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10 Reasons Why People Should Not Fear Digital Health Technologies

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10 Reasons Why People Should Not Fear Digital Health Technologies

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e061d80a-6884-4496-b9a9-d910c7d54f15

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HEALTH INSURANCE, MANAGED CARE, ECONOMICS, FINANCE AND HEALTH INFORMATION TECHNOLOGY COMPANION DICTIONARY SET

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The Future of Health Insurance?

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Preparing for Dr. Big Brother

Bert Mesko

[By Bert Mesko MD PhD]

While futuristic technologies are becoming available in healthcare, patients often can’t access them and the cost of providing care continues to skyrocket.

However, innovations such as artificial intelligence (AI) and health sensors are set to reshape how healthcare insurance works and by doing so bring much needed reforms to healthcare as a whole.

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Insurance

http://medicalfuturist.com/2016/04/13/the-future-of-health-insurance-preparing-for-dr-big-brother/

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Overview of Hospital Information Systems Architecture

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On Configurations and Varieties

[By Brent Metfessel MD MIS]

Dr. Metfessel

Hospitals can use a variety of configurations for HIS implementation depending on business needs and budgetary constraints.

Staffing needed for these systems can range from a few full-time equivalents (FTEs) per 100 beds for very basic off-site processing systems to 15 or more FTEs per 100 beds for sophisticated systems that attempt to combine several architectures into one system (e.g., combination of client-server systems with mainframe processing). Resource use and customizability tend to vary in tandem; the greater the flexibility of the system to meet unique user needs, the greater the cost outlay for capital and/or additional FTEs.

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Relationship of Resource Use and Customizability Based on System Architecture Selected

Values range from one (low) to four (high) stars
Architecture Hospital resource use Customizability
Off-site processing * *
Turnkey systems ** **
Mainframe systems *** ***
Client-server *** ****

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The Possibilities

The basic system architecture possibilities are as follows:

Off-site (remote) processing: In this case the hospital contracts with a vendor external to the hospital. The hospital sends data over to the vendor site where the actual processing takes place. When processing is complete, the vendor sends the data back to the hospital, usually in electronic form.

Turnkey systems: A vendor provides the hospital with systems that are “pre-packaged” so that hospital-based system development is minimal. Limited customization of the system is possible using systems analysts or programmers.

Mainframe systems: Most applicable to large hospitals, this configuration is highly centralized. A large and powerful computer performs basically all the information processing for the institution and connects to multiple terminals that communicate with the mainframe to display the information at the user sites. Hospital IT departments usually use in-house programmers to modify the core operating systems or applications programs such as billing and scheduling programs.

eHR diagram

Client-server systems: In this configuration one or more “repository” computers exist, known as “servers,” that store large amounts of data and perform limited processing. Communicating with the server(s) are client workstations that perform much of the data processing and often have graphical user interfaces (GUIs) for ease of use. Both customizability and resource use is high, depending on the desired sophistication.

Many clinical information systems that process data directly related to patient care use this configuration.  For instance, the Veterans Health Administration, which has implemented what is likely the largest integrated healthcare information system in the United States, uses client-server architecture.  Known as the Veterans Health Information Systems and Technology Architecture (VistA), this system provides technology infrastructure to about 1,300 care facilities, including hospitals and medical centers, outpatient facilities, and long-term care centers.  VistA utilizes a client-server architecture that links together workstations and personal computers using software that is accessed via a graphical user interface.

Overall, for hospitals that have the financial and manpower resources for a significant investment in IT, client-server architectures are the fastest-growing and typically the most preferred of the system architectures, due in large part to their local adaptability and flexibility to meet changing hospital and medical center needs.

Broad Categories

The above architectures are broad categories.  Modifications and combinations of the above also exist, such as the use of client-server technology with mainframe systems and the addition of wireless technology, smart phones, laptop PCs and tablets,  and various personal digital assistants (PDAs) to supplement the core computing functionality.

In considering the optimal architecture for a hospital, management needs to take into account factors such as size of the institution, desired sophistication of the application, IT budget, and anticipated level of user community involvement.

Assessment

EHR

Another important aspect of HIS is the need for integration.  Often, different hospital departments have their own stand-alone systems — such as a Laboratory Information System (LIS) and pharmacy systems — that do not communicate with each other.  Duplicate data may be kept in separate systems, creating additional work to enter the data multiple times.

In an integrated system, each departmental system communicates with the other systems through either a centralized or decentralized. A computerized physician order entry (CPOE) system, for example, would be much less effective if it did not communicate electronically with the pharmacy system that would process the medication orders.

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NOTES: Resource use refers to the need for FTEs and hospital capital expenditure. Customizability refers to the ability for users to alter the system structure or function to meet the unique needs of the institution.

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