eHealth - Emerging Innovative Solutions and EHRs
Shepherdstown 02 November 2006The "e" in eHealth represents emerging technologies and electronic tools being designed, developed and deployed in support of the adoption of electronic health records (EHR). This article attempts to provide a brief review of major trends and highlights of changes in technology, processes and systems that will affect EHR deployment and the realization of improved quality of care. The article explores emerging technologies and innovative solutions that the authors believe will have an impact on healthcare organizations as they reach for performance excellence.
The following are some of the key solutions that are addressed:
- Health Information Exchange (HIE) Solutions
- Trusted EHR & HIE Management Solutions and Systems
- Public Health Systems & Disease Registries and the NHIN Grid
- Next Generation Internet
- NanoMedicine & EHRs
- Robotics & EHR Systems
- Hybrid Solar Powered Health IT Systems
- Conservation Medicine
- Other Emerging Technologies in Healthcare
Health Information Exchange (HIE) Solutions & RHIOs
Future Scenario: The movement toward mutual collaboration on inter-organizational health information exchange (HIE) solutions continues to strengthen in terms of the number and type of joint ventures being formed across the United States. By the next decade, most healthcare organizations will find themselves collaborating with other organizations on a wide variety of other ventures in areas such as software development, joint operations, information exchange, standards, knowledge sharing, technology transfer, and innovation. The authors predict that by 2020, thousands of community level Health Information Exchanges (HIEs) will exist, and will be interconnected to form a National Health Information Network across the United States.
Tools for Organizing Health Information Exchanges
The eHealth Initiative has developed a step-by-step guide and series of tools and resources to help state, regional and community collaboratives plan, develop and operate health information exchange networks. The toolkit includes a set of key principles, roadmaps, sample community experiences and a module of resources to begin or advance a community health information exchange initiative or regional health information organization (RHIO). It is designed to equip states, regions and communities with the information and expertise to begin or advance health information exchange initiatives and "RHIOs" to improve healthcare quality and efficiency. The Toolkit is available online at
Regional Health Information Organizations (RHIO) have been formed across the U.S. to create HIE solutions designed to support interoperability and facilitate secure access to and retrieval of clinical data. The goal is to provide more timely, efficient, effective, equitable, and safer patient-centered care. The RHIOs will seek to allow the secure movement of selected healthcare information electronically between different organizations and disparate information systems within a region or community. Getting to an interoperable HIE network is a complex and costly endeavor. Implementation of an HIE requires a significant degree of collaboration amongst diverse stakeholder groups and the creation of new organizational and governance models to facilitate common agreement on the technical aspects and policies for information sharing. There are also several architectural approaches to consider, given the players and the level of information exchange that will take place.
According to the "Second Annual Survey of State, Regional and Community-Based Health Information Exchange Initiatives and Organizations" by the eHealth Initiative Foundation in 2005, there were only 40 HIEs in the implementation phase and 25 in operation in the U.S. The growth of HIEs and RHIOs is accelerating, however, and by early 2006, there were over 200 RHIOs that were members of Connecting for Health (
http://www.ehealthinitiative.org/coalition/). Despite increasing public concern about the privacy and security associated with RHIOs, the growth will continue as the driving forces of quality, error reduction and national security push forward. As privacy and security issues are addressed and the benefits communicated to the public, then accelerated growth will be realized. It is envisioned that by 2020, there will be tens of thousands of community based RHIOs/HIEs that will be interconnected to form a National Health Information Network across the United States. The key characteristics of these HIEs are:
- standards based
- secure and protect patient privacy
- trusted networks
- regional HIE networks
- used to interconnect EHRs and PHRs
The bottom line is that HIE capabilities and the development of a National Health Information Network (NHIN) are dependent on the widespread implementation and use of EHR systems. If the source of medical information at the point of care is not electronic, then the effectiveness of any HIE is going to be much less.
A number of high profile alliances and coalitions have emerged around mutually beneficial collaborative opportunities in the health IT market. These include collaborative efforts surrounding the development of "open source" electronic health record (EHR) software, establishment of RHIOs systems, the establishment and acceptance of health IT standards, and the sharing of knowledge to make the National Health Information Infrastructure (NHII) a reality.
Some specific examples of successful health information exchange collaborations amongst federal agencies include:
Consolidated Health Informatics (CHI) eGov Initiative - is an initiative of 22 U.S. federal agencies to adopt a portfolio of existing health information interoperability standards (health vocabulary and messaging) enabling all agencies in the federal health enterprise to "speak the same language" based on common enterprise-wide business and information technology architectures.
Federal Health Information Exchange (FHIE) Project - which is supporting clinical data transfer between DoD and Veterans Health Administration.
Recommendations and Next Steps
Evaluate RHIO Participation and Implications for an Organization's Strategic Information Technology Plan - A key question to answer is whether an organization's IT plan and systems will be compatible with national/international clinical data standards. This means that clinical data standards compatibility needs to be a requirement for any medical informatics project. Key components to evaluate in any health information system are its use of open architecture and open standards and its interoperability, measured against current and future clinical data exchange standards.
Identify Your Medical Informatics-Savvy Stakeholders - Doctor, Patients and Board members - Form a diverse task force to provide guidance and oversight over a multi-year period. There are significant implications for the clinical informatics component of the IT plan that need to be vetted and reviewed with a diverse team.
Initiate Regional Medical Informatics Coalitions - If there is a low level of RHIO activity going on in your community, step forward and provide a nexus for action. Commit to lead in interoperability and connecting for quality. Identify several other leaders and ask them to form a steering committee and lend some analytical and managerial resources to jump start the effort to build a plan.
Public Health, Disease Registries and the Future NHIN Grid
Future Scenario: By 2020, public health information systems such as disease registries were integrated into the National Health Information Network grid running on the Next Generation Internet - Internet2. Early versions of the NHIN operated on the original Internet, but for security, privacy and speed purposes, the entire network was recast on the second generation Internet. The additional fees necessary support participation in Internet2 were actually less than the costs of all of the layers of security and anti-virus/anti-spam needed on the original Internet.
Currently, both federal and state health departments in the United States gather public health information on births and deaths, immunization and vaccines, environmental health, occupational health, and have established a number of disease registries. Many states also have some form of automated bio-surveillance systems in development, related to the national Public Health Information Network (PHIN) and the National Electronic Disease Surveillance System (NEDSS). These functions serve as key mechanisms for improving chronic disease care, when the data is made available through health information technology to provide timely information to clinicians (and patients) to ensure that appropriate care is provided and received.
