleske list the reasons individuals visit web sites, most viewed web sites, and criteria for evaluation of information on web sites.(39) What the authors accomplish is a new dimension to health care delivery that might be called Interactive Internet Health Care (IIHC). This new entity includes both risks and benefits. The benefits fall mainly in the area of health education and early detection. The risks are primary unproven medical approaches that could cause more harm. The Internet is becoming the media for health care delivery. The article by Matsumura outlines the integration of hospitals, families, and government support agencies.(40) This paper’s contribution is a view of the future where a holistic approach to health care delivery is part of the framework. Most people start using these technologies with e-mail for interpersonal communication and secondly for information acquisition and entertainment. The use of both e-mail and information acquisition and entertainment features decline from initial levels; however, the decline in web usage is faster. The greater use of e-mail versus the web indicated greater longevity with Internet utilization.(41) These results indicate that effective software training and encouragement for e-mail use are the correct policies. Given the potential for increased productivity, health care businesses need to encourage their employees to use the network technologies. Computer-mediated communication can improve communication over telephone and face-to-face conversation. With computer-mediated communication, there is less distortion of negative information. There is no difference with positive information. People also report a higher level of satisfaction and comfort with computer-mediated communication. The quality of the relationship between the sender and receiver effected the satisfaction with the communication medium; however, relationship quality did not effect distortion.(42) The health care industry is very sensitive to communication and the ability of the receiver to hear the message. The field of Health Education is based upon this goal along with the goal of accuracy of the message. Computer-mediated communication, primarily via intranet, has tremendous potential in health care for the patient. The area of remote access for health care, primarily via Internet, could lead to a paradigm shift in health care delivery with increased ability to feedback medical findings and recommendations. If health care products and services are viewed as products that people purchase, a different view of the value proposition is needed. The medium of delivery, Internet versus face-to-face communication, will affect the value of the product to the customers. The importance of the product affects its value. If it is for pleasure such as a fine book versus for health, the customers will have a different view. Health care products must be viewed from the customers’ value proposition for this industry to fully utilize the Internet.(43)


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Studies of the Internet retailing and conventional retailing indicate that prices are lower and price differences are less in Internet channels when adjusted for market share. Branding, awareness, and trust are important sources of heterogeneity with Internet retailers that explain price variations and sales.(44) These factors are important in health care, where customers pay a portion of the cost. Demand and consumption can be extreme based upon heterogeneity and not medical needs. Given items or information that can be distributed electronically, provision of both free items and purchase items enhances the profitability to the company. Utilizing other distribution channels in addition to the Internet also enhances profitability.(45) The implication for health care delivery is that customers will use a variety such as the Internet, printed material, audiovisual and person-to-person communication. Some material needs to be free or have accompanying advertising and some material is provided with a charge. Continuous medical competency has always been a concern in health care. The current view and preferred method is having providers physically together for guaranteeing continuous medical competency. Telemedicine is another approach that integrated electronic communication and health care, which was pioneered by NASA. Telemedicine offers potential for medical education in rural hospitals.(46) Screnci, Hirsch, Levy, Skawinski, and DerBoghosian discuss teleconferencing between the United States and Armenia.(47) Educational conferences, peer consultations, and distance learning are a few of the activities conducted. Merrell provides a history and overview of telemedicine and its potentials in worldwide health care.(48) Ferguson, Doarn, and Scott provide a review of specific efforts taken worldwide and organizations that are involved in telemedicine.(49) Friedman discusses results from a control trial using telecommunication technology for the purpose of improving medical compliance.(50) The potential for a broad array of telecommunication technologies to have direct medical impact is tremendous. Patel and Babbs present a system to monitor patients convalescing at home.(51) A complete system design along with the results from a pilot study is provided. The ability for each patient to have a tailored treatment plan is possible with the application of AI concepts. Padeken, Sotiriou, Boddy, and Gerzer discuss remote patient monitoring with several specific applications.(52) The hardware is quite complex and the article offers excellent insight into future applications. Nagatuma presents a system that provides prehospital care using video coverage of a patient being transported by ambulance.(53) The system consists of two parts. One is the ambulance side and the other is the emergency hospital side. Various technical issues are discussed in detail. Telemedicine and medical informatics encompass a large number of applications and techniques. Thus, it is more of an integration of concepts of practices. Guler and Ubeyli provide an excellent comprehensive review of these fields and applications.(54) As medical informatics and telemedicine are integrated, information from remote or global database systems can be used in determining an individual treatment program.(55) This integration will lead to improved decision making and care. Grams and colleagues provide specific examples of how medical knowledge or informatics can lead to improved decision making.(56) Falas reviews DSS


