Chapter 15 Computers and technology in health care

1. Chapter 15Computers and technology in health care By Jahangir Moini, M.D., M.P.H. and MorvaridMoini, D.M.D., M.P.H.

2. Overview • Health care professionals must understand basics of computers (at least) • Computer security is of vital importance • Inadequate computer security affects: • Patients • Health care professionals • Facilities • Society

3. Supercomputers • Largest, most complicated type • Extremely fast information processing • Mostly used in research medicine • Cancer or DNA research • Genetic coding

4. Mainframe computers • Mostly used by larger health care institutions: • Hospitals • Universities • Government • Examples: • Medicare • Medicaid

5. Minicomputers • Larger than personal computers • Smaller than mainframe computers • Primarily used in networks • Linking multiple computers together • Most function as servers • Centralized storage locations for shared information

6. Personal computers Also known as microcomputers Small, self-contained Perfect for offices, schools, homes Different designs are based on user needs

7. Desktop • Fit on desks and flat surfaces • Most common type used in medical facilities • Many have a tower case: • Containing operating components • Often placed on floor

8. Figure 15-1: A desktop computer

9. Laptop and notebook Smaller than desktop computers Weigh only a few pounds Operate via A.C. power or by battery Allow easier communication, multiple locations Mobile, easy to move Easily exchange electronic health records

10. Figure 15-2: A laptop computer

11. Subnotebook and tablet PC • Smaller than laptops • Screens measure 14 inches or less • Subnotebooks being replaced by tablet PCs • Offer touchscreens and/or graphics tables • Operated with fingers, stylus, digital pen • Keyboard or mouse not needed • Quickly becoming preferred type of computer

12. Figure 15-3: A tablet PC

13. Personal digital assistant (PDA) • Common in health care facilities • Professionals can easily look up reference information and medications • Users easily enter data into patient charts • Most popular personal computer for many health care professionals

14. Computers in health care • All health care departments utilize computerization • High-speed communication occurs via computer networks: • Electronic record systems • Processing of monitoring device information • Word processing of medical information • Scheduling • Electronic prescribing, prescription processing • Medical coding • Supply inventories, billing • Medical test processing

15. Benefits of computer use in health care systems

16. Information technology • Larger facilities usually have information technology (IT) departments • These oversee computer systems • Employees do not perform as many computer tasks as those in smaller facilities

17. Patient monitoring • Computers are commonly used to monitor: • Heart rate • Respiration • Offer alarm systems • Alert health care professionals to problems • Movable terminals • Allow entering of all needed patient information

18. Patient monitoring • Point-of-care charting systems: • Information entered at the patient’s bedside • Can track vital signs, physical status, other factors • Can be linked to central locations: • Such as nursing stations (constantly monitored)

19. Patient monitoring • Laptops used for: • Monitoring • Mobility • Recordkeeping • Information exchange • Charting • Used in home health care (telemonitoring) • Utilizes patient interaction • Displays reminders for taking medications • Wireless monitoring on devices connected to Internet, phone lines

20. Figure 15-4: Physician using a laptop computer in a home care setting

21. Information management • Database • Uses software that makes information searchable • Record • Each group of related data • Such as an individual patient record • User types data into predefined fields • Name, phone number, address, occupation, insurer • File • A group of related fields

22. Information management • Records searched by: • Last name • Insurers • Addresses • Dates • More than one person has access simultaneously • Changes are easily made • Quality improvement studies can be performed • Data entry must be accurate to avoid lawsuits

23. Computerization of medical records • Electronic medical records (EMRs): • Most common forms of patient information • Better efficiency, lower costs, safer care • Health care facilities • Now required to use computerized record keeping

24. Computerization of medical records • EMRs are shareable, usable by all types of facilities: • Patient I.D. information • Emergency department visits • Preventive care • Clinic and inpatient notes • Lab, pharmacy, and radiology data • Surgical procedures • Billing information

25. Spreadsheets • Spreadsheet software programs: numerical data • Rows and columns with individual blocks (cells) • Calculation formulas inserted for billing, accounting • Changes and recalculations are easy and quick to perform • Easily linked to electronic billing programs • Allow for creation of charts and graphs

