aa (4)

1

Chapter15 Role of IT in Healthcare

V 30 April 2010

For Associates

Certificate in Healthcare and Life sciences ndash L1

2

Confidentiality statement

This document should not be carried outside the physical and virtual boundaries of TCS

and its client work locations The sharing of this document with any person other than

TCSer would tantamount to violation of confidentiality agreement signed by you while

joining TCS

Certificate in Health Care amp Life Sciences ndash L1 TCS Business Domain Academy

3

Chapter 15 Role of IT in HealthCare

In this Chapter

The session discusses about the impact of IT in health care It talks about the nature and

scope of information power granted by IT It also deals with the influence of IT on the

design of healthcare systems Lastly it talks about bioinformatics

Learning Objectives

After reading this session you will know about

bull Impact of IT on healthcare

bull Impact of IT on the design of healthcare system

bull Nature and scope of information granted by IT

bull Role of IT in Life Sciences

Topics Covered

Chapter 15 Role of IT in HealthCare3

151 Introduction 4

152 Impact of IT on Healthcare 4

153 Hospital Information System 7

154 EHR (Electronic Healthcare Records) 14

155 Nature and Scope of Present Trends in IT and Health 18

1551 ITrsquos role in design of healthcare products and services 18

1552 ITrsquos impact on design of healthcare systems 20

1553 Nature and scope of information power granted by IT 20

1554 ITrsquos facilitating role in strengthening public-private partnerships 21

1555 IT-induced vulnerabilities and IT-aggravated risks 23

156 Information Technologyrsquos Role in Life Sciences Research amp Development 25

157 Bioinformatics Assists Drug Discovery and Development 27

158 The Indian Perspective 27

Summary 29

Deleted 15

Deleted 19

Deleted 21

Deleted 21

Deleted 22

Deleted 24

Deleted 26

Deleted 28

Deleted 29


4

151 Introduction

IT investment offers an environment for a new level of care to exist For example IT can

provide a prospect to evaluate trends that previously took much longer to identify

Enhanced information access can lead to rapid decision-making The confirmation of

better information leads to better care can be confirmed by the improvement in health

outcomes Better health outcomes include

bull diagnosing patients more accurately and quickly

bull act in accordance with patientsrsquo wishes and comforting the family

bull decreasing the number and severity of errors

bull supporting care delivery through improved access to information

Information technology (IT) has significantly reduced the costs improved the speed

and enhanced the efficiency of life sciences research and development (RampD) The RampD

in turn has established new challenges and opportunities for IT applications This cycle

has added to an entire new frontier for knowledge production For example the union

of IT and biological progresses made possible the mapping of the whole human

genome and genomes of many other organisms in just over a decade These

inventions along with the current efforts to establish gene and protein functions have

enhanced our capacity to know the root causes of human animal and plant diseases

and find new cures for the same In addition to this many future IT innovations will

likely be stimulated by the data and analysis demands of the life sciences

152 Impact of IT on Healthcare

The maximum advancements of IT will be felt on release of healthcare Some of the

futuristic happenings would include

Right now there is a clear cut difference between healthcare product manufacturers

and marketers and the healthcare delivery systems Pharmaceutical corporations

belong to the previous group and hospitalsclinics are major parts of the healthcare

delivery systems in society IT will associate the two as one leading to blurring of the

boundaries Thus we would have a future situation where Pfizer would be concerned in

storing profiles of patients in a locked web site in an electronic format accessible via a

password through internet and WAP-mobile services Thus Pfizer would help identify


5

cases of hyperlipidemia store e-records and provide access to these to authorized

employees

The second impact of IT would be a new type of experts or companies ndash the electronic

healthcare information providers or healthcare counsel providers These healthcare and

IT knowledgeable people would help incorporate the vast database of health disease

and treatment related information including prevention and would assist therapy

givers provide the best integrated therapy for an individualrsquos sickness condition

The third impact of IT would be in the form of Pharma companies or connected

companies generating and sustaining electronic records of genetic profiles of people

and helping therapy givers give the best treatment based on the hereditary tendencies

of the patients

The fourth impact of IT would be societal media assisted word-of-mouth propagation of

healthcare information tips and knowledge These are very dominant influencers

Information technology presents huge potential benefits to US healthcare As per the

Institute of Medicine as many as 98000 people pass away in hospitals every year from

medical errors such as wrong medications and improper identification of diseases

many of which are preventable A study conducted by the Healthcare Information

Management Systems Society found out that approximately 49 of clinical diagnostic

testing is carried out since prior test results are not available when required

Applications of IT to healthcare such as electronic healthcare records (EHRs)

computerized ordering of prescriptions and tests and updated medical information for

clinical decision support can save thousands of lives and billions of dollars by

decreasing medical faults and miscommunication

The entry of IT into the healthcare has been slow and disorganized Only 12 of

practices with smaller number of physicians have adopted EHRs The healthcare

industry expends only 2 of revenues on information technology which is much lower

than the 10 average of other information-intensive industries

The major difficulty in the adoption of a nationwide interoperable healthcare

information technology (HIT) system is the lack of vigorous commonly accepted

technical standards In spite of the efforts at the Department of Health and Human

Services (HHS) since 2004 such standards have yet to be completely developed and

extensively propagated Furthermore there is also a need of conformance testing to


6

make sure that product and systems meet the terms of the set HIT interoperability

standards Without these standards and conformance tests healthcare providers are

unwilling to spend in HIT systems as there is no guarantee that they will be able to

correspond with other systems

The federal governmentrsquos lead organization for the progress and spread of technical

standards the National Institute of Standards and Technology (NIST) has been

concerned with HIT standards development work since 2005 With its extensive

expertise with issues of system interoperability data security and privacy and

consensus standards development NIST is well placed to make a larger contribution to

HIT standards development work and speed the use of a national secure and

interoperable HIT system

On May 21 2007 Chairman Bart Gordon introduced HR 2406 a bill to sanction NIST to

boost its efforts in support of the incorporation of the US healthcare information

project The bill

bull Directs NIST to set up an proposal for progressing HIT integration and permits it

to support healthcare representatives and organizations and federal agencies in

developing technical roadmaps for HIT standards

bull Requires NIST to build up or take up existing technology-neutral guidelines and

standards to facilitate federal agencies to efficiently choose and exercise HIT

systems that are safe interoperable and guarantee patient privacy

bull Requires the Department of Commerce to start a Senior Interagency Council on

Federal Healthcare Information Technology Infrastructure to synchronize the

development and deployment of federal HIT systems the related technology

transfer and federal work with private HIT standards development

organizations

bull Requires NIST to institute a university funding program for multidisciplinary

research in HIT-related fields and

bull Directs the National High-Performance Computing Program to organize federal

HIT RampD programs

Though the United States is the most technologically advanced nation in the world the

