Tuesday, November 1, 2016

Update on Complementary and Alternative Medicine (CAM) and Integrative Health Information Systems

Complementary and alternative medicine (CAM) is a group of diverse medical and health care systems, practices, and products that are not widely accepted within the realm of conventional medicine. Yet, consumers have increasingly turned to complementary and alternative medicine (CAM) in order to enhance their health and well-being. CAM includes acupuncture, chiropractic medicine, osteopathic medicine, homeotherapy, use of natural herbal remedies and other practices to augment conventional medical treatments. The marketplace reflects the growing acceptance of complementary medicine by many patients and a growing number of health care providers.

In this article, the author advocates developing and further integrating CAM software modules into today's electronic health record (EHR) and personal health record (PHR) systems. By gathering and integrating health care information associated with the application of CAM procedures into a patient's electronic medical record, more accurate measurement of outcomes can be generated. Best practices can then emerge showing which CAM practices are most effective - when used by themselves or coupled with conventional medical treatments for specific disorders.

Definitions

Complementary and Alternative Medicine (CAM) includes a broad domain of healing resources that encompasses all health systems, modalities, and practices and their accompanying theories and beliefs that are often not embraced by conventional, mainstream medicine. CAM therapies are called Complementary when they are used in addition to conventional medical treatments. They are termed as Alternative when they are used instead of conventional treatment.

Integrative Medicine, as defined by National Center for Complementary & Integrative Health (NCCIH), combines mainstream medical therapies and CAM therapies for which there is some high-quality scientific evidence of safety and effectiveness.

Major Complementary & Alternative Medicine (CAM) Categories

The National Center for Complementary & Integrative Health (NCCIH) classifies most complementary and alternative medical products and activities into one of three subgroups—Natural Products, Mind & Body Practices, and Other CAM Therapies.

Natural Products

This subgroup includes a variety of products, such as herbs, vitamins and minerals, and probiotics. They are widely marketed, readily available to consumers, and often sold as dietary supplements.

Mind & Body Practices


Mind and body practices include a large and diverse group of procedures or techniques administered or taught by a trained practitioner or teacher. The 2012 NHIS showed that yoga, chiropractic manipulation, osteopathy, meditation, and massage therapy are among the most popular mind and body practices used by adults. Other mind and body practices include acupuncture, relaxation techniques, tai chi, healing touch, hypnotherapy, and other movement therapies

Other CAM Therapies


In addition to the two broad areas discussed above, there are some some approaches that do not fit neatly into either of those groups. These other practices include traditional healers, Ayurvedic medicine, traditional Chinese medicine, homeopathy, and naturopathy.

Statistics on CAM Therapy Usage

The following are the 10 most commonly used Complementary & Alternative Medicine (CAM) therapies in the US according to a 2008 report published by NCCAM. The report shows that use of CAM has continued to increase to over 38% of American adults now receiving these treatments.

  • Herbalism & Natural Products (17.7%)
  • Deep Breathing (12.7%)
  • Meditation (9.4%)
  • Chiropractic & Osteopathic (8.6%)
  • Massage (8.3%)
  • Yoga (6.1%)
  • Diet-based therapy (3.6%)
  • Progressive relaxation (2.9%)
  • Guided Imagery (2.2%)
  • Homeopathic Treatment (1.8%)

Major CAM Organizations

The National Center for Complementary & Integrative Health (NCCIH) is the Federal Government's lead agency for scientific research on CAM. The NCCIH is dedicated to exploring complementary and alternative healing practices in the context of rigorous science, training CAM researchers, and disseminating authoritative information to the public and professionals.

The NIH Office of Cancer Complementary and Alternative Medicine (OCCAM) was established back in October 1998 to coordinate and further enhance the activities of the National Cancer Institute (NCI) in the arena of complementary and alternative medicine (CAM).


Native-American Indian Healing

There has been a steady surge of interest in the therapies of traditional cultures during recent years and patients' use of alternative medicine, mind-body healing therapies, and behavioral medicine treatments for chronic medical illness. Increasingly, traditional Native American healing practices are being requested by Native Americans and Non-Native peoples alike. Some hospitals have included traditional Native American healers as part of their staff. For example, Harvard University and Brigham & Women's Hospital have established the OSHER Center for Integrative Medicine.

