Ebook: Information Technology Strategies from the United States and the European Union

While clinical and biomedical research production is rapidly growing, delivery to practitioners remains unacceptably slow. Numerous studies document significant delay, loss, and waste in the production and dissemination of evidence from research. To improve health care quality and to make the best scientific achievements part of usual practices, clinicians have to be informed. Better information systems and services are needed to support health care practices in absorbing and efficiently introducing the constantly growing amount of information. There is a need for a more systematic analysis of practical relevance and better overall efficiency in the process of transferring clinical evidence from research to practice.

The purpose of this book is to provide insight into the new and innovative uses of computers and other digital information technologies from European and American leaders in the fields of communication and health information sciences. Information technologies are impacting organizations, communities and societies and redefining systems for education, work, health services and almost every other aspect of life. Throughout the book the issues of how information technologies can facilitate health care quality improvement by transferring research evidence to practitioners is explored through emerging information technologies, better information for quality health care, and international collaboration. The book is divided into three sections, with several chapters in each section.

The first section describes the information infrastructure for transferring research. New scientific information is being discovered at a rapid rate. Putting research into practice should be the ultimate goal of emerging information technologies. The chapter by Donald A.B. Lindberg, M.D. of the National Library of Medicine addresses the transfer of research through high performance computing. Literature-based and fact-based services that help deliver modern scientific information at the time and place that it is most useful are discussed. Otto Rienhoff, M.D. of the Georg August University in Gottingen, Germany provides an overview of how the training and delivery of medical care needs to be reengineered. Medical training is not keeping up with modern realities. Doctors need to be trained to deal with more informed patients and information technologies. Physician practices need retooling to deal with the isolation many physicians feel in their everyday practices. A high degree of specialization, massive information flow, and better-informed patients create a desire among physicians to link to other physicians. Ilias Iakovidis, Ph.D. of the European Commission on Telecommunications in Brussels, Belgium highlights European initiatives in the emerging health information infrastructure and citizen-centered shared care. The health information infrastructure is an enabling mechanism for continuity of care. Reed M . Gardner, Ph.D. of the University of Utah in Salt Lake City, Utah focuses on methods of gathering and using clinical data for clinical research and patient care. The examples in this chapter are based on the HELP hospital computer system at LDS Hospital in Salt Lake City.

The second section includes three chapters that describe aspects of how knowledge can be structured for practical application. Alexa T. McCray, Ph.D. of the Lister Hill National Center for Biomedical Communications which is part of the National Library of Medicine in Bethesda, Maryland provides an introduction to the digital libraries initiative funded by the U.S. federal government, a discussion of the Unified Medical Language System, and issues in creating Web-accessible resources for health care consumers. Nancy M. Lorenzi, Ph.D. of the University of Cincinnati and Robert T. Riley, Ph.D. of Riley Associates in Cincinnati, Ohio discuss knowledge and change in health care organizations by focusing on the reality that managing change is crucial to the success of an information system. Users must be involved in systems development from the beginning to feel ownership in the system and look upon it as “our” system, not “their” system or “my” system. A successful project depends 80% on the social and political interaction skills of the developer and only 20% on implementation of the hardware and software. The developer must have organizational savvy, and be aware of who in the organization has the ability to make things happen, i.e., be “positively political.” Jean Roberts, B.Sc. M.B.C.S., M.H.S.M., C.Eng. of First Consulting Group in Macclesfield, United Kingdom addresses how to incorporate knowledge into commercially available systems. This chapter focuses on attitudes to the transfer of knowledge, funding mechanisms and how to protect an investment in knowledge.

The third section deals with practical solutions to obtain better information for improved health care quality. Janet Corrigan, Ph.D., M.B.A. of the Institute of Medicine at the National Academy of Sciences in Washington, D.C. discusses the current state of health care quality and describes some of the factors that are hindering efforts to move toward evidence-based practice. The efforts of the President’s Advisory Commission on Consumer Protection and Quality are also described. Kenneth D. Bopp, Ph.D. of University of Missouri in Columbia, Missouri highlights the multiple roles patients play in the health care process. Patients are both consumers and co-producers of services. Patients provide information that is critical to their diagnosis and treatment. They need to receive instructions on exactly what they are to do to carry out their treatment. Patients are banding together in self-help groups for their conditions, and giving input as to how they wish health professionals to deal with them. Mary Jane Richman, R.N., M.N., P.N.P. and Jeffrey S. Poltawsky, M.S., C.H.E. of Egleston Scottish Rite Children’s Healthcare System in Atlanta, Georgia provide an example of how evidence-based disease management can be applied to a population of pediatric asthma patients to improve quality and access while decreasing total health care costs.

As mentioned earlier, international collaboration appears to be vital to move forward with efforts to prepare for modern practice and improve health care quality. However, various issues must be addressed between Europe and the United States in order to move forward with collaborations. The main challenges in transferring research to practice are user acceptance, cultural differences, national and regional strategies, legal and ethical issues, and standardization of technologies. We need to shift our attention to these enabling mechanisms for good implementation.

