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CHAPTER 8: Principles of Medical Informatics and Clinical Informatics in the ICU 53

Patients video
monitoring

Fully
functional
Bidirectional EMR
audiovisual link

High-speed, reliable
network connection
Intensivist,
at remote
location

FIGURE 8-3. Functional scheme of tele-ICU.

FIGURE 8-4. Mobile application for synthesis of the EHR viewer at the Mayo Clinic.

smartphones will increase from 64 percent in 2009 to 81 percent by need for health care standards is no different than those of other indus-
2012. Such high rates of acceptance may drive demand for health care tries. In the context of health care, interoperability refers to the ability
applications that run on those devices and integrate with established of different EHR to communicate and share patient data in a secure and
CIS resources. Some concerns persist about radiofrequency interference reliable fashion. Standards usually need to be adopted when excessive
in the critical care environment. A recent study found that there are diversity creates inefficiencies or impedes effectiveness. Historically,
no problems if mobile devices are located more than1 m from medical health care businesses in the United States are independent from each
electronic equipment. Already a number of handheld computers can be other. The first phase of implemented HIT products was based on ven-
24
used to interface with patient EMR (Fig. 8-4); however, access to medi- dors’ standards, with each standard vying for primacy in an emerging
cal reference information is currently the most common use of handheld market.
devices for medical practitioners. 25 Integrating the Healthcare Enterprise (IHE) is a joint initiative by
health care professionals and industry that promotes the coordinated
use of established standards such as DICOM and HL7 for transmis-
“MEANINGFUL USE” OF HIT IN THE ICU sion of data within the EHR. In 1996, president Bill Clinton signed into
■ STANDARDS FOR INTEROPERABILITY law the Health Insurance Portability and Accountability Act (HIPAA).
HIPPA was designed to make insurance more affordable and accessible.
One of the key advantages of the digitalization of the medical record is An important part of this law was designed to simplify administrative
that it should allow the free exchange of information between practitio- processes and protect the confidentiality of personal health informa-
ners and patients. In order to make information exchange a reality, the tion. HIPPA includes four standards or rules: (1) Privacy, (2) Security,

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