A. TECHNOLOGY INVOLVED
Information Technology1 was able to revolutionise the Healthcare Industry. Countless shelves of handwritten hospital medical records, tests taking weeks to have results, astronomical costs and information from one hospital to the next being done via post, telephone or carrier, can become a thing of the past with the introduction of Information and Communication Technology (ICT).
In its approximately 20 year history, HIV/AIDS has ‘reversed socio economic gains, threatening human welfare, developmental progress and social stability on an unprecedented scale’ (UNAIDS 2001) Therefore the primary objectives of information technology in HIV/AIDS research encompasses all forms of technology used to create, store, exchange and use information in its various forms.
Information Technology (IT) is a powerful new tool in health care delivery. Applications of electronic technology are improving care from the systems level to the point of care. Because HIV/AIDS treatment has grown increasingly complex, reaching people living with HIV/AIDS is difficult and clinicians are challenged to provide comprehensive, coordinated care. IT is the technology that is driving what has often been called the ‘information revolution’ by improving the quality of data for improved monitoring and surveillance.
In 1981 AIDS was first reported and one of the first remedies was AZT. As more research was done and clinical laboratory testing advanced, changes occurred in the speed of the development of the combatant drugs. ICT used:
* Telemedicine
* Medical Informatics
* Electronic Health Records
* Hospital Information Systems
* Computing and Smart Drugs
* Live Medical Consultation-
Virtual Teams
* Robotics
* Computer Assisted Diagnosis
* Medical Expert Systems
* E health
* Personal Digital Assistants
* Hospital Test Devices
* Personal Diagnostic Systems
* Tablet PC
*
B. USE IN SOCIETY
In Trinidad and Tobago and the Caribbean, HIV/AIDS is not just a public health problem; the epidemic has far reaching consequences to all social sectors and to development itself. It can decimate the workforce, create large numbers of orphans, exacerbate poverty and inequality and put tremendous pressure on health and social services.
The Caribbean being about fifteen years behind in Technology (PAHO 2004), a core set of prevention intervention has been introduced to effectively reduce the spread of HIV/AIDS, using some forms technology.
The United Nations has recently invested 60 million USD in Trinidad and Tobago to aid in the introduction of preventive measures. These include:
* Interface Technology System – Promoting behaviour change through communication programmes, peer education and voluntary counselling and testing. The project connects counsellors with access to HIV/AIDS resource directories.
* Hospital Test Devices – Diagnosing and testing sexually transmitted infections by Rapid Blood Testing. Rapid 123 Hema is an example of this.
* Electronic Health Records – Data is used to develop programmes from areas that show a trend in the prevalence of HIV/AIDS. In April 2004, an HIV/AIDS Education and Prevention Programme was launched.
With the introduction of ICT2 in Trinidad, there are areas that need to be regulated to ensure safety, privacy and freedom of information. Legislation standards designed
to protect medical records privacy must be implemented to protect sensitive records as in the case of HIV/AIDS patients. Example: An Audit Trail which debars open scrutiny.
C. THE IMPACT ON THE WIDER SOCIAL ENVIRONMENT
The impact of IT in the wider social environment is steps ahead of the Caribbean. The PEST factors – Political, Economic, Social and Technological will be used to explain the impact on the global environment, focusing on the effect of ICT on the relevant PEST factors.
HIV/AIDS ‘is the most devastating disease humankind has ever faced’ (UNAIDS 2001). Information and communications technologies can have an impact on political spending, as it can improve the quality of data needed for informed decision making and planning. According to ADF (1999) ‘the health sector in developing countries is about fifteen years behind other sectors.’ Efficient national planning, evaluation of health policy, a cost effective delivery of health care all require the speedy accurate and comprehensive exchange of data. Investment in ICT can reduce cost, increase time efficiency, reach a wider range of communities and reduce disparities in services between countries.
There are over 40 million people living with HIV/AIDS (See Appendix 1). No cure or effective vaccine has yet been developed, but the tools to prevent HIV infection already exist. A core set of prevention intervention strategies instituted have effectively reduced the speed of HIV/AIDS such as:
A) USA: MTV Television has a global media campaign on HIV prevention called, “Staying Alive 2002” (Youth lens 2003).
B) African Countries. The World Bank developed a project called AIDSWEB to address HIV prevention (Youth lens 2003)
Governments in Europe and the USA have introduced telemedicine and medical informatics to improve health care for HIV/AIDS patients. Telemedicine is allowing instant two-way interaction between an HIV/AIDS patient, the local provider and
international specialist to interact and develop a care plan, without having to transfer the patient. Health Informatics3 allows data sharing and improves health communication and can deliver value and improved health. However, governments need to consider the legal implications with trans-border data4 exchange. ‘Among the many countries of the world there are different laws governing the movement of information, information privacy of citizens, origins of software and hardware in systems’ (Laudon & Laudon 2002).
The technologies that can impact on the economic factors are EHealth, Electronic Health Record (EHR) and e-commerce.
EHealth5 is ‘the single most important revolution in health care since the advent of modern medicine or hygiene (Sibler 2003). The EHR6 stands at the core of ehealth, which allows the sharing of medical records and can be linked to medical, laboratory and service utilisation. This can aid HIV/AIDS clinicians with decision support using up to date guidelines and standards of care, as the EHR data can be manipulated to create information such as summaries and graphs of test results over time.
E-commerce allows products and services to be purchased directly from the manufacturer, cutting out the middlemen, disintermediation. This can reduce cost to HIV/AIDS patients, thus increasing their purchasing power and disposable income. The manufacturing of generic medicine as a result of IT has also reduced the overall cost, thereby improving patient care, and the reversal of developmental gains, as HIV/AIDS hits hardest those in their reproductive years.
