Ukusebenzisa amathuba amatsha enonyameko kunye nokubandakanyeka kuye kwaba yinxalenye ebalulekileyo yolondolozo lwempilo lwangoku. Kwakhona kuphucula nendlela esondela ngayo ukukhusela izifo. Abo bakhawuleza ekutholeni amatsha empilo-zombini izigulane kunye neekliniki-baya kubona ukuzuza kwangaphambili kule nkqubela.
Izikhelo kwiNgcaciso yeeMpilo zeeNkcukacha zeMpilo
Iirekhodi zezempilo ze-elektroniki (i-EHRs) ziyakwamkelwa ngakumbi kwi-United States, ehambelana noMthetho wezoLwazi lwezeMpilo kuMthetho wezeMpilo noKliniki (uMthetho we-HITECH) owadlulileyo ngo-2009.
Lo myalelo uchaza ukusetyenziswa okubalulekileyo kwithekhnoloji yezempilo kunye nokuxhasa ukuphunyezwa kwe-EHRs. Ekuqaleni, izibonelelo zenkxaso-mali zanikezelwa kubaboneleli ngokusebenzisa ii-EHR, yaye kwakuxelwe ukuba ngoku inkqubo yokumkela iyakugqiba. Kwimithetho ye-HITECH yasekuqaleni, izigwebo ezinokwenzeka zingaphathwa ngemibutho yokunakekelwa kwempilo engabonakali ukusetyenziswa ngokubaluleka kwetheknoloji yezobugcisa zedijithali emva konyaka ka-2015. Nangona kunjalo, inkqubo yokumkelwa yancinci kunokuba ilindeleke, ngoko ngo-2014, amaziko e-Medicare kunye neMedicaid Services (I-CMS) yamemezela ukuba isigaba sesi-3 senkqubo yokuthotyelwa kwasuswa kwaze kwaba ngowama-2017. Ngonyaka odlulileyo, ukusetyenziswa okubalulekileyo kwe-EHR kwaba yinto yokukhetha kubo bonke ababoneleli. Ngo-2018, ukuphunyezwa kwecandelo lesi-3 kwenkqubo yokuqulunqwa kwamiselwa. Amanye amaqela, kodwa, acele ukuba isigaba sesi-3 siphinde sihlehliswe ngenxa yokukhathazeka okujikelezayo phakathi kwababoneleli nabathengisi.
Nangona kunjalo, kubekho ukwanda okwenziwe ekusebenziseni ii-EHR. Uphando olwenziwa ngo-2013 nguMichael Furukawa kunye nama-coauthors afumene ukuba i-78 ekhulwini yamagqirha aseburhulumenteni sele sele athabatha uhlobo oluthile lwe-EHR. Izinga lokuthotyelwa kwamanye amazwe lalingaphantsi kwizakhono zonyango kunye neengcali ezingabalulekanga eziphambili, ukubonisa ukuba kusekho igumbi lokunyusa ukuthotyelwa kwamanzi kwezinye izicwangciso.
Uhlalutyo lwengcaciso ye-Furukawa lubonise ukuba ukusetyenziswa kweteknoloji yezobugcisa kwimiba yezinto eziphathekayo kunokunciphisa iziganeko eziyingozi kwizibhedlele, ezifana nokuphambuka kwamachiza, ukugqithiswa kwamanzi kunye nokuphendula. Kwinqaku epapashwe ngo-2017 kwi- Journal ye-American Medical Informatics Association, iFurukawa kunye noogxa baxela ukuba ukunciphisa ipesenti ezingama-20 kwiziganeko ezichanekileyo zeziyobisi kunokubakho ukusetyenziswa kwe-EHR. Le ngcaciso inokubangela izibhedlele ezininzi ukuba zithathe i-EHR kunye noxinzelelo lwabagqirha abancinci olusetyenzisayo.
Amathuba alahlekileyo
Ukungaphumeleli ngokupheleleyo ukufumana i-EHR akuyona mngeni kuphela ophazamisa iziseko zoncedo lwezempilo. Idatha eqokelelwe kwi-EHR inokubakho okukhulu kunokuba kusetyenziswa njengamanje. Xa ezi nkqubo zinikwe amandla ukudibanisa imithombo emininzi yolwazi, baxhotyiswe ngakumbi ukuvelisa izilungiso zokuqulunqa ngokuphathelele impendulo yesigulane.