EHR adoption throughout the United States and the world will support increasingly computerized disease registries systems used to capture and track chronic conditions. Many States use automated systems to collect, store, or process public health information. At the local level, there appear to be numerous opportunities for improved data sharing between private healthcare organizations and the state public health departments. At the state level, there appear to be many opportunities for health information technology sharing opportunities between the states which have already developed automated clinical systems and those that have not yet done so. At the national level, there are many opportunities that ought to be pursued to better share knowledge and public health information between federal, state, and local governments.
Recommendations and Next Steps
Specific recommendations that support the transition for healthcare organizations to tomorrow include:
Organize State-wide Health Informatics Collaborations - State health departments should consider establishing state-wide health informatics collaboration working groups to address such areas as:
- Health clinical data standards;
- Electronic Health Records (EHR);
- Personal Health Records (PHR);
- Health Information Exchange (HIE);
- Public Health Information Systems and Databases.
Establish the Office and Position of State Health Collaboration - Create a state health IT sharing liaison position to serve as the focal point for coordinating and facilitating communications on all health IT collaborative projects in which the state is involved. This would be modeled on the Office of the National Coordinator for Health Information Technology (ONCHIT) at the federal level. Some of the functions of the state level office would be to:
Develop Health Information System Databases - State health departments should consider establishing a database to track information on health information systems used by all provider organizations in the state, key contacts, and other relevant information.
Create a Collaborative Project List - This list can be based on input from public and private sector participants of the health informatics collaboration working groups. Funding and staffing for state-wide collaborative projects should then be made a part of the state public health programs and their IT budgets.
Identify Public Health Connectivity Opportunities - Identify the status of all the connections that are being made between electronic health information systems and disease registries.
HER & HIE Advocacy - Be an advocate for connectivity of clinical data exchanges in a way that protects patients' privacy and addresses problems on the individual and community levels related to public health and population health management.
Provide Seed Funding - Work with state government to obtain seed funding for the integration of Disease Registries, statewide EHRs, clinical data standards and connectivity between providers at all levels.
Free/Open Source Software (FOSS) in Healthcare
Future Scenario: FOSS in Healthcare is growing in three key dimensions: 1) Infrastructure and Network; 2) Tools and Utilities; and 3) Applications (Specific Function: Standalone and Enterprise). By the year 2020, FOSS software will have achieved greater than 50 percent market share in most classes of software across the enterprise and in the home in the United States. In countries such as China, India and much of the developing world, FOSS will be the dominant software used across all IT classifications.
Infrastructure and Network Direction - The movement toward the development and use of FOSS in healthcare continues to grow, and the number and type of FOSS products available is steadily increasing. By the next decade, most healthcare organizations seeking to acquire and implement an electronic health record (EHR) system will examine FOSS solutions as part of the evaluation process, while also considering closed source commercially available alternatives. Open Solutions in healthcare will probably grow fastest in the area of HIE infrastructure.
Utilities and Tools Direction: By the next decade, most healthcare organizations will have integrated FOSS products into their portfolio of standard IT utilities and tools.
Over the last five years, there has been a continued explosion in the amount and quality of Open Source Software (FOSS) being developed and deployed around the world in virtually every industry, including healthcare. Specific examples of FOSS currently being used in healthcare include:
OSCAR is an open source web-based electronic patient record system developed at McMaster University in Hamilton, Ontario, Canada. It was first implemented in 2001, and is now used by a growing number of healthcare organizations in Canada.
OpenEMR is claimed now to be the most widely-distributed open source Electronic Medical Record (EMR) system in the world.
Ampath EHR promises a very simple, yet powerful, EHR system geared to developing countries internationally.
VistA is the comprehensive health information system developed by the Veterans Health Administration that is in the public domain and has been deployed by a wide range of public and private sector provider organizations around the world.
Utilities and Tools: Some specific examples of FOSS tools that can be used in the healthcare setting include:
Linux - an alternative operating systems to Windows
Apache - the world's leading Web site server software
mySQL - an open database software application
Open Office - a complete suite of business applications, comparable to Microsoft Office
SugarCRM - an enterprise Customer Relationship Management software application
... and in healthcare:
Open Infrastructure for Outcomes - a shared and free FOSS infrastructure that supports the creation of web-forms as plug-and-play modules for medical information systems with integrated statistical reports generation.
BLOX - a FOSS project sponsored by Kennedy Krieger Institute and the Johns Hopkins University, which is focused on developing a quantitative medical imaging and visualization program for use on brain MR, DTI and MRS data.
Recommendations and Next Steps
Healthcare organizations seeking to lead into the future should consider take the following steps with regards to open source solutions:
Inventory FOSS Already In Use - Compile an inventory of the use of FOSS products across your organization. This will provide a current landscape of FOSS adoption in your organization and a baseline to measure future progress.
Evaluate FOSS Offerings as Part of Any Healthcare Information Technology Deployment - Lowering the cost of technology, while maintaining functionality, is an imperative. All forms of Open Solutions, Open Source Software in particular, can support quality and EHR adoption effectively.
Do An Open Solutions Assessment of Any Closed Source Healthcare Information Technology Solution - Evaluate the closed source software offering for its use of open architecture, open standards and interoperability against current and future clinical data exchange standards ...
Identify Your Tech Savvy Stakeholders from Doctor Allies to Patients - Involving key stakeholders in the process is critical to success. Many doctors active in computing and clinical informatics are experienced and knowledgeable about Open Solutions.
Selecting Open Source Licensing Option - Further investigate licensing options related to the acquisition or release of Open Source Software that fits the needs of your organization.
Release Software Modules as FOSS - Consider releasing health information software modules you may have developed as FOSS products. This effort would offer an opportunity for some "lessons learned" about working with the FOSS community.
Test One or More FOSS Modules Developed by Other Organizations - Consider pilot testing the implementation and use of one or more FOSS healthcare products. This pilot effort can offer an opportunity to learn about the implications of introducing FOSS solutions.
Investigate Potential FOSS Partnerships - Establish criteria for identifying and possibly pursuing mutually beneficial collaborative relationships with other organizations in the FOSS community.
Next Generation Internet - Internet2
Future Scenario: By 2020, organizations and individuals will have the luxury of surfing with speed and style on the 21st century Internet2 (NG2). Operating on test beds that are 100 to 1,000 times faster end-to-end than today's Internet, the NG2 will vastly improve the ability to deliver telemedicine, access medical libraries, share medical records, and move clinical images.
The current Internet is lacking in its ability to truly deliver speed and services. It is overloaded with spam, viruses and traffic. Its architecture and security protocols were never designed to support the level and type of traffic that is being generated.
