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 1.1 Introduction

The World Health Organization (WHO) describes health as the state of emotional, physical, mental and social well-being and not merely the absence of disease. ICT can be used to explain a variety of technologies for analysis, storage, data collection and recovery. These objectives rely on information as a central element as well as training of the workforce in the required health information skills (Berland et al, 2001).  Healthcare should be safe, but it is not as safe in reality as it must be. It is a common trend in the healthcare system to see preventable errors causing patients harm and sometimes death. The system should be responsible for such errors as the lack of providing safe and effective care.

The gap between different healthcare providers and organizations brings about the preventable errors. On a personal level, these errors lead to the useless loss of a lot of money.  Many lives were saved due to the presence of ICT in providing accessibility of clinical knowledge and overcoming distances.  Through ICT, online discussion groups related to health were formed as well as the provision of telemedicine and valuable clinical information. Over the years, the investments in e-health and the reforms of the healthcare system have been part of the plan. Challenges that most health sectors face include insufficient workforce, the lack of enough supply and distribution, the increase in number of people suffering from chronic disease, rising demand for hospitals due to the population growth, the lack of equal access to the health facilities mostly among the indigenous, poor people and those in rural areas, where of the majority of the population live in developing countries, and the lack of reliable means for receiving information (Armstrong et al, 2007).

The degree of setbacks is immense and must be performed with a small amount of available resources (Coiera, 2004). Shehadi states the guiding principle in the IT Policy Practice in the United Arab Emirates “Patients and physicians are experiencing the advantages of on-demand access to medical information where, when and how it is needed due to rise in Information technology breaking through to the healthcare sector” (Ajeet, 2003). The difference between healthcare facilities is based on enabling the free flow of knowledge in the hospital, especially in the UAE region. Compared to any other service industry, healthcare seems to have the lowest level of IT investment. This trend has been observed over a period of several years. Many challenges have resulted in lack of modernization in the health care system with IT. Thus, it brought a spiral effect on hospitals through infrastructure preventing the growth of any form, lack of the programs associated with clinical workflows and a mixture of different software systems that aimed to share information, which could confuse readers many times.

“Old IT systems will always continue to struggle to deliver a valid integrated flow of knowledge having been designed traditionally around the needs of providers and not on patients’ requirements. This is an expected trend in for the healthcare system to change and improve…”said Shehadi, “…as a result, both medical personnel and patients are gradually subjected to technology that is below standard” (Ajeet, 2003).

1.2 Research Aim

The main objective of the research is to identify in what way technology affected the health sector in the United Arab Emirates. The main areas of concern will be the use of technology in the treatment of diseases and other medical processes. Overall, this study will determine the impact of technology on the quality of healthcare delivery. The study will use the following research hypothesis:

H1: Technology increases the quality of healthcare in the UAE;

H2: Technology improves the efficiency of healthcare organizations in the UAE;

H3: Technology results in the significant cost advantages for the UAE health sector.

H4: Technology increases patient safety by reducing costly medical errors.

1.3 Significance of the Study

This study will be of ultimate significance for the policy makers in the healthcare sector in the UAE, because it will evaluate the impact of technology and provide a framework, through which healthcare organizations can analyze the decision to integrate technology in their operations. In addition, the study will be essential for the healthcare practitioners in the UAE, because it highlights the role of technology in guaranteeing the quality and effectiveness of healthcare delivery.

CHAPTER TWO

2.1 Literature Review

In order to make the right decision, the healthcare professionals need to get access to reliable and comprehensive information in the case of necessity. The reason is that they are accountable for the actions of the patients and the resolutions of health related issues. Reliance on handwritten information becomes outdated due to the development of the ICT sector, which is a faster way of gathering information even in emergency situations. Nicholas (2008) asserts that reliance on the use of papers is wastage of money and scarce resources. It is also an inadequate and slow method of gathering information and may risk the health of the patients, their safety and quality of care.

There is a need for adjustment the way healthcare is funded and delivered in order to deal with the setbacks and ensure that sustainable quality care is given. If this is not done, the challenges will not be solved; the requirements and needs of people will not be met; the health system will deteriorate in terms of sustainability with a high price attached to productivity and economic growth, which is most likely life threatening.  It will be more problematic if the challenges of healthcare are not solved at the moment. Through IT, countries can deliver portable, efficient, reliable, affordable and equitable healthcare. If these measures are done, IT will impact the society positively improving the safety, quality and efficiency of healthcare. Surveys indicate that IT providers plan to spread IT in the healthcare system with the application and settings for the free flow of knowledge.

