Transformation is not something that can be observed based on day-to-day basis. It may not require an extensive amount of time like the evolution of species, but I believe it will take at least several decades or even centuries to unfold and shape our future. Therefore, I would like to examine the healthcare digital transformation that lies ahead and share my thoughts on what we need to prepare for, drawing on my experience in Healthcare Information Technology over the past 30 years.
Health Information Technology (HIT) refers to the application of computer hardware, software, and systems in healthcare to store, retrieve, share, and analyse health information. It plays a critical role in managing health data across different computerised systems and enabling secure information exchange among patients, practitioners, healthcare providers, researchers, government entities, insurance companies, quality monitors, and regulatory bodies. HIT is essential for improving medical care, facilitating communication and decision-making, and meeting the diverse needs of stakeholders in the healthcare industry.
There are many types of HIT. However, the followings seven are considered to encompass the overall meaningful aspects of HIT.
1. Electronic Health Records (EHRs) serve as the central component of the HIT infrastructure. EHRs are digital health records shared among multiple healthcare providers and agencies. They contain comprehensive information about patients' health history, diagnoses, medications, treatments, and other relevant data. EHRs facilitate information exchange between healthcare providers and ensure continuity of care. The most critical component of EHRs is Electronic Prescribing (E-prescribing), which eliminates the need for paper prescriptions by enabling direct communication between healthcare providers and pharmacies. It streamlines the process of medication ordering and pickup, reducing the chances of errors or misplaced prescriptions. E-prescribing systems also provide alerts and reminders for drug interactions, dosage instructions, and formulary compliance.
2. Personal Health Records (PHRs) are self-maintained health records controlled by patients themselves. They allow individuals to manage and track their health information, including data from doctor visits and personal health metrics such as diet, exercise, and blood pressure. PHRs can be integrated with EHRs, enabling seamless data exchange and providing patients with a comprehensive view of their health information.
Picture Archiving and Communication Systems (PACS) and Vendor-Neutral Archives (VNAs) are types of HIT used for storing and managing medical images, such as X-rays, MRIs, and CT scans. These systems allow healthcare professionals to store, access, and share images within a hospital or healthcare system. PACS and VNAs integrate radiology and other specialties into the main hospital workflow, improving accessibility and collaboration among healthcare providers.
3. Health Information Exchange (HIE) refers to the electronic sharing of health information between different healthcare organisations and systems. It enables the secure exchange of patient data, including EHRs, laboratory results, imaging reports, and other relevant information. HIE facilitates care coordination, reduces redundant tests and procedures, and improves patient outcomes.
4. Telemedicine and Patient Portals are technologies that enhance access to healthcare services and improve patient engagement. Telemedicine involves the use of technology to provide remote healthcare services, including video consultations between patients and healthcare providers. Patient portals, on the other hand, allow individuals to access their health information, communicate with healthcare providers, schedule appointments, view test results, and perform other tasks securely online.
5. Data Analytics and Artificial Intelligence (AI) play a crucial role in analysing large amounts of patient data to derive insights and support clinical decision-making. AI and machine learning algorithms are utilised to identify patterns, predict outcomes, and assist in diagnosis and treatment planning. These technologies contribute to population health management, value-based healthcare, and personalised medicine.
6. Privacy and Security are essential aspects of HIT systems. These systems incorporate measures to enhance the privacy and security of health information. Consequently, HIT systems implemented encryption of electronic data, access controls, audit trails to track data access, and compliance with regulations such as the Health Insurance Portability and Accountability Act (HIPAA). Privacy and security measures are crucial to protect patient confidentiality and prevent unauthorised access or data breaches.
HIT offers numerous benefits for both healthcare providers and patients. Among them, the most significant benefit is the improved quality/effectiveness of care.HIT enables healthcare providers to access accurate and complete patient health information, leading to better diagnoses and care decisions. It also supports care coordination, secure information sharing with patients and their families, early diagnosis of health problems, and reduced medical errors. Essentially, HIT provides increased efficiency. HIT systems streamline administrative and clinical processes, reducing the time and effort spent on managing daily operations and paperwork. This allows healthcare organisations to focus more on patient treatment and health. Examples of efficiency improvements include faster prescriptions, improved information sharing, reduced paperwork, and better follow-up. In terms of economic impact, there is decreased healthcare costs. HIT is seen as a means to decrease healthcare costs by improving operational efficiencies, patient safety, and chronic disease management. Digital data transfer, improved communication, and standardised software standards aim to reshape administrative structure and enhance cost-effectiveness.
From the perspectives of healthcare providers and patients, HIT enables healthcare providers to have secure and complete access to patient information, better coordination of care, secure information sharing with patients, improved diagnostics, reduced medical errors, and lower costs. It also facilitates the efficient tracking of patient health information, even outside of regular office hours. Moreover, HIT empowers patients by giving them control over their health information. Patients can access and modify their data, share information with clinicians, request e-prescriptions, and receive secure electronic summaries of office visits. HIT tools and applications also enable patients to set and achieve health goals, monitor lifestyle factors, and participate in online communities for support.
The journey of HIT can be traced back to the early 20th century when basic information processing systems were first introduced in healthcare settings. While different countries may have distinct histories, the United States' history of HIT is the most generally applicable worldwide. Therefore, this section will describe the history of HIT in the United States.
In the 1950s and 1960s, computers began to be used for administrative tasks such as billing and scheduling. These early computer systems laid the foundation for digitising health records and gradually transitioning from paper-based documentation to electronic formats.