A study by IBM in 2005 found that "virus-laden e-mails and criminal driven security attacks" increased 50 percent in the first six month of 2005. Another study by the Pew Internet and American Life Project showed that 43 percent of U.S. Internet users reported having spyware or adware on their computers, thanks merely to visiting websites. Increasingly, Internet users must spend more time and money protecting themselves from harm.
David D. Clark, once the Internet Chief Architect, has identified four areas to address in future Internets:
Security - The Internet should authenticate people and computers to address ever more problematic spam and virus issues.
Protocols - There is a need for better Internet traffic routing agreements between Internet Service Providers.
Mobility - Future Internet systems should assign Internet Protocol addresses to mobile computing devices to allow for secure connection.
Instrumentation - Intelligence should be embedded in the network to detect and report problems.
There is good news on the horizon. The National Science Foundation and its managers are developing a multi-year plan using $200 to $300 million in research funding to develop clean-slate architectures that provide security, accommodate new technologies, and are easier to manage. In addition, Internet2 (http://www.internet2.edu/) is a consortium, led by 207 universities, that is working, in partnership with industry, government and international communities, to develop and deploy advanced network applications and technologies, accelerating the creation of tomorrow's Internet. Internet2 is enabling a new generation of Internet applications that re-create leading edge R&D network capability for the national research community and ensure the transfer of technology and experience to the global production Internet. There are over sixty corporate members, over forty affiliate members, and over thirty international partners involved in Internet2.
Committing the U.S. healthcare industry to creating a fully functional Next Generation Internet (NGI) represents a major step forward in the greater revolution to transform web-based communication and realize a nationwide interoperable Medical Internet. Internet2, or the Next Generation Internet, can be a testing ground for the development of advanced multi-media Internet solutions in healthcare, such as 3-D simulated virtual surgical training, 3-D brain mapping, and virtual reality visualizations. Development and deployment of the Next Generation Internet infrastructure is necessary to support the nation's future electronic health information systems.
Next Generation Internet and Internet2
Internet2 is being led by the university community in close partnership with industry and the Federal government. The Federal government has its own advanced Internet initiative, called the Next Generation Internet (NGI) Initiative (
http://government.internet2.edu/ngi.html). Many government agencies taking part in the NGI Initiative are also collaborating with Internet2.
Some health and medical examples of Internet2 initiatives include:
Virtual Surgery - Stanford University and the Commonwealth Scientific & Industrial Research Organization (CSIRO) are involved in the Virtual Surgery Master Class (
http://health.internet2.edu/news/archive.html). Advanced networking will enable a surgical instructor to lead a student, who is immersed in a 3-D view of the abdominal organs, through a live simulated surgical procedure. Both participants can simultaneously "grasp" pliable body organs, cut tissue, and at the same time feel the actions and forces provided by each other. This is particularly valuable in regions/countries where the population is small and unevenly distributed, and where access to specialized surgical expertise for training can be difficult.
3-D Brain Mapping - The University of Pittsburgh Supercomputing Center, Carnegie Mellon University, and the University of Pittsburgh Medical Center are collaborating on the 3-D Brain Mapping (
http://www.psc.edu/science/Goddard/goddard.html) project. Using the CRAY T3E and high-speed networks to link an MRI scanner with a supercomputer to view the brain at work, they are able to convert scan data almost instantaneously into an animated 3-D image showing what parts of the brain "light up" during mental activity. What previously took a day or more to complete has now been cut down to seconds. This real-time capability will aid neurosurgeons in precision surgical planning, and can be used to test and diagnose cognitive dysfunctions. With high-speech networking, healthcare providers at locations distant from the MRI scanner can actively consult in patient testing.
Real-time Virtual Laboratories - The University of North Carolina at Chapel Hill and the Center for Computer Integrated Systems for Microscopy and Manipulation are collaborating on the Distributed nanoManipulator (
http://www.cs.unc.edu/Research/nano/cismm/nm/) project. They are using virtual laboratories to offer real-time access to remote instruments.
Medical Informatics Education - Oregon Health & Science University and the University of Pittsburgh are involved in a distributed medical informatics education (http://www.ohsu.edu/bicc-informatics/ and http://www.ohsu.edu/dmice/) project, which covers a broad range of fields including electronic medical records and information retrieval. Distance learning provides students with access to faculty, expertise, and other students.
Human Embryology Digital Library - George Mason University, Oregon Health Sciences University and the National Library of Medicine are collaborating on the Human Embryology Digital Library and Collaboratory Support Tools (http://www.nac.gmu.edu/visembryo.htm) project. They are using an Internet2 network of medical collaboration workstations, operating at data rates over 100 megabits/second, to provide a way for medical professionals to communicate detailed information about human embryo development in a visual form. Healthcare providers will be able to remotely visualize and manipulate real-time high-resolution 3-D image data collaboratively for diagnoses, clinical case management, and medical education. It will also provide animations of embryo system development for students.
Virtual Pelvics Tele-Immersion - The University of Illinois at Chicago is involved in the Virtual Pelvic Floor, A Tele-Immersive Educational Environment (
%20Educational%20Environment') project. They are using tele-immersive applications, combined with teleconferencing, telepresence, shared virtual reality, and Internet2 networking capabilities to allow surgeons, teachers, and students to share and interact with 3-D complex anatomical structures, even in geographically remote locations. Participants use ImmersaDesk systems to interact with 3-D anatomical models.
Virtual Aneurysm - The University of California at Los Angeles is involved in the Virtual Aneurysm project (
http://www.radsci.ucla.edu:8000/vra/index.html), which is a simulation and virtual reality visualization of brain blood flow. Using Internet2 high-performance networking and advanced capabilities, researchers and healthcare providers are able to examine critical flow patterns and evaluate simulated surgical interventions.
Rural Health and GIS - The University of Wyoming and the Wyoming Department of Health are involved in the Surveyor project, which uses a web-based research environment to integrate rural health data with GIS technology (
http://www.internet2.edu/presentations/20040224-Health-Kratz_files/slide0507.htm). High-level Internet2 applications quickly locate and transmit large volumes of reliable data on healthcare issues, providing support for rural healthcare providers in underserved areas. This project also supports continuing education through Internet resources and telecommunication.
