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Journal of the Academy of Hospital Administration

Utilization of Computer by Health Care Professionals - Current Status

Author(s): N.C. Prajapati *, S Bala **

Vol. 12, No. 2 (2001-07 - 2001-12)

Introduction

The latter half of the present century has gone through the following phases: 60s Indian Civil Services, 70s, Medical Mania, 80s Engineering euphoria and now-Information technology (IT) of which computers are inalienable partners. The impact of IT and computers is being felt daily, in our living rooms through TV, VCRs, satellite imaging, electronic mail etc.

In India, computer education is just fifteen years old, but has out grown even the most optimistic estimates. Their role in efficient management of services by organizing, retrieving and using information effectively, has come in a big way to assist us1,2,3.

Why computers in health care systems?1,4,5

There is hardly any area today, which has not been influenced by computers, and health care systems are no exception. Health sector, infact is field where computers could make maximum social impact. There are human beings today who are half computers and half human e.g. patients with Pacemaker, Computerized precision made artificial heart, computerized hearing aid, and computerized dialysis machine. The present day hospitals are able to understand the complex processes and manage materials, money and manpower effectively and efficiently only due to computers.

We lag behind by decades, as USA even in 1972, 81% of the hospitals had one or more in-house computers. Today it is a norm in USA to allocate 10% of the hospitals budget for computerization. I wonder if any hospitals management in India would do so?

Doctor's Dilemmas5,6

Nothing on this earth is more complex than the human body, the processors used in the most powerful super computers don't come close to matching any of the human organs. Doctors can understand the human body, but are afraid/hesitant in using computes. This hesitancy/phobia/fear/lack of awareness is the main hurdle in the utilization of computers in health.

The awareness amongst health professionals has certainly increased over the past few years but still many continue to shy away from computes - some are hesitant, some are unsure about their utility and quite a few procure it for a status symbol. Applications in health5-12

Wide applications of computers in health care include hospital management, patient care, billing, counselling, appointments, curriculum planning, research, study, communication etc. Most of the diagnostic instrument e.g. X-rays, CAT scan, Blood gas analyzers, spirometer, ultrasound, automatic analyzers are based on computers, and have made the monitoring of patients and interpretation of diagnostic tests easy. It is not uncommon to see qualified professionals being utilized in clerical tasks for maintenance of records etc. at the cost of patient care. Computers could help solve some of the problems like:

  1. Relieving physicians from routine documentation and other clerical functions.
  2. Cutting down on the paper work; sparing more time for patient care, reducing errors and increasing accuracy in transmission and storage of data.
  3. Establishment of consistent standards and continuous monitoring or transactions
  4. Easy and direct access to various information regarding patient through remotely located terminals.

Local Area Networking (LAN)

Has made hospitals information system easy, fast, accurate and comfortable. The patient's data, x-rays, sonograms, CT Scans and other investigation reports can be brought to the terminals in the operations theatres, patients' bed, the consulting room or the desk of administrators, just at the press of a button.

In the hospitals and medical related organization the computers can be utilized through LAN for

  1. Communication of Medical Information
  2. Assistance in diagnosis
  3. Assistance in evaluating prognosis
  4. Patients Profile
  5. Administrative Support
  6. Medical research
  7. Legal requirements
  8. Linkage with other specialized computers
  9. Inventory management
  10. Cost control, billing
  11. Maintaining medical records
  12. Patient Counselling
  13. Medical Literature Archival
  14. Image archival and processing
  15. Interactive learning and CME

As 75% of the activity of hospitals is concerned with the processing of information. Computers can help improve the efficiency of this information processing that too at low cost.

HELP (Health Evaluation through Logical Processing)

HELP is a computer system in use at USA. It provides consultation and updating of medical knowledge. Each patient can take a self-administered history questionnaire while sitting at the terminal. The computer processes the answers. It can then list some diagnosis along with reasons, it can read ECG and various tests and also suggest interpretation. It can prompt potential hazards to the patients (in the light of its known sensitivity, deranged kidney or liver function) if a drug is prescribed.

Telemedicine and Internet 10,12

Patient in ICU and CCU can be monitored directly by the computer for a variety of hemodynamics and rhythm measurements. The data transmission systems enable doctors to check on the status of a patient on a continual basis, even when they are away from the hospital; by connecting to personal computer or a machine by the patient's bed side.

A doctor from another city/remote areas can know the status of the patient he has referred or even see and speak to him through computer. This system has recently been introduced at one of the hospitals at Mumbai.

The Internet has linked doctors, health care providers and patients, thereby accelerating medical research and landing a flow dimension to patient care. India has Internet also allows Job opportunities for medicos, on line consultation with specialists, latest techniques, links up with hospitals etc. New technology via Internet has saved many lives.

