The Promises and Challenges of Health Information Technology

The Promises and Challenges of Health Information Technology

Brian Gugerty (Gugerty Consulting, LLC, USA) and Michael J. Maranda (Evaluation Researcher, Belgium)
DOI: 10.4018/978-1-4666-2770-3.ch004
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This chapter explores the application of Information Technology to healthcare in the United States. Recent developments and trends in healthcare information technology (HIT) are presented and discussed. Widespread adoption of HIT promises to save lives, save money, and improve health. Definitions, descriptions, and examples of electronic health records (EHRs) and personal health records (PHRs) are provided. The significant efforts to broadly and meaningfully adopt HIT over the next several years are discussed. The significant challenges in implementing EHRs are discussed, including transformation of clinical processes. Finally, the impact of HIT on the concept of ownership of the healthcare record and how it may change the relationship between the patient and healthcare provider are explored. Implementing effective HIT on a nationwide scale will require considerable effort.
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The application of information technology to healthcare offers the promise of the comprehensive management of health information, including the exchange of information between patient and healthcare providers, among providers, and between providers and payers/government agencies. Healthcare information technology (HIT), if implemented extensively, has the potential to improve the quality of healthcare, to increase efficiency of providing care, and to reduce medical errors. This result translates into saving lives and saving money. The systematic application of HIT through a country can result in the general improvement of the population’s health.

Despite the fact that much of HIT was pioneered and developed in the US and this country remains an innovator in HIT, the US lags behind some other countries and regions in the implementation of HIT. Currently, there is a federal initiative in the US to promote adoption of HIT by healthcare providers. It is hoped that HIT will be implemented in the US broadly enough so that—in the words of David Blumenthal, MD, U.S. National Coordinator for Health Information Technology—a “nationwide electronic health information system” will develop (Blumenthal, 2010).

The Alliance for Health Reform (2009) describes HIT as encompassing “a broad array of technologies involved in managing and sharing patient information electronically, rather than through paper records.” The central component of this broad array of technology is the electronic health record (EHR). An EHR is a record of an individual’s health and healthcare-related information that is created, managed, and consulted by authorized clinicians and staff within one or more healthcare settings. Computer hardware and software technologies and standards underpin the EHR, and networking technologies and standards extend the EHR into the area of health information exchange (HIE). HIE enables the important information contained in the EHR to be shared across healthcare delivery organizations, regions, and nations.

Despite several decades of vigorous efforts to encourage the adoption of EHRs, most physician office practices and many hospitals have not done so in the United States. Even hospitals in the US that have begun to adopt HIT have a long way to go to achieve the desired end points, as will be discussed in detail later in this chapter. In fact, several countries or regions, including the Netherlands, the UK, France, Hong Kong, Singapore, and Australia, are significantly more advanced in the basic penetration and use of the EHR than the US. The US federal government through the Office of the National Coordinator of Health Information Technology and other agencies are trying to change that. The Bush administration set a goal of a fully functional EHR being used by every American by 2014. The Obama administration concurs with that goal and has appropriated tens of billions of dollars to make it a reality. This high-level focus on EHR adoption and the significant money that is available for such adoption over the next five years has generated great interest and activity in the US and beyond. Although the US has far to go in implementing HIT on a national scale, it remains a major innovator of HIT. The fragmented healthcare system with diverse types of providers allows for much innovation and experimentation in HIT.