The 1970s witnessed the emergence of Hospital Information Systems (HIS) aimed at streamlining administrative processes within healthcare facilities. These systems encompassed patient registration, inventory management, and basic data storage but had limited functionality and lacked interoperability.
With the advent of personal computers in the 1980s, healthcare professionals gained access to more powerful tools for data processing and analysis. During this era, Electronic Medical Record (EMR) systems were developed, enabling the digital capture, storage, and retrieval of patient health information within a single healthcare organisation.
The 1990s marked a significant milestone in HIT with the introduction of standards for health data exchange. The Health Level Seven (HL7) protocol and the creation of the Clinical Document Architecture (CDA) provided a framework for interoperability, facilitating seamless sharing of health information between different systems and organisations. This era also saw the utilisation of internet technology and telemedicine applications to improve healthcare connectivity and access to specialised care.
The early 2000s brought a renewed push for HIT adoption, driven by various initiatives and legislation. The Institute of Medicine's (IoM) call for electronic prescribing systems in 2001 and the President's HIT Plan in 2004 emphasised the importance of digitising medical records and improving care efficiency. The American Recovery and Reinvestment Act of 2009 allocated significant funding for the implementation of EHRs through the Meaningful Use program, accelerating the adoption of HIT across the United States.
In recent years, HIT has experienced rapid advancements fueled by technological innovations. Cloud computing, mobile applications, and wearable devices have expanded the capabilities of HIT, enabling remote patient monitoring, telehealth services, and personalised healthcare solutions. Moreover, the integration of artificial intelligence and machine learning algorithms has opened new avenues for data analysis, clinical decision support, and population health management.
The historical journey of HIT reflects a gradual shift from basic information processing systems to advanced, interconnected networks that revolutionise how health information is managed, shared, and utilised. The ongoing advancements in HIT promise to reshape the healthcare landscape, enhancing patient care, improving outcomes, and driving innovation in the pursuit of a healthier future.
It is evident that HIT has experienced remarkable growth in recent years. However, there have been some disappointments . Despite the potential benefits and advancements in digital innovation, the healthcare industry has been slow in adopting advanced technologies compared to other industries. The COVID-19 pandemic accelerated the digital transformation of health and care services in certain areas, such as the rapid uptake of remote consultations. However, poor interoperability, privacy concerns, and difficulties in real-time data flow are persistent barriers that hinder the effective utilisation of HIT for policy and planning purposes. One area that exemplifies the lackluster progress is genomics. Despite significant advancements in human genomics over the past two decades, the integration of genomic research into routine patient care has been limited. Although millions of genomes have been sequenced, translating genomic data into clinical practice remains a challenge. While single nucleotide polymorphism (SNP) arrays have been used to determine polygenic risk scores for common conditions, their implementation in clinical practice has been restricted. The availability of lower-cost whole genome sequencing holds promise for wider implementation, but challenges persist in presenting complex genomic data in a user-friendly manner and addressing the shortage of medical geneticists and genetic counselors. Efforts are needed to overcome these barriers and effectively incorporate genomics into patient care, as routine medical practice has yet to fully realise its potential.
Looking ahead, the future of HIT is marked by the evolution of data interoperability, patient engagement, and cybersecurity. The integration of genomic data, the Internet of Medical Things (IoMT), and blockchain technology holds immense potential for transforming healthcare delivery and empowering individuals to play a more active role in their own well-being. Experts predict that integrated healthcare data, coupled with AI-driven research, will enable personalised and precise care based on genetics, proteomics, and environmental factors. Robotics will assist in surgical procedures, rehabilitation, and elderly care.
The shift from hospitals to home-based care will become more prevalent, as healthcare embraces personalised and home-based approaches. Patients will receive care in the comfort of their own homes, supported by technology and remote monitoring. Technology advancements, including AI and avatar therapists, will make healthcare more convenient and accessible, enhancing patient outcomes while preserving the doctor-patient relationship.
Efforts will be made to democratise healthcare knowledge and access through automation and technology. The aim is to ensure equitable access to high-quality care for all, addressing disparities and ensuring that healthcare advancements benefit everyone. The focus of healthcare will shift towards preventive care, leveraging AI and emerging technologies. The possibility of fully sequencing individuals at birth will enable early disease detection and emphasise disease prevention.
Promoting digital inclusivity is crucial to ensure equal access to healthcare services and HIT systems. Steps should be taken to bridge the digital divide, address disparities in technology access, and promote health literacy across all populations.
In summary, the future of HIT holds great promise, with personalised care, home-based healthcare, democratised access to knowledge, a focus on preventive care, and efforts towards digital inclusivity. These advancements, driven by technology and collaboration, will revolutionise healthcare and improve the well-being of individuals.
While recent advancements in medicine and engineering have shown promising progress, predicting the exact future of healthcare 100 years from now is challenging. Experts highlight key developments that could shape healthcare in the future, such as personalised engineering, regenerative medicine using technologies like 3D printing, and the integration of AI-driven robots with AR/VR. However, these advancements come with significant challenges that need to be addressed, including equity issues, genomics utilisation, privacy concerns, and data protection.
Although there is a vision of hospitals undergoing innovative transformations and potentially disappearing in the future, the current state of genomics utilisation and the need for advancements in patient-centered approaches like Web 3.0 present additional obstacles. Healthcare information technology plays a central role in this transformative process, despite progress being gradual. Achieving a patient-centered approach and successfully integrating technology require careful consideration and continuous efforts.
Overcoming these challenges is essential to create a future healthcare system that prioritises patient well-being and provides a safer and more comfortable environment. While the ultimate outcome is uncertain, it is crucial to strive for a patient-centric future and embrace the potential of healthcare information technology.