Izifundo eziliqela zivavanywe ngale ndlela ekunyamekeleni isifo sikashukela. Xa i-EHR idibaniswe ne-algorithms yeklinikhi, isicwangciso saye saboniswa ukuba siphezulu kunoko ukuqhuba kwangoku. Ukudibanisa ulwazi lomntu kunye nokuchazwa kwangaphambili kwesigxina kukugqithise ukwenziwa kweendlela ezidlulileyo.
Yanikezela ukuchazwa ngcono kolwazi ngesigulane kunye nezikhokelo zokunakekelwa ngcono. Uphando oluqhutywe nguDkt. Michael Klompas waseHarvard Medical School kunye neHarvard Pilgrim Health Care Institute eBoston kwafumanisa ukuba iinkcukacha ze-EHR zinokukunceda ukuba zibone iimeko ezininzi zesifo sikashukela kwaye zikhethe phakathi kohlobo 1 kunye nohlobo lwesibini lweswekile. I-Klompas kunye neqela lakhe bakholelwa ukuba le teknoloji entsha inokuqaliswa njengenkonzo yezempilo ye-automation kwaye inokukunceda ekulawuleni umgangatho kunye nokuqashwa kwabagulane kwizifundo zeklinikhi.
Ngee-EHR zanamhlanje, ulwazi ngoku luyakwazi ukubonakaliswa ngokuzenzekelayo kwaye lunikeze iqela lezobugcisa ngononophelo olufanelekileyo kunye nolawulo lwezonyango olujoliswe ngumonde kwaye lulungelelaniswe nesigulane ngasinye.
Enye yezigxeko zemiqathango yonyango olusisiseko-manani kukuba ukungenelela okulinganiselwe kumlinganiselo wesiseko kusetyenziswa kwi-generalizations malunga nabemi. Le ndlela iyaziwayo ngokugqithiseleyo okanye ngaphezulu-ukuhlawulela iimfuno zomntu. Ukongezelela, i-algorithm echanekileyo echanekileyo yedatha iyaqinisekisa ukuba isicwangciso sokunyamekela komntu sisisiseko esinobuchule kwaye sisengqiqo. Imiyalelo kunye neeprotoksi zihlaziywa rhoqo, ezenza unonophelo olulungelelanisiweyo nolulinganisiweyo oluhambelana neemfuno ezizodwa zesigulane. Kukho ubungqina obubalulekileyo bokudibanisa ii-EHR kunye neenkqubo zenkxaso yeekliniki (ii-CDSSs) ezinokuguqula ukunakekelwa kwempilo nokuguqula idatha eqokelelwa kwiinkcukacha ezithintekayo.
Ikhompyutyana yokwenza izigulane
Ngo-2015, i-IBM kunye ne-CVS Health yamemezela ukusebenzisana ngokubambisana ukusebenzisa amandla amakhulu okuhlalutya kwikhompyutheni ye-IBM ye-Watson ukubonelela ngononophelo ngabathengi beCVS. Ukusebenzisana kwenza ukuba iiCVS zichonge ngakumbi abathengi abangasengozini yokufumana iziphumo zempilo ezimbi baze banikezele iinkonzo ezilungelelanisiweyo kubo abakwandisa iingxaki zokuphucula impilo yabo.
I-Watson Oncology, inkqubo entsha yokucubungula i-computer, isetyenziswa ngokusasazwa yiSikhumbuzo seSikhumbuzo saseKrottering ukuba zichaze iinkcukacha zegulane zegulane kwaye zifumane unyango olungcono ngokusekelwe kwiminyaka yobuchule kunye nophando olondoloziweyo. Oku kuthetha ukuba ubungqina bwakutshanje bunokuhamba ngokukhawuleza ngokusebenzisa uluntu lwe-oncology nokuphucula ukunakekelwa kwezigulane. Ngaphezu koko, kunceda nokwandisa ulwazi oluvela kwelinye ingcali ukuya kwelinye. Oku kungakuqinisekisa ukuba ufumana unonophelo olumgangatho ophezulu naluphi na ugqirha wakho. Ukunyusa ukufaka izinto ezithembekileyo ezisekelwe kwidatha yesigulane sempilo yesigulane kuya kulandelwa ngokukhawuleza ngokukhuphisana, kwaye kuphela ukuqala kokwandisa ukusetyenziswa kweengqondo zobuchule ukuphucula impilo yabantu. Intsebenziswano phakathi kweenkampani ezinjenge-IBM kunye neenkampani zonyango kunye nezobisi ziqinisekisa ukuba ukusetyenziswa kwintshukumo kwindlela yokunakekelwa kwezempilo kwansuku zonke ngokukhawuleza.