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Editorial Advisory Board
Table of Contents
Chapter 1
Rakesh Biswas, Joachim Sturmberg, Carmel M. Martin
This chapter is an introduction to user driven learning that initially dwells on features that are unchanged such as the role of collaborative... Sample PDF
The User Driven Learning Environment
Chapter 2
Roberta Bernardi
The objective of the chapter is to discuss how Information Technology can mitigate constraints to policy implementations stemming from a highly... Sample PDF
Information Technology and Resistance to Public Sector Reforms: A Case Study in Kenya
Chapter 3
Janine R. A. Kamath, Amerett L. Donahoe-Anshus
Over the last two decades there has been considerable deliberation, experience, and research in the arena of Health Information Technology (HIT)... Sample PDF
Electronic Health Record: Adoption, Considerations and Future Direction
Chapter 4
Brian Gugerty, Michael J. Maranda
This chapter explores the application of Information Technology to healthcare in the United States. Recent developments and trends in healthcare... Sample PDF
The Promises and Challenges of Health Information Technology
Chapter 5
Brett Harnett
In many locations throughout the world, the optimal process is non-existent or has broken down; the United States is no exception as explained from... Sample PDF
Patient Centered Medicine and Technology Adaptation
Chapter 6
Daniel Morrow, Jessie Chin
The authors explore the role of technology in supporting collaboration between health care providers and older adults. They focus on two... Sample PDF
Technology as a Bridge between Health Care Systems and Older Adults
Chapter 7
Keith Lui
Health informatics (HI) is an increasingly important discipline to healthcare. HI is the scientific field concerned with improving how information... Sample PDF
The Health Informatics Professional
Chapter 8
Lemai Nguyen
Family carers play an important role in care for aged patients with chronic illness, particularly in home and community settings. The information... Sample PDF
Supporting Family-Based Care for Aged Patients with Chronic Illness
Chapter 9
Charlotte Tang, Sheelagh Carpendale
This chapter presents issues that may arise in human-centered research in health care environments. The authors first discuss why human-centered... Sample PDF
Human-Centered Design for Health Information Technology: A Qualitative Approach
Chapter 10
Erin Willis, Ye Wang, Shelly Rodgers
The purpose of the chapter is to define health literacy and e-health literacy in the context of online health communities (OHCs). The chapter has... Sample PDF
Online Health Communities and Health Literacy: Applying a Framework for Understanding Domains of Health Literacy
Chapter 11
Lorna Gibson, David Sloan, Wendy Moncur
In this chapter, we describe in detail the opportunities e-health can offer in the context of digital inclusion by reducing social exclusion and... Sample PDF
E-Health and Digital Inclusion
Chapter 12
Motshedisi B. Sabone, Keitshokile D. Mogobe, Tiny G. Sabone
This chapter presents findings of mini-survey that utilized an exploratory descriptive design to examine the accessibility, affordability... Sample PDF
ICTS and Their Role in Health Promotion: A Preliminary Situation Analysis in Selected Botswana Rural Communities
Chapter 13
Evangelos Kotsonis, Stelios Eliakis
Current developments in the field of integrated treatment show the need for IS security approaches within the healthcare domain. Health information... Sample PDF
Information Security Standards for Health Information Systems: The Implementer’s Approach
Chapter 14
Mohamed K. Watfa, Manprabhjot Kaur, Rashida Firoz Daruwala
Pervasive healthcare is the ultimate goal of all healthcare facilities and e-healthcare is the most talked about medical assistance these days.... Sample PDF
RFID Applications in E-Healthcare
Chapter 15
Xiaomin Zhao, Ming J Zuo, Ramin Moghaddass
Diagnosis of fault levels is an important task in fault diagnosis of rotating machinery. Two or more sensors are usually involved in a condition... Sample PDF
Generating Indicators for Diagnosis of Fault Levels by Integrating Information from Two or More Sensors
Chapter 16
Åsa Smedberg
There are e-health communities of many different kinds available on the Internet today. Some e-health communities are for people who need to change... Sample PDF
E-Health Communities for Learning Healthy Habits: How to Consider Quality and Usability
Chapter 17
Dung V. Pham, Malka N. Halgamuge, Thas Nirmalathas, Bill Moran
Epilepsy is one of the most common serious neurological disorders, affecting about 60 million people worldwide. There are currently about 220,000... Sample PDF
A Centralized Real-Time E-Healthcare System for Remote Detection and Prediction of Epileptic Seizures
Chapter 18
J. Escayola, J.D. Trigo, I. Martínez, M. Martínez-Espronceda, A. Aragüés, D. Sancho, S. Led, L. Serrano, J. García
Traditional fields in health delivery such as chronic diseases or independent aging are evolving to novel healthcare applications like... Sample PDF
Overview of the ISO/IEEE11073 Family of Standards and their Applications to Health Monitoring
Chapter 19
Michelle Lee D’Abundo
The Health Information Technology for Economic and Clinical Health (HITECH) Act (2009) was legislation passed focused on improving health care... Sample PDF
