Healthcare IT (HCIT) systems are of great benefit to the medical industry. They are repositories of a large amount of clinical data, tucked away under digital security and safety, to be retrieved whenever and wherever necessary. Patients get access to their personal clinical data at the click of a button. Furthermore, the system also keeps track of charges incurred, making reimbursement easy, much to the comfort of the patient and the healthcare community.
Presently, the healthcare industry is caught up with integrating all its data outputs into electronic patient medical records (EMRs), in an effort to manage the data with coherency and consistency. The intermediate goal to provide increased availability, online EMR repositories have already been initiated with Microsoft and Google bringing out their web EMR services, the Safe Health Vault and Weaver respectively.
The final goal is to reach a level where the clinical information system (CIS) will be globally available, while maintaining the regional language data representation, which is a patient or end-user requirement in some geographical regions.
But what problems lay beneath these mammoth data collecting, processing and archiving systems? Has interoperability between man-machine and machine-machine reached its aimed state?
What are the possible strategic concepts that need to be infused within the giant CIS systems to make the workflow more efficient?
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With activities such as easy availability of clinical data, integration of monitoring devices with hospital IT management systems and integration between individual management systems of various hospitals, the complexity of the entire HCIT system is growing day by day. This increase in complications with HCIT solutions will have diverse challenges, which can be resolved only through proper standardised procedures and workflow.
The first of these challenges is storage standardisation and compliance. Healthcare enterprise data storage is approximately a $30bn market, aiding in performance optimisation, capacity optimisation, centralisation and web-based management. However, the HCIT industry is suffering from a lack of standardisation in the realm of data storage.
Furthermore, the industry lacks proper certification in place to ensure effective capacity planning, data management and good emergency data backup are followed in data archiving systems. The resultant effect is seen in the form of lack of cost containment and reduced vendor product efficiency owing to mismanagement of clinical data and reduced interoperability between hardware and software in storage.
Constructive steps are being taken in order to correct the mistakes and flaws. For example, the Storage Networking Industry Association (SNIA), a group which develops robust solutions for storing and managing the massive volumes of information generated by present day organisations, has recently been formed.
SNIA strives to bring recognition of storage issues to the IT world, by making storage less complicated for the end user. As a result, the SNIA has adopted the role of industry catalyst for the development of storage solution specifications and technologies, global standards and storage education. Vendors gain the benefits of quicker time-to-market, reduced costs and greater customer acceptance than if each company were to attempt to create its own unique process for every technical interaction.
SNIA standards enjoy greater interoperability, reduced training, and ultimately lower total cost of ownership. Two key initiatives created by SNIA and facilitating standardisation are Storage Management Initiative (SMI) and Storage Management Initiative Specification (SMI-S). SMI is an initiative to develop and standardise interoperable storage management technologies and aggressively promote them to the storage, networking and end-user communities.
SMI is dedicated to fostering the creation of deployable and verifiable end-user storage management solutions based on SNIA standards adopted industry-wide. These solutions take into consideration industry evolution and growth with a cost-effective approach emphasising continuous support, and standardisation due to industry maturation and vendor development variation.
Such initiatives, when rigorously implemented in HCIT data storage, will aid in combining the comprehensive and integrated enterprise solutions forming a holistic storage management system. This is depicted in Figure 1. Figure 2 depicts a SWOT analysis of enterprise storage management technologies.
The second challenge in this domain is the fact that the medical device peripherals reporting back to the HCIT systems do not follow a standard feedback/reporting format. The medical devices are manufactured by multiple vendor organisations. These devices have variegated codes or programmes controlling the modus operandi of the device. Once integrated with the HCIT system, these patient monitoring or diagnostic devices will report in differing manners to the central data collection system,
finally leading to the EMRs in the HCIT management systems.
The feedback provided by these medical devices, both in the hospital care and the homecare industry, does not have any fixed reporting manner. This leads to the necessity for manual data formatting to be done at the EMR creation stage to maintain uniformity. In cases where manual formatting is not performed, the data going into the EMR is not uniformly organised.
This challenge can easily be resolved by using a slight modification in one particular subprogramme controlling the functionality of the device. A standardisation committee needs to be set up through government legislation. This committee would need to decide upon a standard format and content for all the medical devices reporting back to the HCIT system.
BENEFITS OF SMI
The standard would essentially be a simple modification in the microcontroller subprogramme/subroutine of the device, which when implemented by the industry vendors would result in the medical devices reporting to the HCIT systems in one uniform manner and format. Thus, this minor modification would automate the HCIT system further.
This change would also benefit the medical research community as such standardisation of device feedback or reporting format would make it easier for medical researchers to run diagnostic algorithms such as HRV (heart rate variability) on a database where data is represented in a single format. The researcher data mining on the system archives would not need to manually format data according to the needs of the software algorithm, thus saving time. This process is not an immediate pressing
requirement for the industry to initiate. However, in the long run, this would definitely aid in making the clinical data management workflow simpler.
Speaking of advanced benefits in the long term, healthcare costs incumbent on the patients and affecting the vendor communities also need to be considered. This is the third challenge as any additional device reporting format change (due to standardisation) may require the vendors to call back their products and make modifications. If this results in increased cost and lower profitability for the vendor community, then change in government legislation, asking for additional standardisation,
will be obstructed owing to the vested interest of the industry.
Similarly, additional standardisation making healthcare costlier will not be favoured even within the patient community. Therefore, the cost of imposing new standards needs to be checked.
WHY IS STANDARDISATION IMPORTANT?
Murphy's technology law states: "A failure will not appear until a unit has passed final inspection". This holds true for standardised practices followed in the HCIT industry, which already has some major standards already in place. Industry set standards such as DICOM (image registration and representation), HL7 and HIPAA (network security) have already been implemented to facilitate interoperability among equipments. However, as any change requires time and trials before
being perfected, every working standard needs time-based trials in practical situations before it can transition into a gold standard.
The same is the case for HCIT systems. In spite of having many standards in place, the systems still suffer from glitches that were overlooked or not taken into consideration. These glitches are found in the form of bugs in the system. These bugs can only be rectified once the systems are tried in practical life applications. This would in turn help the industry refine the present standards, thus leading to the formation of the gold standard.
Hence, it is found that while standardisations help prevent mistakes in the form of bugs/glitches, the absence of time-tested standards themselves can result in the same or more severe bugs. Therefore, absolute standards/gold standards need to be set. Integrated and interoperable HCIT systems are unanimously appreciated and considered to be the need of the day. This is a new technology domain and the industry is rapidly shifting towards it.
However, like every other technology, this has its
own pitfalls. For example, unavailability of clinical data due to bugs or glitches in IT systems can lead to fatal results, even patient death.
While adoption of newer and more beneficial technology is of importance, the industry also needs to set up working standards faster and evolve those working standards into gold standards/absolute standards through rigorous experimentation while in practical application. While the necessity of standardisation cannot be undermined, we should think twice before employing new changes in the systems without proper standardisation.