ICT IN MEDICINE

Continuous developments in information and communication technologies (ICT) have resulted in an increasing use of these technologies in the practice of medicine and in the provision of medical care. There present perspectives from different areas of expe rtise on some of the ways in which ICT have changed the social picture in respect of the practice of medicine. ICT working with Medicine has helped with; The diagnosis of patients. The treatment. Better running of hospital. ICT has made a massive impac t in medicine beyond doctors and hospital databases. The many areas of Medicine that have seen substantial impact from ICT includes:

    

Medical Equipments Patient s Records Support/Diagnosis (Web-based) Communication Research/Market

Medical Equipments:

Medical equipment is used by medical practitioners to help them make the diagnosis, monitoring or treatment of the medical conditions of their patents. To ensure that they are completely accurate and helpful, all medical equipments should pass the most stringent and rigorous safety standards. Medical equipment is part of the ICT advancement in medical technology as it is technology that improves and extends life. Incessant medical technology creates more medical equipment which enhances the quality and eff ectiveness of healthcare. All medical equipment depends on the computer to make a patient s condition readable/understandable to the medical professional. There are different kinds of medical equipment depending on their function or whether these are for diagnosis, monitoring or for treatment. 1. Diagnostic medical equipments are those used to help in diagnosis such as medical imaging machines. Medical imaging is the method used to create images of the human body or parts of the human body in order that medi cal

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experts can diagnose the problem or identify the possible disease or disorder. Examples of diagnostic medical equipment are ultrasound and magnetic resonance imaging (MRI) machines, positron emission tomography (PET) and computed tomography (CT) scanne rs, and x-ray machines. 2. Life-support medical equipments are used to maintain the bodily function of a patient such as medical ventilators, anaesthetic machines, heart -lung machines, ECMO, and dialysis machines. A medical ventilator is designed to move breathable air into and out of the lungs for those who are unable to breathe or breathing insufficiently. Medical ventilators are classed life -critical system as failure of this medical equipment can result to death. The anaesthetic machine is used to support the administration of anaesthesia. Heart-lung machine or the pump or cardiopulmonary bypass (CPB) is used in heart surgery. During the operation, the CPB temporarily takes over the function of the heart and lung. The extracorporeal membrane oxygenation (ECMO) is a simplified form of the heart -lung machine but for newborns. Dialysis machine is used on patients with kidney problems to remove wastes and excess water from the blood which the kidney can no longer do. 3. Therapeutic medical equipments such as infusi on pumps, medical lasers and LASIK (laser-assisted in situ keratomileusis) surgical machines 4. Medical equipments for the laboratory which helps analyze urine, blood and genes which can help in the diagnosis of the illness. Medical equipments can also be ca tegorized as hospital medical equipment which is primarily employed in the hospitals. A BMET or biomedical equipment technician is the person responsible for ensuring the hospital's medical equipment is working at its best when needed. BMETs are highly ski lled technicians who make sure that the medical equipment is safe, functional and properly configured. Below will be a brief discussion of one Medical Equipment (MRI SCANNER) amongst many others that was born by the continuous advancement in ICT: Published by Bupa's Health Information Team, October 2010.

MRI SCANNERS About MRI scans/scanners. MRI is a special technique that uses powerful magnets, radio waves and computers to produce detailed images (or scans) of the inside of the body. The images that an MRI scanner takes are very detailed. They are taken in thin 'slices' through your body and can be taken from any direction. They show your bones, soft tissues such as muscle, skin, nerves and blood vessels, and organs such as your brain

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and heart. An MRI scanner can take pictures of most parts of your body. An MRI scan uses radiowaves and a magnetic fie d to create images of the inside of your body. Because an MRI scanner takes very detailed pictures of the body it can often show things that aren't seen on an X-ray or in other tests such as an ultrasound.
 