Electronic Health Record Implementation in the United States Healthcare Industry: Making the Process of Change Manageable
Chapter 20
Hartmut Remmers, Manfred Hülsken-Giesler
The innovative impact of advancing e-Health technologies is more frequently being discussed in nursing science. Nurses play an important role in... Sample PDF
e-Health Technologies in Home Care Nursing: Recent Survey Results and Subsequent Ethical Issues
Chapter 21
Anna Zvikhachevskaya, Lyudmila Mihaylova
This chapter is dedicated to the investigation of IEEE 802.16, a technology that would allow efficient, reliable and affordable healthcare. More... Sample PDF
Advanced Video Distribution for Wireless E-Healthcare Systems
Chapter 22
Krishna K. Venkatasubramanian, Sidharth Nabar, Sandeep K. S. Gupta, Radha Poovendran
With a rapidly aging population, the healthcare community will soon face severe medical personnel shortage and rising costs. Pervasive Health... Sample PDF
Cyber Physical Security Solutions for Pervasive Health Monitoring Systems
Chapter 23
Dennis Backherms
The crime of identity theft has proven to be one of the most costly crimes in American history. Identity theft has become so prevalent in our... Sample PDF
Using Biometrics to Secure Patient Health Information
Chapter 24
Ainara Garzo, Stefan P. Carmien, Xabier Madina
Accessibility is a critical aspect of health care system design, particularly E-health systems. Ability to access services may change as ones... Sample PDF
Mapping Input Technology to Ability
Chapter 25
Takeshi Toda, PaoMin Chen, Shinya Ozaki, Kazunobu Fujita, Naoko Ideguchi
In Japan, electronic health record systems are gradually becoming popular at large hospitals, but are not yet frequently implemented in clinics.... Sample PDF
A Simple Web-Based Image Database System for Facilitating Medical Care in Dermatological Clinics
Chapter 26
N.P Chowdhry, Adnan Ashraf, B.S Chowdhry, A.K Baloch, A.W Ansari, H. De Meer
To address the solution for problems of e-health systems, the various new algorithms are developed. Today, the parallel and distributed programming... Sample PDF
Grid for Post Operative Care through Wireless Sensor Networks
Chapter 27
Ricardo Mendoza-González, Miguel Vargas Martin, Laura C. Rodríguez-Martínez
We believe that well-designed and usable user interface is critical, as the adequate use and the effectiveness of any application usually depend on... Sample PDF
Identifying the Essential Design Requirements for Usable E-Health Communities in Mobile Devices
Chapter 28
Wiktoria Wilkowska, Martina Ziefle
Facing the growing aging population in many countries of the world, healthcare-related technologies become increasingly important, representing a... Sample PDF
User Diversity as a Challenge for the Integration of Medical Technology into Future Smart Home Environments
Chapter 29
Vincent Shaw, Jorn Braa
The expansion of ICT across Africa is influenced by many factors including political imperatives, donor priorities, private sector and NGO needs... Sample PDF
“Developed in the South”: An Evolutionary and Prototyping Approach to Developing Scalable and Sustainable Health Information Systems
Chapter 30
Anna Marie Balling Høstgaard
Despite there being extensive cumulative knowledge and many experiences about factors that contribute to health Information Technology (HIT)... Sample PDF
End-User Participation in Health IT Development: The EUPHIT Method
Chapter 31
Nirmalya Roy, Sajal K. Das, Christine Julien
Pervasive computing applications envision sensor rich computing and networking environments that can capture various types of contexts of... Sample PDF
Resolving and Mediating Ambiguous Contexts in Pervasive Environments
Chapter 32
Jane Fitzpatrick, Willie Ako
In developing equitable health systems, the World Health Organisation (2005) advocates strengthening the repository of social science research to... Sample PDF
Developing Community Ontologies in User Driven Healthcare
Chapter 33
Vahideh Zarea Gavgani
This chapter introduces a model for Information Therapy service through social networks. It discusses how health care providers including... Sample PDF
Ubiquitous Information Therapy Service through Social Networking Libraries: An Operational Web 2.0 Service Model
Chapter 34
Saptarshi Purkayastha
In the context of developing countries, there is a mounting interest in the field of mHealth. This surge in interest can be traced to the evolution... Sample PDF
Design and Implementation of Mobile-Based Technology in Strengthening Health Information System: Aligning mHealth Solutions to Infrastructures
Chapter 35
Jing Shi, Sudhindra Upadhyaya, Ergin Erdem
In healthcare industry, providers, patients, and all other stakeholders must have the right information at the right time for achieving efficient... Sample PDF
Health Information Exchange for Improving the Efficiency and Quality of Healthcare Delivery
Chapter 36
Juanita Fernando
Health authorities need to review the privacy and security of real-life work contexts before pioneering new, privileged information handling... Sample PDF
The Protocols of Privileged Information Handling in an E-Health Context: Australia
Chapter 37
Korinna Zoi Karamagkioli, Evika Karamagioli
European health systems are under mounting pressure to respond to the challenges of population ageing, citizens’ rising expectations, migration, and... Sample PDF
European E-Health Framework: Towards More “Patient-Friendly” Healthcare Services?
