Computers in medicine: liability issues for physicians

Considerations on the quality of medical software and information services

Fast developments in information and communication technology have made it possible to develop new services for citizens. One of the most interesting areas is health care. Medical knowledge is usually valid all over the world that makes the market global. Information services and decision support software are becoming important tools for medical professionals but also ordinary citizens are interested in health related information. It has been estimated that by the year 2010 the turnover of health care telematics industry may be close to that of the drug industry today. The nature of this global information industry is very different from any industry in history. Since there are no frontiers, no clear products and no shops in the information market, it is difficult to develop any effective legislation. However, the history of medicine has shown that health care sector cannot be free from regulation without risking citizens' health. The huge commercial potential of the Internet has already been used to promote products and services that have no proven effect on health and that may sometimes be even dangerous. In this paper we discuss the needs and possibilities to assess the quality of medical decision support software and information services. For brevity the terms medical software and medical knowledge are used, but the issues also relate to informatics systems used by any health professional, and to computerised systems used to schedule care or to organise record systems.

Why certification of medical software would be useful?

Human drugs and medical devices have to be approved by the health authorities before they can enter the market. For medical software this is not needed. The main argument to resist all attempts to regulate medical software has been that it is impossible to guarantee that software is error-free. This is true of all software. However, in medical software the correctness of medical knowledge is at least as important as the correctness of the code itself. The medical contents of the software could usually be evaluated but the end-users do not have the time or possibilities to do so. The Internet makes it possible to provide commercial services designed by non-professionals. For health care, there are already several commercial services on the net. Since there is no quality assurance or regulation of medical software anyone can sell medical software on the net. Even if physicians were cautious enough not to use untested software, there is a possibility that patients do. In Finland, where over 10% of the population is using the Internet at least weekly, the problem is real. It is impossible to remove poor services from the net and therefore, it is essential to guide the users to use high quality services. The paper discusses different aspects of evaluation of medical software.

Computers in healthcare: overview and bibliography

OBJECTIVE

The objective of this article is to provide an overview of computer technology and an associated bibliography, emphasizing institutional-based healthcare applications and pharmacoinformatics.

DATA SOURCES

References were selected from the authors' files and from a computerized search over the last five years on computers in healthcare/medical informatics and in pharmacy.

STUDY SELECTION

Articles selected for review and discussion were considered to be important contributions to the respective areas listed in the bibliography and representative of advancements in computer applications in healthcare and pharmacy.

DATA SYNTHESIS

The computer has become an important support tool for healthcare professionals. Medical informatics and the discipline related to pharmacy, called pharmacoinformatics, have evolved from the cognitive underpinnings of medicine, pharmacy, and computer science. Recent developments in computer technology have resulted in computers that are fast, increasingly portable, and user friendly. Hospital information systems employ computers in various ways to deal with the vast amount of information used by various departments. Standards for electronic data exchange are being developed to increase the integration potential of these systems. Hospital pharmacists have used computers for drug distribution, financial analysis and inventory control, drug interaction detection, pharmacokinetic dosing, drug information, and drug therapy monitoring. Expert systems are being developed in several areas of drug therapy. Pharmacy educators have developed interactive courseware to help students learn problem-solving skills in the areas of calculations, therapeutics, and drug information.

CONCLUSIONS

Pharmacists need to become more involved with applications of technology to pharmacy. Properly implemented, computers can provide more time for pharmacists to use their cognitive skills in the delivery of pharmaceutical care.