US healthcare system persists to depend on pen and paper for the bulk of its

information requirements From patient medical histories to prescriptions to hospital

charts handwritten notations are the foundation for patient care information This

system is expensive outdated and prone to risky or life-threatening medical errors As a


7

result of broken down healthcare practices and system malfunctioning over 98000

Americans die and more than one million patients experience injuries every year

According to the National Academies between 30 and 40 of the healthcare costs

which is more than half a trillion dollars annually is used up on overuse underused

mishandling duplication system failures and redundant repetition poor

communication and inefficient healthcare practices

Information technology proposes vast potential benefits to enhance the functioning

and efficiency of US healthcare A completely realized national interoperable

healthcare IT (HIT) system could decrease errors improve communication assist in

eliminating redundancy and supply many other benefits that would guard the patients

and save up to tens of billions of dollars per year The fundamental challenge to

achieving such a system is interoperabilitymdashthe capability of data systems medical

devices and software from different vendors based on various array of platforms to

share patient electronic healthcare records (EHRs) electronic physician orders for lab

tests and drug prescriptions electronic referrals to specialists electronic access to

information about present suggested treatments and research findings and other

information

An important characteristic of a practical HIT system is that it protects the privacy and

confidentiality of patientsrsquo medical information It must also have strong data safety

provisions so that medical information cannot be altered or destroyed by illegal

entities HIT standards must include privacy and security in the original standards

design in order to make sure that these features will be an essential constituent of a

national HIT system

153 Hospital Information System

Various Hospital Information System (HIS) are being developed with the objective of

organizing the treatment process of a patient and allowing doctors and other staff to

perform to their maximum in an organized and efficient manner

It ensures benefits through technological advancement and is a guaranteed return for

investment It is operated in such a way that it is beneficial to both the recipients and

providers of healthcare because it is modeled on a unique combination of a patient

centric and medical staff centric paradigm


8

HIS uses a network of computers to gather process and retrieve patient care and

administrative information for easy availability to the users It helps the hospital

authorities by acting as decision support system for developing comprehensive health

care policies It incorporates an integrated computerized clinical information system for

improved hospital administration and patient health care It also helps to provide

updated electronic medical record of the patient These serves as data for research

undertaken by hospital authorities

HIS software is built around a highly optimized core library Application modules are

layered around this core and can be suitably customized for any user specific

requirements

Advantages of maintaining electronic records are

bull Reliable information storage querying and retrieval

bull Easy access to query data as the classification is based on many factors such as

age gender etc

bull Instant information access

bull Efficient and accurate administration of all hospital activities including finance

diet etc

bull Improved monitoring

Example of an effective HIS can be C-DACrsquos Sushrut A hospitalsrsquos administration can be

best explained through this example


9

Direct Sourcewwwcdacin

The various modules maintenance and functionality using this HIS can be explained as

1) Out-Patient Management

The out-patient module deals with recording the basic medical treatment details

required for the patient It consists of the following parts

a) Bay Management

This module depends on the registration module for the patients demographic

data

o Paging and Checking of patients in the bay

o Appointment scheduling of patients (normal and investigations)

o Printing of investigation requisition forms

b) Patient Visit Creation and maintenance

o Creation of sessions and recording of complaints and history

o Creation of visit and recording of clinical summary provisional

diagnosis drugs diets and Problem Oriented Medical Records

o Raising Investigation requisition

o Viewing of reports of tests for which results have been entered

o Printing of reports (visit record investigation reports etc)

o Allotment of beds for patients to be admitted

o Appointment Scheduling (normal and investigations)

o Closing of treatment session and recording of final diagnosis

o Making OPD summary and printing it

o Printing all pending investigation reports for a patient till date

o Facility to print duplicate investigation reports

o Printing a report on the total number of old patients handled during a

period

2) Investigation


10

For daily hospital activities various types of investigations are carried out Carrying out

number of investigation tests and making the results available promptly is very crucial

for assessing the patients medical status and deciding on the further course of action

The main functions of this module are generating investigation requisitions accepting

investigation requisitions collection of samples for investigations preparation of lab

reports sending samples to laboratories entry of test results and validation of results

Salient Features

bull Raising the Investigation Requisition

bull Sample Collection

bull Printing Packing List

bull AcceptingRejecting the samplesPatient in the Laboratory

bull Entering the details of the Film used in the Investigation

bull Entering the Investigation Results

bull Validation of the Investigation Results

bull Printing the Investigation Reports

bull Viewing of the Investigation results

bull Quality Control Check

bull Keeping track of films Slides issue and returns

bull Tracking of the status of a Test

bull Viewing and Printing of Work-list

3) Billing

The Billing module deals in collection of money for services availed by a patient The

module works in two ways

bull Money can be collected in cash for outpatient services availed

bull Advance can be collected when a patient is to be admitted In this case the

billing module maintains the status of each in-patients account The account is

finally settled when the patient is discharged

The module consists of the following sub-modules Cash Collection Account

Maintenance and Billing Reports

Salient features


11

a) Cash Collection

b) Account Maintenance

4) Appointments

This module deals in allotting appointments to patients for a visit to the hospital It

keeps track of available slots in various categories of appointments This module also

deals with cancellation of existing appointments

The module consists of

bull Appointment Scheduling

bull Appointment Cancellation

5) Operation theatre

The Operation Theatre module contains information about the availability of all the

theatres and EquipmentTools Scheduling of operations is the main function of this

module Various departments give the requisition for an operation theatre Various

Functions covered by this module are as follows

bull Operation Theatre Scheduling

bull Raising and validating an operation

bull Preparing an operation dossier

bull Entering Operation record

bull Entering Anesthesia record

6) Blood bank

The Blood Bank is one of the major components of a hospital concerned with various

related activities including donor registration physical examination blood grouping

blood infectious tests component separation blood requisition and cross match The

Blood Bank module provides ready information about blood reservestock daily cross-

matched details total daily blood requisitions and information regarding blood and

donor

7) In-Patient Management


12

The In-patient module commences when the patient is being allotted a bed in the

ward It deals with the complete treatment of the patient during hisher stay in the

hospital

Salient Features

bull Bed Allotment

bull Inter-departmental Consultation

bull Transfer of patient between wards and beds

bull Requisition of drugs and consumables from the pharmacy

bull Raising investigations and report viewing

bull Maintenance of billing sheets for patients

bull Discharge of patients

8) Registration

Registration of the patient is the foremost activity in the overall Hospital Information

System Every patient who approaches a hospital has to get registered prior to getting

any consultation treatment and investigations done from the hospital

InputScreen Interfaces

bull Capturing Demographic Details

bull Visit Creation for the Old Patients

bull Change of Department

bull Duplicate Card Printing

bull Modification Request

9) Enquiry

This module provides information about all the enquiries received regarding the

hospital and the patients admitted or registered in the hospital The details of the

utilities are outlined in the later part of the write up Eg In-patient enquiry Out-

patient enquiry holiday enquiry etc

10) Master management

The functioning of the Hospital Information System depends on a large set of data that

remains static for a long period of time The Master module is used to enter modify and