Chapter 38
Josep Ma. Monguet, Eduardo Huerta, Joaquín Fernández, Marco Ferruzca, Susana Badillo
Internet and IT (Information technologies) among other innovative drivers push companies to update their business models, and design stands out as... Sample PDF
E-Health Business Models Prototyping by Incremental Design
Chapter 39
Thanos Papadopoulos, Spyros Angelopoulos, Fotis Kitsios
E-government projects have a breadth of impact that extends far beyond their respective context. However, current e-Government methodologies and... Sample PDF
A Strategic Approach to e-Health Interoperability Using e-Government Frameworks
Chapter 40
Ori Gudes, Elizabeth Kendall, Tan Yigitcanlar, Jung Hoon Han, Virendra Pathak
This chapter investigates the challenges and opportunities associated with planning for a competitive city. The chapter is based on the assumption... Sample PDF
Developing a Competitive City through Healthy Decision-Making
Chapter 41
Chad Lin, Yu-An Huang, Chien-Fa Li, Geoffrey Jalleh
Traditionally, little attention has been paid by hospitals to the key issues in the health information systems (HIS) outsourcing decision-making... Sample PDF
Key Health Information Systems Outsourcing Issues from Six Hospital Cases
Chapter 42
Cristina Botella, Rosa M. Baños, Ernestina Etchemendy, Diana Castilla, Azucena García-Palacios, Mariano Alcañiz
The disproportionate increase in the world’s aged population, especially in developed countries, is one of the biggest challenges for developing... Sample PDF
An E-Health System for Promoting Wellbeing in the Elderly: The Butler System
Chapter 43
Anni Dugdale
Three citizen health organizations in Australia are examined for how they are consuming information and communication technologies. In particular... Sample PDF
Australian Patient Organizations: Using Digital Technologies to Engage Health Citizen Communities in Health Policy
Chapter 44
Ali Zalzala, Stanley Chia, Laura Zalzala, Subrat Sahu, Suresh Vaghasiya, Ali Karimi
The following sections describe the implementation of a healthcare records system in rural areas of India’s Gujarat State. The system reduces the... Sample PDF
Rural E-Health Infrastructure Development
Chapter 45
Say Yen Teoh, Mohini Singh, Josephine Chong
This chapter is a discussion of e-health development in Australia. The Australian government has been very proactive in e-government and... Sample PDF
An Overview of E-Health Development in Australia
Chapter 46
Suzana Rocha Siqueira, Eliane Cristina de Freitas Rocha, Marcelo Souza Nery
This chapter aims at contributing to serious games studies taking into consideration two aspects: “as a tool of social change” and as “applications... Sample PDF
Brazilian Occupational Therapy Perspective about Digital Games as an Inclusive Resource to Disabled People in Schools
Chapter 47
Wayne Usher, Lay San Too
This study is the first research project to investigate Australian university students’ e-health knowledge management trends. An online survey was... Sample PDF
E-Health Knowledge Management by Australian University Students
Chapter 48
Jane Fitzpatrick
Women across the world migrate for a wide range of reasons. Some gravitate to urban centres in their own countries seeking safety, education, health... Sample PDF
An Exploration of the Experiences of Migrant Women: Implications for Policy Development of Effective User Driven Health Care Delivery Systems
Chapter 49
Panos Constantinides
This chapter draws on a secondary analysis of publicly available data on the development of the English National Program for IT (NPfIT). This... Sample PDF
The Development of the English National Health Information Infrastructure
Chapter 50
Panos Constantinides
This chapter draws on empirical research carried out during the years 2003-2006 on the development of a regional health information infrastructure... Sample PDF
The Development of a Regional Health Information Infrastructure in Greece
Chapter 51
Dimitris K. Kardaras, Bill Karakostas
This chapter discusses existing service customization projects in the health sector. It first defines e-health and compiles a list of personal... Sample PDF
