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Impact of Technology in Better Dispersal of Health Care Methods and

Improving Health Care Systems

Article  in  Occupational Medicine & Health Affairs · May 2014

DOI: 10.4172/2329-6879.1000162

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 Occupational Medicine &
Health Affairs Rajkumari, Occup Med Health Aff 2014, 2:3
http://dx.doi.org/10.4172/2329-6879.1000162

Short Communication Open Access

Impact of Technology in Better Dispersal of Health Care Methods and Improving

Health Care Systems
Nonika Rajkumari*
Department of Laboratory Medicine (Microbiology Division), Jai Prakash Narayan Apex Trauma Center, All India Institutes of Medical Sciences, New Delhi, India
*Corresponding author: Nonika Rajkumari, Department of Laboratory Medicine (Microbiology Division), Jai Prakash Narayan Apex Trauma Center, All India Institutes
of Medical Sciences, New Delhi, India, Tel: 91-11-26731268; E-mail: [email protected]
Received date: April 13, 2014, Accepted date: May 20, 2014, Published date: May 27, 2014
Copyright: © 2014 Rajkumari N. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use,
distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Background: Using new information technology (IT) has provided remarkable opportunities to decrease medical
errors, support healthcare specialist, increase the efficiency and even the quality of patient's care and safety.
Studies are few which actually deals with the outcomes of the patients and improving the healthcare dispensing by
health care workers and hence the study.

Methods: A six month prospective study among 40 enrolled health care workers (doctors and nurses) by dividing
them into two subgroups; one using conventional paper work and other using electronic health record system,
computerized physician order entry, patient clinical information systems and using mobiles for health care. They
were given instructions at the beginning and end of six months and data collected using single blinded method
based on a questionnaire.

Results: The study observed that doctor (90%) and nurses (95%) found that CPOE has improved their health
care dispensing but it did not affect the outcomes of the patients in the long run. Another important finding in this
study was the use of cellular phones which has helped the health care workers (85% doctors and 70% nurses) in
better health care especially in following up patients who were unable to attend follow-up. Also, there was work flow
improvement by 20-fold reduction in the delay from writing admission orders to the execution of those orders.
However, this need large infrastructure to set up and maintain it.

Conclusion: Though there was reduction in the paper related work load of conventional method and was time
saving, it however did not affect the outcome of the in patients significantly (p > 0.05) in the long run but helped in
the post discharge patient care.

Keywords: Technology; Healthcare; Improvement; Methods; Data effectiveness of cellular phone-based medical informatics (CPBMI) for
storage healthcare [3]. Hence, we conducted this study to assess if
conventional written method is better to that of the technology itself
Introduction and to see for any drawbacks in it.

In modern times, using new information technology (IT) has Material and Methods
provided remarkable opportunities to decrease medical errors, support
health care specialist, increase the efficiency and even the quality of We have conducted this 6 month study among the resident doctors
patient’s care and safety [1,2]. On the other hand, there are numerous and nursing staff of an apex health care set up to assess the efficacy of
problems in the scope of IT-based systems in the field of health care; (1) electronic over the conventional physician order entry (2)
therefore, these problems should be tackled before the positive electronic health care record system over the conventional paper filing
potential for IT to help health care organizations can be optimally systems (3) dispersal of patient health information at different user
utilised. It also needs a huge infrastructure and if not properly points using password protected systems (4) use of duty mobiles for
implemented could lead to wastage of the resources which could have easy access of doctors and nurses when needed.
been used in direct heath care of the patients.
A total of 40 health care workers were enrolled for the study. These
The role of computerized physician order entry (CPOE) electronic health care workers consist of resident doctors and nurses and were
health records and patient clinical information systems (PCISs), which enrolled in the study randomly. The doctors and nurses were from
often include CPOE is also a matter of debate though most hospitals Medicine, Surgery, Orthopaedic, Neurosurgery, Emergency medicine,
are using it where infrastructure are adequate. We live in an age where Pathology and from Anaesthesia and Critical care Departments. They
computers are nearly replacing human work and data storage. Is it were divided into 2 groups of health care workers (1) doctors (n=20)
sufficient to leave everything to the information technology itself? and (2) nurses (n=20). Each group was again subdivided into two
Cellular phones enable communication between healthcare providers groups again: one using the conventional system (10 doctors and
and patients for prevention, diagnosis, and treatment of diseases. nurses each) and the other was using the electronic system/duty
However, few studies have examined the user-friendliness or mobiles (10 doctors and nurses each). They were matched for sex and