13

validate the Master data that is used by all the other modules It is the responsibility of

the System Administrator to maintain the integrity of this data Eg of masters

maintained are Department master Designation master Lab master etc

11) Central Sterile Services

The Central Sterile Services Departments (CSSD) main function is to provide sterile

items linen equipment to wards and OTs The CSSD receives reusable equipment

linen from various wards and OTs for sterilization Items are exchanged depending

upon the requirements The linen is sent for washing to the laundry directly or through

CSSD Washed linen from laundry is sent to CSSD for sterilization These sterilized items

are issued to wardsOTs as per the requisition received from their side The CSSD also

prepares linen and dressing material from the cloth in different sizes which are

standardized by hospital management Once the dressing material and linen is

prepared new item details are entered into the system and stocks are updated

accordingly

12) Diet Kitchen

The functionality of the kitchen module is to manage the patients meal services Its

features include Meal scheduling Meal cancellation Diet requisition Slip Diet

Cancellation Report Late admission report and Therapeutic Diet

13) Bio-Medical Engineering Department

The Bio-Medical Engineering Department (BMED) module keeps track of the details of

the Bio-medical equipment installed at SGPGI The details include equipment code

category department name location and vendors name and purchase details This

module also handles complaints and service details of different equipment This

module interacts with the central stores module for equipment receipt

14) Central Stores

This module deals with Hospital EquipmentMaterialInventory Purchase and Supply to

different Departments Requisitions for different itemsequipment are sent to this store

from different departments and accordingly the CSD issues itemsequipment to various

departments The CSD also maintains records of purchases stock and supplier list

itemequipmentmaterial master tables and also takes care of the inspection details


14

15) Pharmacy management

The Pharmacy Module deal with the maintenance of drugs and consumables in the

hospital The functions of this module include online drug prescription inventory

management of drugs consumables and sutures This module optionally handles the

billing of drugs consumables and sutures if required The Pharmacy module ensures

that there is a round the clock availability of a sufficient quantity of drugs and

consumable material for the patients in a mode that neither hinders efficient clinical

work nor it becomes a threat to the survival of the Pharmacy

12) Patient Medical Records

The Patient Record Management Module is crucial in the overall integrated hospital

management system The rationale behind computerization of PMR is to maximize the

usage of the patients medical information This improves patient care as it functions as

a central source of information for communication between health care providers

covering the patients history observation diagnosis and therapeutic conclusions and a

wide variety of unstructured documents and information Moreover it facilitates

external linkage possibilities with health care providers and identification of clinical

events that need attention It can solve many of the logistics problems of archiving

retrieving tracing and finding out paper based medical records Various reports like

discharge summary diagnostic classification as per international classification of

diseases statistical report according to diagnosis age sex geographical area and other

parameters of the patient surgeon index wise reporting hospital statistics and analysis

of cases for research purpose are generated PMR updates the patients file with the

information like diagnosis details and test results and final patient status

154 EHR (Electronic Healthcare Records)

An EHR is the clinical component that records the credentials of patientsrsquo medical

histories symptoms diagnoses treatments etc Thus EHRs contains the financial

administrative research and educational characteristics of patient care As represented

in the figure below the end users of HER includes hospitals ambulatory care clinics

primary care offices physicians nurses etc ancillary departments like radiology

laboratory pharmacies etc patients through a Personal Health Record (PHR) portal

public health departments and payers (insurance companies) Moreover


15

Pharmaceutical companies may even be involved in evaluating data from EHRs

However the users have access to only those aspects of the EHR for which they are

approved EHRs from different hospitals and physician offices need to be interoperable

to encourage local regional national and global sharing of information Just as an ATM

card can be read in New York and New Delhi EHRs should be able to connect globally

have the capacity to access and share data as needed and enhance the quality of

patient care

Source Datamonitor

EHRs will assist in changing the healthcare industry from current reactive to more

proactive up to date and leverages planned workflows The quality of care patients

obtain within conventional healthcare settings will progress the information available

to clinicians will increase and the pace at which association for patient care public

health examination and medical research occurs will be immediate

The following factors are leading the implement EHRs in the market

bull Improving the quality of care is a main concern for healthcare organizations


16

EHRs are part of the explanation to improving patient security in the healthcare system

For example medication errors in particular accounted for a considerable proportion

of the number of avoidable errors that take place on a day to day basis in healthcare

settings EHRs deal with many of the areas where medication errors are likely to

happen At the most fundamental level an electronic system reduces the problems of

illegibility A carefully typed drug prescription is expected to be filled appropriately

than one that is hurriedly scribbled With the addition of decision-support tools doctors

are capable to now check for likely complications with other prescriptions while

recommending medication or rapidly confirm the distinction between two medications

that have like names These are only a few of the various benefits EHRs can provide that

current paper based systems cannot offer

In addition to reducing medical errors EHRs raise the value of care by varying the way

in which care is distributed and improving the general patient experience At present

with paper charts only one doctor can use a patientrsquos record at one point Moreover at

the point of cure patient files are often incomplete a part of the record may be in the

lab the radiology department or another physicianrsquos office pending certification As a

result of this lack of management diagnoses and treatment plans are made on

incomplete information Various medical tests have to be repeated because the results

have been lost With EHRs several providers are capable to interpret and modify patient

records improving communication between clinicians Files are no longer misplaced

misfiled or left behind EHRs permit providers to expend less time searching for fresh

lab tests or documentation from other physicians and spend more time with the

patients themselves Increased access to information with physician notes lab results

x-rays and prescriptions all at the reach of the doctors aids them in making better

appropriate clinical decisions and improve patient care EHRs also improve the

scheduling and billing processes Tasks like recovering patient files become less time

consuming leading to faster admission of patients Regardless of the costs and risks of

breakdown the skill to improve patient care is motivating healthcare organizations to

employ EHRs

bull Government initiatives are increasing

As a result of the impact EHRs have on improving the quality of care governments all

over the world are supporting the implementation of EHRs UKrsquos National Health Service

(NHS) formed an organization within the Department of Health known as the

Connecting for Health in 2005 Its objective is to convey the National Programme for IT


17

(NPfIT) NPfIT proposal consist of the Care Records Service arrangement prescribing

infrastructure email picture archiving and communications systems (PACS) as well as

the Quality Management and Analysis System As the NHS is supporting all these

projects these IT systems have and are being put into practice No other country has so

far achieved a countrywide EHR system than the UK because no other government has

spent as compared to UK

In the US government support has been mainly through improved consideration to

healthcare technology to encourage awareness In 2004 President Bush issued an

Executive Order to set up the National Health Information Technology Coordinator in

the Department of Health and Human Services and lay down an aim for every American

to have right to use to an EHR by 2014 To aid rural hospitals execute EHRs the Office of

