New paradigms for health care delivery

Changes occurring in Health care delivery and Medicine are the result of social, economical, technological, scientific forces that have evolved in the 21st century. Among the most significant changes are shift in disease patterns, advanced technology, increased consumer expectations and high costs of health care. These factors have redefined medical practices to fit into the changing health delivery system. Many health care professionals have come to the conclusion and belief that they will be compelled to explore new paradigms for health care delivery in the future like electronic medical record keeping, telemedicine, computer-based diagnostics and health monitoring to keep pace with the changing scenario. This is due to the accountability of the medical profession today and changing disease patterns. Doctors are under increasing pressure to keep up to date and to base their decisions more firmly on evidences as opposed to anecdotal information of the past. Patients are much more informed than they were 10 years ago. No doctor can tell a patient what to do without being questioned today. Further, with the advent of concepts like informed consent and advance directives, such scientific changes gain relevance. ELEMENTS OF THE NEW PARADIGM The use of electronic documentation is becoming increasingly prevalent in terms of convenience. The National Academy of Sciences report states that the US health care industry spent between $10 and $15 billion on information technology in 1996. Much of this expenditure is attributed to creating electronic records systems and converting conventionally stored data to electronic formats.   There are many software programs specially developed for electronic record keeping. This includes ‘Doctors partner’, an advanced Electronic Medical Records (EMR) System with Integrated Appointment Scheduling Billing, Prescription Writer, Transcription Module, Document Management and Workflow Management built to meet HIPAA standards. ‘Practice Partner Patient Records’ is an award winning electronic medical records (EMR) system, allowing practices to store and retrieve patient charts electronically. There are innumerable such branded medical record softwares available today. The standards in practice for EMR include ASTM International Continuity of Care Record , ANSI X12 (EDI) CEN , EN13606, HISA, DICOM , HL7 ,ISO   and openEHR . (Ringold et.al.,2000). The American Medical Association and 13 other medical groups representing 500,000 physicians have signaled their intention to go electronic with the AMA formed   Physicians' â€Å"Electronic Health Record Coalition† to recommend affordable, standards-based technology to their constituents. President Bush has also promoted a nationwide computerized medical records system in a recent visit to a children's hospital at Vanderbilt University. Scientific innovations have found a niche in complicated medical procedures as well. A recent study successfully has evaluated a bar code patient identification system, which involves a hand-held computer for sample collection and for compatibility testing administration of blood. (Turner et.al, 2003). A recent research article (Sandler et.al, 2000) reports of a solid phase and micro titer plate hemagglutination method for pretransfusion compatibility tests. This I-TRAC is an automated process of blood matching with improved serological sensitivity and standardized compatibility testing supporting electronic record keeping and linking to a bar code identification system. San Raffale Hospital in Milan, Italy, has recently collaborated with Intel and CISCO systems to use wireless-enabled infrastructures and Radio frequency identification (RFID) technologies. The system uses RFID-radio frequency identification technology to address the sources of   human and systems error in blood transfusion supply chain. This pilot programme has been   implemented at the 1,100 bed San Raffale hospital where more than 15000 blood transfusions are done every year. The CAT (Computer Aided Tomography) is yet another revolution in medicine which combines the X-ray technology with computer signal processing to generate images of tissues of the body obscured by other organs. Magnetic Resonance Imaging (MRI) is a common technique used to scan pathological or physiological status of living tissues. Much is known about the computer aided continuous ECG monitoring with a play back facility for assessing the cardiac status of the patient. Today we are in a wonderful situation where we will be able to develop a drug based on computer analysis skipping a few phases of clinical testing. PERSPECTIVES ON THE PARADIGM SHIFT Thus, scientific innovations are part of the evolutionary process of the medical science. The basic instrument of a physician, the Stethoscope, the Sphygmomanometer used for monitoring the patient blood pressure, the Catheter, Radiotherapy, Chemotherapy, the EEG, ECG, EMG, Echocardiogram, Ultrasonic scan, to name a few were nothing but such scientific innovations integrated into the field of medicine in the nineteenth and twentieth century. Thus, Computer based telemedicine, medical record system, and diagnostic procedures are scientific innovations of the twenty-first century. Hence, it is nothing but a natural and moral obligation of the health care sector to integrate them into the field of medicine. Changes in financial incentives and health care delivery structures are producing new threats to health care quality (A.Brennan, 1991). The retributive measures are cumbersome and expensive. Hence, there is a need for more accountable health delivery system, which will enable application of modern scientific approaches to quality health care system. In this context, quality of the medical care depends on promotion of quality medical care by managed care organizations. REFERENCE Brennan, T, et.al, â€Å"Incidence of adverse events and negligence in hospitalized patients: the results of the Harvard Medical Practice Study†, New England Journal of Medicine 324: 370-76, 1991. Là ¦rum Hallvard, MD, Tom H. Karlsen, MD, and Arild Faxvaag, MD, PhD . â€Å"Effects of Scanning and Eliminating Paper-based Medical Records on Hospital Physicians' Clinical Work Practice†. Journal of the American Medical Informatics Association 10: 588-595.2003. Ringold DJ , JP Santell, and PJ Schneider , â€Å"ASHP national survey of pharmacy practice in acute care settings: dispensing and administration–1999†. American Journal of Health-System Pharmacy 57 (19): 1759-75. 2000. Sauer et.al, â€Å"Errors in transfusion medicine† Lab Med. 32(4): 205-207, 2001. Turner et.al, â€Å"Bar code technology: its role in increasing the safety of blood transfusion†, Transfusion, 43(9): 1200:2003.