Case Studies in Customization of E-Health Services
Chapter 52
Henrik Enquist
The objective of the case study presented here was to develop and investigate the use of a novel e-health technology called the Memory Stone. This... Sample PDF
From Idea to Use: Lessons Learned From a Participatory ICT Healthcare Case Study
Chapter 53
Susan Sliedrecht, Elmarie Kotzé
This chapter reports on a qualitative research project which explored patients’ experiences of counselling and which provided the impetus for... Sample PDF
Patients with a Spinal Cord Injury Inform and Co-Construct Services at a Spinal Cord Rehabilitation Unit
Chapter 54
Paramartha Bhattacharya, Amar Puri Asanga, Rakesh Biswas
This chapter contains physician and patient perspectives of their gastrointestinal system problem solving experiences beginning from one anatomical... Sample PDF
Stomodeum to Proctodeum: Email Narratives on Clinical Problem Solving in Gastroenterology
Chapter 55
Kam Hou VAT
This article investigates the potential of community knowledge records (CKRs) in the electronic transformation for healthcare provision in Macau. Of... Sample PDF
Conceiving Community Knowledge Records as e-Governance Concerns in Wired Healthcare Provision
Chapter 56
Liam Peyton, Jun Hu
E-health networks can enable integrated healthcare services and data interoperability in the form of electronic health records accessible via... Sample PDF
Identity Management and Audit Trail Support for Privacy Protection in E-Health Networks
Chapter 57
Anastasia N. Kastania
E-health evaluation, which involves different dimensions, has increased. In traditional healthcare, quality dimensions exist but these are not... Sample PDF
Evaluation Considerations for E-Health Systems
Chapter 58
Milan Petkovic, Luan Ibraimi
The introduction of e-Health and extramural applications in the personal healthcare domain has raised serious concerns about security and privacy of... Sample PDF
Privacy and Security in e-Health Applications
Chapter 59
Cynthia L. Corritore, Beverly Kracher, Susan Wiedenbeck, Robert Marble
Trust has always been an important element of healthcare. As healthcare evolves into ehealth, a question arises: What will the nature of trust be in... Sample PDF
Foundations of Trust for E-Health
Chapter 60
Jawahitha Sarabdeen
E-healthcare systems through electronic medical records (EMRs), electronic prescribing and decision support systems endeavour to reduce the cost and... Sample PDF
Legal Issues in E-Healthcare Systems
Chapter 61
Max E. Stachura, Joseph Wood, Fjorentina Angjellari-Dajci, James Grayson, Elena V. Astapova, Hui-Lien Tung, Donald A. Sofge, W.F. Lawless
The authors review a model of the conservation of information (COI) applied to organizations. Following this review, the authors briefly review the... Sample PDF
Representing Organizational Conservation of Information: A Review of Telemedicine and E-Health in Georgia
Chapter 62
John McGaha
The United States congress and the past several administrations have dedicated considerable funding for incentives focused on accelerating the... Sample PDF
Implementation Issues on a National Electronic Health Record Network
Chapter 63
Keith A. Bauer
The social consequences of the internet are profound. Evidence of this can easily be found in the enormous body of literature discussing its impact... Sample PDF
Caught in the Web: The Internet and the Demise of Medical Privacy
Chapter 64
Kerry Johnson, Jayshiro Tashiro
Health care systems are complex and often approach a deterministic chaos in the number and types of interactions that occur among health care... Sample PDF
Interprofessional Care and Health Care Complexity: Factors Shaping Human Resources Effectiveness in Health Information Management
Chapter 65
Kei Hoshi
The aim of this chapter is to propose a new way to meaningfully bridge the dichotomy between technological and human concerns in the context of... Sample PDF
Reframing Dichotomies: Human Experiential Design of Healthcare Technologies
Chapter 66
Amit Chattopadhyay, Khushdeep Malhotra, Sharmila Chatterjee
One of the keystone concepts of healthcare improvement is the belief that informed choices will lead to enhanced quality of life and healthcare.... Sample PDF
