Download - ICT Applications for Healthcare
ICT Applications for HealthcareMUICT Seminar
Nawanan Theera-Ampornpunt, M.D., Ph.D.Faculty of Medicine Ramathibodi Hospital
February 19, 2014
SlideShare.net/Nawanan
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A Bit About Myself...
2003 M.D. (First-Class Honors) (Ramathibodi)2009 M.S. in Health Informatics (U of MN)2011 Ph.D. in Health Informatics (U of MN)2012 Certified HL7 CDA Specialist
• Deputy Executive Director for Informatics (CIO/CMIO) Chakri Naruebodindra Medical Institute
• Lecturer, Department of Community MedicineFaculty of Medicine Ramathibodi HospitalMahidol University
[email protected]://groups.google.com/group/ThaiHealthIT
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Outline
• Healthcare & Information• Why We Need ICT in Healthcare• Health IT & eHealth• Some ICT Applications• A Dream for Healthcare• Food for Thought for ICT Folks• Q&A
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Let’s take a look at these pictures...
5Image Source: Guardian.co.uk
Manufacturing
6Image Source: http://www.oknation.net/blog/phuketpost/2013/10/19/entry-3
Banking
7ER - Image Source: nj.com
Healthcare (on TV)
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Healthcare
(At an undisclosed nearby hospital)
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• Life-or-Death• Difficult to automate human decisions
– Nature of business– Many & varied stakeholders– Evolving standards of care
• Fragmented, poorly-coordinated systems• Large, ever-growing & changing body of
knowledge• High volume, low resources, little time
Why Healthcare Isn’t Like Any Others
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Back to something simple...
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What Clinicians Want?
To treat & to care for their patients to their best abilities, given limited time & resources
Image Source: http://en.wikipedia.org/wiki/File:Newborn_Examination_1967.jpg (Nevit Dilmen)
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High Quality Care
• Safe• Timely• Effective• Patient-Centered• Efficient• Equitable
Institute of Medicine, Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy Press; 2001. 337 p.
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Information is Everywhere in Healthcare
Shortliffe EH. Biomedical informatics in the education of physicians. JAMA. 2010 Sep 15;304(11):1227-8.
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“Information” in Medicine
Shortliffe EH. Biomedical informatics in the education of physicians. JAMA. 2010 Sep 15;304(11):1227-8.
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Outline
“Information” in Healthcare• Why We Need ICT in Healthcare• Health IT & eHealth• Some ICT Applications• A Dream for Healthcare• Food for Thought for ICT Folks• Q&A
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Why We Need ICT in Healthcare?
#1: Because information is everywhere in healthcare
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(IOM, 2001)(IOM, 2000) (IOM, 2011)
Landmark IOM Reports
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Patient Safety
• To Err is Human (IOM, 2000) reported that: – 44,000 to 98,000 people die in U.S.
hospitals each year as a result of preventable medical mistakes
– Mistakes cost U.S. hospitals $17 billion to $29 billion yearly
– Individual errors are not the main problem– Faulty systems, processes, and other
conditions lead to preventable errorsHealth IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US: Regulating Healthcare - Lecture d
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IOM Reports Summary
• Humans are not perfect and are bound to make errors
• Highlight problems in U.S. health care system that systematically contributes to medical errors and poor quality
• Recommends reform• Health IT plays a role in improving patient
safety
20Image Source: (Left) http://docwhisperer.wordpress.com/2007/05/31/sleepy-heads/ (Right) http://graphics8.nytimes.com/images/2008/12/05/health/chen_600.jpg
To Err is Human 1: Attention
21Image Source: Suthan Srisangkaew, Department of Pathology, Facutly of Medicine Ramathibodi Hospital, Mahidol University
To Err is Human 2: Memory
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To Err is Human 3: Cognition
• Cognitive Errors - Example: Decoy Pricing
The Economist Purchase Options
• Economist.com subscription $59• Print subscription $125• Print & web subscription $125
Ariely (2008)
16084
The Economist Purchase Options
• Economist.com subscription $59• Print & web subscription $125
6832
# of People
# of People
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• It already happens....(Mamede et al., 2010; Croskerry, 2003; Klein, 2005; Croskerry, 2013)
What If This Happens in Healthcare?