Aims and Objectives

The present study was aimed at knowing about a) the interest of health professionals regarding use of computers in health care systems, b) the current status of utilization of computers in different health care setting, c) the main hurdles faced by health professionals in using computers and d) the possible solutions to increase utilization of computers in health care systems.

Materials and Methods

The study was conducted at Mahatma Gandhi Institute of Medical Sciences (MGIMS) Sevagram Wardha, in March 2000. Opinion and comments of the health professionals regarding their interest, accessibility, knowledge and utilization/ utility of computers in different health care systems was collected. A specially designed, pretested proforma (containing simple questions, with open and closed-ended answers) was sent to health professionals along with self-addressed stamped envelop. The information received was kept confidential and results were analyzed using EP16 statistical package.

Observation and Discussions

A total of 300 questionnaire were sent. Only 188 (62.66%) forms could be collected/returned, here after referred to as "respondents". Most of those who did not return the forms said "it was not relevant to them", and was therefore interpreted that they were not interested in computers. The results of 188 respondents are summarized below. **

Their responses were as follows:

  • Is computer a useful tool in health care system?
    182/188 (96.8%) replied yes, 2/188 (1.1%) said No while 4/188 (2.1%) said don't know.
  • 1.1 Are you interested in computers?
    This was responded as ? Yes by 97.9% (184/188) and No by 2.1% (4/188).
  • 1.2 Reasons for being interested in computers?
    The responses are summarized in decreasing order of frequency in table 1.
  • 1.3 Reasons for not being interested in computers
    4 respondents were not interested in computers stating that to work on computers requires lot of time and knowledge and is expensive too.

Table 1: Reasons for being Intersted in Computer

Reasons Frequency Percentage
Is useful for data storage and analysis 112 60.9
Is a fast working machine 46 25.0
Helps in keeping in touch with the latest 36 19.6
Is a useful tool 34 18.4
Useful for personal management 32 17.4
It improves quality of work 30 16.3
Is the need of the time 16 8.7
Is a fascinating instrument 12 6.5
Helps in making diagnosis 10 5.4
Prevents lots of paper work 2 11

2.0 Accessibility of Computers

Only 46% (88/184) of the respondents interested in computers had access to computers (Fig. 2). The type of computers they access to are shown in table 2.

Table 2: Type of Computer accessible

Type Frequency Percentage
Personal 18 20.5
Officials 66 75.0
Others** 4 4.5
Total 88 100.0 *

*14(15.9% had access to both personal and official computers.
** Friends, computers institutes etc.

2.1 Utilization in comparison to access

Only 70.5% of those having access to computers were using it. Table 3 and

Fig 3 clearly depict the increase in both accessibility and utilization in the past two years.

Table 3: Accessibility and Utilization of computers in the last 10 years

Duration (Yrs) Freq. Accessibility Freq. Using Use c.f. Access
< 1 42 (47.7%) 36 (52.9%) 85.7%
1-2 16 (18.2%) 12 (17.6%) 75.0%
2-5 20 (22.7%) 11 (20.6%) 55.0%
5-10 10 (11.4%) 3 (8.8%) 30.0%
Total 88 (100.0%) 62 (100.0%) 70.5%

100% of those owning personal computer were using it too. On the other hand, of those having access to official computers only 60.6% were using them. This use too has increased in the last 2 years, but even today officials computers are being used by just 79.3% (Table-4). This under-utilization becomes more significant when viewed in light of the accessibility as 75% responders have access to official computers but being subordinates are not allowed to use them.

3.0 Knowledge about computers

The knowledge of respondents about computers is summarized in Fig.- 4.

3.1 Configuration of the computer

Of those having access to computers 35.3% did not know the configuration or type of computer they were using. The knowledge was slightly better in those having personal computer (77.8%). Of those using official computer (63.6%).

Table 4: Accessibility and use of personal Vs Official computers

Duration Personal Official Other
(Yrs) Access Use Access Use Access Use
< 1 12 12 29 23 (79.3%) 1 1
1-2 2 2 11 7 (63.6%) 3 3
2-5 3 3 17 8 (47.1%) 0 0
5-10 1 1 9 2 (22.2%) 0 0
Total 18 18 66 40 (60.6%) 4 4
100% 100%

3.2 Software

About 1/3rd of those having access to computers and 2/3rd of those not having access to computers do not know about the word processor software/s, used on computers. The situation is still worse regarding knowledge about database management software and Graphics software, where the figure is approximately 50%. Only 10% respondents were aware of statistical software used in computers.