The degree of difference between the definitions of health professions in the various countries is quite dramatic. The same words are used, but they represent different legal concepts, professional roles, and self-understanding. For international collaboration to be successful, we need to recognize that we deal with hundreds of different professional types and not just with three or four. In countries that are in dire need of health professionals, differently educated health professionals may help fill that need. A major stumbling block to future international collaboration is agreement on protection of medical data. The Council of Europe recommendations, issued in February 1997, do not carry the weight of law, but do highlight the need for serious dialogue between the European Union and United States. Information ethics research is needed to address medical ethics aspects of the use of databases.

This book comes out of the conference “Transferring Research to Practice in the Information Age” held at the University of Missouri, November 12 and 13, 1998. This two-day conference also coincided with the opening of the European Union Center at (he University of Missouri.

E. Andrew Balas, M.D., Ph.D.

Suzanne Austin Boren, M.H.A.

Gordon D.Brown, Ph.D.

For “retooling” one needs two components: new hardware and new skills. “Hardware” in the Medical Informatics environment includes not only hardware in a narrow definition, but operating and application software, network services, security services etc. Since the sixties, Medical Informatics has slowly moved from fighting computer hardware to fighting the complexity of application software and its installation. Thus the hardware part in the retooling process has changed but did not decrease in importance. Retooling medical professionals also means retraining of professionals - often a major investment. Regarding the necessary skills, we have to adapt existing medical curricula and continuous medical education (CME). So far, these have not successfully been adjusted to the retooling needs. The international community has to address these matters, specifically in the context of medical curriculum and CME.

Over the last decade information and communication technologies - telematics technologies - have demonstrated their potential to improve the quality, access and efficiency of health care. Health telematics applications are presently revolutionizing the developments not only in diagnosis, treatment, surveillance and rehabilitation of patients, but also on the side of the more collective aspects of health care and health prevention such as clinical trials, epidemiology and health education. Moreover, for the first time in the history of health care the emerging Health Information Infrastructure (HII), i.e. telematics networks together with a set of technologies, health telematics applications and services, is making possible the rapid dissemination and sharing of health information and research results. This is leading to knowledge creation and to promotion of innovative approaches based on evidence collected in medical practice all over the world.

The last decade has seen an exponential rise in the amount and the nature of information that is available on the Internet. Internet and World Wide Web technology have raised many technical as well as social and economic issues. The paper begins with a description of the recent digital library research initiative funded by the U.S. federal government. Digital library research addresses a host of informatics issues relevant to the current Internet-based environment. The paper continues with a discussion of some problems in information access, including a discussion of the potential of the Unified Medical Language System for navigating among multiple biomedical information systems. Next, some issues in creating Web-accessible resources for health care consumers are addressed, with a focus on recent work at the National Library of Medicine, including a description of the MEDLINE/plus system. The paper ends with a brief discussion of some implications of digital library research for the health informatics community.

All of us realize that these are times of high change in virtually every health care system, regardless of size or location. As part of this change process, many health care systems are taking a serious look at the area that has evolved as knowledge management. While change may be mandatory, progress is definitely optional.

The ways in which a potential commercial ‘user’ treats different knowledge types are explored in this paper. The issues are dealt with by the pragmatism with which a marketing manager might evaluate an opportunity. Academics are typically motivated by drivers that are different from a commercial ‘push’. Thus partnership is needed for a productive compromise; addressing questions such as why should academic institutions let commercial organizations have their intellectual capital. The paper considers issues of hand-over, product maintenance and a continued development partnership, especially in a volatile [Inter] net-based age.

This paper discusses the current state of health care quality and describes some of the factors that are hindering efforts to move toward evidence-based practice. The President's Advisory Commission on Consumer Protection and Quality spent one year looking at the state of health care quality and developed a set of recommendations to tackle the serious quality problem in the health care industry. The Institute of Medicine has started an initiative, Quality of Health Care in America Project, which is addressing many of the quality of care areas identified by the President's Advisory Commission on Consumer Protection and Quality. This paper discusses the work of these two groups and concludes with key issues in the advancement of quality health care.

A new era of consumerism is emerging. Increasingly educated consumers are demanding convenience, choice, and self-efficacy or self-mastery. These educated consumers are causing businesses in a variety of service industries, including health care, to change their business design in response to changing consumer preferences. Increased consumer pressures to change health care business designs are evidenced by a flood of state and federal legislation and managed care organizations broadening their networks and product offerings to respond to consumer complaints about lack of choice. These pressures are also evidenced by educated patients, armed with information they have gathered via the Internet and other sources going to their physician and saying, “Together let's figure out how I can do this myself.”

In addressing the entire scope of illness cost drivers that are causing health care expenditures to spiral upward in this country, providers need not overlook the role that the effective relay of information plays in moving the patient from their traditional roles as resource and customer to more effective roles as co-producer and partner in the transformation process. Health care organizations and professionals must experience a paradigm shift in both their approach to providing health care and in their understanding of the new role of the patient as co-producer.

Partnership for Excellence in Asthma Care, a practical example of evidence-based disease management, was launched by Egleston Scottish Rite Children's Health Care System. The process of development and implementation of evidence-based practice guidelines for the outpatient management of asthma is described. Methods to influence physician practice patterns and the preparation of feedback reports are discussed. The method for measuring outcomes and preliminary outcome data are shared.