Supporters of IT investment argue that the technology will be of high quality and economic benefit. Complications brought by IT are the cost and complexity of IT implementation, which often requires a lot of work and changes in terms of culture. Some aspects of the healthcare market include policies that involve payment to reward volume instead of quality and a divided delivery scheme, which can prevent IT implementation.

The public and the private schemes are connected to encourage the use of IT within and around health care facilities. Moreover, joint efforts, financial incentives, nomenclature and communication agreements could be used to encourage interoperability. Nevertheless, the stimulating investment policy must be considered carefully due to the probability of unintended consequences. Providing new strategies for patients and healthcare providers to easy access and use of health information from IT can enhance the safety, quality and efficiency of healthcare. On the other hand, only few healthcare providers are familiar with the IT technology. Low distribution of IT is connected with the complications brought by IT investment, which requires more change of the work procedures than the purchase of technology, as the culture of work will also have to change among the nurses, physicians and other staff, who need to use it.

Payment policy that rewards quantity instead of quality should be considered, since it hinder IT investment. Thus, there is the need for policy makers to comprehend the way information technology spreads among the IT providers since there may be unintended results such as failure of implementation because of the company’s inadequacy to stimulate the necessary cultural changes. This chapter is the initial step required to comprehend the present condition of IT in healthcare. The Commission will make conclusions through the implementation of the point. There has been considerable attention to the issue, but not much is known concerning the impact of IT in healthcare situation. Emerging queries include the following questions: is there a certain type of IT that was used? Is there a connection between IT use and quality improvement? Are there any investments made by physicians and hospitals in the IT field, and if there are, what changes were made and observed? Are there any factors that push investment of IT (for example, quality upgrade plans or financial gains)? Are there any factors that prevent IT investment and implementation (such as incompatibility of other IT systems or changes in the work flow)? Are there any steps that were taken by private organizations for the further spread of IT? Are there any other actions that may be reasonable?

There is the need for patients and healthcare providers to include information from various sources. Therefore, the ability of nurses, physicians and clinical technicians to use the correct information concerning their patients could improve the care and safety of patients. Patients, who can get knowledge in what way to manage their disease and communicate with health personnel, could improve their chances of recovery as well as improve the quality of care and efficiency. The ability to improve care enables IT to spread at a very fast rate. There is the need for further research in order to understand the various types of IT applications and the most necessary among them for the improvement of healthcare in diverse conditions, and the prevailing circumstances needed to guarantee successful implementation. Recent studies indicate that some technologies can lead to improved health care, in fact. However, the evidence base of the projection narrowed down to facilities that did not represent the average service provision because of their own systems.

 Providers steadily increase investment in health facilities despite the fact that they use less IT compared to other industries. The new type of used IT differs depending on the institution and its setting. The spread of IT used in any facility shows the benefits of investment. The majority of organizations is focused on primary drivers, quality and process improvements. Other organizations focus on gains in efficiency in order to attract investment opportunities. This comes at a high price and the complications caused by IT implementation, especially the modernization of the company working processes, which can lead to the emergence of barriers.

The healthcare market is a barrier for investment in IT. The reason is that the methods of payment, which require a range of sent services, may penalize providers, who improve quality using methods that lead to a smaller amount of services than earlier. The majority of people, who invest in it, cannot gain anything since investment in IT may reduce the quantity. The ability to get the IT efficiencies for systems enables them to integrate proper care. Obstacles can be caused by fee systems, where a division of the delivery system may reduce investments since many providers lose economies of scale. This feature of the delivery system is a barrier for adoption dealing with issues brought by division and wide usage of IT in order to enable providers deal with care in different conditions. The technique deals with the promotion of standards most required by industries, often with the involvement of credits for those who invest in IT researching the impact of IT on quality and coming up with means to improve the flow of information among providers. The encouragement of diffusion can change the laws/rules in policy and make a requirement for implementation of certain technologies.

2.2 What is health IT?

It enables healthcare providers to retrieve, transfer and store information. Additional discussion of it in healthcare is problematic due to the lack of exact definitions, quick technological change and the number of applications. The same products can be defined with various names and, thus, the precise function of the system will vary depending on the specific implementation policy used in the settings. The function and term can vary with time. For instance, computerized provider order entry (CPOE), which can reduce the size of writing or any communication mistake by other providers entering orders into the system of the computer, can be used when drugs are prescribed. Furthermore, more information can be added by a physician such as consultation, physician orders and transfers. Electronic records also known as electronic health records or computer based records among other names show that many classification can be used (Brailler & Tarasawa, 2003).