3.3 Advanced facilities

E-mail, Fax modem and Internet facilities improves the communication (making it fat and cheaper). Use of LAN allows a good MIS and prevents duplication of work. Use of Internet makes all information available accessible on the desk itself. All these facilities are being used by very few health care workers, but more important that many of them are not even aware of these.

Table 5: Utilization of advanced facilities of computers (N=96)

  LAN Internet E-mail Exam Mode
Yes 14 10 12 16
(14.6%) (10.4%) (12.5%) (16.7%)
No 64 74 72 68
(66.7%) (77.1%) (75.0%) (70.8%)
Don't know 18 12 12 12
(18.8%) (12.5%) (12.5%) (12.5%)

4.0 Utilization current status

The main use of the computer by those who have it is summarized in table 6. The figure themselves speak about the current status of utilization of computers and the need of emphasize the utility of computers in health care systems.

Table 6: The main use of computer presently (n=96)

For making cards etc. 5.0% For communication 22.9%
As a status symbol 10.2% For keeping patient record 28.1%
For Playing games 18.8% For Research 34.4%
For Diagnosis 18.8% For Typing reports 37.5%
For Accounting 21.9% For typing letters 42.7%
For Administration 28.1%    

5.0 Training in computers

Only 22 out of 188 respondents had some formal training in computers:- sixteen had 3-6 months training in a computer centre, four had attended 1 week institutional training while two had some exposure in school.

6.0 Hurdles in use computers

The hurdles faced by the health professionals in the use of computers are summarized in table 7. The reasons cited are small and varied but need to be tackled if optimal use of computers is to be ensured in the health sector.

Table 7:Main hurdles in use of computers amongst health professionals

Lack of Access 75%
Lack of Knowledge 45.8%
Lack of training 33.3%
Lack of time 31.3%
Old Computers and softwares 8.4%
Lack of practice 4.2%
Own carelessness 4.2%
Not having Personal computer 2.1%
Computers without Printer 2.1%
Lack of medical based softwares 2.1%

6.1. Overcoming hurdles

Utilization of computers in health care systems can be improved by:- making them accessible to all, training of health professionals for utility of computers in health care settings, periodic awareness drives and making computer literacy compulsory.

6.2 Other Concerns

Other major concern of health professionals in using computer is the fast changing computer technology / configuration and software procured today gets outdated very fast.

Conclusions

In this era of information Technology, there is a need to stress the need for optimal utilization of computers by the health care professionals.

Following points emerge from the above study:

  1. Almost everybody, irrespective of age, sex, qualification, speciality or place of work agree regarding the usefulness of computers in health and are interested in it too.
  2. The youngster are more interested.
  3. Although aware of computer utility, its fast speed, capability to store, retrieve and analyze data, role in keeping in touch with the latest, many of those having access to computers are not having sufficient knowledge about the relevant software and are not using the same in their professional practice.
  4. Official computers are under utilized at many places. The department senior colleagues should allow access to interested youngsters on the official computer.
  5. Unrestricted accessibility place of work and on going training programs should be a regular feature to keep one updated and increase the use of computers in health care systems.

References

  1. Lale R D. Computers in Medicine 3rd reprint. Tata McGraw Hill Publishing Company Ltd., New Delhi, 1992.
  2. Philip Burnard - Health care computing. Chapman and Hall London, 1995.
  3. Medicine on the Web - P C Quest, February 1996.
  4. Hospital information Management Systems. C-DAC Pune IE Convention. 23 Nov. 1996.
  5. Computers for the medics, Chip July 1998.
  6. Nanda L. The need for a computerized patient-record system for the public hospitals in Andhra Pradesh. J Academy of Hosp Administration. 2000; 12: 7-13.
  7. M Dayanda, R P Sinha. Medical Informatics - An overview, J Academy of Hospitals Administration July 1993. 9-11.
  8. Bhave S Y. Introduction to basics of computers. Bombay hospital journal vol. 33, No.3, 1991, pg. 5-40.
  9. Computerized Neonatal Information system. Archives of Diseases in Childhood. 1991:66:823-826.
  10. Kishore N. Internet for doctors. Vikas publishing house Pvt. Ltd. New Delhi. 1998.
  11. Prajapati NC Proceedings of workshop on "Applications of computers in Health Care Systems", held at MGIMS Sevagram, September 1998.
  12. Chintamani A. Cyber health. Health action, 1999; 8-10.

Dr. N.C. Prajapati: Prof. Of Paediatrics, MGIMS Sevagram Wardha Phone : 07152-84118 Fax: 07152-84333
E-mail : [email protected]

Dr. S. Bala: Deptt. of Paediatrics, MGIMS, Sevagram, Wardha

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