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Cognitive Biases in Healthcare
Mamede S, van Gog T, van den Berge K, Rikers RM, van Saase JL, van Guldener C, Schmidt HG. Effect of availability bias and reflective reasoning on diagnostic accuracy among internal medicine residents. JAMA.
2010 Sep 15;304(11):1198-203.
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Cognitive Biases in Healthcare
Croskerry P. The importance of cognitive errors in diagnosis and strategies to minimize them. Acad Med. 2003 Aug;78(8):775-80.
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Cognitive Biases in Healthcare
Klein JG. Five pitfalls in decisions about diagnosis and prescribing. BMJ. 2005 Apr 2;330(7494):781-3.
“Everyone makes mistakes. But our reliance on cognitive processes prone to bias makes treatment errors more likely
than we think”
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• Medication Errors
– Drug Allergies
– Drug Interactions
• Ineffective or inappropriate treatment
• Redundant orders
• Failure to follow clinical practice guidelines
Common Errors
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Why We Need ICT in Healthcare?
#2: Because healthcare is error-prone and technology
can help
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Fragmented Healthcare
http://www.dplindbenchmark.com/wp-content/uploads/2013/02/HHRI-Our-Health-Care-River.pdf
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Why We Need ICT in Healthcare?
#3: Because access to high-quality patient
information improves care
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Why We Need ICT in Healthcare?
#4: Because healthcare at all levels is fragmented &
in need of process improvement
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Outline
“Information” in HealthcareWhy We Need ICT in Healthcare• Health IT & eHealth• Some ICT Applications• A Dream for Healthcare• Food for Thought for ICT Folks• Q&A
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Use of information and communications technology (ICT) in health & healthcare
settings
Source: The Health Resources and Services Administration, Department of Health and Human Service, USA
Slide adapted from: Boonchai Kijsanayotin
Health IT
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Use of information and communications technology (ICT) for health; Including
• Treating patients• Conducting research• Educating the health workforce• Tracking diseases• Monitoring public health.
Sources: 1) WHO Global Observatory of eHealth (GOe) (www.who.int/goe)2) World Health Assembly, 2005. Resolution WHA58.28
Slide adapted from: Mark Landry, WHO WPRO & Boonchai Kijsanayotin
eHealth
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eHealth Health IT
Slide adapted from: Boonchai Kijsanayotin
eHealth & Health IT
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HIS
All information about health
eHealthHMIS
mHealth
Tele-medicine
Slide adapted from: Karl Brown (Rockefeller Foundation), via Boonchai Kijsanayotin
More Terms
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HealthInformationTechnology
Goal
Value-Add
Tools
Health IT: What’s in a Word?
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All components are essential All components should be balanced
Slide adapted from: Boonchai Kijsanayotin
eHealth Components (WHO-ITU Model)
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eHealth in Thailand: The current status. Stud Health Technol Inform 2010;160:376–80, Presented at MedInfo2010 South Africa
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Thailand’s eHealth: 2010
40Slide adapted from: Boonchai Kijsanayotin
Thailand: Unbalanced Development
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eHealth Applications
Enabling Policies & Strategies
Foundation Policies & Strategies
• Services• Applications• Software
• Standards & Interoperability
• Capability Building
• Leadership & Governance
• Legislation & Policy• Strategy & Investment • Infrastructure
Slide adapted from: Boonchai Kijsanayotin
eHealth Development Model
42Slide adapted from: Boonchai Kijsanayotin
Thailand’s eHealth Development
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Silo-type systems Little integration and interoperability Mostly aim for administration and management 40% of work-hours spent on managing reports and
documents Lack of national leadership and governance body Inadequate HIS foundations development
Slide adapted from: Boonchai Kijsanayotin
Thailand’s eHealth Situation
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Outline
“Information” in HealthcareWhy We Need ICT in HealthcareHealth IT & eHealth• Some ICT Applications• A Dream for Healthcare• Food for Thought for ICT Folks• Q&A
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Hospital Information System (HIS) Computerized Provider Order Entry (CPOE)
Electronic Health
Records (EHRs)
Picture Archiving and Communication System
(PACS)
Various Forms of Health IT
Screenshot Images from Faculty of Medicine Ramathibodi Hospital, Mahidol University
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mHealth
Biosurveillance
Telemedicine & Telehealth
Images from Apple Inc., Geekzone.co.nz, Google, HealthVault.com and American Telecare, Inc.
