Ukusebenzisa amathuba amasha wokunakekelwa kwesineke nokubandakanya sekuyingxenye ebalulekile yokunakekelwa kwezempilo yanamuhla. Kubuye kuthuthukise nendlela esibheka ngayo ukuvimbela izifo. Labo abasheshayo ukuthola imishanguzo yezempilo-kokubili iziguli nabahlengikazi-bazobona ukuzuza okusheshayo kulezi zintuthuko.
Amaphutha kwi-Electronic Health Records Adoption
Amarekhodi ezempilo e-elekthronikhi (EHRs) ayanda ukwamukelwa kuwo wonke ama-United States, okuhambisana noMthetho WezeMpilo Wezobuchwepheshe Wezomnotho Nezokwelapha (uMthetho we-HITECH) owadluliselwa ngo-2009.
Lo mthetho ubeka ukusetshenziswa okunembile kwezobuchwepheshe bezempilo futhi usekela ukuqaliswa kwe-EHRs. Okokuqala, izibonelelo zemali zanikezwa kubahlinzeki abasebenzisa ama-EHR, futhi kwabikezelwa ukuthi manje inqubo yokwamukelwa yayizoqedwa. Kumthetho wokuqala we-HITECH, izinhlawulo ezingenzeka kungenzeka zingenziwa yizinhlangano zokunakekelwa kwezempilo ezingabonakali ukusetshenziswa okunembile kwezobuchwepheshe bezobuchwepheshe bedijithali ngemuva konyaka we-2015. Noma kunjalo, inqubo yokwamukelwa iye yancipha kunalindelekile, ngakho-ke ngo-2014, amaCenter for Medicare kanye neMedicaid Services (I-CMS) yamemezela ukuthi isigaba sesi-3 senqubo yokwamukelwa saqedwa kuze kufike ngo-2017. Ngonyaka odlule, ukusetshenziswa okunenzuzo kwama-EHR kwaba yinto yokukhetha bonke abahlinzeki. Ngo-2018, ukuqaliswa kwesigaba sesi-3 senqubo yokuqeda kwenzelwa amandla. Amanye amaqembu, acele ukuthi isigaba sesi-3 siphinde sihlehliswe ngenxa yokukhathazeka okuzungezile phakathi kwabahlinzeki nabathengisi.
Noma kunjalo, kuye kwaba nokwanda okukhulu ekusetshenzisweni kwe-EHRs. Ucwaningo olwenziwe ngo-2013 nguMichael Furukawa kanye no-coauthors bathola ukuthi amaphesenti angu-78 ama odokotela asehhovisi asemukele uhlobo oluthile lwe-EHR. Izindleko zokutholwa kwaba yizinyathelo eziphansi ezinkambisweni eziyingqayizivele kanye nezinkampani zokunakekelwa okungezona eziyinhloko, okubonisa ukuthi kusekhona indawo yokuqhubeka nokwamukelwa kwamanye amazwe kwezinye izilungiselelo.
Ukuhlaziywa kwedatha kaFurukawa kubonise nokuthi ukutholakala kokusetshenziswa okunembile kwezobuchwepheshe bezokwelapha kunganciphisa imicimbi yezidakamizwa ezimbi ezibhedlela, njengamaphutha okuphuza imithi, ukukhipha ngokweqile nokuphendula okweqile. Ku-athikili eyanyatheliswa ngo-2017 ku- Journal of the American Medical Informatics Association, uFurukawa kanye nozakwethu babike ukuthi ukwehlisa amaphesenti angu-20 emicimbi yezidakamizwa ezimbi kungabhekwa nokusetshenziswa okubalulekile kwe-EHRs. Lolu lwazi lungase lufake izibhedlela eziningi ukuba zamukele ama-EHR kanye nokumelene nodokotela ophansi okwamanje okuphazamisa ukusetshenziswa okuwusizo.
Amathuba alahlekile
Ukuhluleka ukwamukela ngokugcwele i-EHR akuyona inselelo kuphela evimbela ingqalasizinda yezempilo. Idatha eqoqwe kuma-EHR inamandla amakhulu kunalokho okwamanje isetshenziswa. Uma lezi zinhlelo zinikwe amandla ukuxhuma imithombo eminingi yolwazi, zihlomele kangcono ukukhiqiza izilungiso zokuqagela mayelana nokuphendula kokwelashwa kwesiguli.