Occup Med Health Aff Volume 2 • Issue 3 • 1000162

ISSN:2329-6879 OMHA, an open access journal
Citation: Rajkumari N (2014) Impact of Technology in Better Dispersal of Health Care Methods and Improving Health Care Systems. Occup Med
Health Aff 2: 162. doi:10.4172/2329-6879.1000162

Page 2 of 3

age in each subgroup; 5 each were males and remaining 5 of them were Details regarding their experience in using the electronic health
females. All the staff enrolled in the study falls in the age group record system, automated physician order/instructions, the easy
ranging from 20 – 35 years. The HCWs enrolled were selected based accessibility over their duty mobiles against their conventional on call
on their ability to use electronic system or not though this was not via an attendant system and convenience regarding the online
disclosed to them when they were enrolled. This was done in a single accessibility of laboratory investigation reports. The final outcomes
blinded manner. regarding its usefulness in the patient’s health was measured by using
the tool of monthly mortality report from those departments
The two subgroups were given the details at the beginning of the
(Medicine, Surgery, Orthopaedic, Neurosurgery, Emergency medicine,
study and again at the end of 6 months and information regarding
Pathology and from Anaesthesia and Critical care Departments) where
their experience were noted through an interview cum questionnaire
such an electronic system was used compared to those departments
form. They were asked their personal experience of the work given to
(Ophthalmology, Otorhinolaryngology, Pediatrics, Psychiatry and
them and after that given a multiple choice questions based
Obstetrics and Gynaecology) where it was not used. All these data
questionnaire in which each question’s answer were to be rated on a
were noted, complied and analysed.
range from 1 to 5; 1 for poor and 5 for excellent. The details of the
questionnaire were given in Table 1.
Statistical analysis
1) How was your experience regarding the system given to you for use?
Descriptive statistics were used wherever feasible. The two groups
a) 1 b) 2 c) 3 d) 4 e) 5 were compared using the Student t test. A value of p < 0.05 was taken
as significant.
2) Did it improve your work output and performance?

a) 1 b) 2 c) 3 d) 4 e) 5 Results
3) How was your ease of contacting post discharge patients? During the 6 month study period, it was observed that the work
output and performance was better in the subgroups (both doctors
a) 1 b) 2 c) 3 d) 4 e) 5 and nursing staff) where the electronic and technology were used by
4) How easily can you retrieve the patient’s data?
75% (15/20) compared to those using the conventional method. Also,
the availability of the doctors or nurses in their off duty hours were
a) 1 b) 2 c) 3 d) 4 e) 5 capable of providing services when they are needed was also more
among those using duty mobiles 90% (18/20). It reduced the cost of
5) Was your work made faster?
care and improved the workflow among CPOE users by 25%
a) 1 b) 2 c) 3 d) 4 e) 5 compared with the control group who used the traditional paper
orders. An example of its benefit to work flow improvement is the 20-
6) Was any special training required for using this system? fold reduction in the delay from writing admission orders to the
a) 1 b) 2 c) 3 d) 4 e) 5
execution of those orders: from an average of six hours to 30 minutes.
Not surprisingly, physicians liked it too. The details of the experience
7) How much error do you find in the data entered? by the two groups of health care workers (doctors and nurses)
regarding the different methods used were shown in Table 2.
a) 1 b) 2 c) 3 d) 4 e) 5
Conventiona
8) Do you feel large amount of infrastructure is required for this system which CPOE* PCISs** EHR# CPBMIs^
l
you are using?
Doctor 90%(18/20
a) 1 b) 2 c) 3 d) 4 e) 5 45%(9/20) 80%(16/20) 50%(10/20) 85%(17/20)
s )
9) Is the system you are using time consuming?

a) 1 b) 2 c) 3 d) 4 e) 5
95%
Nurses 50% (10/20) 90%(18/20) 70%(17/20) 70%(14/20)
(19/20)
10 Has your system which you are using improved the patient care and
) treatment?
*CPOE = Computerized Physician Order Entry, **PCISs = Patient Clinical
Information Systems, #EHR = Electronic Health Records, ^CPBMIs = Cellular
a) 1 b) 2 c) 3 d) 4 e) 5
Phone Based-Medical Informatics
INDEX (Where)
1 = poor/extra efforts needed 2 = average/ might need extra efforts 3 = ok/ can Table 2: Details of the easy usability or good experience by the two
be done 4 = good/ easily done 5 = excellent/ can do the work very quickly ( 1 groups of health care workers (doctors and nurses) regarding the
rating = 1 point, 2 rating = 2 points, 3 rating = 3 points, 4 rating = 4 points and 5 different methods used.
rating = 5 points)