Not everyone can have an MRI scan. The magnetic field from the scan affects some metals and can cause any metal inside your body to move. This is why it's important to tell your radiographer (a health professional trained to perform imaging procedures if you have any metal in your body. The kinds of metal you might have in your body include heart pacemaker, metal valve or defibrillator (a device that keeps your heart rhythm regular) an inner ear hearing aid (cochlear implant) aneurysm clip (a metal clip on an artery) joint replacements or large metal implants etc... An MRI scan usually takes between 20 and 30 minutes to complete. However, some scans may last for an hour. You will be asked to lie on your back on a table, which slides inside a cylinder-shaped machine. The radiographer may use pillows or straps to adjust your position and help you to stay still. Usually the part of your body being scanned is placed in the middle of the scanner. A radiologist (a doctor who specialises in using imaging methods to diagnose medical conditions) will e amine your MRI scans. The results will be sent to the doctor who re uested your test.
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Side-effects are the unwanted but mostly temporary effects you may get after having the test. You may feel slightly claustrophobic and uncomfortable from being inside the scanner. If you're worried about this, talk to your radiographer. Patient s Record: The most obvious way that ICT is used in medicine is the database in each doctor s surgery in which the details of patients are kept. These would include: - Patient s name - Date of Birth - Address - Occupation - Lifestyle - Last visit to the doctor. Although health sciences will benefit from many of advances in information and communications technology that are applied to a wide variety of research areas, information technology is of particular importance to health care delivery. Developments of computerized patient records will enhance the efficiency, effectiveness, and distribution of health care. There has been a gradual move to store all patients records in digital format. The advantages are: Writing will be easy to read. It will be a more economical storage of data. Access will be quicker. Transfer of records will be quicker between GPs and hospitals. Data can be examined to provide analyses of medical conditions, e.g. regional patterns. A number of problems are: Agreed codes for different conditions, treatments, parts of the body etc. Inputting enormous amounts of data from paper -based records. Having security systems to protect confidential data. May be disputes about different groups sharing information, e.g. between the NHS and private companies. Support/Dia nosis (Web-based)
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Concurrent with major changes in medical care delivery has been an explosion of digital resources for patients as well as physicians. Websites such as WebMD.com, MedlinePlus.gov, MerckSource.com, HealthFinde r.gov, and MayoClinic.com answer questions and provide links to discussion groups about particular illnesses. In states such as Massachusetts, California, New York, and Michigan, consumers can visit health department sites and compare quality performance data on provider care programs. Nationally, the U.S. government has a website, www.hospitalcompare.hhs.gov, that evaluates 2,500 hospitals on mortality rates, room cleanliness, call button responses, and how patients judge their quality of care. Social networking sites represent another way to share information among chronic condition sufferers. For example, a network developed by the company PatientsLikeMe has 23,000 patients who have signed up to share information regarding five different illnesses: m ood disorders, Parkinson s, multiple sclerosis, HIV/AIDS, and Lou Gehrig s disease. Also on the internet you can find many other wide variety of medical information, including: Symptom diagnosis, for people who wish to identify their problem without consulting a GP (General Practitioner).

    

Information about available treatments/alternative therapies. Support groups for people suffering from particular conditions. Access to medical research/journals. Information about side effects. Expert systems to aid diagnosis.

The problem with certain diagnostic web -sites is that they are not trustworthy. This can lead to incorrect diagnosis and cause false complacency or anxiety. Communication Modern information technology has opened world of instant communication and vast tracts of easily accessible information to the modern ophthalmologist. The information and communications technology has the potential to transform the doctor and patient relationship into one of informed shared decision making. Some organisations are even thinking about the possibility of performing surgery from distance like, US Army is already working on telemedicine -based vehicle that would allow paramedic soldiers to rescue wounded soldier in hostile territories. Physicians interested in dealing with rare or difficult problems could hone their expertise by reaching not only patients residing or willing to travel to their geographic area, but also those from every corner of the world.

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Teleconferencing has been used to share expertise. Surgeons in one country have helped those in another. Wireless transmission (Field Care) helps medical personnel, transport workers and hospitals keep in touch. Each injured person has a PIC around their neck which monitors them and personnel have hand held PDA s to enter information about the patient. Doctor in the house ( uardian.co.uk/online) Investment in IT has been about getting people into hospital, but IT can also be used to treat people in their homes; It covers any arrangement for diagnosing and treating disease remotely, via everything from a telephone call to videoconferencing. Conditions such as skin cancer can be detected remotely on a consultant's screen, while x -ray images and data from heart monitors can be assessed thousands of miles from the pati ent. One of the most promising uses of telecare is to allow elderly and other vulnerable people to stay in their homes rather than go into residential care. An even more promising development is to help people take control of their health. Studies have shown that patients who monitor their blood pressure, for example, are healthier than those who have it done in the consulting room. Home monitoring reduces the incidence of "white coat hypertension. The national NHS programme for IT represents a "unique opportunity to provide the vehicle for equality of care and support the public in adopting cost -saving, lifeenhancing self-care".
Research/Market (HEALTH INFORMATICS)
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Most drugs are developed through trial and error, but now drugs can be designed to do a specific job which involves the atomic structure of the target analysed and drugs developed to attack the specific compound structure. This research is made possible by the use of advanced computers. Can information technology (IT) tools extend the suc cesses they have generated in healthcare overall to the evolving realm of personalized medicine? Yes - based on the demand from consumers for portable and real -time access to health information; the need for patients, physicians, and biopharmaceutical comp anies to be connected; and the overall desire by governments to explore newer and cost -effective ways to deliver healthcare, IT is indeed a driving force that will push personalized medicine forward.