Ucwaningo oluthile luhlolwe le ndlela ekunakekelweni sikashukela. Lapho ama-EHR ehlanganiswa nemigomo yokusebenza kwemithi, leli cwaningo laboniswa ukuthi liphakeme kunomkhuba wamanje. Ukuhlanganiswa kwedatha yomuntu siqu nokubikezelwa kwesifiso se-prognosis kudlulele ukusebenza kwezindlela zangaphambilini.
Yanikeza incazelo engcono yolwazi ngesineke kanye nemikhombandlela yokunakekelwa ngcono. Ucwaningo oluqhutshwa uDkt. Michael Klompas weHarvard Medical School neHarvard Pilgrim Health Care Institute eBoston futhi lithole ukuthi idatha ye-EHR ingasiza ekutholeni amacala amaningi yesifo sikashukela nokubandlulula phakathi kohlobo 1 nohlobo lwesibili lwesifo sikashukela. U-Klompas kanye neqembu lakhe bakholelwa ukuthi lobu buchwepheshe obusha buzosetshenziselwa njengesevisi yezempilo yomphakathi ezenzakalelayo futhi kungasiza ekulawuleni umkhuba kanye nokuqashwa kweziguli ezifundweni zemitholampilo.
Nge-EHRs yanamuhla, ulwazi manje lungaboniswa ngokuzenzakalelayo futhi lunikeze ithimba lezokwelapha ngemikhombandlela efanele yokunakekelwa kanye nokuphathwa kokwelashwa okugxilwe ngesineke futhi ishintshelwe isiguli ngasinye.
Enye yezigameko zemigomo yokwelapha esekelwe kubantu ukuthi ukungenelela okulinganiselwe ngokumelene nesilinganiso esisisekelo kuncike ekukhiqizweni ngokubanzi ngabantu. Le ndlela iyaziwa ngokuthi ingaphansi noma ngaphezulu-inxephezela izidingo zomuntu ngamunye. Ngaphezu kwalokho, i-algorithm eqinisekisiwe kodwa ehambisana nedatha iqinisekisa ukuthi uhlelo lokunakekelwa komuntu luyisisekelo esisekelwe ebufakazini futhi sinengqondo. Imiyalelo nemigomo yokuthola imithi ivuselelwa njalo, eyenza ukunakekelwa okuhlelekile nokuhambisanayo okuhambisana nezidingo ezihlukile zesiguli. Kukhona nobufakazi obubalulekile bokuhlanganisa ama-EHR nezinhlelo zokusekela izinqumo zempilo (CDSSs) zingashintsha ukunakekelwa kwezempilo futhi zishintshe idatha eqoqwe kolwazi oluphathekayo.
Ikhompyutha Esiza Iziguli
Ngonyaka we-2015, i-IBM ne-CVS Health yamemezela ukuhlanganyela okuhlanganyelwe ukusebenzisa amandla amakhulu okuhlaziya okucatshangwayo kwekhompyutha ye-IBM's Watson ukuhlinzeka ngokunakekelwa komuntu kumakhasimende e-CVS. Ukubambisana kwenza i-CVS ikwazi ukubona kangcono abathengi abangase babe engozini yokuthola imiphumela emibi yezempilo bese behambisa izinsizakalo ezihambelana nabo ezikhulisa izinkinga zokuthuthukisa inhlalakahle yabo.
I-Watson Oncology, uhlelo olusha lokusebenzisa i-computing system, manje lisetshenziselwa abahlengikazi beCommer Sloan Kettering ukuze bahumushe idatha yeziguli zomdlavuza futhi bathole ukwelashwa okungcono kakhulu okusekelwe eminyakeni yobuchwepheshe obugciniwe kanye nocwaningo. Lokhu kusho ukuthi ubufakazi bamuva bungakwazi ukuhamba ngokushesha ngomphakathi we-oncology nokuthuthukisa ukunakekelwa kwesiguli. Ngaphezu kwalokho, lenza ukwazi nokwandisa ulwazi oluvela kumuntu oyedwa kuya kwesinye. Lokhu kungenza uqiniseke ukuthi uthola ukunakekelwa okufanayo okuphezulu ngaphandle kwanoma ubani udokotela wakho. Ukuthutha ukufaka izakhi zokubikezela okusekelwe kwidatha yezempilo yesiguli kungasheshe kulingiswe ngabancintisana, futhi kungukuqala kokwandisa ukusetshenziswa kobuhlakani bokufakelwa ukuthuthukisa impilo yabantu. Ukusebenzisana phakathi kwezinkampani ezinjenge-IBM nezinkampani zezokwelapha nezamakhemikhali zingaqinisekisa ukuthi izinyathelo ezintsha zenziwa ukunakekelwa kwezempilo kwansuku zonke.