A very important finding was that the health care personals

Table 1: Questionnaire (doctors and nurses) were able to check and reach the patients through
mobile phones especially in those patients who stay out-station. They
The instructions and data collection was done by a different group were able to call them and follow-up such patients even when they
of people and the data compiling and analysis were done by another so missed their check up and check their condition and their treatment
as to avoid bias in the results and interpretation. advice. This was included as part of routine post-discharge patient
follows up and for surveillance and found to be very useful especially

Occup Med Health Aff Volume 2 • Issue 3 • 1000162

ISSN:2329-6879 OMHA, an open access journal
Citation: Rajkumari N (2014) Impact of Technology in Better Dispersal of Health Care Methods and Improving Health Care Systems. Occup Med
Health Aff 2: 162. doi:10.4172/2329-6879.1000162

Page 3 of 3

in case of late infections developing after discharge. A total of 85% however did not affect the outcome of the patient in the long run.
(17/20) doctors and 70% (14/20) nurses gave positive response Similar findings were seen in another study [4]. Another major issue
regarding the easy access and better health dispensing to the patients overcame by the CPOE was the elimination of sloppy and ineligible
through CBPMIs. handwriting and hence better dispensing of the medical instructions.
This was seen in our study and supported by another study [4].
Another observation from this study was the reduction in the
workload created by the paperwork and avoidance of the slow Our study did not observe any direct health benefit outcomes from
processing of admission of a patient to its access of his/her CPOE. No study has shown any direct health outcome benefit from
information to other health care working involved in healthcare CPOE, and we doubt that CPOE (order entry by the physician per se)
though not in the immediate treating team. Doctors told us they were systems will produce lifesaving benefits that cannot be delivered by
80% (16/20) satisfied with faster work and reduction in the paper work other computer processes (e.g., checking on drug dosages when
processing and a total of 90% (18/20) nurses said that it had removed pharmacists enter the orders or reminders delivered to physicians
many of their loads. Also, while retrieving healthcare information, through other mechanisms)[5]. On the other hand, CPOE systems
doctors found 50% (10/20) discrepancy in the electronic method as definitely can have large and important benefits on institutional
compared to the conventional method; though its time consuming to efficiency and costs [4].
retrieve a file and subjected to wear and tear and data loss. A total of
Our study also observed a better and easy access to out-stationed
70% (14/20) nurses noted the discrepancy. It was also observed that
patients in their follow-up and checking their treatment and
health care workers who had knowledge of technology like computers
medications being taken by the patients. It also helped to connect with
can access the data easily and can also update the data. Here, proper
health care workers even during their off duty hours but when their
training in the use of the technology and knowledge of the medical
expertise were needed. This was seen in 85% doctors and 70% nurses.
terminology were needed and staff who does not have much
Similar findings in the better dispensing of health care systems were
knowledge about the electronic system use need to be educated
seen in another study [3].
regarding its use compared to using the conventional system of using
pen and paper work. Hence, this was a drawback which we have Such a use of technology was not without loopholes. The main
observed in this study. drawback was that it needed trained staff to use it and update it. Hence
healthcare workers who are tech savy can access it better than those
Another important finding from this study was that though
who are not. Another drawback is the extra infrastructure needed to
technology has improved our easy access to the health care systems
set it up and to maintain them.
and better dispensing of the medical information leading to reduced
workload in terms of paper work and storage, it didn’t affect the final
outcomes of the patient either in terms of morbidity and mortality Conclusion
significantly (p > 0.05). These findings were observed equally by both Though technology has improved in better dispensing health care,
the doctors and nurse each (70%, 14/20). This was done based on making us easily accessible to patient information as and wherever
comparing the mortality report from those departments where such an needed and also reducing the paperwork volume, it did not
electronic system is being used with those departments where such a significantly reduce the outcomes of the patient in the long run. Maybe
system is not used. The study found that monthly mortality in those a combination of either method is still.
areas where such a system was used and hence enrolled in our study
(Medicine, Surgery, Orthopaedic, Neurosurgery, Emergency medicine,
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