Running head: HIGH TECH VERSUS HIGH TOUCH
High Tech versus High Touch
Chris Common
Ferris State University
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Abstract
The question of whether or not the use of technology is a benefit or a downfall to the healthcare
industry has caused some debate by those who have direct contact with the patient population.
The goal of this paper is to provide the reader with the facts about the topic and allow them to
decide whether technology is truly an advancement or a set back to the overall care of the
patient. This analysis paper will define information and communication technologies, eHealth
and how it relates to nursing, and describe the advantages and disadvantages to the advancement
in technology within healthcare.
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High Tech versus High Touch
In the world of nursing there have been many new advancements. There has been a large
push to have hospitals across the nation get on board with these technological advances and have
set forth incentives to encourage the process. One of the biggest advancements is electronic
medical records or EMRs. Under the 2009 American Recovery and Reinvestment Act, up to $27
billion in incentive payments will be given to doctors, hospitals, and other providers who adopt
and make meaningful use of these health record systems (Health Affairs, 2010). Providing such
incentives has gained the attention of hospitals nationwide along with the likes of many software
companies.
The term “high tech” was originally coined in the 1980’s by John Naisbitt in his best
selling book Megatrends. Naisbitt defined high tech as the latest advancements in computers and
electronics as well as to the social and political environment and consequences created by such
machines (Naisbitt, 1980). Although this source is over thirty years old it remains credible as the
author’s ideas were ahead of his time. The author went on to define “high touch” as dealing with
a human being instead of a computer screen or voice response system. Naisbitt pointed out the
fallacy of automating every business transaction without human interaction at some point. There
is no substitute for “the personal touch”. In regards to the nursing profession, truer words could
not have been spoken.
Before deciding to adopt any new policy one must weigh out the advantages and
disadvantages. The hospitals that have made the switch to high tech are experiencing reduced
paperwork as many of the paper forms are now available in electronic form via the computer.
Another main selling point of EMRs are the cost savings due to the reduction in paperwork and
increases in the quality of care because medical errors are reduced (Wyoming Department of
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Employment, 2010). Once staff members become proficient with the EMR the speed of care
increases as the systems themselves are easily accessible from multiple locations. Other
advantages include higher patient satisfaction and an improved administrative process.
High technology has its disadvantages as well. The cost efficiency of purchasing the
computer programs to create the electronic medical records is costly to say the least. The
incentives mentioned earlier are used to help offset the large costs associated with
implementation of such programs. During the implementation process, hospitals are left with no
choice but to keep extra staff on while the employees learn the new system. Some hospitals have
designated employees who act as “super users” during the roll out process. These “super users”
are given advanced training to learn the program well enough to train other employees. A study
by O’Brien (2006) found that each time a system upgrade occurred it was similar to starting over
without EMR because of the additional overtime and nursing agency expenses. Although the
hospitals in the study saved an estimated $50,000 in office supplies during the two years
following implementation, the savings were more than offset by overtime and nursing agency
expenses. Aside from cost constraints there has been a decrease in the hands on patient care. The
reason for this lies in the fact that nurses are having to spend more time documenting on the
computer and are unable to spend equal time caring for their patients. Others argue that high tech
devices are being relied upon to heavily and basic principles of assessment are sometimes
forgotten.
The advancements in technology have allowed the field of nursing to evolve into more
than basic patient care. There are now opportunities for registered nurses working in the field to
become involved in information and communication technologies (ICT). ICT is an umbrella term
that includes any communication device or application, encompassing: radio, television, cellular
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phones, computer and network hardware and software, satellite systems and so on, as well as the
various services and applications associated with them, such as videoconferencing and distance
learning. ICTs are often spoken of in a particular context, such as ICTs in education, health care,
or libraries. The term is somewhat more common outside of the United States (CIO-Midmarket
Resources, 2011). Information and communication technologies are becoming more readily
available throughout hospitals nationwide. Telemedicine is the use of ICT, such as a video
conferencing link, to enable a doctor in one place to examine a patient who’s in another place,
perhaps miles away. The term has been widened to include: 1) Telenursing – for example, where
a nurse uses a link to a patient’s television set at home to monitor medication or provide advice
and support. 2) Telecare refers to the remote delivery of care, for instance, using sensors to
detect when frail or elderly people fall in their own homes or wander into an unsafe environment.
3) Telehealth is the preferred overarching term as it seen to be more inclusive/multidisciplinary
in scope and it focuses on health rather than disease and illness.
The increase in demand for technology within the field of nursing has created a unique
opportunity for nurses to get involved in the development of these new technologies and
computer programming. This area of nursing is known as nursing informatics and is an extension
of the information and communication technologies (ICT). Nursing informatics was officially
recognized as a specialty by the American Nurses Association (ANA) in 1992 and defined in the
2001 ANA Scope and Standards of Nursing Informatics as a specialty that integrates nursing
science, and information science to manage and communicate data, information, and knowledge
in nursing practice. Nursing informatics facilitates the integration of data, information, and
knowledge to support patients, nurses, and other providers in their decision-making in all roles
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and settings. This support is accomplished through the use of information structures, information
processes, and information technology (ANA, 2001).
