Another area of administrative efficiency is the use of bar codes not only on all medical supply packaging as proposed by Rundle (1997) but also for services rendered to the patients. Patients can be bar-coded when they are admitted. The code should include personal details as well as their medical history. Such a hybrid barcode will facilitate: keeping track of patient treatment services and billings, as well as decisions concerning lines of treatment, if (associated with codes) we can also have medical evidence-based expert-systems formulations. With the internet revolution sweeping the globe and internet technology transforming the world of commerce so rapidly, e-healthcare (entailing effective involvement of IT in healthcare delivery and hospital operations) has become recognised as a new and important strategy in the healthcare arena. Some of its applications entail patient-care services online (http://www.netcare.com.sg/), medical record online (http://www.meetdoc.com/), pharmaceutical products online (http://www.drugstore.com/), blood appeal (donation) through net (www.donorweb.org).
Additionally, e-procurement has been implemented by numerous organisations in recent years (Perez, 2000). It is expected that the volume of US pharmaceutical and medical transactions will increase from $1 billion in 1999 to $44 billion in 2003, representing a 136% compounded annual growth rate. E-procurement solutions in the healthcare market offer significant cost reduction benefits to buying organisations, primarily in terms of process cost-savings as opposed to reductions in net pricing.
In general, e-healthcare entails translation of the needs of healthcare units by the IT department. Possibly, the most impactful e-healthcare activity would be e-patientcare, entailing the following operations: patient history-taking generation of intelligent medical records development of decision-tree based diagnostic and interventional procedures specific to the patient. A major application of e-healthcare is in patient-centered services. For instance, by employing emerging technology, patients at the National University Hospital, (Singapore) have been provided with online personalised healthcare with the new health service. The service enables general practitioners to develop patient history, forward it to the tertiary-care hospital and then set up appointments.
For non life-threatening, semi-emergency situations, telemedicine is another patient-catering service, by which the elderly and the invalid would not have to make a trip to a clinic or hospital to get a consultation. The system consists of a video camera and computer screen, by which doctor and patients can communicate through info-communication technology. Basic medical information, such as body temperature, blood pressure and even ECG can be measured by the nurse from the remote patient’s site, and this information can be transmitted to the doctor/hospital. With these computer-assisted consultations, the patient saves on trips, but can still ‘see’ a doctor. Subsequently, follow-up medical checks and consultations are equally easy. While we have been talking about the scope of electronic hospital operations, probably the biggest impact of e-procedures could be in modelling of some specific functional processes, with a view to optimising them or making them cost-effective.
Examples of such clinical services that lend themselves to simulation are: functioning of intensive-care units (ICU), operation theatres and emergency medicine departments. For instance, simulation of ICUs can enable optimal layout of nurses stations and patient beds to maximise patient monitoring and surveillance. Simulation of an operation-theatre can also provide the optimal doctors and nurses’ circulation about the patient. In the case of emergency medicine, simulation can help to determine the optimal number of doctors and nurses in attendance, so as to minimise the wait-time. A mathematical approach to simulation (based on control theory) was initiated by Simon (1952) and Vassian (1955) for continuous-time and discrete-time events, respectively.
In another type of simulation (using a computer) involving system dynamics in total quality management (TQM), Khong (1999) proposed a human resource management model for computer software simulation. The e-clinic (Virtual Diagnostic Clinic) is yet another area of electronic healthcare. Traditionally, patients are required to travel to a clinic, by queuing and waiting for their turn before they can seek medical attention. The entire process can be time-consuming and inefficient.
An online virtual diagnostic clinic is thus proposed to minimise waiting and travelling time spent in the current practices, is shown in picture. The virtual diagnostic clinic is an outpatient clinic, designed to serve patients round the clock, as schematised in picture. The patient just needs to log on to the virtual clinic system to seek medical attention. The server is manned by doctors to help the patients decide if they should seek treatment for a condition. The consultation process can be done via the internet, whereby the patient discloses her/his age, sex, blood group, drug allergies and the medical problem.
The doctor further assesses the patient condition and gives advice accordingly. This system could also have the tools to enable the patient to monitor their high blood pressure or their blood sugar level. In such cases, the patients could purchase the relevant monitoring equipment, measure their own blood pressure and blood sugar level, and have these readings entered into the system. Should the doctor detect the slipping of the patients’ control on their own medical condition, the system can prompt the patients to visit the doctor and fix an appointment for them. This interactive system can also function as an e-healthcare advisory centre, whereby the patient could log on to the system to seek healthcare advice.
After the patient enters the profile and topic-of-interest into the computer, the relevant information can be directed to them. This is done with the aim of narrow-casting the patient, instead of broadcasting the patient with all information. For instance, a patient suffering from high blood pressure need not stop at just monitoring her/his condition on the system. S/he can ask for information about the medication s/he is taking to control her/his condition, the dangers of over and under consumption of the drugs, the dosage of the drugs, the recommended diet plan, and where to get the cheapest and most reliable drugs.
Alternatively, doctors can also access and know the patient’s medical history as well as family history when the patient gives the user-ID and password to the doctor, ensuring the continuity of records and thus the continuity of care. This access is especially crucial in the case of an emergency, where such knowledge can be a matter of life and death. For instance, the doctor can avoid giving the patient medicine that the patient is allergic to.
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