The advent of computing has had widespread effects in all areas of society, with medicine no exception. Computer systems are vital – as they are in any modern enterprise – for the administration of hospitals, general practices and health authorities, supporting payroll, finance, stock ordering and billing, resource and bed management, word-processing correspondence, laboratory-result reporting, appointment and record systems, and management audit.
The imaging systems of COMPUTED TOMOGRAPHY (CT) (CT) and magnetic resonance imaging (see MRI) have powerful computer techniques underlying them.
Computerised statistical analysis of study data, population databases and disease registries is now routine, leading to enhanced understanding of the interplay between diseases and the population with the results of research, available on computerised indexes such as MEDLINE.
The direct computerisation of those activities which are uniquely medical – history-taking, examination, diagnosis and treatment – has proved an elusive goal, although one hotly pursued by doctors, engineers and scientists working in the discipline of medical informatics. Computer techniques have scored some successes: patients are, for example, more willing to be honest about taboo areas, such as their drug or alcohol consumption, or their sexual proclivities, with a computer than face to face with a clinician; however, the practice of taking a history remains the cornerstone of clinical practice. The examination of the patient is unlikely to be supplanted by technological means in the foreseeable future; visual and tactile recognition systems are still in their infancy. Skilled interpretation of the result by machine rather than the human mind seems equally as remote. Some computer-supported diagnostic systems are in use, for example apps which will open a questionnaire to deal with minor illness.
In therapeutics, computerised prescribing systems still require the doctor to make the decision about treatment, but facilitate the process of writing, issuing, and recording the prescription. In so doing, the system can provide automated checks, warning if necessary about allergies, potential drug interactions, or dosing errors. The built-in safety that this process offers is enhanced by the superior legibility of the script that ensues, reducing the potential for error when the medicine is dispensed by the nurse or the pharmacist.
Success in these individual applications continues to drive development, although the process has its critics, who are not slow to point to the lengthier consultations that can arise when a computer is present in the consulting room and its distracting effect on communication with the patient.
Underlying these many software applications is networking technology that enables interconnection and the sharing of data. As in essence the doctor's role involves the acquisition, manipulation and application of information – from the individual patient, and from the body of medical knowledge – great interest surrounds the development of open systems that allow different software and hardware platforms to interact. Many problems remain to be solved, not least the fact that for such systems to work, the whole organisation, and not just a few specialised individuals, must become computer literate. Such systems must be easy to learn to use, which requires an intuitive interface between user(s) and system(s) that is predictable and logical in its ordering and presentation of information.
Many other issues stand in the way of the development towards computerisation: standard systems of nomenclature for medical concepts (see CLINICAL CODING) are now well developed and are crucial for successful information-sharing between users. Sharing information between existing legacy systems is a major challenge, often requiring customised software and extensive human intervention to enable the previous investments that an organisation has made in individual systems (e.g. laboratory-result reporting) to be integrated with newer technology.
Clinical workstations, with personal computer networked to the hospital or practice system enables clinicians to record clinical data and diagnoses; automate the ordering of investigations and the collection of the results; and facilitate referral and communication between the many professionals and departments involved in any individual patient's care.
Once data is digitised – and that includes text, statistical tables, graphs, illustrations and radiological images, etc. – it may be as freely networked globally as locally, albeit in line with legislation regarding confidentiality. Consultations in which live video and sound transmissions are the bonds of the doctor–patient relationship (the techniques of telemedicine) are already reality, and have proved particularly convenient and cost-effective in linking the patient and the generalist to specialists in remote areas with low population density.
As with written personal medical records, confidentiality of personal medical information on computers is essential. In the UK, computerised data are covered by the Data Protection Act 1984. This stipulates that data must:
be obtained and processed fairly and lawfully.
be held only for specified lawful purposes.
not be used in a manner incompatible with those purposes.
only be recorded where necessary for these purposes.
be accurate and up to date.
not be stored longer than necessary.
be made available to the patient on request.
be protected by appropriate security and backup procedures.
As these problems are solved, concerns about privacy and confidentiality arise. While paper records were often only confidential by default, the potential for breaches of security in computerised networks is much graver. External breaches of the system by hackers are one serious concern, but internal breaches by authorised users making unauthorised use of the data, or simply losing or mislaying the data are, in practice, a much greater risk. Governing network security so that clinical users have access on a need-to-know basis is a difficult business. The software tools to enable this – encryption, and anonymisation (ensuring that clinical information about patients is anonymous, to prevent confidential information about them leaking out) of data collected for management and research processes exist in the technical domain, but remain a complex conundrum for solution in the real world. In the UK, legislation separate from the Data Protection Act seeks to protect society against the unauthorised use of identifiable information.
The mushroom growth of websites covering myriad subjects has, of course, included health information. This ranges from clinical details on individual diseases to facts about medical organisations and institutes, patient support groups, etc. Some of this information contains comments and advice from orthodox and unorthodox practitioners. Such open access to health information has been of great benefit to patients and health professionals, but web browsers should be aware that not all the medical information, including suggested treatments, has been subject to PEER REVIEW, as is the case with most medical articles in recognised medical journals.