Izigulana Zizinceda
Olunye ithuba elihle linikezwa ngeteknoloji yezobugcisa bedijithali lithuba lokunyuka kwesigulane. Izigulane ziyakwazi ukujonga, ukukhuphela kunye nokufikelela kwiinkcukacha zabo zempilo, kunye nokwenza izigqibo ezinolwazi malunga neendlela zokwenza unyango. UMichael Furokawa kunye neqela lakhe labaphandi bafumanisa ukuba oogqirha baqhubela phambili ukusebenzisa iteknoloji ukwabelana ngolwazi ngezigulane zabo. Ngo-2014, iipesenti ezingama-30 zabagqirha abaphandwayo babesebenzisa izilungelo zokuthumela imiyalezo ekhuselekileyo, kwaye i-24 ekhulwini yayinika izigulane ngokufikelela kwi-intanethi kwiinkcukacha zabo zempilo. Le nombolo mhlawumbi ikhule ngokuqhubekayo kwiminyaka edlulileyo kwaye inokunyusa ukubambisana kwegulane nodokotela.
Amasu amatsha asetjenziswa lonke ixesha ukunyusa ukubandakanyeka kwesigulane ngokusebenzisa iteknoloji. Imfesane-inhlangano yezempilo enezifo ezingapheliyo ukufikelela kwi-program-pairs technology kunye nabaqeqeshi bezempilo. Abaqeqeshi basebenzisa iteknoloji ekuncedeni ukukhuthaza izigulana ukuba zithathe amanyathelo kwaye zibandakanyeke ngakumbi kwiinkathalo zabo. Ngaloo ndlela, iteknoloji yedwa ayiyiyo impendulo. Uxhumano lwabantu luyakunceda ukuguquka kwesimo kwaye luxhasa ukuguquka kokuziphatha okulungileyo, ngelixa i-teknoloji ikwandisa oku Ukusebenzisana kwabantu kuya kuhlala kuqhubeka kubalulekile kwaye kuhlale kuyimfuneko malunga nokuphumelela kweziphumo zempilo, njengoko ukuphendukela kweteknoloji kusinceda siphucule ngendlela ezenza ukukhawuleza kunye nokwandisa inkqubela phambili ekujongeni impilo enhle.
> Imithombo
> Furukawa M, King J, Patel V, Chun-Ju H, Adler-Milstein J, Jha A. Nangona inkqubela phambili kwi-EHR yamkelwa, utshintshiselwano ngolwazi lwempilo kunye nokubandakanyeka kwesigulane kuhlala kusezantsi kwiisetyenzisi zeofisi. Imicimbi yezeMpilo , ngo-2014; 33 (9): 1672-1679
> Furukawa M, King J, Patel V. Isigulane sengqondo ngokukhululeka kokusetyenziswa kwezixhobo ze-EHR ezinxulumene nokusetyenziswa okunentsingiselo. I-American Journal of Care Managed , 2016; 21 (12): E684
> Furukawa M, Spector W, Limcangco M, Encinosa W, Rhona Limcangco M. Ukusetyenziswa okubalulekileyo kwitheknoloji yolwazi lwezempilo kunye nokunciphisa kwiziganeko ezichasayo zezibhedlele. Umbhalo we-American Medical Informatics Association , 2017; 24 (4): 729-736.
> Klompas M, Eggleston E, McVetta J, uLazaru R, Li L, Platt R. Ukufumanisa ngokuzenzekelayo kunye nokuhlelwa kohlobo lwe-1 ngokubhekiselele kumhlobo wesi-2 weswekile usebenzisa idatha yerekhodi yezempilo. Uncedo lweSwekile . 2013; 36 (4): 914-921.