Ethical Guidelines for the Quality Assessment of Healthcare
Chapter 67
Suptendra Nath Sarbadhikari
This chapter discusses the role of integrating medical education with medical practice through online collaborative learning among the various... Sample PDF
Unlearning and Relearning in Online Health Education
Chapter 68
Lamprini T. Kolovou, Dimitrios K. Lymberopoulos
e-Health considers the healthcare environment as an electronic workspace where different Medical Information Systems (MIS) supports the automation... Sample PDF
The Concept of Interoperability for AAL Systems
Chapter 69
Mary Kuehler, Nakeisha Schimke, John Hale
Electronic Health Record (EHR) systems are a powerful tool for healthcare providers and patients. Both groups benefit from unified, easily... Sample PDF
Privacy Considerations for Electronic Health Records
Chapter 70
Alejandro Enrique Flores, Khin Than Win, Willy Susilo
Protecting the confidentiality of a patient’s information in a shared care environment could become a complex task. Correct identification of users... Sample PDF
Secure Exchange of Electronic Health Records
Chapter 71
Bandar Alhaqbani, Colin Fidge
Electronic Health Record systems are being introduced to overcome the limitations associated with paper-based and isolated Electronic Medical Record... Sample PDF
A Medical Data Trustworthiness Assessment Model
Chapter 72
David Haniff
The chapter presents case studies of e-health applications that the author has been involved in such as a paramedic application that presented... Sample PDF
Usability Engineering and E-Health
Chapter 73
Åsa Smedberg, Hélène Sandmark
Different kinds of applications for self-help are available on the Internet today. Some aim to intervene with users’ life patterns such as negative... Sample PDF
Dynamic Stress Management: Self-Help through Holistic System Design
Chapter 74
Mary Brown
The Affordable Healthcare for America Bill that was signed into law in March 2010 includes support for activities that come under the heading of... Sample PDF
Will Comparative Effectiveness Research Lead to Healthcare Rationing?
Chapter 75
Anastasius Moumtzoglou
The collaborative nature of Medicine 2.0/Health 2.0 and its emphasis on personalized health care clearly outlines it with respect to e-health and... Sample PDF
Health 2.0 and Medicine 2.0: Safety, Ownership and Privacy Issues
Chapter 76
Kristina Zgodavová, Aleš Bourek
This paper discusses managing healthcare organization for sustained success through the use of IMPROHEALTH® project WEB based learning. The paper... Sample PDF
Potential of WEB Based Learning in Managing for the Sustained Success of a Healthcare Organization Based on IMPROHEALTH® Project
Chapter 77
Kevin Yi-Lwern Yap
The rapid growth of the internet and the World Wide Web has led to the development of pharmacoinformatics technologies to assist oncology healthcare... Sample PDF
The Evolving Role of Pharmacoinformatics in Targeting Drug-Related Problems in Clinical Oncology Practice
Chapter 78
Handan Victan
The purpose of this chapter is to explore transformations in market roles and relations that reflect collaborative, connective and communal... Sample PDF
Emerging Trends in User-Driven Healthcare: Negotiating Disclosure in Online Health Community Organizations
Chapter 79
Nicole St. Germaine-McDaniel
As health-information websites become more popular, healthcare corporations have worked quickly to create Spanish-language sites to reach the... Sample PDF
The Emerging Hispanic Use of Online Health Information in the United States: Cultural Convergence or Dissociation?
Chapter 80
Vasupradha Vasudevan, H.R. Rao
The increase in electronic health records has introduced an increase risk of litigation related to collection, storage and exchange of health... Sample PDF
E-Discovery and Health Care IT: An Investigation
Chapter 81
Omotunde Adeyemo
The Nationwide Health Information Network (NHIN) promises many benefits, but may be prone to a new phenomenon in healthcare fraud now rapidly... Sample PDF
The Nationwide Health Information Network: A Biometric Approach to Prevent Medical Identity Theft