5.1.1 TRENDS AND NEED
As described in Chapter 2, there are quite many important trends that affect the health care sector enormously. Health care is very complex and quite inefficient industry. Health care and medicine specifically is an information and image-intensive field. Hospitals need to be efficient and timely in their works and this includes their information management. Information management is the critical part of decision making in medicine as it has to be timely, relevant, and reliable. As the amount of clinical knowledge has become very large, computers are of great help. Machines are able to store, process, manipulate, and retrieve huge amounts of information and images efficiently and quickly. As delivery of health care may have to deal with physical, geographical, and other barriers, the field of informatics can help here a lot to overcome these hurdles. It is important to transmit and share medical and health information across organizations and enterprises using local area networks or wide area networks including the Internet. It is also necessary to provide health care services to remote and underserved areas where regular delivery is too complicated, expensive, or low quality. Technological solutions are crucially needed for sustaining medical education by reaching out to professionals. One of the biggest areas health care is pressured to redesign its thought process is cost-efficiency and here technology is hoped to be the savior. Ultimately going paperless and filmless is meant to reduce costs and make work more efficient. Doctors usually do have not enough time for the visits and there is lack of attention as the number of doctors per patient is too small. Technology also aims to help to provide better care and services. Clinical decision support helps doctors to do better choices. It should be seen clearly now that there is a huge need for health informatics and technologies.
5.1.2 BRIEF HISTORY
Between the 1960s and 1970s, hospitals started to have computers. Together with computers came the first administrative applications. The adoption of these applications was driven by the need to process large volumes of hospital data, which was much easier and better to do with computers rather than by hand. First, the applications were mainly for billing and health insurance claims.
Throughout the 1970s to 1980s, administrative systems started to be replaced by hospital information systems (HISs). During this period, the attempts of integration of clinical components into the administrative and financial systems were starting. Early examples of these information systems include the HELP system that was developed at Latter-Day Saints Hospital in Utah, USA (Collen & Ball, 2015) and the DIOGENE system that was developed in Geneva, Switzerland (Borst et al., 1999).
The 1970s brought along the early developments of digital medical records systems. The aim was to automate the entry, storage, and retrieval of patient data. Examples of these systems are PRoblem-Oriented Medical Information System (PROMIS) from University of Vermont Medical Center (Goldberg, 1988) and TMR from Duke University (Collen & Ball, 2015). PROMIS featured Problem-Oriented Medical Record, which is thought to be one of the earliest medical record systems. It was the first system to link patient and patient care by using hypertext.
During the 1980s, medical informatics was formalized as a scientific discipline. During this decade, professional groups such as the International Medical Informatics Association, the American Medical Informatics Association, and the European Federation for Medical Informatics were formed and medical informatics departments grew in North America, Asia, and Europe.
From 1990 to 2000, technology including Internet was rapidly evolving and gaining mainstream popularity. In medicine, this trend manifested in fast and pervasive adoption of networked and clientâserver technology. This was the time of growth for Internet and PC-based clinical information systems and knowledge bases. The field of medical informatics development accelerated.
During the change of millennium, several nations started to plan for a countrywide integration platform that would cover all the different health care stakeholders. Denmark, Finland, and Estonia were the first pioneers in this field. Estonia launched its nationwide health information exchange (HIE) platform in January 2009. At the same time, Estonia was the first country to show all collected health data to the patients. For that, a patient portal service was developed, where people could look up health information that was collected about them, give permissions (organ donation permission, prohibition of resuscitation, and blood transfusion), and designate trustees and close own health data (OECD, 2010; Sabes-Figuera & Maghiros, 2013).