Very Fast, Secure, Real-time Video Conferencing - The National Library of Medicine is providing a test bed environment that demonstrates the use of MPEG-2 video conferencing and NTSC quality video over Internet2 networks and the NGI for use in telemedicine/consultation and distance learning programs. The test bed environment allows point to point and multi-point videoconferencing (via multicast) between collaborating sites, and also allows transmission of a range of medical content from varied sources, including data from instruments. This effort is part of The NLM Collaboratory for High Performance Computing and Communications that focuses imaging and collaboration research. In addition, it is a venue for communicating electronically with others over advanced networks using a complement of collaboration technologies (http://collab.nlm.nih.gov/).
Recommendations and Next Steps
Healthcare organizations interested in collaborating on Internet2 or NGI medical informatics initiatives should:
Develop a business case for collaborating in the healthcare initiatives of Internet2 or NGI.
Identify potential partners for actively joining in Internet2 workgroup committees that focus on healthcare and related initiatives.
Review and prioritize Internet2 or NGI projects for potential participation within organizations key clinical departments.
Assess Implications of IPv6 on medical informatics deployments - Examine closely implications of current and anticipated technologies and the transition into the use of the next generation Internet Protocol Version 6 (IPv6).
Conduct a detailed feasibility analysis for collaborating on selected projects.
Future Scenario: Nanotechnology will revolutionize almost every industry, including healthcare, pharmaceuticals, communications, computers, manufacturing, materials, energy, and security. In the coming decades, cheaper and high performance nanotechnology solutions, combined with convenience and greater functionality, will change the daily business practices of healthcare organizations and how they provide patient care.
Currently, biologists, physicists, chemists, materials scientists, computational scientists, and mechanical and electronic engineers are all collaborating to share knowledge of tools and techniques and information on the physics of atomic and molecular interactions. The following are just a few examples, the tip of the iceberg, so to speak, of nanotechnology initiatives in the healthcare arena:
Better Artificial Joints and Nanotube Brain Surgery - Researchers at Purdue University, the University of Alberta, and Canada's National Institute for Nanotechnology have discovered that bone cells called osteoblasts attach better to nanotube-coated titanium than they do to conventional titanium used to make artificial joints. Purdue University researchers have shown that extremely thin carbon fibers called nanotubes might be used to create brain probes and implants to study and treat neurological damage and disorders. These nanotubes not only caused less scar tissue but also stimulated neurons to grow 60 percent more fingerlike extensions, called neurites, which are needed to regenerate brain activity in damaged regions (Purdue News, Jan 2004, at
NanoDrug Delivery - A chemical engineer and professor at MIT was awarded the Albany (N.Y.) Medical Center Prize in Medicine and Biomedical Research, America's top tribute in medicine, for his research on polymer-based drug-delivery systems that allow clinicians to control the release of large molecules in a steady, controlled manner through surgically implanted plastic devices. His work has spawned revolutionary advances in cancer treatment (Modern Physician MP Stat, May 3, 2005; free subscription required -
NanoBioMarkers - Northwestern University developed the "Bio-Barcode Assay", a highly sensitive diagnostic test that could revolutionize the detection of disease. The technique involves nanotechnology and the use of magnets, gold, DNA and antibodies. Experts are already exploring ways of using it to spot early markers of Alzheimer's disease and in the future, it could also be used to diagnose the earliest signs of cancer, HIV infection, or the human form of Mad Cow disease. (News.scotsman.com, Nov 2004,
Nanotechnology will lead to new generations of prosthetic and medical implants designed to interact with the body, fundamentally altering the management of illnesses, patient-doctor relationships, and medical culture in general. Three major areas in which nanotechnology applications will be valuable to healthcare organizations include (The Royal Society & The Royal Academy of Engineering Nanoscience and Nanotechnologies, July 2004,
Implants and prosthetics - "With the advent of new materials, and the synergy of nanotechnologies and biotechnologies, it could be possible to create artificial organs and implants that are more akin to the original, through cell growth on artificial scaffolds or biosynthetic coatings that increase biocompatibility and reduce rejection. These could include retinal, cochlear and neural implants, repair of damaged nerve cells, and replacements of damaged skin, tissue or bone."
Diagnostics - "Within microelectromechanical (MEMS), laboratory-on-a-chip technology for quicker diagnosis, which requires less of the sample, is being developed in conjunction with microfluidics. In the medium term, it could be expected that general personal health monitors may be available. Developments in both genomics and nanotechnology are likely to enable sensors that can determine genetic make-up quickly and precisely, enhancing knowledge of people's predisposition to genetic-related diseases."
Drug delivery - "With nanoparticles, it is possible that drugs may be given better solubility, leading to better absorption. Also, drugs may be contained within a molecular carrier, either to protect them from stomach acids or to control the release of the drug to a specific targeted area, reducing the likelihood of side effects. The ultimate combination of the laboratory-on-a-chip and advanced drug delivery technologies would be a device that was implantable in the body, which would continuously monitor the level of various biochemicals in the bloodstream and in response would release appropriate drugs. For example, an insulin-dependent diabetic could use such a device to continuously monitor and adjust insulin levels autonomously."
A quick listing of some areas that are converging on the field of nanomedicine includes: Biotechnology, Genomics, Genetic Engineering, Cell Biology, Stem Cells, Cloning, Prosthetics, Cybernetics, Neural Medicine, Dentistry, Cryonics, Veterinary Medicine, Biosensors, Biological Warfare, Cellular Reprogramming, Diagnostics, Drug Delivery, Gene Therapy, and Clinical Imaging. Looking forward to the next decade, the linkage of these nanotechnology diagnostic, drug delivery, or implant devices to a patient care information system and personal health record become very real possibilities.
Recommendations and Next Steps
Next steps for large healthcare organizations to take include:
Establish NanoTech Monitoring as Part of Technology Early Warning Systems - Obtain lessons learned from existing nanotechnology projects, especially as they relate to healthcare and IT systems.
Investigate Research and Development Opportunities - If your healthcare organization has a clinical research and development function, assess the opportunities in research and development efforts in nanotechnology that relate to the delivery of patient-centered healthcare and health information systems.
Identify Potential Nanotechnology Pilot Projects involving healthcare related product development and implementation that may benefit your patients in the future (e.g., drug delivery, gene therapy, and diagnostics).
Investigate Changes in Clinical Practices and business processes that your organization may need to make in anticipation of implementing nanotechnology applications/devices.
Conduct a Cost Benefit Analysis and Return on Investment for this type of initiative for your organization.
Solar and Other Renewable Energy Powered IT Systems and Facilities
Future Scenario: By 2020, a significant number of healthcare organizations around the world will have begun to acquire and deploy "hybrid" energy systems that tap into renewable solar and wind energy sources along traditional electrical energy sources to support their IT infrastructure and overall facility energy needs. Realizing that lower emissions stand to improve air quality and therefore reduce incidences of health conditions such as asthma and other respiratory ailments, healthcare organizations will actively seek energy from renewable resources. In addition to reducing pollution and global warming impacts, alternative energy sources such as wind and solar will allow healthcare to power the delivery of care in rural and hard-to-reach areas around the globe.