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IDENTIFYING RELEVANT FUTURE TECHNOLOGICAL DEVELOPMENTS 1. What rele ant technolo y trends are likely to impact on health and healthcare in the next ten to fifteen years?
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IT and communications applications are expected to develop rapidly. Likely innovations include: y Methodologies for remote sensing and addressing individual non -intrusively. y Ubiquitous connectivity: enabling patients to be monitored and interacted with 100% of the time. y Integrated sensors and micro -machines: These will lead to a much improved ability to monitor biometrics and deliver drug s in a more continuous way. y Advanced Robotics: advances in robotics will provide support for surgeons and anaesthetists in their duties. y Connectivity to international experts: a GP, for example, could have access to world experts on a particular disease so urcing papers, photos etc to help with their diagnosis. Computing applications includes: y The Integrated Patient Record. y Security and Identity: reducing identity fraud and fraudulent use of medical insurance and facilities. y Expert/knowledge-based system for signal interpretation, image analysis and knowledge management. y Methodologies for extracting relevant information from complex data for monitoring purposes and research. y Information processing based on multi -cellular neural recordings used to interpret and control body movement. y Computer modelling of human biology, accelerating drug discovery and making possible more personalised medicine.

ASSESSING THE POTENTIAL POSITIVE AND NEGATIVE IMPACTS OF RELEVANT FUTURE TECHNOLOGICAL DEVELOPMENTS. 2. What areas in the pro ision of Health and Healthcare could be positi ely or ne ati ely affected by these de elopment? Positi e effects:
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a). Advances in condition assessments, daily prognosis and avoidance of the development of critical situation requiring costly emer gency actions, including:

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y Remote testing of blood sugars or other blood chemistry; remote monitoring of pulse rates, blood pressure; heart monitors and foetal monitoring. y Better diabetic care with improved reliability of readings and possible alerts/direct action for hyper or hypo-glycaemic incidents. Direct access to blood sugar readings by medical staff may improve patients' own behaviour with respect to maintaining good levels. monitoring, and its associated actions, should reduce the long term effects o f diabetes with great benefit to the patient and reduced load on the NHS. y Improved monitoring of the frail/elderly in their own homes, for example using remote detection of movement sensor/access to demotic devices and generation of alerts on abnormal patt erns. y Monitoring person in the detention prone to self harm or suicide. b). Reduced need to hospitalise patients to observe them. This could result in the separation of 'physical care' (other than pre -and post operative care, and emergency care) and medical treatment'. The possibility of picking up infections in the hospital would be reduced. However, it would require an increase of nursing support at home or in nursing homes. c). Cost-effective air quality monitoring for wide scale use could reduce health threatening effects for vulnerable groups. d). Early indication of fatigue could reduce accident potential and loss of life. For example in the case of long distance vehicle drivers. e). The use of optical sensor arrays/monitors and information extraction techniques for remote, non-intrusive monitoring of physiological condition will provide cost effective opportunities whilst minimising trauma. For example; y Stroke effects the lives of thousands of people with annual cost of over 2.3 billion Pounds to the NHS. Assessing swallowing dysfunctions, a clinically common problem often associated with stroke, will have a high impact on rehabilitation, care, mortality rates and costs. y Gait_analysis is of paramount importance to a multitude of pathologies (diabetes, stroke, cerebral palsy, paralysis, etc). Giat -lab, an expensive and laborious facility is the gold standard for acquiring data for clinical gait analysis. The construction of portable, intelligent and cheaper sensors is critical to the future development o f diagnosis and treatment, e.g, electrical stimulation of spastic paralysis, etc. f) True data reported on a regular basis: Information gained in real -life situations will be much more informative and accurate. g) Better data for studies - With greater volumes of input, the capability to produce accurate and anonymous data for studies improves. Ne ati e effects: The Hypochondriac effect will escalate as a result of ubiquitous connectivity. The more well-off members of society will tend towards a "Prevent ative Maintenance"
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approach to health. This will lead to them requiring treatments before symptoms are visible, or even before a condition has established itself. This will mean a huge increase in diagnostic work, much of which will be wasted. In theory th is in-field monitoring and control will result in more people classing themselves as patients, however it should result in fewer patients needing to be hospitalised, so the net result may well not be as strongly negative as implied. The 'interventionalist' effect is likely to escalate. People will learn that by monitoring a body parameter they can control something else. Perhaps the most obvious example is the obesity and using insulin ton control weight, but there will be other cause/effect pairings. However, the body is a complex machine, and 'corrective' action will usually result in some other effect - which will need another corrective action, and so on. Instability of the body system will result and medical intervention will be necessary to return sta bility, or prevent death. 3. What action should be undertaken now to maximise positi e impacts, or to pre ent or minimise ad erse effects? y A sizeable live trial of remote monitoring could gain real insight into the potential benefits and costs. y International collaboration and standardisation could greatly reduce the cost of the necessary devices. y The Government should initiate timely public debate on the ethical issues arising, including bow to tackle the possibility of costs rising because more advanced and earlier treatment options will exist.
References:
http://www.bupa.co.uk/health-information/directory/m/mri-scan www.bupa-intl.com (http://www.researchandmarkets.com/research/effea7/exploiting_informa ) www. HealthFinder.gov/ http://www.radiologyinfo.org/en/info.cfm?pg=PET www.RadiologyInfo.org/en/safety/ http://www.iee.org/oncomms/pn/healthtech/
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