Published in medi.philica.com
The aim of this article is to present the ten major challenges faced by the healthcare domain today. The author lists them in the order of their perceived importance and provides explanations for including them in the list. The 10 challenges are Health disparity, Epidemic response, Healthcare communication, quality improvement at lower costs, m-Health, Intelligent Clinical Decision Support Systems(CDSS), Interoperability, Unified terminology adoption, Knowledge translation (KT) and Medical Robotics.
The desire to be healthy and enjoy the various facets of life has been a cardinal feature of man's aspirations from time immemorial. Ancient scriptures like Bible and Upanishads contain several verses extolling the value of good health. In modern times every responsible nation has acknowledged the primacy of Health of their populations by including it in the rights and duties in their constitutions. With such a pride of place among the pantheon of human rights and the great advances in medical sciences in the last century one must expect that mankind would have conquered the burden of disease effectively. Unfortunately, nothing is farther from truth. Safeguarding the health of its citizens and improving the quality of their lives still remain the greatest challenge of societies all over the world. Health informatics or application of information communication tools to health care has been touted as one of the possible means to improve the utility, access, safety and application of healthcare methods. The objective of this paper is to present a high level scan of the major challenges in the Healthcare domain within the backdrop of informatics. These challenges have been ranked solely according to the author's viewpoints for ease of presentation and comprehension.
1.Disparities in Health: Perhaps this is the greatest challenge staring at the face of Global Health agencies, governments and non - profits. The greatest challenge today is not just to how to conquer illnesses, but the means to ensure access to care to all that who needs the care. Health disparities refer to differences between groups of people. These differences can affect how frequently a disease affects a group, how many people get sick, or how often the disease causes death.
Many different populations are affected by disparities. These include
* Racial and ethnic minorities
* Residents of rural areas
* Women, children, the elderly
* Persons with disabilities.
Canadians enjoy one of the best health care systems in the world. Canadian health indicators have traditionally been better than that of almost all nations in the world with an organized health care system. Still the Public Health Agency of Canada reports that "Major health disparities exist throughout the country. These health disparities are not randomly distributed; they are differentially distributed among specific populations (e.g. Aboriginal peoples) by gender, educational attainment and income, and other markers of disadvantage or inequality of opportunity. The most important consequences of health disparities are avoidable death, disease, disability, distress and discomfort; but it is clear that disparities are also costly for the health system and Canadian society as a whole. Health disparities are inconsistent with Canadian values, threaten the cohesiveness of community and society, challenge the sustainability of the health system, and have an impact on the economy". Comprehensive approaches to disparities reduction involves commitment to documenting the extent of disparities, developing evidence-based policies and evaluating interventions. E-health applications can play a major role in the above mentioned strategies.
2. Coordination of Global Health efforts during disasters and epidemics
One of the defining features of modern day epidemic is that unlike outbreaks in the past they are no longer confined to their respective provinces or nations of origin. Beginning with the SARS outbreak each of the subsequent epidemics have crossed oceans and continents with breathtaking speed and devastating effects. Advances in aviation and the resultant spurt in cross border travel has been the major reason behind this transition. It has led to a situation where the control of epidemics needs a global alert, surveillance and co-ordination mechanism which transcends geographical and political boundaries. Although many have suggested control of international travel during epidemics as a solution to the problem it is impractical to ration travel based solely on public health concern. The author believes that effective utilization of informatics resources can aid in dynamic data collection and transfer, effective coordination amongst national and international health agencies and rapid response triggering and monitoring mechanisms.
3.Communication between healthcare providers
One of the most important reasons the patients are admitted to acute care facilities is to monitor for deterioration in their clinical condition and intervene early. Thus communication between clinicians, allied professionals and support staff is critical in providing high quality and safe patient care. Never before in human history has been communication technology ubiquitously available as is now. Yet communication problems are the most common cause of preventable death or disability in a review of 14000 hospital admissions. Literature is scarce regarding effectiveness of various communication systems for health care use. Although smart phones and other hand held devices have been suggested as potential solutions much work is yet to be done in this area. Undoubtedly this is one area where e - health professionals have their task cut out. Their unique positioning at the interface between Health and information technology gives them a unique view of the state of affairs and a decisive strategical advantage to provide solutions in the area.
4. Improving Quality while controlling costs.
Healthcare expenditure has been steadily rising across the world since the beginning of the first decade of the twenty first century. In the aftermath of the recent worldwide economic meltdown renewed calls to reign in the cost of healthcare has gained broad based support all over the world. Healthcare costs have been reported to be growing rapidly to be soon capable of threatening to derail the budgetary allocations for other essential services in many countries. Ironically, clarion calls for improved patient safety and quality of medical care have also reached crescendo at the same time. Healthcare administrators, policymakers and the general public are currently debating the ways and means to reconcile the seemingly hostile factors of cost and quality. Historically, better quality healthcare has been associated with increased monetary expense. The time has come to arrest this relationship and to marry economy with quality. This might involve improving efficiency, increasing predictability, developing low cost yet highly effective medical technology and probably radically reengineering the healthcare systems. Informatics will be a powerful tool in the hands of public health administrators and medical researchers in pursuit of quality healthcare at sustainable costs.
