Clinical Semantics - Computational Intelligence in Healthcare: Advanced Methodologies - page 10

Fig. 2. Architecture of the electronic anticoagulation management system [15]
The primary reorganization methodology was the introduction of an anticoagula-
tion nurse model where routine tasks were transferred to nursing personnel from phy-
sicians supported by computerization. The results showed that the quality of care was
maintained while the physicians' time allocation was reduced [15]. The latter result
represents a potential for cost savings.
However, the paper concludes with the observation that investments into case-
specific, highly structured information management tools are potentially difficult to
justify. Why is this so? Considering the studied case, the clinic in question already
utilized a basic electronic medical record. A separate system was developed for anti-
coagulation treatment as the basic system didn't include support for the structured
entry of these data and the related task management functionality required for the
anticoagulation nurse model in a realistic timeframe. This situation is an example of
one standard dilemma in clinical informatics. Novel care management models (such
as the anticoagulation nurse model) benefitting from the use of integrated information
management tools (replacing manual entry) are developed regularly but the system
development processes of comprehensive, structured electronic medical records are
prohibitively long and cumbersome to support the agile testing and introduction of
such models. On the other hand, there is understandable resistance to the introduction
of new case-specific systems by health care providers.
Apart from the few academic institutions having the necessary in-house personnel
to develop such functionality it can be argued that many innovations requiring infor-
mation technology tools never take off due to the inflexibility of the information man-
agement infrastructure of health care providers.
Ideally, the personnel developing new care management processes would be them-
selves able to augment supportive functionality to the basic electronic record.