In the last thirty five years, the message has been clear, but ignored. Much of the world, including the United States, is being held over a barrel - an oil barrel - when it comes to energy. The public and private sectors need to collaborate and take the initiative to lead the way into our diversified energy future where the centerpiece of our strategy is conservation and increased usage of solar power across all sectors of the economy.
The times have changed. More efficient solar energy systems, now being produced at lower costs, are becoming attractive alternatives as the price of oil climbs ever higher. The number of examples where Commercial-Off-The-Shelf (COTS) solar energy components are being used to power computer systems has increased dramatically, including installations by healthcare facilities in various locations around the world.
In the healthcare industry, there are compelling reasons to acquire and implement hybrid energy systems that include solar power. These include providing continuity of care during major natural and man-made disasters, as well as providing power for health IT systems in remote locations where traditional electrical services cannot be reliably provided to support these systems. Healthcare organizations will need to modify their corporate visions to include having more and more of their IT infrastructure, Web sites and computers powered by a "hybrid" energy system that taps into solar, wind, and traditional electrical energy sources.
Solar Powered Health Facilities and Clinical Computer Systems - Lack of electricity has substantially negative impact on the health of millions of rural villagers in developing countries, severely affecting many women and young children. Indoor air quality, water quality, and fire safety in rural homes and health clinics all depend on reliable electricity. For many of the nearly two billion people in developing countries who still live without electrical power, solar energy offers a cost-effective, reliable, and earth-friendly solution to provide it. When Hurricane Katrina hit the Gulf Coast of the United States in 2005, large parts of the region quickly found themselves operating in 3rd world like environments.
HHS Solar Energy Project Enhances CDC Health Care Facility in Kenya - The Centers for Disease Control and Prevention (CDC) Health Initiative facility in Homa Bay, Kenya, benefits from a solar energy power system that delivers reliable power and reduces losses of vital medicine and laboratory test samples. The facility houses an on-site laboratory that supports a project to reduce diarrheal diseases using a simple household-based method to improve water quality. In the past, the facility and program has experienced frequent power outages that required excessive use of an emergency diesel-powered generator. This has added excessive costs, due to the simple facts that: (1) there is no maintenance available; (2) the cost of fuel is so high; and (3) the generator has to be replaced every five years. To reduce the site's power disruptions, CDC teamed up with the Department of Health and Human Services (HHS) to install a photovoltaic module for the laboratory. The program to install a solar energy system at the Homa Bay laboratory was a culmination of the dedication of personnel in many different offices such as the CDC, the HHS Energy Program, and DOE. As a result, the CDC Homa Bay laboratory now has a more reliable energy source that will allow the staff to address the real needs of improving the health of the Kenyans.
WiFi on Wheels and Solar Powered Computers in Cambodia - An article by Amanda Thomas, "Doctors here link up with patients in remote Cambodia via innovative system" (Boston Globe, 12-12-04), reported on a cart pulled by two oxen that was used to transport computers for use in remote rural areas of Cambodia. In the article, Ms. Thomas states, "Ratanakiri province is gradually emerging from the shadows due in part to technology developed by First Mile Solutions, a Cambridge-based company founded by two MIT graduate students, Rich Fletcher, 38, and Amir Hasson, 28, which in turn has enabled a telemedicine link with Massachusetts General Hospital to be forged. Their wireless system, which Hasson calls wi-fi on wheels, uses a combination of wi-fi technology and motorcycles to bring the Internet to places like Ratanakiri. The system relies on an Internet access hub in the provincial capital, Ban Lung, wireless-equipped solar-powered computers in Ratanakiri, and five motorcycles, each with a storage device, a wireless transmitter card, and an antenna fitted to the back."
Solar Powered Hospital in Uganda - In a USAID news release, it was reported that youth volunteers from the United States traveled to rural areas of East Africa to work with "Solar Light for Africa", a faith-based non-governmental organization, in providing power to clinics, orphanages, schools and churches. With USAID assistance, the organization electrified the Kakuuto Hospital in Uganda's Rakai District using solar energy, which has improved the health of patients and enabled staff to treat them more effectively. This includes solar power for computers.
Solar Energy Supports Safe Vaccines in Latin America - The Cold Chain is a World Health Organization & Pan American Health Organization support effort that uses reliable refrigeration to conserve vaccines from manufacture to distribution to point of use. Solar electricity is used in non-electrified communities to maintain a safe supply of vaccines and to freeze icepacks for transport to the most remote populations. Vaccine refrigeration, lighting, safe water supply, communications, and medical appliances are powered by solar electricity at rural health care facilities throughout Latin America.
CubaSolar Powers 300 Rural Clinics - CubaSolar is a non-governmental organization promoting the use of renewable energy and energy consciousness in Cuba. The organization has worked to install photovoltaic panels in 300 medical clinics in the remote mountain regions of the country, which have proven to increase quality of life and decrease infant mortality rates in these areas. Initially, all of the systems included lights, a vaccine refrigerator, and other medical equipment such as electrocardiographs and x-ray machines. Because each clinic has a live-in doctor, the systems included a TV and radio for the physician as well. After CubaSolar employees noticed that many children in the communities they served were crowding around the TV in the physicians' homes at night, they evolved their installations to include a PV panel on the community center for TV and other social functions.
FEMA & Solar Power - When energy efficiency, passive solar, and daylight are combined with solar systems to generate electricity and hot water, partial or even full operation can be maintained when traditional utility services fail. National Renewable Energy Laboratory (NREL) is working with the Federal Emergency Management Administration (FEMA) to educate staff and field personnel on the use of portable Photovoltaic systems. There are currently two systems traveling to several FEMA training centers to educate emergency response teams. The National Center for Photovoltaics (a NREL center of excellence), the National Association of Independent Insurers, and the U.S. Dept. of Energy are working together to promote a new tool for disaster recovery using solar technology. Unfortunately, this work has been chronically underfunded for years. Otherwise, solar energy could have been part of the solution in responding to hurricane Katrina. For more information, visit http://www.nrel.gov/
The following are some key points to keep in mind about the future.
- Cost of traditional non-renewable, fossil fuel energy sources are escalating.
- Commercial Off-The-Shelf (COTS) solar energy solutions are becoming readily available.