Some of the spiritual approaches which patients may request, especially in the American Southwest, are Native American Healing (NAH) practices that are used to complement conventional medical treatment. Some Native-American patients even voice a preference for exclusive use of NAH.

The Market

In a 2005 report on Complementary and Alternative Medicine (CAM) in the U.S., the Board on Health Promotion & Disease Prevention states that the total visits to CAM providers exceed total visits to all primary-care physicians. In a 2009 report, NCCIH reported that out-of-pocket costs for CAM by adults in the U.S. exceeded $33 billion. A more recent Grand View Research 2014 Report reconfirmed that the global market for alternative medicine and therapies still remains well over $30 billion in size.

In particular, it should be noted that North America is one of the largest complementary and alternative medicine markets in the world. According to a national survey, in a given year more than 35.0% of all Americans incorporate some kind of alternative therapy into their healthcare routine. For example, more than 3 million people in the U.S. use acupuncture and around 2% of the Americans use homeopathy for the prevention or treatment of chronic diseases.

A 2013 article in the Smithsonian reinforces the point that alternative treatments and therapies are gaining popularity in the U.S., where around 50% of people say they have used them. That does not include those therapies or treatments covered by insurance. Hospitals, managed care plans, and conventional practitioners are now incorporating CAM therapies into their practices. In addition, medical schools, nursing schools, and schools of pharmacy now teach their students about CAM. Clearly, the CAM industry is big business.

Finally, despite the billions of dollars spent on these remedies each year, only a third of them have ever been scientifically tested. As USA Today reports, many American consumers cite distrust of big pharmaceutical companies as one of the main reasons they often lean toward using traditional therapies.

Electronic Health Records (EHR) and CAM Systems

The Healthcare Information and Management Systems Society (HIMSS) defines the Electronic Health Record (EHR) as a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports. See http://www.himss.org/ASP/topics_ehr.asp

According to the American Health Information Management Association (AHIMA), the Personal Health Record (PHR) is an electronic, lifelong resource of health information needed by individuals to make health decisions. Individuals own and manage the information in their PHR, which comes from both health care providers and the individual patients themselves. For more detail, see http://library.ahima.org/xpedio/groups/public/documents/ahima/pub_bok1_027351.html

Most modern EHR and PHR systems to date have been developed to meet the requirements of conventional Western medical practitioners. As work groups continue to formulate the standards and functional requirements for certified EHR and PHR systems of the future, one of the areas that ought to be addressed is the added domain of complementary and alternative medicine (CAM).

Examples of CAM Computer Systems & Software

The following are links to a few of the hundreds of examples of commercial-off-the-shelf and 'open source' CAM software products that are currently available:


In other words, take the time to search the Internet and you'll find a growing range of Complementary and Alternative Medicine (CAM) and Integrative Health software solutions.

Key Findings & Conclusions

To gain more acceptance, there is a need to utilize the power of advanced computational systems to introduce more rigor in capturing and analyzing data related to complementary and alternative medicine practices. By gathering and integrating health care information associated with the application of CAM procedures into a patient's electronic health record (EHR), more accurate measurement of outcomes can be generated. Best practices can them emerge showing which complementary medical practices are most effective when coupled with conventional medical treatments for specific disorders.

At present, there appear to be a number of companies marketing CAM software modules. There are also a number of open source CAM solutions now available. However, none of the companies appear to have taken any major steps forward to integrate these products and data with PHR or EHR systems. There also seems to be little coordinated activity related to standardizing data elements within the major CAM domains.

Recommended Next Steps

There are a number of recommendations and next steps for health care organizations should consider taking with regards to development of CAM software modules to be integrated within their EHR systems:

  • Conduct more detailed research into CAM health information systems
  • Identify and prioritize CAM software modules to be developed and/or integrated within EHR and PHR systems, e.g. acupuncture, chiropractic, etc.
  • Initiate a collaborative, open source initiatives to develop key CAM software modules
  • Initiate efforts to identify and standardize data elements for each CAM domain
  • Develop a prototype and begin pilot tests of high priority CAM modules
  • Develop and release production versions of CAM software modules
  • Integrate CAM software modules with PHR and/or EHR systems
  • Put in place mechanisms needed to refine and further enhance CAM modules
  • Encourage efforts to analyze, evaluate, and report on the outcomes of complementary and alternative medicine therapies using data collected by CAM modules in EHR and PHR systems

Selected References & Web Sites





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