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in medicine and telemedicine in particular.(57) Several applications are covered that include drug interaction and mobile access to the network. Prioritizing medical alerts was considered with various AI tools including neural networks. The future direction is platform-independent software. Puskin discusses many problems that have been encountered with telemedicine projects and many of these problems generalize to the Internet-based health care delivery systems.(58) Economic and infrastructure barriers to access are discussed and solutions proposed. Puskin and Sanders extent the prior discussion to infrastructure design, regulation, information needs, health care financing, and telemedicine evaluation.(59) The Telematics project in Bhutan is comprehensive and demonstrates what can take place with limited resources.(60) The sending of X-rays for analysis is one application. The Teleradiology Pilot Project provides medical consultation quickly that would otherwise be unavailable or extremely slow. These projects must parallel development of telecommunications and other basic infrastructures. Bashshur focuses on telemedicine and explains the interrelation of costs, quality, and access.(61) These economic arguments also apply to Internet health care delivery applications. Another difference between telemedicine and the Internet is the breath of those impacted. Telemedicine tends to focus on undeserved populations, and the Internet health care delivery applications will focus on the vast majority of the population. There are disadvantages with the use of network technologies in health care; the major one is security. This cannot be overlooked. If security concerns are not addressed the technology will not be used. Kobayashi, Goudge, Makie, Hanada, Harada, and Nose discuss filters and the prevention of computer worms and virus. They emphasize that special approaches need to be taken to protect medical records.(62) The reader is referred to the Mobile Health Care section for additional discussion of security. Intranet Intranet is a network system that is internal to a company and uses firewalls and gateways to limit and enhance access to the outside world. The cost efficiency comes from using software and hardware developed for the Internet. The health care industry is beginning to understand the potential and develop applications. Quality assurance programs are using the potential of intranet. The advantage of using software developed for Internet with local inputs and control is hard to imagine and measure. User acceptance was high for one quality assurance program in surgery.(63) Intranet will change our business culture and will have tremendous impact on our society. This is especially true when information is dynamic and calculations complex such as with visual or voice information. Bhargava discusses the fundamentals of Internet and details of how the net functions with a focus on application developers. Several management science models or applications are examined.(64) Trick discusses the customers, users of management science, about quantitative applications and how the World Wide Web has affected them. This discussion relates to similar concerns in health care delivery and offers parallel potentials.(65) These discussions are more


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appropriate for intranet and apply to the same applications, user involvement, and access issues. An area of great potential for hospitals is Electronic Data Interchange (EDI) via Internet. The intranet contribution is the gathering and organization of information. With computers making ordering decision and gateways providing Internet and intranet integration, the process becomes seamless. Normally, it reduced cost and therefore improved profit is the result; however, availability of medical supplies when needed is certainly an improvement in quality of care.(66) Shared information is becoming more important in supply chain management. Investments in information technology to accelerate and smoothen product movement from order entry to shipping are a preferred investment.(67) As product definitions change to include physical item, distribution channel, customer service, and warranty, information technology will become increasingly valuable. As information becomes available for smoothing out the production system, the theories of just-in-time production can be applied to health care delivery.(68) This will require intranet for information sharing via browser-compatible databases and Internet for ordering and distribution. Intraoffice communication can be redesigned to save time and increase productivity. Patient information, resource information, diagnostic information, and personal information need to be communicated over intranet, Internet, and MHC. Improved efficiency provided more time for patient care and increased workloads.(69) The use of predefined analysis and construction modules or responses can improve the efficiency and effectiveness of e-mail. This complex approach would be more appropriate for an intranet where all participants could have the same software and security procedures. The database linkages could allow for message storage and institutional history at a complex level. When the system is used over Internet, the power will be greatly limited.(70) The analogue is similar to Internet phones where both parties need the same software and a common server. New tools are being developed. These tools are seamless and employees from various companies or health care units can function as one health care delivery unit. The concept of virtual organization has become part of the health care landscape. Given the potential for increased productivity, businesses need to use every strategy for encouraging their employees to use the network technologies. Considering the patient for a moment, computer-mediated communication can improve communication. With computer-mediated communication, there is less distortion of negative information. Patient can be contacted in the health care facility or via Internet in their home or at any desired location. The integration of health care resources and information via intranet, Internet, and MHC will lead to a paradigm shift in health care delivery. The ability for rapid feedback of medical test results and patient comments will improve specialized patient treatment plans. Additionally, improvements in the AI software’s ability to provide patient care recommendation will improve patient treatment plans. Decision systems have advanced to incorporate intranet technologies and this has greatly enhanced their effectiveness, efficiency, and utilization. These systems include decision support systems, group decision support systems, GroupWare,