- Solar energy can be part of a hybrid solution that uses solar, wind, and traditional electrical energy sources, all working together to reduce dependence on non-renewable.
Solar energy meets nano-technology. Research into nanoparticles of gallium selenide for solar energy conversion holds the promise of increasing the efficiency of solar energy capture while reducing the cost of equipment production.
- This should be a First World solution, not just a Third World nation solution.
Worldwatch Institute reports that solar energy has surpassed wind power generation to become the world's fastest-growing energy source. World solar markets are growing at ten times the rate of the oil industry. Worldwatch predicts that "solar energy may join computers and telecommunications as one of the leading growth industries in the 21st century."
One final observation - Solar Power & Open Solutions (including Open Source Software and Open Standards) are intriguing many progressive-minded people. The underlying philosophy is very similar. Both appeal to the ideas of:
- National Security
- Improved Health Status
- Creativity and Innovation
- Being Good Stewards of Resources
Recommendations and Next Steps
There are a number of recommendations and next steps for healthcare organizations relating to solar and other renewable energy sources.
Conduct a Renewable Energy Feasibility Analysis - Commission a detailed systems requirements analysis and cost/benefit study on the potential uses of hybrid solar energy systems in current and future facility design.
Consider New Facility Design and Existing Facility Renovation That Includes Renewable Energy - Encourage health care facility and technology designers and architects to use solar and renewable energy into their next generation designs.
Initiate Solar Energy Pilot and Demonstration Programs - Conduct a pilot test of solar powered computer systems and incorporate renewable energy considerations in all future health care buildings. Or, implement a solar powered demonstration project for a Web site, rural health clinic or telemedicine program.
Advocate for Solar Power - Support political action to encourage much higher levels of government funding of solar and renewable energy as well as tax cuts/incentives for healthcare facilities and health information computing systems that install solar.
Document the Benefits - Use of solar powered systems will expand over time, as the benefits are documented. Be sure to quantify how the system reduces pollution and lowers costs.
Seek Resources - Take a solar and renewable energy position and seek out funding sources that will support this next generation of community and economic development.
Robotics & EHR Systems
Future Scenario: In 2020, the use of robots will become a routine part of healthcare and an important component of EHR systems. Up to 30 percent of all minimally invasive surgery will be performed robotically. In this next decade, we will see a wide array of more sophisticated robotic devices being used to collect and feed clinical data into the EHR, including nanobots injected or embedded in patients. There will also be a growing range of robotic devices used at the back end of an EHR system to package and dispense prescriptions, and also to deliver prescriptions, supplies, and other items directly to the nursing station or to a specific patient's room.
The 1980's saw the emergence of some of the first uses of robots in the healthcare setting. These were primarily restricted to robotic carts used to move mail, medical records, prescriptions, and laboratory specimens around a medical center. There was also an increasing commitment to research and development (R&D) of stationary robotic devices used for specialized purposes, e.g. packaging drugs.
The 1990's saw the production and deployment of a limited array of stationary robotic devices, used to package and dispense drugs. The decade also witnessed the emergence of the first robotic surgical devices used by surgeons to perform selected procedures either on-site or via tele-surgery at very remote locations, e.g. RoboDoc, Aesop 1000, Neuromate, da Vinci, and the Zeus surgical systems.
This first decade of the 21st century is seeing more widespread deployment of robotic surgical systems for use in a growing range of surgical procedures. Robotic surgical assistants are now being used in a number of operating rooms. In addition, robotic devices used to package and dispense drugs are becoming more sophisticated and are now being interfaced to electronic health record (EHR) systems. Prototype robotic systems are being tested as robotic health aides, for remote bedside teleconsultations, personal care assistants for the elderly, and for many other purposes.
Some recent news articles on specific uses of robots in healthcare include:
In an article in Virtual Medical Worlds in June 2005, it was reported that a new surgical assistant at the University of North Carolina (UNC) Hospitals had arrived. It sports three arms, a computerized brain and a glowing track record in helping to repair heart valves, remove cancerous prostates, bypass blocked coronary arteries and perform gastric bypass operations for morbid obesity. The new arrival is a robotic machine, the da Vinci Surgical System, manufactured by Intuitive Surgical. UNC currently is the only gynecological oncology program in the Southeast that is using it.
In an article in The Financial Express (8/8/2005), there is a story about Penelope, a robot that recently made medical history by becoming the first to act as an independent surgical aide during an operation. During a June procedure at New York-Presbyterian Hospital to remove a benign tumor from a patient's forearm, Penelope responded to voice commands from a surgeon, handing over clamps, forceps and other instruments with her magnetized mechanical arm. Watching with digital cameras, the robot retrieved the instruments when the surgeon placed them down.
According to an article in the Washington Post by Susan Okie on the use of robots by the VA, whenever a new patient is admitted to the VA Medical Center in Durham, North Carolina, a four-foot eight-inch talking robot rolls up to the nurses' station nearest to the patient's room, bringing doses of whatever drugs the doctor has ordered. TOBOR, the robot, is a delivery "droid" that glides along the corridors day and night, ferrying medicines from the hospital's central pharmacy to its wards. Pyxis Corp., the company that manufactures HelpMate Robots such as TOBOR, has placed almost 100 of its robots in U.S. hospitals, including 11 in seven VA medical centers.
OptiFill, AutoScript III Robotics, Robot-Rx are some examples of robotic Rx packaging and dispensing systems deployed at VA medical Centers across the country. The McKesson Robot-Rx is used to fill unit dose inpatient medication orders for the Hines VA Medical Center in Chicago.
Recommendations and Next Steps
The authors recommend that advanced healthcare organizations seeking to acquire, develop, and deploy robotics technology take the following steps:
Assemble an Interdisciplinary Team - This team would identify functional requirements and/or potential uses of robotic systems designed for use by physicians and for the care of patients.
Research Existing Options - Conduct a detailed literature search on a regular basis and learn lessons from robotics projects underway at other institutions.
Seek Collaborators - Identify potential organizations to collaborate with on the research, development, testing and use of robots in healthcare, e.g. medical schools, vendors.
Conduct a Feasibility Study - Conduct a feasibility study into the use of robotics and select potential pilot projects. Investigate changes in clinical practices and business processes that may need to be made in anticipation of utilizing robot technology.
Select and Fund Pilot Projects - Use the outcome of these projects to choose the most cost beneficial robotic systems for organization-wide deployment.