Iziguli Ezizisiza
Enye ithuba elikhulu elinikezwa ubuchwepheshe bezobuchwepheshe bedijithali lithuba lokukhulumisana ngesiguli. Iziguli manje zingabuka, zilande futhi zithole ulwazi lwazo lwezempilo, futhi zenze izinqumo ezinolwazi mayelana nezinketho zokwelapha. UMichael Furokawa kanye neqembu lakhe labacwaningi bathola ukuthi odokotela baqhubeka besebenzisa ubuchwepheshe ukuze babelane ngolwazi neziguli zabo. Ngo-2014, amaphesenti angu-30 ochwepheshe abacwaningiwe basebenzisa amandla okuthumela imiyalezo ephephile, futhi amaphesenti angu-24 avame ukuhlinzeka iziguli ezinokufinyelela ku-inthanethi kwedatha yabo yezempilo. Le namba cishe ikhule ngokuqhubekayo eminyakeni edlule futhi kungenzeka ukuthi yanda ukubambisana nodokotela.
Amasu amasha asetshenziswe sonke isikhathi ukwandisa ukubandakanya kwesiguli ngokusebenzisa ubuchwepheshe. Umusa-inhlangano yezempilo enezifo ezingelapheki ekufinyeleleni uhlelo lwe-pair-technology nobuqeqeshi bezempilo. Abaqeqeshi basebenzisa ubuchwepheshe ukusiza ukugqugquzela iziguli ukuba zithathe isinyathelo futhi zibandakanye ngokwengeziwe ekunakekeleni kwazo. Ngalokhu, ubuchwepheshe kuphela akuyona impendulo. Ukuxhumeka kobuntu kusiza isimo sengqondo sokushintsha futhi sisekela ushintsho oluhle lokuziphatha, kuyilapho ubuchwepheshe bukhulisa umphumela. Ukusebenzisana komuntu kuzoqhubeka kuyingxenye ebalulekile futhi kuhlale kuyinhloko ngokuqondene nempumelelo yemiphumela yezempilo, njengoba nje ukuphendukela kwemvelo kuyasisiza ukuba sithuthuke ezindleleni ezisheshisa futhi zenze intuthuko ibe nenhlalakahle engcono.
> Imithombo
> Furukawa M, iNkosi J, Patel V, Chun-Ju H, Adler-Milstein J, Jha A. Naphezu kwenqubekela phambili enkulu ekuhambeni kwe-EHR, ukushintshaniswa kolwazi lwezempilo kanye nokubandakanyeka kwesiguli kuhlala phansi ezindaweni ezisesikhundleni. Izempilo , 2014; 33 (9): 1672-1679
> Furukawa M, iNkosi J, Patel V. Isimo sengqondo sokusebenzisa kalula ukusebenza kwe-EHR okuhlobene nokusetshenziswa okunenjongo. Umagazini waseMelika Wokunakekelwa Okuphethwe , 2016; 21 (12): E684
> Furukawa M, Spector W, Limcangco M, Encinosa W, Rhona Limcangco M. Ukusetshenziswa okunenzuzo kwezobuchwepheshe bezokwelapha kanye nokwehla imicimbi yezidakamizwa ezimbi. Umagazini we-American Medical Informatics Association , 2017; 24 (4): 729-736.
> Klompas M, Eggleston E, McVetta J, uLazaru R, Li L, Platt R. Ukutholakala okuzenzakalelayo nokuhlelwa kohlobo lwe-1 ngokumelene nohlobo lwesifo sikashukela 2 usebenzisa idatha yerekhodi yezempilo. Ukunakekelwa yisifo sikashukela . 2013; 36 (4): 914-921.