5. Developing effective m-health applications
Mobile eHealth or mHealth broadly encompasses the use of mobile telecommunication and multimedia technologies as they are integrated within increasingly mobile and wireless health care delivery systems. The field broadly encompasses the use of mobile telecommunication and multimedia technologies in health care delivery. m - Health applications include the use of mobile devices in collecting community and clinical health data, delivery of healthcare information to practitioners, researchers, and patients, real-time monitoring of patient vital signs, and direct provision of care (via mobile telemedicine). m - Health has the potential to provide increased access to healthcare and health-related information (particularly for hard-to-reach populations); improved ability to diagnose and track diseases; timelier, more actionable public health information; and expanded access to ongoing medical education and training for health workers. Emerging challenges in the field includes Emergency response systems (e.g., road traffic accidents, emergency obstetric care) Human resources coordination, management, and supervision, Mobile synchronous and asynchronous telemedicine diagnostic and decision support to remote clinicians, Clinician-focused evidence-based formulary, database and decision support information available at the point-of-care,Pharmaceutical Supply Chain Integrity & Patient Safety Systems, Clinical care and remote patient monitoring, Health extension services, Health services monitoring and reporting, Health-related mLearning for the general public, Training and continuing professional development for health care workers, Health promotion and community mobilization and Support of long-term chronic conditions. m - Health applications have the ability to influence the entire gamut of healthcare activities. This makes it easily one of the most challenging areas in health care research.
6. Interoperability of Health information Systems.
"Interoperability is a fundamental requirement of ensuring that widespread electronic medical record (EMR) adoption gives us the social and economic benefits that we want. Without interoperability, EMR adoption will further strengthen the information silos that exist in today’s paper-based medical files, resulting in even greater proprietary control over health information and, with it, control over patients themselves".We think about interoperability only in today’s terms. Looking ahead, the demands that future health care technologies will make on health information exchange could be large, as could the health benefits delivered because of interoperability. Streaming real-time video interactions between physicians and patients and among physicians will be integrated into the EMR in some form and will require profound broadband capacity. Monitoring of live-feed data from the homes of the elderly or infirm will tell clinicians and family members about medication taking, ambulation, consumption, and other aspects of autonomous daily living. Implantable devices with wireless feeds will report patients’ physiological status to physicians and monitoring centers and will report functional anomalies to the manufacturer and relevant federal agencies. And that is not to mention inputs about weight and reaction times from automobiles, ambient environmental sampling data linked to one’s location by wearable global positioning system (GPS) devices, exercise data from implantable stress monitors, and sensors at one’s desk for other kinds of stress. In short, the future of interoperability is to bind together a wide network of real-time, life-critical data that not only transform health care but become health care.
7. Intelligent Clinical Decision Support Systems.
"Clinical Decision Support systems link health observations with health knowledge to influence health choices by clinicians for improved health care". The main purpose of CDSS is to assist the clinician at the point of care.While the first generation CDSS was supposed to make the decisions literally for the clinician the trend is towards a system which will allow interaction with the clinician to use the clinician's knowledge and the knowledge base of the system to analyse the patient's complaints and arrive at at a solution. Developing such systems is one of the ongoing challenges of Health Informaticians.
8. Unified Terminology Adoption
There is a bewildering variety of terms used by clinicians across different systems to denote the same condition. While that was largely acceptable while healthcare remained compartmentalized and localized the ongoing efforts to merge health data in to a interoperable mode has necessitated the adoption of a 'common language' to bridge the chasm between various health providers. The existing systems have largely been successful to a very limited extent due probably in part to lack of ease of use and paucity of adequate effort and zeal from clinicians and administrators. But it is unanimously agreed that adoption of a unified medical terminology system is a prerequisite for seamless health care and this remains a challenge for the health profession as a whole.
9. Knowledge Translation (KT).
"At CIHR, knowledge translation (KT) is defined as a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically-sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the health care system". The blinding pace at which medical knowledge is being created and modified has all but ensured that it is beyond human capacity to discriminate and assimilate it. It is a challenging task to make sure that the right information is passed along to the right people at the most approveriate time so that it becomes actionable. Clinicians need to be updated about relevant practice guidelines and recent trends in medical literature; patients also need to be provided with the right evidence based information. Internet has become a crowded and tricky place to search for medical information because many of the sources are not accurate and appropriate. These reasons make it a formidable challenge for the health profession to device, implement and modify effective KT tools.
10. Medical Robotics.
While literature is scant regarding the advantages of robotic surgery over traditional approaches it has been widely regarded as an accurate and efficient means of achieving surgical precision. Robotic operated patients experience reduced healing time, less post operative pain and remarkably shorter stay in the hospital. These reasons are adequate for continued rigour in developing smart robotic systems which can be of used by surgeons. The current scenario involves only a handful of players in the field and considerably high expenses for the system and the patient. The challenge is to develop cost effective, precise, intelligent robots which can assist the surgeon to improve the productivity, increase patient comfort and reduce the strain on the health care system.
The challenges facing the healthcare domain are wide and varied. They range from operational challenges to technology related issues. Health Informaticians and e- health professionals have the opportunity to work closely with the clinicians and arrive at sustainable solutions for the problems.
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Keepanasseril, A. (2011). Top Ten Challenges Facing Healthcare in Informatics Domain: An Opinion Paper. PHILICA.COM Article number 285.