In the Spotlight: Health Information Systems

Healthcare systems deal with only a part of the health continuum as they are organized to diagnose and treat patients. The Connected Health paradigm covers the continuum and includes the healthy and at risk individuals and chronically ill patients. The current system has been characterized as health profession centric; patients seek medical care which is delivered by healthcare professionals. In Connected Health, individuals are equal partners with healthcare professionals and take part in managing their health, wellness and care. Connected Health can be construed as being made up of one vertical layer providing privacy, security and interoperability services so that the users are able to use and trust the services and of five interacting horizontal layers as follows. The bottom layer houses the communications infrastructure, data stores (e.g. EHRs and PHRs) etc. The second layer health IT applications that enable and support the services on the third layer. The third layer is the one where health services are delivered. These cover the health continuum from end-to-end. The services span, e.g., wellness, self-management, retail clinics, policlinics, surgical operations and intensive care. The users see these as one integrated and accessible bundle. The fourth layer deals with reimbursement of health services. Providers can be paid on fee for service, capitation or pay for performance basis or a combination of these. The fifth layer sets the laws, regulations and policies that govern how health services are delivered and consumed. Health systems are already costly. Changes in demographics, our lifestyles and innovations in life sciences, medicine and technology are enabling new and improved care for all, which adds pressure to increase health expenditures.