Rural Health Policy at the federal Health Resources and Services Administration

awarded $16m to the Minnesota Health Department Similarly the state of California

will offer $25m in grants to healthcare technology projects (EHRs as well as other

healthcare technology solutions) in underserved areas of the state

bull Other healthcare players will encourage late adopters to implement EHRs

The numbers of providers who have not yet implemented EHRs are decreasing but

there are still a group of late adopters These late adopters badly influence the

efficiencies and return on investments (ROI) of EHRs for those who have already

implemented EHRs The full advantages of EHRs will not be recognized until every

provider is linked Having an EHR that is not interoperable is like being the only person

with a phone and thus not being able to call anyone Increased competition and the

possibility of decreasing damages will drive providers to adopt EHRs and regard them

as very important to their practice as their stethoscopes Competition plays an

additional role in the organizations with an efficient EHR solution and will catch the

attention of younger providers and increase employee satisfaction and retention The

fact that everyone else has an EHR should persuade the late adopters that they must

have one as well

Furthermore recommendation to hospitals with better EHR systems will increase

Employers and patients will promote EHR implementation if they choose which

doctors and hospitals to go to based on the technologies in use


18

155 Nature and Scope of Present Trends in IT and Health

Healthcare needs and desires cannot be met in most of the countries because of the

size of the worldrsquos population and the prevailing structures of resource distribution

There are numerous disagreements between various countries for making and

observing policies of global trade in healthcare goods and services

Information and communication technologies can transform healthcare system

Through the accurate policy choices IT enables the support of new entry of human

connectivity and is a powerful means of global union through cross-border supply of

services IT enables new opportunities for production of knowledge and trade in it for

direct economic benefits IT is the only factor of production which is not subject to the

economic laws of diminishing returns The international distribution of new knowledge

and best practices establishes new ways of enhancing the performance of health

systems

The most important aspect of IT is its ability to permit reliable storage recovery and

immediate transfer of text sounds images and numbers as audio visual and data

communications This substitutes the face-to-face contact and transportation As a

result of this the resources and needs connect easily and add new links to productive

capacity in all aspects of healthcare-development delivery and administration

IT touches all aspects of healthcare and at many different points of contact These are

(1) ITrsquos role in design of healthcare products and services

(2) ITrsquos impact on design of healthcare systems

(3) Information power effects

(4) Its facilitating role in strengthening public-private partnerships

(5) IT-induced vulnerabilities and IT-aggravated risks and

1551 ITrsquos role in design of healthcare products and services

IT has formed prospects for optimizing connections between domestic markets and

exportsimports which is represented in the design of healthcare products and services

The idea of Telemedicine thus came out as the practice of using audio visual and data

communications for medical consultations diagnosis cure nursing care medical

education and transmission of medical data with a broader model of lsquoTeleHealthrsquo which

contains Telemedicine and healthcare management examination literature and access


19

to information from a distance The concept of E-health has slowly emerged to illustrate

the joint use of electronic communication and information technology to facilitate

transfers and interactivity The latest requirements of speed economies of scale

standards simulation and safety have quickly changed healthcare into an information-

based science driven by IT New medicines and treatments develop more rapidly and

enhanced with cross-border distribution of work across time-zones and instantaneous

clinical testing in trials covering a wider geographical area all of which is IT enabled

On-line discussion by patients and doctors through websites and email distance

recommendations urgent evacuations and advance broadcast of images and data of

patients from ambulances can decrease lead times of involvement in emergency wards

of hospitals Treatments managed in a joint mode distance examination of recovering

patients risk estimation by insurers distance consultations on indications revealed by

patients and comments noted by doctors with the help of transferable data from image

scanning machines processing of medico-legal documents and cross-border

networking for TeleEducation are some of the ways in which ITrsquos involvement to new

products and services is growing quickly Applications like TeleEducation for medical

degrees of well-known universities in collaboration with local institutions and for

continuing medical education of professionals in hospitals medical colleges and

healthcare centers have immense demand in developing countries

Outsourced healthcare management operations include medical transcriptions

invoicing collections purchases and inventory management accounting payroll

management continuing education networks linking hospitals and medical schools

surveys and research networks currently are a higher section of domestic business and

trade where ITrsquos function is important and rising

These opportunities symbolize possible services exports not only amongst developed

countries like among Norway and Sweden for prenatal checkups and nursing care in

Lapland or between Australia and Canada for TeleConsultations between doctors but

also from developed to developing countries as Japan to Thailand USA to Mexico

UK to Kenya France to Ivory Coast and Singapore to Indonesia for TeleDiagnostics and

TeleRadiology) from developing countries to developed countries such as

SrilankaIndia to UK USA Australia and New Zealand for healthcare organization

services which could in future be extended to TeleDiagnostics when professional

qualifications are jointly documented or coordinated and among developing countries


20

such as Bhutan Thailand Argentina Nigeria India Brazil China Nepal Bangladesh

Tanzania for a range of telemedicine applications

In Japan and Finland initial warning signalling of communicable disease plague is done

from database searches of physicians trying to identify from signs at the time of the

occurrence of disease This type of IT application could be transferred to any

developing country allowing faster involvement when epidemics break out though

protection would be required to guarantee it does not cause panics or false alarms

1552 ITrsquos impact on design of healthcare systems

IT facilitated new ways of working and managing work locally nationwide and

worldwide

IT is an essential concern in the design of public health systems in less developed

countries where governments require to concurrently following schedule associated to

healthcare development and trade Declining budgets and rising expenses of

healthcare support these innovations also in developed countries This has

considerably improved trade potential Medical expenses in OECD countries have risen

to over 10 per cent of GDP and could reach 15 per cent in the next decade High cost

medical procedures increased long life ageing populations and expensive medicines

are the chief cause patients national public health systems and health safeguarding

organizations seek cross-border supplies offering more beneficial pricequality ratios

