075 - A roadmap for the Information Technology in Laboratory Medicine
Autor(s): Romolo M. Dorizzi
Issue: RIMeL - IJLaM, Vol. 3, N. 2, 2007 (MAF Servizi srl ed.)
Page(s): 75-81
A recently published comment discussed the dilemma of Health Information Technology; some think that it will transport the health care to perfection, other are afraid that it will transform clinicians, admistratives and patients in prisoners of IT support people. Many types of HIT are important, but three deserve particular attention because of their potential significance for the day-to-day delivery of health care services: the electronic health record (EHR), the personal health record (PHR), and clinical data exchanges. According to Institute of Medicine EHR has core functionalities (Health information, results management, order entry and support and decision support) and minor functionalities (Electronic communication and connectivity, patient support, administrative support, reporting and population health management). The clinical data exchange is established and managed by a regional health information organization (RHIO), that consists of local groups including hospitals, insurance companies, employers, pharmacies, consumer groups, and government officials that are brought together to connect the HIT systems maintained by the separate health care providers and insurers in a given geographic area. The major limitation of the literature on EHRs is that most of the key studies originated at an extremely restricted number of institutions that pioneered the use of HIT and developed their own EHRs.The relevance of these studies to the probable experience of most organizations, hospitals and doctors is uncertain. Ten simple rules for an Effective Clinical Decision Support developed in Boston have been shortly presented: speed is everything; anticipate needs and deliver in real time; fit into the user’s workflow; little things can make a big difference; recognize that physicians will strongly resist stopping; changing direction is easier than stopping; simple interventions work best; ask for additional information only when you really need it; monitor impact, get feedback, and respond; manage and maintain your knowledge-based systems. A Roadmap has been developed identifying three pillars for fully realizing the promise of Clinical Decision Support (CDS): best knowledge should be made available when needed, high adoption and effective use and continuous improvement of knowledge and CDS methods. Recent reviews have suggested that decision support can improve performance, although it has not always been effective. A pivotal role in the success of an implementation has been always played by key individuals. These special people were high level leaders, non-physician clinicians who assisted with the implementation, or physicians who played a special role during implementation. Their roles spanned disciplines from administration to information technology and to the clinical realm.