A term frequently used to describe the high tech advancements is eHealth. E-health is an
emerging field in the intersection of medical informatics, public health and business, referring to
health services and information delivered or enhanced through the internet and related
technologies. In a broader sense, the term characterizes not only a technical development, but
also a state-of-mind, a way of thinking, an attitude, and a commitment for networked, global
thinking, to improve health care locally, regionally, and worldwide by using information and
communication technology (JMIR, 2001). The Journal of Medical Internet Research describes
the 10 e’s of e-Health as:
1. Efficiency - one of the promises of e-health is to increase efficiency in health care,
thereby decreasing costs. One possible way of decreasing costs would be by avoiding
duplicative or unnecessary diagnostic or therapeutic interventions, through enhanced
communication possibilities between health care establishments, and through patient
involvement.
2. Enhancing quality of care - increasing efficiency involves not only reducing costs, but at
the same time improving quality. E-health may enhance the quality of health care for
example by allowing comparisons between different providers, involving consumers as
additional power for quality assurance, and directing patient streams to the best quality
providers.
3. Evidence based - e-health interventions should be evidence-based in a sense that their
effectiveness and efficiency should not be assumed but proven by rigorous scientific
evaluation. Much work still has to be done in this area.
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4. Empowerment of consumers and patients - by making the knowledge bases of medicine
and personal electronic records accessible to consumers over the Internet, e-health opens
new avenues for patient-centered medicine, and enables evidence-based patient choice.
5. Encouragement of a new relationship between the patient and health professional,
towards a true partnership, where decisions are made in a shared manner.
6. Education of physicians through online sources (continuing medical education) and
consumers (health education, tailored preventive information for consumers)
7. Enabling information exchange and communication in a standardized way between
health care establishments.
8. Extending the scope of health care beyond its conventional boundaries. This is meant in
both a geographical sense as well as in a conceptual sense. e-health enables consumers to
easily obtain health services online from global providers. These services can range from
simple advice to more complex interventions or products such a pharmaceuticals.
9.
Ethics - e-health involves new forms of patient-physician interaction and poses new
challenges and threats to ethical issues such as online professional practice, informed
consent, privacy and equity issues.
10.
Equity - to make health care more equitable is one of the promises of e-health, but at the
same time there is a considerable threat that e-health may deepen the gap between the
"haves" and "have-nots". People, who do not have the money, skills, and access to
computers and networks, cannot use computers effectively. As a result, these patient
populations (which would actually benefit the most from health information) are those
who are the least likely to benefit from advances in information technology, unless
political measures ensure equitable access for all. The digital divide currently runs
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between rural vs. urban populations, rich vs. poor, young vs. old, male vs. female people, and
between neglected/rare vs. common diseases.
Some devices that are becoming increasingly popular in an attempt to increase efficiency
within the workplace include: Computers , COWs (computers on wheels), PDAs (Personal
digital assistants), Palm pilots, mobile phones, electronic white boards, bar-coding scanning
systems, software (the information systems) that enable information to be manipulated and
transmitted from one place to another. Evaluating these advancements in technology is essential
to their success within in the field of nursing. Another division of information and
communication technologies known as health informatics specializes in evaluating such
processes. Health informatics is the science that underlies the academic investigation and
practical application of computing and communications technology to healthcare, health
education and biomedical research. This broad area of inquiry incorporates the design and
optimization of information systems that support clinical practice, public health and research;
modeling, organizing, standardizing, processing, analyzing, communicating and searching health
and biomedical research data. Understanding and optimizing the way in which biomedical data
and information systems are used for decision-making; and using communications and
computing technology to better educate healthcare providers, researchers and consumers. Tools
and techniques developed from health informatics research have become and will remain integral
components of the best strategies in biomedical research and the best practices in healthcare
delivery and public health management (University of Virginia School of Medicine, 2006).
Health informatics will benefit patients by improving safety because of better and more accurate
patient information, allow continuity of care, provide convenience since patients won’t have to
repeat basic information over and over again as they pass along the chain of health providers.
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Eradication of appointments wasted because of ‘lost’ notes, improved partnership, as patients can
access their own records to ensure inaccuracies or misinterpretations are corrected. The benefits
to health care professionals include care being effectively coordinated across multi-professional
teams, new models of care – care pathways, clinical networks, changing roles – can be supported
in a way that’s not possible with today’s fragmented and dispersed paper records. Records can be
analyzed retrospectively to identify outcomes, and for audit and research purposes.
Documentation will be legible and structured, so relevant information can be quickly and easily
found, valuable time spent on writing, filing, finding (lost) records will be saved, releasing more
time for patient care (Royal College of Nursing, 2006).
The world of nursing is continuously evolving in order to accommodate for the
technological advancements. The nursing profession is no longer confined to the bedside as there
are many new job opportunities available in the information and communication technologies
department. The debate as to whether the new technology is a benefit or a setback to the overall
care of the patient remains a matter of opinion to those who have direct contact with the patients
and the technology in question. “IT is at the top of the agenda for modernizing our health care
systems. IT will change the practice of every nurse, health visitor, midwife and health care
assistant. IT will also affect nursing students while on clinical placements. Nurses will have to
learn new skills to use this technology and if IT is to fulfill its promise, then nurses need to be
involved in telling the systems developers and vendors what information these systems must
contain. If nurses don’t do this, other people will, and nurses may find themselves using systems
that increase their workload without benefiting patients.” (Royal College of Nursing, 2006)
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