IT And Health Care

Obtaining and synthesizing information from electronic sources are time consuming tasks, which explains in part why physicians and other health professionals under use the information sources now available to them. More than thirty years ago a modification of the traditional role of the reference librarian, called the clinical librarian, brought an information access specialist into the hospital wards as part of the medical care team. They identified questions related to the care of individual patients for which additional information was needed and to find that information from printed or online sources. Clinical librarian programs have been shown to have beneficial effects on health care outcomes and process measures such as shortened hospital

length of stay. Notwithstanding these benefits, such programs have not come into widespread use, because of lack of reimbursement incentives and physicians' ambivalence about needing help to find clinical information.

Frank Davidoff and Valerie Florance recently proposed recasting the clinical librarianship as a new job named the informationist, whose focus would be information retrieval in support of clinical care. They call for the establishment of a national program, modeled on the experience of clinical librarianship, to train, credential, and pay for the services of information specialists in health care practice settings. The countervailing view holds that all health care professionals should be required to have the skills of acquiring and synthesizing the information necessary to perform their jobs efficiently and effectively. Knowledge management is so integral to health care decision making that it cannot be usefully segregated into its own subspecialty.

New roles and opportunities also exist for telemedicine practitioners. Experience has been gathered for more than two decades on the use of two-way audio and video to provide health care at a distance. Successful practitioners have mastered the elements of diagnostic evaluation via remote technologies and the art of working with geographically dispersed teams of health care providers of various backgrounds to deliver a coordinated set of services. Charisma may not be a prerequisite, but it is already clear that communication styles have a definite impact on patient satisfaction in telemedicine settings, and specialized training is needed beyond that now provided in health professions curricula.

A new role, filled primarily by independent nurse practitioners, is that of "telemedicine presenter." This is an adaptation of primary care skills where the focus of the activity is to acquire the necessary elements of the medical history and clinical findings so that they can be presented in a telemedicine consultation session with a consultant specialist. The telemedicine presenter is both the patient advocate in the consultation session and the hands of the distant consultant for doing procedures such as placing a stethoscope on the chest or positioning a video camera for a close-up view of a rash.

Source: www.medscape.com, 2/14/07