Within household economies of USA Canada and Japan TeleMedicine services halved

conventional expenses and improved the efficiency of medical professionals

1553 Nature and scope of information power granted by IT

New networks contracts and licenses organization structures control systems and

administration processes facilitated by IT increase choices and decrease response times

for all concerned Patients doctors hospitals pharmacies statutory health authorities

and health insurers can quickly benefit regulate to and propose new responses

interactively and reorganize their tasks towards each other Information power

encourages new ways of exercising power power and accountability to appear

approximately combinations and tradeoffs involving choice costs effectiveness as the

criteria by which performance is judged Performance comparisons promoted during


21

honesty and responsibility elevates the incentives for private and public health systems

to participate and execute better Hospitals medical schools pharmaceutical

companies related enterprises as well as local health authorities and health journals

and advisory services have all developed and sustain web pages available during

internet About 25 per cent of the content of the World Wide Web tackles with health

and health-related topics covering traditional and interchange healthcare possibilities

which have extended choice to a great deal 21 Millions of individuals visit world wide

web sites for information which would facilitate them eat intelligently discover to

implement their bodies and to find out other healthcare information IT enables links to

nutrition diet exercise primary healthcare ante-natal and post-natal care hygiene and

sanitation to be located in the proximity of other healthcare and medical information

with obvious synergies

1554 ITrsquos facilitating role in strengthening public-private partnerships

Private sector participation in financing production and delivery of healthcare products

and services is a welcome addition to the resource-starved healthcare sector but also a

challenge to the regulation of public health and in ensuring equitable access to the

poor and needy The sharing of information about facilities performance resources

costs and prices among health authorities planners contributors governments service

providers and patients is an important aid to promoting better management of

healthcare systems with shared perspectives developed through interactive

communications This reduces the chance of missing opportunities of trade promotion

in healthcare that require businesses and governments to act in concert The capacity

of different people and organizations to work together across complex networks is an

important element in novel and experimental advances If communities of expertise

can be connected and resources mobilized together with public interest political

energies and accountability IT diffusion could play an important role in public-private

partnerships in managed healthcare Success in any form of accountable and

responsible public-private partnership is based on ongoing reviews feedbacks and

consultations where informed participation is the key to success IT connectivity

provides an interactive platform to exchange ideas and information at low cost which

encourages participation and acts against exclusion By this process IT facilitates

participation in collaborations by spawning communications networks with strong

incentives to move away from isolated systems towards risk syndications and risk

exchanges harvesting value through designs of communications networks Aided by IT


22

the success of Mercks Ivermectin drug donation for curing river blindness enabled a

hundred million people to be treated in 31 countries with credibility of the programme

based on communications networks which enabled wide participation and lots of

feedback This success later spawned one of the biggest public-private partnerships

when Merck joined hands with the Gates Foundation for more such initiatives

In contrast Glaxo-Wellcomes anti-MalariaM alarone drug donation programme in

Kenya suffered from inadequate communication and participation and lack of sufficient

information to conduct a reasoned discourse Failures experienced in drug donation

programmes due to communication gaps could be easily remedied by IT IT

connectivity would have enabled facts of the Malarone case to be known at the time it

happened with scope for timely intervention by all concerned instead of the public

remaining unaware for four years until details were published by scholarly journals like

Lancet Electronic archiving accessible through internet could simplify dissemination of

new knowledge published by scientific journals

The core role of IT in healthcare may be understood from the way designs of healthcare

development and delivery enabled and supported by IT include or exclude people and

encourage or discourage their participation in influencing decisions about allocation of

healthcare resources Participation is a vital aspect of healthcare because health

consumption requires participation in its production at every level starting from

individual persons (diet hygiene lifestyle belief and trust in one or more medical

systems) to communities (safety pollution control sanitation public hygiene) and

nations (healthcare standards budgetary allocations medical education support to

research and innovation in diagnosis and treatment and availability of medicines)

rendering it uniquely amenable to communicative technologies horizontally and

vertically in and between these aggregations

Public-private partnerships are also required to cope with trading in bioinformatics and

clinical databases Significant transactions costs arise when contributions are sourced

from a wide range of value creators using different platforms of data transfers and with

multiple claims to proprietary rights over fragments of a whole process before a

marketable product arise This creates incentives for venture capital pharmaceutical

firms biotech start-ups and the State (and its marketwise counterparts such as health

maintenance organizations) to make new forms of partnerships in predictive medicine

and treatments Alliances of universities and research centers with drug developing and

clinical trial enterprises are being established within developed and developing


23

countries and also between organizations in developed and developing country

locations IT-intensity sustains such networks contributing to efficiency and equity

through rationalization of financial constraints as well as non-financial constraints

1555 IT-induced vulnerabilities and IT-aggravated risks

IT is distinguishable from other technologies because it is process oriented and

transformative in its effects on production consumption and organization Connection

speeds are constrained by availability of bandwidth spectra and the risk of data loss

from contamination by viruses and bugs can only be minimized but not altogether

eliminated While information that IT produces is easily commoditized much of the

knowledge that IT driven biotechnology incubates is tacit and not easily reducible as

information This is the reason that biotech requires science parks and trustful

networking anchored in a location Placing information on the web poses risks to

ownership of intellectual property Nor can all information belong to everyone being

unsustainable even in its elements without being hosted or sponsored IT products are

excludable divisible and own able through introduction of filters but cyberspace does

not create a domain governed from within itself insulated from other jurisdictions The

reliance on IT obliges adaptation to ever-changing new technical norms and to new

rules introduced by regulators or censors

Policies and safeguards need to be envisaged to harmonize private and public interest

so that IT is not used as a tool to propagate harmful substances and drugs There could

be four different ways in which IT as a media channel could be protected from

undesirable traffic

1 International legal agreements on e-commerce prohibiting certain products and

services as ldquoglobal public badsrdquo from the purview of e-commerce

2 Introduction of rules by regulators with enforceable penalties

3 The use of IT itself to neutralize the canvassing of ldquosins and badsrdquo with counter-

campaigns disclosing more information on health hazards

4 Censorship of cyberspace through filters

IT has enabled certain kinds of abuses that would have previously not been possible to

execute on a large scale Pharmaceutical firms provide incentives to pharmacies to sell

prescription drugs over the counter without prescriptions in less developed countries

IT has made it possible for chemists pharmacies and extension counters of clinics and

hospitals to build databases and push products using retail store models of incentives -


24

something that would be impossible in developed countries where firms target

doctors not individual chemists or pharmacies

New vulnerabilities point to the need for policy safeguards to deal with the following

problems

(a) Rights to privacy and personal data protection are easily breached because

healthcare databases have to be kept open for updating old records and for

initiating new records and entries So confidentiality cannot be secured by

coding the data or disconnecting the data from personally identifiable features

Patients could lose trust in the confidentiality of their conversations with their

doctors unless this problem is solved Demands of payment for parting with

bio-information could arise

(b) Medical databases are easily linkable to databases of genealogy castes tribes

clans ethnicity and genetics The principle that such data be stored only at its

place of origin and used only for the original purpose for which it is collected is

difficult to enforce Personal data on whole nations and ethnic groups could be

exploited in ways that endanger public health (Mathur 2002) Without

enforceable international agreements no individual or social institution is in

any position to supervise the use of healthcare databases In the hands of

mercenaries and rogue states healthcare databases could be misused to trigger

complex humanitarian emergencies or for fostering permanent dependencies

using biopower as a means of disruption

(c) The scientific and commercial value of health databases is limited to those who

have the means to maintain and update these databases and link them to other

databases in their possession This could accentuate the information and

technology gaps between developed and less developed countries

(d) IT enables decoding of personal data using genotypes and phenotypes as

personal identifiers and the design of novel organisms against which vaccines

or antibiotics would be useless When private information held in public

databases is commercially traded by privatising public domains rights of

natural persons get transposed with rights of artificial juridical entities Since

intellectual property rights are private rights international regimes for e-

commerce in healthcare and consumer protection are needed for what remains

outside the public domain

(e) If it is known that normal data protection controls can be easily bypassed by

powerful interests in a vital area like health in any particular country it would

also have consequences for trade and development in other sectors due to loss


25

of confidence in that countryrsquos capacity to provide adequate data protection for

business secrets and intellectual property rights

Doctors and patients benefit from the way IT enables records to be safely stored

efficiently retrieved easily updated and quickly transferred IT promotes awareness

