Individualization, globalization and health – about sustainable information technologies and the aim of medical informatics
The focus of this paper is to discuss aspects of information technology in health care, particularly transinstitutional health care information systems, and the future globalization of these systems.
2. The Situation
We have seen great progress in information and information technology in most aspects of our day-to-day life. Medicine has benefited from this progress and health care has been transformed by information technology. The influence that information technology had in health care led to the foundation of new scientific journals in the 1960s.
Progress in medicine has led to changes in demographics for many societies in the world: life expectancy has risen, and as a consequence we have seen a trend toward an aging society. This means new opportunities, but also new challenges for society. One challenge is the cost of supporting an aged person is higher than the cost of supporting a child. The number of people age 60 or older is expected to grow from 629 million in 2002 to almost 2 billion in 2050.
3. On transinstitutional health information systems and globalization
The application of computer information systems during the 60s and 70s focused on hospitals and, in particular, on teaching hospitals. Health information systems (HIS) process information, data, and knowledge in the health care environment. This general description can be further categorized according to the subgroup each HIS serves. HIS that deal with institutions are institutional information system (iHIS). One example of an iHIS is a hospital information system (HoHIS). When data are processed across institutions the system is described as a transinstitutional information system (tHIS) and when processing region-specific data the system is described as a regional information systems (rHIS). In a globalized world we need to mention national health information systems (nHIS) and global health information systems (gHIS).
The aim of a good HIS is to improve the quality of care, but there is also an important cost factor, especially considering that approximately 10% of the gross domestic product of nations is devoted to health care. This underscores the importance of systematically processing data, information and knowledge for the quality and efficiency of health care. The information system architecture of many hospitals can be characterized by a mixture of paper and computer base documents, a set of application systems having a dedicated purpose, communication interfaces connecting databases of computer-based applications, one or more of the databases being used a reference database, and some computer-based application systems sharing one database system. Even though there are undeniable benefits of HIS systems, there remain “problems” that have made them targets of criticism. These problems have arisen as a result of the increasing amount of data (through the recording of diagnostics and therapeutic procedures) and the increasing amount of information being processed (due to the functionality provided by computer-base application systems). These are problems of costs, user acceptance, transcription, and the maintenance of referential integrity; however, there are strategies that can be implemented to overcome these problems: decrease redundancy by minimizing the paper-based part of the hospital’s information system, decrease the number of applications systems with redundant data, use a unique patient identifier, use one application system database as a reference for the electronic patient record, and establish an organizational solutions for professional information management.
When expanding to tHIS and rHIS we need to keep in mind that each institution has one central authority that will make decisions that benefit the institution as a whole, and when they become part of a tHIS, the authority of each institution will consider first the benefits to their own institution, which may be in conflict with the more global or regional benefits. Other problems we need to consider when moving from a iHIS to a tHIS or rHIS is that the communication between institutions is usually paper based, which may cause a considerable time delay. Institutions will tend to stay as autonomous as possible concerning their patients and their records, and will try to make their health care process as lean and efficient as possible with within their own institutions. These problems have to be added to those that can be encountered in the iHIS, plus some other problems like information logistics, terminology, stability, and information management. Some risks need to be considered for the future development of tHIS, and the main one is the architecture of the systems. The question of how tHIS should evolve is still open and a lot of research will be needed to answer this question. Some of the challenges necessary to address this issue include interoperability, ubiquitous access, common data models and terminologies as well as related socio-technical aspects. Another aspect to be considered is the architecture of the system: one option is to keep the architecture as it is mostly today, with the consequent risk of cost-intensive redundant architecture, a second options is to copy the architecture of a HoHIS with the risk of creating an over-centralized architecture.
4. On health-enabling technologies and individualization
A new field and practice of medical informatics is the health-enabling technologies, which are strongly related to ubiquitous health care systems. This technology includes unobtrusive, active, non-invasive technology that allows us to continuously monitor and respond to changes in the health of a patient. This will give us new ways of managing care through which patients will be able to maintain a good health and enjoy life in their usual social setting. This is especially important considering our aging society; this technology will allow early detection and prevention of diseases and will alleviate chronic diseases. This kind of technology will need a powerful, self-organizing, reliable network. Health-enabling technologies will produce greater amounts of data for one person, which will be more than the data that can be obtained in a intensive-care situation. In the context of a over-centralize architecture systems, it is necessary to consider the risk of misuse of this data, and how much of this data should stay with the individual. These new technologies will potentially create a shift in health care from primary acute care to preventive care.
To support this type of technology, powerful transistitutional systems will be necessary. In the context health information systems we may call them ubiquitous health information systems (uHIS).
5. On medical informatics and health
“The aims of medical informatics is to contribute to the progress of the science and to high-quality, efficient, and affordable health care that does justice to the individual and to society.” To this we must also add the contribution to self-determined and self- sufficient life. In the end, what counts for medical informatics is health, quality of life and well being of the individuals.
6. Discussion and final remarks
“Medicine and health care can only benefit substantially from progress in informatics and information technology, if health care professionals and health care consumers are provided with sufficient knowledge and skills in the field.”