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.
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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).
You might also want
to consider visiting the web sites of the American
Botanical Council, American
Chiropractic Association, American
Osteopathic Association, American
Association of Acupuncture & Oriental Medicine, National
Center for Homeotherapy
(NCH), or the National Association
of Nutrition Professionals (NANP)
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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