26. Diagnostics • Expert systems • Fiber optics • Patient questionnaires • Diagnostic imaging: • Images mathematically converted into measurements • Better viewing of soft tissues • More detailed, clearer than X-rays • Digital X-rays also available (less radiation)

27. Diagnostics • Other diagnostic technologies include: • Computerized tomography (CT) • Magnetic resonance imaging (MRI) • Positron emission tomography (PET) • Ultrasound

28. Figure 15-5A: Computed tomography (CT) machine

29. Figure 15-5B: Ultrasound (ultrasonography)

30. Diagnostics • CT • X-rays taken from many angles • Tissue density measurements • Converted to cross-sections • MRI • Magnetic field measures hydrogen atom activity • Converted to cross-sections

31. Diagnostics • PET • Radioactive substance is injected, scanned • Converted to three-dimensional images • Ultrasonography • High-frequency sound waves create echoes of body structures • Captured signals are used to create images

32. Diagnostics • Electrical impedance tomography (EIT) • Newer, experimental technology • Uses skin electrodes • Allow electrical currents to be measured • Detects tissue differences

33. Expert systems • Help diagnose, treat conditions via artificial intelligence • Computer performs tasks usually needing human intelligence: • Visual perception • Decision-making • Speech recognition • Language translation • Assist in decisions, not replacing human interaction • Examples: • ATHENA • GIDEON • CEMS • TherapyEdge HIV

34. Fiber optics • Organ or cavity viewed via plastic fibers that transmit light through a special tube • This reflects a magnified image • Examples include fiberoptic: • Colonoscopes • Duodenoscopes • Bronchoscopes

35. Fiber optics • Tiny cables, thin as human hairs, that transmit data • Has greatly increased safety for many surgical procedures • Tiny cameras are inserted through narrow tubes • Only tiny incisions and instruments are needed • Often used for: • Repair of hip fractures • Spinal fusions

36. Patient questionnaires • Computer terminals allow them to enter information into electronic forms • Answers help identify risk factors, perform health screening • Health calculators aid in determining: • Target heart rates • Body mass index • Energy expenditure • Other information

37. Treatment • Robotic surgery • Allows use of minimally invasive procedures with more accuracy • Specially trained surgeon guides robot • Interacts with 3-D cameras, voice commands • Often used for: • Head and neck cancers • Gynecological cancer • Cardiac surgery • Prostate cancer

38. Treatment • Laser surgery • Finely focused light rays used • Corrective eye surgery • Image-guided surgery • CT is combined with infrared technology • Uses invisible radiant energy for 3-D accuracy • Computer modeling used in: • Dentistry • Reconstructive surgery • Cosmetic surgery

39. Research • Detailed searches for very precise data • Electronic research • Much faster, accurate than traditional research with printed materials • Bioinformatics • Used in the Human Genome Project • Organization of biological data into electronic databases

40. Research • Gene therapy • Uses normal genes inserted into cells • These replace abnormal genes linked to disease • Drug therapy has also benefitted by • Computerized research • New drugs developed more quickly than ever before

41. Telemedicine • Uses telecommunication equipment, information technology • Provides clinical care to individuals at distant sites • Transmits information, images • Allows examinations, monitoring, testing • All types of professionals, patients linked: • Emergency caregivers • Physicians • Home-bound • Specialists

42. Telemedicine • Legal challenges about practice location regulations exist • Telemedicine has been performed successfully on a global basis • Robotic systems have been integrated • Offers assistance to people who lack access to the latest imaging equipment

43. Telepharmacy • Delivery of pharmaceutical care • Via use of telecommunications equipment • Drugs dispensed at locations other than pharmacies • Prescriptions sent to computerized dispensing units • Video conferencing, patient counseling possible

44. Computer security Passwords are unique to every user No sharing of passwords Do not leave workstations unattended Close all open programs before leaving Keep unauthorized individuals from viewing information Computer printouts shredded before discarding Regular back-ups of files

45. Computer security • Computer viruses • Destructive programs that attempt to access information illegally • Usually spread from programs downloaded via Internet • Or from infected files loaded into computer • At work, Internet usage should only involve work-related tasks • Do not “surf” Internet for personal reasons