Future Scenario: For the foreseeable future, wireless technology will complement wired computing in enterprise environments. Even new buildings will continue to incorporate wired LAN because wired networking remains less expensive than wireless - even though wireless has lower support costs. In addition, wired networks offer greater bandwidth, allowing for future applications that may be beyond the capability of today's wireless systems. By the year 2020, due to technological advances and the demands of a very mobile workforce, wireless will be the dominant connectivity infrastructure.
Wireless communication is currently one of the fastest growing technologies in the information technology (IT) industry. The use of wireless modalities in settings such as hospitals, clinics, long-term care facilities, and home care is becoming well established, as indicated by the proliferation of software applications and use of mobile computing devices in such settings. The wireless landscape is finding a secure place within major healthcare organizations.
VA Program Wins Mobile and Wireless Security Award - The Department of Veterans Affairs (VA), in support of its healthcare facilities nationwide, has already taken initial steps to support medical services at the point of care through the use of wireless technology and the adoption of appropriate mobile computing devices and applications. Staff from the Veterans Health Administration (VHA) Office of Information (OI) national Bar Code Medication Administration (BCMA) Joint Program Office were recently selected by the Security of Mobile and Wireless Business Applications in Government II Conference Awards Committee to receive the award for Outstanding Accomplishment in the category of Enterprise-wide Applications of Mobile and Wireless Security. The award was given for their work on deploying VHA's Bar Code Medication Administration (BCMA) software over secure wireless data networks throughout VHA medical facilities. The system ensures VHA's network and patient information are secure from unauthorized access and meet HIPAA privacy guidelines for the healthcare industry.
Many companies have already chosen to move forward and are using wireless networks to connect portable computing devices to enterprise applications. These are the companies that have examined the business processes of their customer-facing employees and identified areas where today's technology can improve those business processes. Possible business process improvements exist in the following areas:
Cost reduction. Activities and resources can be removed from existing processes.
Cycle time reduction. Sales, service, expense, and billing cycles can be reduced.
Increased revenue. Wireless networks can introduce revenue-generating activities that wouldn't otherwise be possible.
Optimal use of time. At points in a business process where workers must wait, wireless can support them in the performance of other useful tasks.
Increased customer satisfaction. The quality of the service to the customer is maximized.
Increased employee satisfaction. Mobile solutions can reduce tedium, unnecessary trips to the office, and paperwork.
Physicians today can acquire a mobile practice companion, or PDA device, that offers immediate and secure access to critical clinical information, no matter where or when they need it to help them provide patient care. One of the biggest challenges for mobile computing vendors is to provide deeper and broader functionality. Expect mobile computing vendors to continue to expand functional capability, from tasks such as prescription writing and charge capture to actual clinical documentation, in the coming years - especially as these companies merge with or acquire other mobile computing application vendors. The complexity of mobile and wireless applications, combined with a lack of standards, will continue to make mobile and wireless an area of overdue innovation. The lack of sufficiently useful and usable applications will be the biggest barrier to "always-on" consumer acceptance in the near term. The real question about the future of the wireless enterprise network is not whether it is here to stay, but rather the extent to which we have the foresight to fully exploit it while preserving the privacy and security of the individual's health information.
Healthcare is re-imagining its workplace and the provision of care and using wireless information technology to achieve many of its business objectives. Optimal to its success is the priority of securing the infrastructure and data stream. Any wireless strategy must understand how every decision impacts the security of the enterprise and yet implement devices and applications that provide great value. In general, wireless technology will complement wired computing in enterprise environments through the next decade.
Wireless Solutions Inventory
- Wireless Phone Switch (PBX)
- Wireless Data Networks
- Wireless Internet/Intranet
- Wireless Web-based Reference Sites
- Wireless/Mobile Enterprise Computing Devices
- Cellular Phones
- Handheld Personal Digital Assistants (PDA)
- Laptop Portable PC
- "Wearable" Computing Systems
- Wireless/Mobile Enterprise Healthcare Applications
- Clinical Documentation
- Alert Messaging
- Electronic Health Records (EHR)
- Bar Code Medication Administration (BCMA)
Recommendations and Next Steps
Here are some recommended next steps in exploiting wireless technologies in healthcare:
Operate a Multi-disciplinary Work Group - Establish an enterprise wireless working group to develop a long range strategy and plan.
Agree on Infrastructure, Device and Application Standards - Standardize on a single mobile infrastructure platform and a single application solution whenever possible.
Set High Security Standards - Maintain a comprehensive security protocol, and conduct ongoing monitoring of advances in security threats and responses.
Establish the Connectivity Imperative - Enable connectivity with your intranet and legacy systems.
Rethink Processes Based on Mobile Technology - Use innovation and quality improvement tools such as Six Sigma and LEAN to transform, streamline and improve business and clinical processes throughout the healthcare organization.
Identify and Conduct Pilots - Build the organization's wireless knowledge, skills and capabilities sooner with pilot deployments in selected facilities and departments. Achieve some wins and expand the program to additional locations.
Be Wireless - Deploy wireless systems management tools from the outset.
"Conservation Medicine" is an emerging, interdisciplinary field that studies the relationship between human and animal health, and environmental conditions. By leveraging technology such as an international, open database of genetic information about animals and viruses, the discipline of Conservation Medicine will be focused on early identification, vaccine development and isolation of epidemics and pandemics. Due to the world's ever faster globalization, Conservation Medicine will play a critical role in the coming decades in detecting human-to-animal health interactions - such as a virulent strain of Swine Flu making its way from Hong Kong to the U.S.
Humans have always been part of their environment. Environmental conditions have impacted the growth and development of humans throughout our species history. Conservation medicine, also called Ecological Medicine, is an emerging, interdisciplinary field that studies the relationship between human and animal health, and ecological systems and conditions. It champions the integration of multiple techniques and the partnering of scientists from diverse disciplines. The field has begun to evolve rapidly as a result of human-induced environmental degradation that has resulted in more than 30 new diseases that have moved from wildlife to human populations since the 1970s, including AIDS, Ebola, Lyme disease and SARS.
Conservation medicine evolved out of a crisis - unprecedented levels of disease and ill health in many species, driven by the increasing burden of environmental change. Climate change, chemical pollution, global trade, domestic animals, encroachment into wilderness areas, and the overuse of antibiotics are some of the primary mechanisms through which humans are rapidly transforming eco-systems worldwide.
Conservation medicine represents a significant paradigm shift in the environmental movement and in medicine. The basic principle is that all things are related. An example is when large tracts of the rainforest are burned for agriculture, driving wild animal species into contact with livestock, often transferring diseases to domesticated animals, which then enter the human food chain and in turn create a new human disease problem. According to a Newsweek article, "The destruction of the Peruvian rain forest, for example, has led to an explosion of malaria-bearing mosquitoes that thrive in sunlit ponds created by logging operations. Even a one percent increase in deforestation leads to an eight percent increase in mosquitoes, according to Jonathan Patz at the University of Wisconsin."