They can be put into practice as the compound decision support operators or can be used as the inactive storage features for the patients’ order. In order to purchase IT, providers must access to various functions and applications given by many vendors. The different IT applications usually are grouped in the following way:

  • Financial and administrative class that do accounting among other functions;
  • Clinical systems that contribute to the care process;
  • Infrastructure that promotes clinical and administrative requests.

The subsequent technological terms are frequently used in the IT healthcare dialogue:

  • Electronic Health Record (EHR). Initially, EHR was foreseen as the electronic cabinet for the storage of patients’ data from different sources (in due course, handwritten notes, voice and text were incorporated). Currently, it is used as part of automate order entry and also for tracking of patient’s system and management of their treatment records.
  • Computerized Provider Order Entry (CPOE). This is a type of equipment for ordering of medication and fulfillment of the system with the patient’s details. Advanced CPOE can be used in radiology studies, lab orders and the transfer of patient from one hospital to another.
  • Clinical Decision Support System (CDSS). This equipment presents the real-time diagnostic and treatment solutions of nurses and physicians. The name covers varied advancements ranging from alert, prescription and warning about possible side effects of medicine. The system can be used as a section of HER and CPOE.
  • Picture Archiving and Communications System (PACS). The system seizes and puts together radiological graphics from different machines such as x-ray and amasses them on health medical care record.
  • Bar coding. Using optical scanner, information is recorded electronically and encoded. Primarily, it is used for the selection of drugs using codes on medications and patients. It is also used for radiology and laboratory tests.
  • Radio Frequency Identification (RFID). This equipment traces patients in the hospital, lab process and when taking medicine. However, this system is still in the initial stages of its development.
  • Automated Dispensing Machines (ADMs). The equipment is used to supply medication doses.
  • Electronic Materials Management (EMM). The technology is used to trace and manage medical supplies and determine the location of pharmaceuticals.
  • Interoperability. This technology connects companies with electronic means for the integration of data from one IT into another. Debates on interoperability aim at meeting standards for messaging, sufficient privacy and security measures.

2.3 Current Status of Health IT

Various healthcare settings use different degrees of IT.  Nursing homes and physician lag behind IT, but pharmacies are more advanced in the use of IT in the health sector. Location affects the type of technology that will be used. For instance in residential health, people prefer to use technology that can monitor essential signs and report the results to the healthcare facility in order to forward the problem to healthcare provider ahead of time to avoid acute care. In both nursing homes and residential settings, the use of hand portable computers for records can improve efficiency and give more data to care givers. The caregivers can simply be taught the way to use the technology just in the case of the emergency situation, especially for patients who go to hospital on a regular basis. The internet and IT have a vital effect on consumers. Many websites made health information more accessible to patients and even those, who seek to get general knowledge about prevention and health.

Through the Internet, insurers and hospitals can upload information that may benefit consumers. In some cases, they upload comparative information that can be used in research. This sector describes two settings such as physicians’ place of work and hospitals that obtained significant policy attention. The section connects healthcare providers with systems that enables the use of IT faction by variable providers.

2.4 IT in Hospitals

Not much is known about the circulation of IT in hospitals and steps that hospitals take when making investment in IT. Most of the available information on IT diffusion originates from the voluntarily done surveys, some of which are made through the Internet. Consequently, the result may lack representativeness feature and is likely to favor the advanced IT users. Different approximation exists due to the development of IT sector and the lack of available representative surveys at the national level.

The following debate is based on literature review of hospital IT investments made by Abt Associates for Medpac. It derives from the interviews that were conducted by Abt Associates about hospitals, which made remarkable investments in the IT sector and which fell behind in it (Abt Associates, 2004).

Circulation of IT in hospitals differs from one hospital to another in regard to the adoption of IT.  IT in hospitals is mostly used in payroll, billing and patient registration. IT is rarely used in clinical applications such as entry of drug orders and labs. Technologies in the form of infrastructure build the foundation, from which other advancements can work and which include e-mails and telecommunications. Wireless connection and voice recognition are less common. Investment in infrastructure also entails the maintenance of IT system that is secure and complies with the federal rules.  It is estimated that from 5 to 6% of hospitals use CPOE according to the several research reports (Denvers & Liu, 2004). Other reports assert that these studies can have different definitions that lead to the low approximation of CPOE usage (HealthBeat, 2003). When it comes to the use of HRE in hospitals, the report states that the equipment is almost never used (Glaser, 2002). As for the other categories of clinical IT, communications systems (PACS) and picture archiving are widely used due to their ability to store data and obtain x-rays. It is projected that 15% of hospitals use this technology. A study of Morrissey (2004) shows that 49% of the hospitals are in the stage of equipment implementation..

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