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electronic meeting systems, expert systems, etc. Virtual Integrated Practice (VIP) is similar to virtual teams and can remove the barriers of time and space from decision making.(71) A VIP was set up to manage chronic illness in patients in an outpatient setting. VIP can be quite effective for case management where various practitioners are integrated into the patient care. The goal is for technology to empower patients to take control of their health care. Medical diagnostic, treatment selection, and health education involve the customer or patient more directly in their own health care decision. Health care providers can use these systems in addition to patients. The questions of remote medical care, ownership of your health, and CDROM-based systems take on a new potential. The information system’s model components are described in detail. Grams, Zhang, and Yue provide an excellent overview of medical diagnostic in their discussion of MDX—A Medical Diagnostic Decision Support System.(72) Zelic, Kononenko, Lavrac, and Vuga used a Bayesain classification method for diagnosis of sport injuries.(73) Knowledge was extracted from medical databases to develop the rules for identification of sport injuries. Expert-defined diagnosis rules were added because of limitations of the medical database. Unique information was obtained from each individual in the classification process. As AI software improves, the ability to identify medical disorders will also improve. Patients will have greater access to software for self-diagnosis and treatment selection. Preventive health care programs can become more patient controlled with the assistance of the computer for monitoring and record keeping. Various decision models based on the patient’s computer or via a browser over Internet and intranet can assist the patient. The development of hardware support devices will provide another dimension of patient monitoring and generate information for decision models. As Mobile Health Care (MHC) become popular, the medical monitoring and advice provided to patients can reach a real-time level. Providers can use AI software for patient management, diagnosis, and treatment assignment, and the major advances are the integration of internal data and the addition of external data. Solin, MacPherson, Schultz, and Hanchak developed a software program that can identify women with carcinoma of the breast from prior claims in a health maintenance organization (HMO) database.(74) The prediction rate was approximately 84%. Kaspari, Michaelis, and Gademann used Neural Network in Radiotherapy to predict the target volume of detected tumors.(75) New information, because of the standardizations of the databases for intranet sharing, will allow more precise medical diagnosis. Hospitals, institutions, government agencies can share data and information, which was not shared before, and this integration will lead to new information and knowledge. Data mining software contains AI features. It allows existing databases to be examined and value-added products to be developed. In the future, hospitals will design and develop databases specifically for data mining and the value achieved will be even higher.(76) Data mining is one example of a tool that will become commonplace as intranet resources such as intranet- or Internet-ready databases are developed. Isken and Rajagopalan used data mining to gather information for determining patient profiles with a clustering algorithm.(77) The profiles were used for a patient–hospital


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bed occupancy simulation model. Ethics must be an issue as providers have this enhanced ability to access vast amounts of information for decision making and create knowledge. Mobile Health Care Mobile Health Care (MHC) will be a part of Internet and intranet such as wireless and portable devices. Patients carrying smart cards have valuable information that will be part of the network. Security offered by the smart card provides both confidentiality and privacy. Lambrinoudakis and Gritzalis provide an excellent overview of the technology and application.(78) Smart cards can improve physician productivity by virtue of the method and point of data collection and availability. They become part of electronic medical record systems that could be connected via networks. Decision Support Systems Software can be available via Internet or intranet for analysis of the medical information.(79) Data security becomes a larger problem because of the wireless access.(80) Frenzel discusses methods to secure wired networks and wireless networks including the pros and cons. He discusses current methods and their strengths and weaknesses. The realizations are that methods exist for increasing security with wireless access allowed; however, it requires planning and standards. Mobile devices such as wireless phones, pager, PDAs, etc., will become integrated in the health care delivery system both for the providers and the patients. Mobile Emergency Triage (MET) is a system installed on palm that is used for triaging children with abdominal pains.(81) This approach is a forerunner to future systems. Various AI tools are employed to solve medical problems where information is limited or only a minimedical record is available. MET includes some concepts from virtual teams and patient management. As discussed, before handheld devices are used in medical care, this application is the administering of nutrition questionnaires.(82) The handheld device allowed gathering of nutrition information among Burmese refugees at the camps. The project was highly successful for both data quality and implementation in such an austere setting.

SUMMARY OF TECHNOLOGIES This section summarized the categories of technologies and their attributes. The purpose is to give some framework to the vast literature and isolate the features that can be generalized to other situations. Each of the four applications is listed under the appropriate technologies used by the applications. The applications are presented below and will be discussed is subsequent articles. Internet • • • •

Computer-mediated communication. Health education. Internet retailing. Distance learning.


