Information Technology for the Health Professions / Edition 4

Information technology continues to change many aspects of society, including health care and its delivery. In Information Technology for the Health Professions, we take a practical approach to introducing health care professionals to the myriad uses of computer technology in health care fields. After a brief introduction to the essential concepts needed to understand computer hardware, software, telecommunications, and the privacy and security of information, we see how these technologies have affected various aspects of health care. The term information technology includes not only computers, but also communications networks and computer literacy, that is, knowledge of the uses of computer technology. Rapidly changing computer technology continues to exert a major influence on all aspects of society. The understanding of the interconnections of hardware, software, networks, and new medical techniques is essential.

The second edition of Information Technology for the Health Professions has been expanded and updated for the new millennium. It includes new sections on recent technological developments and their uses in health care and its delivery, on new laws affecting privacy and security of medical information, an expanded chapter on medical informatics and the administrative uses of computers, and a new chapter on computer technology in dentistry. Dated materials have been deleted. Although Information Technology is geared to an audience interested in health care, it is written at a level appropriate for the layperson.

The first three chapters of the first edition on computer literacy, computer hardware and software, and networking and telecommunications have been condensed, keeping only information essential to students and others interested in computers and health care. These chapters have been combined into a new Chapter 1, which provides the student with information necessary to anyone living and working in a computerized society.

Chapter 2 deals with the problems of security and privacy of information in electronic form and on networks. Both general issues of security and privacy in an electronic age and problems specific to health care are discussed. New issues of security and privacy are raised by new laws. The student is introduced to the Health Information Portability and Accountability Act of 1996 (HIPAA) that provides the first national minimum standards for the privacy of medical information. The book also deals with the effects of the USA Patriot Act on medical privacy.

Chapter 3 is an expanded introduction to medical informatics—the use of technology to organize information in health care. The student is introduced to the traditional classifications of clinical uses of computers (used in direct patient care); administrative uses of computers used in office administration, financial planning, billing, and scheduling; and the special purpose uses of computers in education and pharmacy. The chapter has an expanded section on the administrative uses of computers discussing the computerization of tasks in the medical office, the electronic medical record, and bucket billing. It also introduces the student to grouping and coding systems, insurance, and the various accounting reports used in the health care environment.

Chapter 4 deals with telemedicine and its rapid expansion. Telecommunications and connectivity have made possible telemedicine, from the simple sharing of patient records or X-rays over networks, to distance exams, to remote operation of medical instruments, to teleconferencing. The earliest telemedicine used store-andforward technology to send images. This is still used in teleradiology, telepathology, teledermatology, telestroke programs, and telecardiology programs. Interactive videoconferencing allows a medical exam in real time—with all participants seeing and hearing each other.

Chapter 5 introduces the student to digital imaging techniques. Digital images (CT scans, MRIs, PET scans) are more precise than the traditional X-ray. The CT (computerized tomography) scan and MRI (magnetic resonance imaging) have become standard diagnostic tools. PET scans (positron emission tomography) allow the physician to examine the electrical and chemical processes in the brain. Currently interventional radiologists treat diseases that once required traditional surgery.

A new chapter that surveys computer technology in dentistry has been added. Dentistry is changing due to changing demographics and the introduction of new computer-based techniques. During the second half of the twentieth century, dental care allowed most children to grow up with healthy teeth. Now good dental care prevents cavities in children who can afford it. An aging population seeks dental care for many reasons, including cavities, periodontal disease, and cosmetics. The fully computerized dentist's office uses the electronic medical record to integrate all aspects of care.

Chapter 7 surveys the uses of computers in surgery. Computers are used in surgery from the teaching and planning stages to the actual use of robotic devices in the operating room. Computer simulations help in the training of students. Minimally invasive, endoscopic surgery makes use of robotic devices to hold the endoscope.

The use of computer technology in pharmacy has traditionally been considered a special purpose application. Today, information technology is involved with medication from its design to its administration. The development of medications for the treatment of genetically-based diseases is slowly becoming a reality because of the knowledge gained through the Human Genome Project. Supercomputers, using special software, are now being used to design new medications. Software packages allow pharmacies to print out extensive drug descriptions along with side effects and interaction warnings that accompany prescription medications. Computerized infusion pumps automatically administer medication. The networking of medical devices allows a monitoring device to communicate with a drug delivery device. Robots are being used to fill prescriptions and count out capsules and tablets. Telepharmacy is expanding due to a shortage of pharmacists, a drive to cut costs, and the interest of the U.S. Department of Defense, Veterans Administration, and Immigration and Naturalization Service.

Computer controlled medical devices include the most established clinical use of computers—the use of computerized monitoring devices. For people with disabilities, adaptive technology can make an independent life a reality. Electronic prosthetics refer to computerized replacement body parts. An artificial limb designed with the help of a computer with embedded microprocessor chips can sense and react to nerve signals. It can work like a natural limb so that a person with an electronic prosthetic foot can even participate in college sports. Some devices, such as pacemakers, make use of the technology called functional electrical stimulation, which delivers low-level electrical stimulation to muscles.

Computer-assisted instruction, both drill-and-practice and simulation, has long been used to educate patients and practitioners. Currently programs make use of virtual reality techniques, so the student actually feels the experience of performing a medical procedure. Online medical literature databases aid in both academic research and diagnosing patients. Expert systems try to make a computer an "expert" in one field. Interactive self-help applications include both self-help software and the use of the Internet for medical advice. Advice and information on every aspect of health care, every drug, and every disease is on the Internet.

Computer technology is continuing to have an enormous impact on health care fields. Today, medical technology is in a constant state of flux. Whole new fields, such as telemedicine, are emerging and changing the way medicine is practiced. The future may hold unbelievable techniques and devices. Electronic brain implants are in their infancy, holding the promise of communication for locked-in patients as well as the threat of mind control. Other devices are currently in the testing stages. Not only are sensors being developed to help paralyzed patients move. In the future, nanotechnology may diagnose and treat disease at the molecular level.