Medical Informatics: Streamlined Efficiency or Rigid Technology?

(Part 5 of Stateside Healthcare: Art, Science, and Commerce?)

Perhaps the most striking of all aspects of US healthcare is the heavy use of information technology. Thus is posed this question: is medical informatics a boon or a bane in clinical practice?

As part of the elective rotation, shadowing with a KSC hospitalist-internist was undertaken at the Methodist Willowbrook Hospital , a part of The Methodist Hospital System. This would perhaps best illustrate the extensive use of medical informatics, which is also the case in the KSC Copperfield Clinic. The following were seen:

About a half hour before going on call, the hospitalist receives via electronic mail “check-out information” from the physician on call immediately prior to his/her shift. This would serve as virtual endorsement rounds, bearing clinical abstracts of patients on the service. On arrival at the hospital, the triage nurse would key in the physician’s schedule at a computer terminal, and a patient census would then be printed.

Barcodes bearing patient-identifiable numbers are used everywhere – sheets in the charts, medication containers, lab specimens collected, etc. Medical records/charts, while still on paper and filled-in by hand, are scanned (digitized) into electronic images within a short time, which can be digitally signed from anywhere an attending physician is physically located by simply logging onto the internet and using the appropriate security codes.

Each nurse at the nurse station has a computer terminal assigned to him/her. Nursing flowcharts bearing the vital signs and nursing notes of a patient are electronic. Telemetry can be easily availed of if indicated, and a centralized console at the nurse station provides a continuous monitor of vital signs including electrocardiogram traces if necessary. Laboratory and imaging results are typically accessed by the nurse and printed onto paper only for the physical convenience of having a hard copy, but the records are primarily electronic.

Radiology is a technological advance on its own. Radiological transparencies are no longer the norm – entire plates/films are digitized the moment a patient undergoes imaging, and the same are instantly made available for the attending physician who might want to make a preliminary impression by accessing the system anywhere there is high-speed internet access. The films are also transmitted electronically to the radiologists who would then make interpretations at a different location via dictation, the transcriptions of which would be available within the same day or the morning after the examination. It goes without saying that given the technology, physicians viewing films online can alter the brightness, contrast, and magnification of the radiological images. Details not previously seen on traditional x-ray transparencies can be studied in detail, allowing for a more accurate interpretation.

This connective nature of information flow is also the case for other diagnostic examinations. Electrocardiogram traces, while still printed on strips for rapid bedside or outpatient interpretation, are also sent to another location where cardiologists interpret them and return the results to the attending physician in the same way that the radiologist returns reports.

Patients themselves can have access to their own diagnostic information. In cases wherein imaging or laboratory results are normal, KSC has a system called “TeleVox” wherein two days after an examination (some special tests taking perhaps a week at most), the results can be obtained by the patient through a convenient website on the internet or via phone call. Otherwise, if the results may indicate an ongoing disease process, the physician himself makes the call to inform the patient and suggest further treatment plans such as follow-up consultations.

Since records can be transferred with ease, continuity of care is maintained. This is the case when a patient admitted into the hospital is discharged for follow-up at a KSC branch with a PCP. The PCP simply asks that the patient sign a release waiver authorizing the transmittal of confidential medical information, and the same is sent via fax to KSC’s medical records section. The same is true when a new patient previously cared for by another physician outside of the KSC system comes for consultation – the prior physician, upon request, promptly transmits the patient’s medical record to the new KSC doctor.

The professional sharing of medical information, seldom seen in the Philippines wherein patients have to narrate their entire medical history almost always when seeing a new physician, allows for the avoidance of duplicate or unnecessary diagnostic examinations or treatments. It also has a bearing on the PCP’s role – who, as the gatekeeper, has to see the patient in his/her entire context.

As posed earlier, this raises a few doubts however as to the reliability of the entire system. Power outages pose a threat to the information stored, and the dependency on computers may be a downside. The risks associated with technology and power supply fluctuations are minimized, however, by the proper infrastructure that involves back-up systems. That translates to an improved quality of care for the patient and efficiency on the part of the physician.

Next: Legalities