The interaction of humans and environmental causes of health problems are complex, global, and just now starting to be understood. Conservation medicine brings together multidisciplinary teams of microbiologists, pathologists, marine biologists, toxicologists, epidemiologists, climate biologists, anthropologists, economists and medical doctors to solve problems and develop solutions.
Another branch of Conservation Medicine is focused on creating healthcare systems that are compatible and sustainable from an ecological perspective. One group leading this effort is Health Care Without Harm, an international coalition of hospitals and health care systems, medical professionals, community groups, health-affected constituencies, labor unions, environmental and environmental health organizations and religious groups. Its mission is "to transform the health care industry worldwide, without compromising patient safety or care, so that it is ecologically sustainable and no longer a source of harm to public health and the environment." Several of the key goals are:
- "1. Create markets and policies for safer products, materials and chemicals in healthcare. Promote safer substitutes, including products that avoid mercury, polyvinyl chloride (PVC) plastic and brominated flame retardants.
- 2. Eliminate incineration of medical waste, minimize the amount and toxicity of all waste generated and promote safer waste treatment practices.
- 3. Transform the design, construction and operations of healthcare facilities to minimize environmental impacts and foster healthy, healing environments."
Recommendations and Next Steps
Raise Awareness - Take the time to research and understand the scope of the environmental issues that interact with healthcare. Recognize that ecological principles can help in designing the next generation healthcare systems for the year 2020.
Recognize the Connection - The Hippocratic oath states, "I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone." This can be extended to the design of the business and medical informatics systems that support the operation of healthcare services anywhere a patient might be.
Participate - Consider supporting the various organizations that are working to expand the understanding and effectiveness of Conservation Medicine.
Other Emerging Health Information Technologies
Future Scenario: There are numerous technologies currently being researched, tested and deployed that will impact the quality of healthcare services and the speed of EHR adoption in the world. Many of these technology tools and systems will allow for radical change in the business and clinical processes of health and medical care. These emerging technologies include:
CAM and EHRs - Complementary and alternative medicine (CAM) is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. Patients are increasingly turning to complementary and alternative medical (CAM) in order to enhance their health and well-being. CAM includes acupuncture, chiropractic medicine, osteopathic medicine, use of herbal remedies and other practices as an augmentation to more conventional medical treatments. The marketplace reflects this growing acceptance of complementary medicine by many patients and a small, but growing number of health care providers. By gathering and integrating health care information associated with the application of CAM procedures into a patient's electronic health record (EHR), more accurate measurement of outcomes can be generated. Best practices can then emerge showing which complementary medical practices are most effective when coupled with conventional medical treatments of specific disorders. Over this next decade, look for automated CAM software modules to emerge that will be integrated into the personal health record (PHR) systems of the future.
Radio Frequency Identification Device (RFID) - is an automatic identification method that stores and remotely retrieves data stored on a small device RFID tag that is attached to or inserted into a product, animal, or person. Each RFID tag has a small silicon chip which provides the ability to receive and respond to radio based queries from an RFID transceiver. There are two kinds of tags: passive tags, which require no internal power source, and active tags which do. RFID use is growing in healthcare and is typically used to track the location of equipment, patients and the timing of the administration of medicine.
Ubiquitous Computing - is term that references computing elements embedded in surrounding objects such as walls, desks, chairs and just about anything else. "Pervasive computing" is another term for this approach, which evolves computers from distinct objects to being incorporated into clothing and surrounding objects. There are various goals of ubiquitous computing, such as the ability to sense changes in the environment then automatically adapt and act on these changes based on user needs and preferences.
Grid Computing - describes the use of many networked computers to create a virtual computing architecture that provides the ability to perform higher throughput computing. This virtual network of computers distributes process executions across a parallel infrastructure. Success of this approach depends on data communication standards and interoperability. Grids use this Internet-networked computer power to solve large-scale computation problems. Grids also provide the ability to perform computations on large data sets, by breaking them into many smaller steps that can be executed during low use time of a personal or business computer. The Cancer Research Project is one of several distributed computing projects that have been operated on the grid.org website by United Devices. Nearly 300,000 people and their computers participate and this effort, which is also supported by an alliance of companies such as the National Foundation for Cancer Research and the University of Oxford Department of Chemistry.
Security BioMetrics - is the study of automated methods for uniquely recognizing humans based upon one or more physical or behavioral traits. Biometric authentication refers to technologies that profile and assess human physical and behavioral characteristics for purposes of validating the identity of an individual. Fingerprints, eye retinas and irises, facial patterns and hand measurements are examples of physical characteristics. Gait, signature, typing patterns and other traits are examples of behavioral factors. Voice is considered a mix of both physical and behavioral characteristics. In information technology, biometrics is used to provide access to computers or levels of access within computer systems. Various forms of encryption such as PKI - Public Key Infrastructure - and other evolving technologies can be used to identify the identity of individuals and to validate rights for access to levels of security within a medical informatics system.
Conclusion - In Support of Better Medical Care
In this article we have attempted to focus on some of the many highlights of electronic and emerging technologies that will impact EHR adoption and improve quality of care over the next 20 years. The new Medical Informatics 20/20 Model is the recommended delivery system to aid in the transport of new technologies and techniques to the point of care. Within the Medical Informatics 2020 model, the anchor strategies of Collaboration , Open Solutions, and Innovation (COSI) are essential to accelerating the development and rapid diffusion of proven technologies.
The three major strategies of the Medical Informatics 20/20 Model are known as COSI - Collaboration, Open Solutions, and Innovation
If you want to know more about the COSI strategies and other innovative solutions, the authors delve deeper into this area and further elaborate on the subject in their upcoming book entitled "Medical Informatics 2020" to be published in December by Jones & Bartlett. See http://www.jbpub.com/catalog/0763739251.
Douglas Goldstein is a "Practical Futurist", Author and President of Medical Alliances, Inc. He guides leading healthcare organizations in clinical and business performance improvement through intelligent use of technology, knowledge management and "Distinctive Innovation". He can be reached at
Peter Groen was the former Director of the Health IT Sharing (HITS) program within the Veterans Health Administration of the U.S. Department of Veterans Affairs. He recently retired and is now on the faculty of the Computer & Information Sciences Department at Shepherd University in West Virginia. He can be reached at
Peter Groen, Douglas Goldstein
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