People easily obtain information concerning diseases treatments and facilities

Discerning consumers get to understand their own responsibility as co-producers of

their health and to evaluate choices Studies have established that small inputs of

TeleHealth resources contributed to huge gains in access to healthcare for consumers

in Bhutan Ethiopia Sri Lanka South Africa Argentina Mozambique Taiwan Saudi

Arabia Thailand and Jordan

156 Information Technologyrsquos Role in Life Sciences Research amp Development

In recent years innovations where IT and the life sciences converge have created vast

quantities of data The development of automated DNA sequencing and other

innovative methods have reduced the costs and time needed to discover the genetic

makeup of various organisms Additionally innovations such as high-throughput

screening and micro-arrays are enabling studies of gene and protein functions (ie

genomics and proteomics)

The expanding complexity and diversity of information also pose new challenges For

example data produced from studies of protein and gene function and interaction can

require the consolidation of information in various formats and from diverse sources

Additionally data may not be in a standard or readily usable format particularly if they

are not available electronically or are text-based information from scientific literature

patents and clinical trials Critical biological information also is found throughout

various scientific disciplines such as the chemical sciences The ability of researchers to

manage and analyze these diverse and extensive data is critical to the future success of

life sciences RampD

The needs described above have spawned the research field ldquobioinformaticsrdquo which

focuses on the use of IT to collect organize store interpret share and analyze

biological data Developments in bioinformatics will be critical for facilitating RampD in

areas such as human and animal health agriculture industrial processing natural

resource recovery and environmental remediation Figure 61 illustrates the IT and life

sciences components of bioinformatics


26

Bioinformatics Use Information Technology to Manage and Analyse Information

Generated by the Life Sciences

Researchers are exploring strategies to increase computing capabilities for diverse life

sciences purposes such as computer-based drug design One strategy is to expand the

potential of supercomputers Another is to unify computing resources through

development of global or grid computing networks These networks link the power of

individual PCs or supercomputers Researchers have achieved teraflop speeds (a trillion

floating point operations per second) using these grid networks In the future they

hope to achieve petaflop speeds (a thousand trillion floating point operations per

second)

The Internet is a particularly valuable tool for life sciences researchers especially for

those with limited resources It enables researchers to tap into data software and

computing power

New software developments also promise life sciences researchersrsquo the ability to

acquire format search and analyze disparate data sources and types Data mining and

visualization software are improving scientistsrsquo ability to screen data and identify

important relationships One software analysis tool 3-D molecular modelling facilitates

studies of the function and relationships between biological molecules These analysis

tools are enabling scientists to conduct some research at the computer instead of at the

lab bench reducing the time and costs of life sciences RampD


27

Standardization enables researchers to link different databases and software programs

thereby making the discovery process more efficient Standardizing scientific

nomenclature databases and software helps researchers exchange and analyze

information more easily Researchers also benefit from the development of technical

and computational standards for hardware and software

Given the diversity of and rapid developments in life sciences databases and software

standardization is too difficult and costly for any organization to undertake alone To

overcome this obstacle the Interoperable Informatics Infrastructure Consortium (I3C)

was founded in 2001 to collectively address some standardization problems I3C is an

international consortium that includes life science and IT participants from private

industry government institutions academia and other research organizations They

develop and promote ldquoglobal vendor-neutral informatics solutions that improve data

quality and accelerate the development of life science productsrdquo I3Crsquos

accomplishments include standards developed to identify and access biologically

significant data and a method that simplifies data retrieval from multiple databases

157 Bioinformatics Assists Drug Discovery and Development

Bioinformatics is improving the RampD process in drug discovery and development IT

tools have become important for managing and screening genetics data and for

modelling outcomes in drug development New developments in bioinformatics and

genetics such as pharmacogenetics (ie the study of the relationships between

diseases genes proteins and pharmaceuticals) will enable researchers to identify

quickly a patientrsquos genetic predisposition to contract certain diseases as well as their

potential drug response

Costs of drug discovery have been escalating It now costs $900 million and takes 15

years on average to develop a new drug Clinical trials constitute most of these costs

Additionally about 75 percent of drug development costs can be attributed to failures

Analysts anticipate that advances in IT and the biological sciencesmdashsuch as the

computer-enabled ability to quickly screen drug candidates and predict drug

responsesmdashcould lower failure rates substantially reducing costs by as much as one-

third and time by as much as two years

158 The Indian Perspective

The Indian healthcare sector is today lagging behind in IT adoption The reports show

that the rural sector is the most affected as Indian healthcare is not spread onto small


28

hospitals though the rate of expansion is very rapid The main reason for slow adoption

of IT in health industry is due to lack of regulations and standardization and the lack of

professionalism Another major reason is the fragmented nature of the Indian

healthcare

Today however the Indian healthcare landscape is changing in the urban cities and IT

is poised to revolutionize healthcare in India The technology adoption is very rapid due

to severe competition The big Indian hospitals like Apollo Fortis Wockhardt Manipal

earlier believed that IT can only help in automation of the medical industry but now

they believe that IT can help in cost reduction and increase return on investments

Healthcare has realized the value of IT due to the changing regulations and framework