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• Medical education. • Applications: The health education and provider education. Telemedicine • Telemedicine integrates electronic communication and health care, which was pioneered by NASA. • Application: Database storage of X-ray. Medical informatics and telemedicine are integrated • Remote or global database systems. • Determining an individual treatment program. • Application: Database storage of X-ray. Security • A big problem in all health applications. • Applications: minimedical record, database storage of X-rays, provider education, and health education. Intranet-work flow management • • • • • •

Firewalls and gateways to limit and enhance access to the outside world. Electronic Data Interchange (EDI) via Internet. Supply chain management. Just-in-time production. Intraoffice communication. Virtual organization.

Intranet-management impact • • • • • •

Quality assurance programs. Minimedical records. Video conferencing, e-mail and chat-rooms. Staff satisfaction: Reduce staff frustration and to improve staff morale. Morale building and social structuring. Applications: Minimedical record and database storage of X-rays.

Intranet technologies • Greatly enhanced the effectiveness, efficiency, and utilization of health care delivery. • Decision systems: Decision support systems, group decision support systems, GroupWare, electronic meeting systems, expert systems, etc. • Medical diagnostic. • Treatment selection. • Health education. • Provider education. • Applications: Minimedical record, health education, and provider education. Artificial Intelligence (AI) software improvements


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• • • • • • •

Identify medical disorders. Self-diagnosis and treatment selection. Preventive health care programs. Patient monitoring and record keeping. Provider education. Health education. Applications: Provider education and health education.

Data mining • • • •

Hospitals, institutions, government agencies share data and information. Knowledge created via AI software. Ethics is a concern. Applications: Minimedical record and health education.

Mobile Health Care (MHC) • Smart cards provide both confidentiality and privacy. • Electronic medical record systems. • Mobile devices such as wireless phones, pager, PDA.

APPLICATIONS There are four applications that are discussed in depth. Minimedical Record Application (Information) Title: Annual registrar for flu shot vaccinations (registrars). A database has been established utilizing patient information based on age, medical diagnose, and employment history. Using analytical tools, the knowledge it created determines who is at high risk and who needs flu shot. Database Storage of X-Rays and Labs (Database Application) Title: X-ray and lab—computerized, storage, review, interpretation, and distribution. Stenter lets the health care worker order an X-ray that is produced as a computer image rather than on flat film. The digitized image can to viewed, analyzed, manipulated, distributed, and stored as a digital image. Provider of Education for Competency of Scope of Practice Title: Medicine Department Safe training is a computer-based review program named de’medri Medicine Department Safe training is a computer-based review program named de’medici and it is an employee-training program. This annual review packet serves as a generic training tool.


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Health Education application Title: Weight management An overweight person could access the weight management program and develop a weight reduction plan. The patient enters specific data to personalize the program.

SUMMARY, FUTURE TRENDS, AND RECOMMENDATION A value of information philosophy must be developed. Value of information will increase in health care delivery systems as the market becomes more competitive. For example, when patients can choose between place of services and their mode of health education delivery, information’s value attribute will become more important in decision making.(83) Hospitals could invest in shared databases over intranet or share data with outside organization via Internet. So more information would be available to their patients. Patients could choose or be directed to treatments programs based upon their preferences or recommendations by AI programs. This will lead to higher profits for the health care system, lower cost to the patient, and improved health care. As the demand on primary care provider increase and continuous educational requirements increase, technology offers the answer. Distance learning and training offers tremendous cost savings in reduced travel cost for training. The future will have continuous training modules developed and available via Internet, intranet, and MHC. Training can be specific to the practitioner’s unique situation. Internet will allow access from homes, private offices, libraries, or learning centers, and MHC will remove any space and time boundaries. Video conferencing or interactive video enrich the messages and provides for more effective education and provides opportunity for rural areas. Asynchronous mode allows each person to progress at his/her own pace. Medical libraries all over the world are becoming available via Internet, intranet, and MHC. Additionally, publications from the last hundred years are becoming available online and this history data provides a rich background for understanding current situations. The cost benefits for distance learning and training are positive.(84) As medical informatics and telemedicine are integrated, knowledge and information from remote or global database systems are integrated and made available via intranet. This information and knowledge are used in determining an individual treatment program.(85) This can also be viewed as the seamless integration of Internet, intranet, and MHC that will lead to improved decision making and care. Grams and colleagues provide specific examples of how medical knowledge or informatics can lead to improved decision making.(86) In reality, the definition of health care is being changed. The health care industry is moving to another level and in reality a paradigm shift has taken place. This includes not only technology, but also human resource management, and patient responsibility. Health care practitioners are receiving full packages that include retirement, sick leave, etc. Patents are being expected to


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manage their own health care and assume more of the cost. Technology is making this new health care vision possible by creating a new paradigm of health care.

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