By attempting to change culture, through communication and education, ‘ICT can have social impact’ (OECD 2004). The World Bank and World Links Organisation are using ICT to reach students and teachers across Africa to spread preventive campaigns on HIV/AIDS education. The project connects students and teachers from
various schools and countries who use e-mail and Internet to exchange questions, answers and hold discussions. Over 200 teachers and students in the USA and African countries are involved in the project. Computer based interactive health surveys can promote patient adherence to treatment and encourage healthy behaviours.
The use of Tablet PC and PDA can change the belief and attitude towards healthcare, when it is viewed as ineffective, inefficient and prone to medical errors. It allows professionals to carry a powerful PC instead of clipboard or patient file, this is currently being implemented throughout Europe and US. Geoff Palmer, president of InfoCater, provider of Tablet PC solutions, said ‘roughly one-quarter of his company’s sales are to health-care organizations’ (Gros 2002). These systems have numerous benefits, the most important is that they enable clinicians to download from the Internet and thus access up to the minute information in a hand held repository. At the point of care, decision support is an invaluable tool for clinicians prescribing complex and rapidly evolving antiretroviral therapy for HIV/AIDS patients. This aid is changing the populace attitudes and beliefs and will help reduce the stigma of the disease.
Information Technologies have fuelled another societal trend that will continue to have an impact on the health care workforce. The flag bearer of this technological trend is the Internet. The rapid increase in Internet and information technologies has increased communication, discussion groups, information sharing and exchange of records and sales.
A 1997 survey of Internet users found that 65% had sought health care information regularly. IT can improve patient involvement in and adherence to care, while streamlining service delivery in HIV/AIDS care. It must be noted however, that while promising, IT has not been sufficiently evaluated in the HIV/AIDS clinical setting. The benefits of IT today in the wider society must be documented so that health care providers and financers are encouraged to adopt and use the technology.
D. FUTURE IMPLICATIONS OF TECHNOLOGY
In the 21st century and beyond ICT is mind ‘boggling’ to our imagination. “The innovations we will encounter as we step beyond feasibility are dazzling in their potential” (Merril 1995), innovations of today will be archaic in the future.
In the near future complex automated laboratory equipment, which contains individual systems will assist clinical staff in all steps of collecting samples and deliver a safe delivery of drugs for HIV/AIDS patients. Further down the road, each of us could have a Personal Diagnosis System as part of our home entertainment centres, sufferers of HIV/AIDS could scan and chart their stage in the HIV/AIDS recovery, as by then there should be a cure. This system would monitor the daily health status and automatically notify a health professional of his condition.
The future implications of Computing and Smart Drug Technologies, will allow patients to keep tabs of their health and even treat themselves without having to visit a medical professional. Artificial Intelligent Mechanical Devices, implantable microchips, new and complex therapeutic molecules and clothes that incorporate body-monitoring circuitry and sensors, will continuously check the health of HIV/AIDS patients and may even treat without persons even being aware of it.
Robotics will be used for telesurgery applications. This would be vital for the safe removal of contaminated blood or the treatment of lesions in HIV/AIDS care.
Telemedicine will continue to advance medicine. By connecting patients to doctors electronically, HIV/AIDS patients in remote areas will have access to the same specialist who may be physically located on the other side of the world. Virtual Videoconferencing will be used when a face to face consultation is necessary, equipment at both locations allows a ‘real-time’ consultation to take place. Telemedicine will make a country’s border transparent, making transnational health care feasible and interactive. Virtual Teams will link and open the talent pools and broaden the range of customer service for HIV/AIDS patients.
Modern information and communication networks will be used as a vehicle for illuminating health concerns and developing world public opinion on pressing health issues. The importance of global health surveillance7, will chart the trends of HIV/AIDS occurrence and its determinants with a view to prevent reoccurrence of the disease. One of the key lessons learned in health care is the importance of prompt and open reporting of any disease with the potential of spreading internationally. Prompt reporting allows for timely global alerts and policy development, which help to minimize the international spread of an emerging infection.
The expertise of the world’s top HIV/AIDS researchers in medical expert systems who will diagnose via eye scans may be the norm. ICT however may depersonalise medicine, and attempt to take out the human factor. Some people argue that the economics of medicine and the capabilities of ICT offer more efficient, less costly, and a higher and more consistent quality of care. Others argue that no matter how good ICT is, patients will still want to be reassured by another human totally leaving in the human factor.
CONCLUSION
The extent to which ICT applications may be adopted in HIV/AIDS research, treatment and awareness will be determined by social, economic and political factors of countries. The implication of ICT will change the way people live, work and communicate with each other, and it is likely to become an important part of how public health and medical professionals communicate with the public.
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“Computer Hardware, software, data and storage technology and networks providing a portfolio of shared information technology resources for the organisation” (Laudon & Laudon , 2002, pp. 13).
2 Information communication technology, including laptops, desktop computers, fax, all digital
technologies and mobile phones.
(Heinrich 1997)
3 The transformation of paper chart into electronic medical record” (Silber 2003).
4 The movement of information across national borders (Laudon and Laudon 2002)
5 The application of ICT across the whole range of functions that affect health” (Silber 2003)
6 Digitally stored clinical and administrative health care information about an individual’s lifetime of health
experiences. (Sibler 2003)
7 The methodical collection of data or the level of distribution and trends of disease occurrence. (http://www.itaa.org)
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