India spends about 30 million $ on healthcare industry and the cost is expected to

increase more than double fold in next ten years


29

Summary

bull IT investment offers an environment for a new level of care to exist

bull Information technology (IT) has significantly reduced the costs improved the

speed and enhanced the efficiency of life sciences research and development

(RampD)

bull The maximum advancements of IT will be felt on release of healthcare

bull Information technology presents huge potential benefits to US healthcare

bull The major difficulty in the adoption of a nationwide interoperable healthcare

information technology (HIT) system is the lack of vigorous commonly

accepted technical standards

bull Though the United States is the most technologically advanced nation in the

world the US healthcare system persists to depend on pen and paper for the

bulk of its information requirements

bull Information technology proposes vast potential benefits to enhance the

functioning and efficiency of US healthcare

bull An important characteristic of a practical HIT system is that it protects the

privacy and confidentiality of patientsrsquo medical information

bull An EHR is the clinical component that records the credentials of patientsrsquo

medical histories symptoms diagnoses treatments etc

bull EHRs will assist in changing the healthcare industry from current reactive to

more proactive up to date and leverages planned workflows

bull As a result of the impact EHRs have on improving the quality of care

governments all over the world are supporting the implementation of EHRs

bull In the US government support has been mainly through improved

consideration to healthcare technology to encourage awareness

bull IT has formed prospects for optimizing connections between domestic markets

and exportsimports which is represented in the design of healthcare products

and services

bull IT enables new ways of working and organizing work locally nationally and

globally

bull Public healthcare systems can be significantly rationalized with IT

bull The drug discovery process in the new biotechnologies is IT-intensive


30

bull According to the National Human Genome Resource Institute in USA genes

contain codes for more than 50000 proteins in the human body and drugs on

the market presently target only 10 per cent of these

bull Private sector participation in financing production and delivery of healthcare

products and services is a welcome addition to the resource-starved healthcare

sector but also a challenge to the regulation of public health and in ensuring

equitable access to the poor and needy

bull IT is distinguishable from other technologies because it is process oriented and

transformative in its effects on production consumption and organization

bull IT has enabled certain kinds of abuses that would have previously not been

possible to execute on a large scale

bull In recent years innovations where IT and the life sciences converge have

created vast quantities of data

bull Bioinformatics is improving the RampD process in drug discovery and

development

31

2

Confidentiality statement

This document should not be carried outside the physical and virtual boundaries of TCS

and its client work locations The sharing of this document with any person other than

TCSer would tantamount to violation of confidentiality agreement signed by you while

joining TCS


3


In this Chapter




Learning Objectives






Topics Covered


151 Introduction 4













Summary 29

Deleted 15

Deleted 19

Deleted 21

Deleted 21

Deleted 22

Deleted 24

Deleted 26

Deleted 28

Deleted 29


4

151 Introduction































5


employees









of the patients























6














project The bill











organizations




HIT RampD programs







7

















information






national HIT system










8










requirements




age gender etc



diet etc





9






a) Bay Management


data


















period

2) Investigation


10







Salient Features














3) Billing









Salient features


11

a) Cash Collection


4) Appointments

















6) Blood bank






donor



12



hospital

Salient Features

bull Bed Allotment







8) Registration










9) Enquiry









13














accordingly

12) Diet Kitchen










14) Central Stores







14

































15







patient care

Source Datamonitor









16





























employ EHRs







17




























have one as well





18













systems




















19



































20










worldwide






















21




































22




































23






















undesirable traffic













24




problems


































25


























life sciences RampD








26










second)



computing power









27



































28




healthcare










29

Summary




(RampD)























and services


globally




30















development

31


3


In this Chapter




Learning Objectives






Topics Covered


151 Introduction 4













Summary 29

Deleted 15

Deleted 19

Deleted 21

Deleted 21

Deleted 22

Deleted 24

Deleted 26

Deleted 28

Deleted 29


4

151 Introduction































5


employees









of the patients























6














project The bill











organizations




HIT RampD programs







7

















information






national HIT system










8










requirements




age gender etc



diet etc





9






a) Bay Management


data


















period

2) Investigation


10







Salient Features














3) Billing









Salient features


11

a) Cash Collection


4) Appointments

















6) Blood bank






donor



12



hospital

Salient Features

bull Bed Allotment







8) Registration










9) Enquiry









13














accordingly

12) Diet Kitchen










14) Central Stores







14

































15







patient care

Source Datamonitor









16





























employ EHRs







17




























have one as well





18













systems




















19



































20










worldwide






















21




































22




































23






















undesirable traffic













24




problems


































25


























life sciences RampD








26










second)



computing power









27



































28




healthcare










29

Summary




(RampD)























and services


globally




30















development

31


4

151 Introduction































5


employees









of the patients























6














project The bill











organizations




HIT RampD programs







7

















information






national HIT system










8










requirements




age gender etc



diet etc





9






a) Bay Management


data


















period

2) Investigation


10







Salient Features














3) Billing









Salient features


11

a) Cash Collection


4) Appointments

















6) Blood bank






donor



12



hospital

Salient Features

bull Bed Allotment







8) Registration










9) Enquiry









13














accordingly

12) Diet Kitchen










14) Central Stores







14

































15







patient care

Source Datamonitor









16





























employ EHRs







17




























have one as well





18













systems




















19



































20










worldwide






















21




































22




































23






















undesirable traffic













24




problems


































25


























life sciences RampD








26










second)



computing power









27



































28




healthcare










29

Summary




(RampD)























and services


globally




30















development

31


5


employees









of the patients























6














project The bill











organizations




HIT RampD programs







7

















information






national HIT system










8










requirements




age gender etc



diet etc





9






a) Bay Management


data


















period

2) Investigation


10







Salient Features














3) Billing









Salient features


11

a) Cash Collection


4) Appointments

















6) Blood bank






donor



12



hospital

Salient Features

bull Bed Allotment







8) Registration










9) Enquiry









13














accordingly

12) Diet Kitchen










14) Central Stores







14

































15







patient care

Source Datamonitor









16





























employ EHRs







17




























have one as well





18













systems




















19



































20










worldwide






















21




































22




































23






















undesirable traffic













24




problems


































25


























life sciences RampD








26










second)



computing power









27



































28




healthcare










29

Summary




(RampD)























and services


globally




30















development

31


6














project The bill











organizations




HIT RampD programs







7

















information






national HIT system










8










requirements




age gender etc



diet etc





9






a) Bay Management


data


















period

2) Investigation


10







Salient Features














3) Billing









Salient features


11

a) Cash Collection


4) Appointments

















6) Blood bank






donor



12



hospital

Salient Features

bull Bed Allotment







8) Registration










9) Enquiry









13














accordingly

12) Diet Kitchen










14) Central Stores







14

































15







patient care

Source Datamonitor









16





























employ EHRs







17




























have one as well





18













systems




















19



































20










worldwide






















21




































22




































23






















undesirable traffic













24




problems


































25


























life sciences RampD








26










second)



computing power









27



































28




healthcare










29

Summary




(RampD)























and services


globally




30















development

31


7

















information






national HIT system










8










requirements




age gender etc



diet etc





9






a) Bay Management


data


















period

2) Investigation


10







Salient Features














3) Billing









Salient features


11

a) Cash Collection


4) Appointments

















6) Blood bank






donor



12



hospital

Salient Features

bull Bed Allotment







8) Registration










9) Enquiry









13














accordingly

12) Diet Kitchen










14) Central Stores







14

































15







patient care

Source Datamonitor









16





























employ EHRs







17




























have one as well





18













systems




















19



































20










worldwide






















21




































22




































23






















undesirable traffic













24




problems


































25


























life sciences RampD








26










second)



computing power









27



































28




healthcare










29

Summary




(RampD)























and services


globally




30















development

31


8










requirements




age gender etc



diet etc





9






a) Bay Management


data


















period

2) Investigation


10







Salient Features














3) Billing









Salient features


11

a) Cash Collection


4) Appointments

















6) Blood bank






donor



12



hospital

Salient Features

bull Bed Allotment







8) Registration










9) Enquiry









13














accordingly

12) Diet Kitchen










14) Central Stores







14

































15







patient care

Source Datamonitor









16





























employ EHRs







17




























have one as well





18













systems




















19



































20










worldwide






















21




































22




































23






















undesirable traffic













24




problems


































25


























life sciences RampD








26










second)



computing power









27



































28




healthcare










29

Summary




(RampD)























and services


globally




30















development

31


9






a) Bay Management


data


















period

2) Investigation


10







Salient Features














3) Billing









Salient features


11

a) Cash Collection


4) Appointments

















6) Blood bank






donor



12



hospital

Salient Features

bull Bed Allotment







8) Registration










9) Enquiry









13














accordingly

12) Diet Kitchen










14) Central Stores







14

































15







patient care

Source Datamonitor









16





























employ EHRs







17




























have one as well





18













systems




















19



































20










worldwide






















21




































22




































23






















undesirable traffic













24




problems


































25


























life sciences RampD








26










second)



computing power









27



































28




healthcare










29

Summary




(RampD)























and services


globally




30















development

31


10







Salient Features














3) Billing









Salient features


11

a) Cash Collection


4) Appointments

















6) Blood bank






donor



12



hospital

Salient Features

bull Bed Allotment







8) Registration










9) Enquiry









13














accordingly

12) Diet Kitchen










14) Central Stores







14

































15







patient care

Source Datamonitor









16





























employ EHRs







17




























have one as well





18













systems




















19



































20










worldwide






















21




































22




































23






















undesirable traffic













24




problems


































25


























life sciences RampD








26










second)



computing power









27



































28




healthcare










29

Summary




(RampD)























and services


globally




30















development

31


11

a) Cash Collection


4) Appointments

















6) Blood bank






donor



12



hospital

Salient Features

bull Bed Allotment







8) Registration










9) Enquiry









13














accordingly

12) Diet Kitchen










14) Central Stores







14

































15







patient care

Source Datamonitor









16





























employ EHRs







17




























have one as well





18













systems




















19



































20










worldwide






















21




































22




































23






















undesirable traffic













24




problems


































25


























life sciences RampD








26










second)



computing power









27



































28




healthcare










29

Summary




(RampD)























and services


globally




30















development

31


12



hospital

Salient Features

bull Bed Allotment







8) Registration










9) Enquiry









13














accordingly

12) Diet Kitchen










14) Central Stores







14

































15







patient care

Source Datamonitor









16





























employ EHRs







17




























have one as well





18













systems




















19



































20










worldwide






















21




































22




































23






















undesirable traffic













24




problems


































25


























life sciences RampD








26










second)



computing power









27



































28




healthcare










29

Summary




(RampD)























and services


globally




30















development

31


13














accordingly

12) Diet Kitchen










14) Central Stores







14

































15







patient care

Source Datamonitor









16





























employ EHRs







17




























have one as well





18













systems




















19



































20










worldwide






















21




































22




































23






















undesirable traffic













24




problems


































25


























life sciences RampD








26










second)



computing power









27



































28




healthcare










29

Summary




(RampD)























and services


globally




30















development

31


14

































15







patient care

Source Datamonitor









16





























employ EHRs







17




























have one as well





18













systems




















19



































20










worldwide






















21




































22




































23






















undesirable traffic













24




problems


































25


























life sciences RampD








26










second)



computing power









27



































28




healthcare










29

Summary




(RampD)























and services


globally




30















development

31


15







patient care

Source Datamonitor









16





























employ EHRs







17




























have one as well





18













systems




















19



































20










worldwide






















21




































22




































23






















undesirable traffic













24




problems


































25


























life sciences RampD








26










second)



computing power









27



































28




healthcare










29

Summary




(RampD)























and services


globally




30















development

31


16





























employ EHRs







17




























have one as well





18













systems




















19



































20










worldwide






















21




































22




































23






















undesirable traffic













24




problems


































25


























life sciences RampD








26










second)



computing power









27



































28




healthcare










29

Summary




(RampD)























and services


globally




30















development

31


17




























have one as well





18













systems




















19



































20










worldwide






















21




































22




































23






















undesirable traffic













24




problems


































25


























life sciences RampD








26










second)



computing power









27



































28




healthcare










29

Summary




(RampD)























and services


globally




30















development

31


18













systems




















19



































20










worldwide






















21




































22




































23






















undesirable traffic













24




problems


































25


























life sciences RampD








26










second)



computing power









27



































28




healthcare










29

Summary




(RampD)























and services


globally




30















development

31


19



































20










worldwide






















21




































22




































23






















undesirable traffic













24




problems


































25


























life sciences RampD








26










second)



computing power









27



































28




healthcare










29

Summary




(RampD)























and services


globally




30















development

31


20










worldwide






















21




































22




































23






















undesirable traffic













24




problems


































25


























life sciences RampD








26










second)



computing power









27



































28




healthcare










29

Summary




(RampD)























and services


globally




30















development

31


21




































22




































23






















undesirable traffic













24




problems


































25


























life sciences RampD








26










second)



computing power









27



































28




healthcare










29

Summary




(RampD)























and services


globally




30















development

31


22




































23






















undesirable traffic













24




problems


































25


























life sciences RampD








26










second)



computing power









27



































28




healthcare










29

Summary




(RampD)























and services


globally




30















development

31


23






















undesirable traffic













24




problems


































25


























life sciences RampD








26










second)



computing power









27



































28




healthcare










29

Summary




(RampD)























and services


globally




30















development

31


24




problems


































25


























life sciences RampD








26










second)



computing power









27



































28




healthcare










29

Summary




(RampD)























and services


globally




30















development

31


25


























life sciences RampD








26










second)



computing power









27



































28




healthcare










29

Summary




(RampD)























and services


globally




30















development

31


26










second)



computing power









27



































28




healthcare










29

Summary




(RampD)























and services


globally




30















development

31


27



































28




healthcare










29

Summary




(RampD)























and services


globally




30















development

31


28




healthcare










29

Summary




(RampD)























and services


globally




30















development

31


29

Summary




(RampD)























and services


globally




30















development

31


30















development

31

aa (4)

Education

healthcare impact

healthcare v

release of healthcare

design of healthcare

healthcare delivery

design of healthcare

information technologys

life sciences topics