Personal Health Records (PHRs) and Patient Portals
Still Many Other Forms of Health IT
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• Guideline adherence• Better documentation• Practitioner decision making or
process of care• Medication safety• Patient surveillance & monitoring• Patient education/reminder
Values of Health IT
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• Master Patient Index (MPI)• Admit-Discharge-Transfer (ADT)• Electronic Health Records (EHRs)• Computerized Physician Order Entry (CPOE)• Clinical Decision Support Systems (CDS)• Picture Archiving and Communication System
(PACS)• Nursing applications• Enterprise Resource Planning (ERP)
Enterprise-wide Hospital IT
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• Pharmacy applications
• Laboratory Information System (LIS)
• Radiology Information System (RIS)
• Specialized applications (ER, OR, LR, Anesthesia, Critical Care, Dietary Services, Blood Bank)
• Incident management & reporting system
Departmental IT in Hospitals
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The Challenge - Knowing What It Means
Electronic Medical Records (EMRs)
Computer-Based Patient Records
(CPRs)
Electronic Patient Records (EPRs)
Electronic Health Records (EHRs)
Personal Health Records (PHRs)
Hospital Information System
(HIS)
Clinical Information System (CIS)
EHRs & HIS
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Computerized Provider Order Entry (CPOE)
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Values
• No handwriting!!!• Structured data entry: Completeness, clarity,
fewer mistakes (?)• No transcription errors!• Streamlines workflow, increases efficiency
Computerized Provider Order Entry (CPOE)
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• The real place where most of the values of health IT can be achieved
– Expert systems• Based on artificial intelligence,
machine learning, rules, or statistics
• Examples: differential diagnoses, treatment options(Shortliffe, 1976)
Clinical Decision Support Systems (CDS)
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– Alerts & reminders• Based on specified logical conditions• Examples:
– Drug-allergy checks– Drug-drug interaction checks– Reminders for preventive services– Clinical practice guideline integration
Clinical Decision Support Systems (CDS)
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Example of “Reminders”
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• Reference information or evidence-based knowledge sources– Drug reference databases– Textbooks & journals– Online literature (e.g. PubMed)– Tools that help users easily access
references (e.g. Infobuttons)
More CDS Examples
57Image Source: https://webcis.nyp.org/webcisdocs/what-are-infobuttons.html
Infobuttons
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• Pre-defined documents– Order sets, personalized “favorites”– Templates for clinical notes– Checklists– Forms
• Can be either computer-based or paper-based
Other CDS Examples
59Image Source: http://www.hospitalmedicine.org/ResourceRoomRedesign/CSSSIS/html/06Reliable/SSI/Order.cfm
Order Sets
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• Simple UI designed to help clinical decision making– Abnormal lab highlights– Graphs/visualizations for lab results– Filters & sorting functions
Other CDS Examples
61Image Source: http://geekdoctor.blogspot.com/2008/04/designing-ideal-electronic-health.html
Abnormal Lab Highlights
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External Memory
Knowledge Data
Long Term Memory
Knowledge Data
Inference
DECISION
PATIENT
Perception
Attention
WorkingMemory
CLINICIAN
Elson, Faughnan & Connelly (1997)
Clinical Decision Making
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Abnormal lab highlights
Clinical Decision Making
External Memory
Knowledge Data
Long Term Memory
Knowledge Data
Inference
DECISION
PATIENT
Perception
Attention
WorkingMemory
CLINICIAN
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Clinical Decision Making
External Memory
Knowledge Data
Long Term Memory
Knowledge Data
Inference
DECISION
PATIENT
Perception
Attention
WorkingMemory
CLINICIANDrug-Allergy
Checks
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External Memory
Knowledge Data
Long Term Memory
Knowledge Data
Inference
DECISION
PATIENT
Perception
Attention
WorkingMemory
CLINICIAN
Elson, Faughnan & Connelly (1997)
Clinical Decision Making
Drug-Drug Interaction
Checks
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External Memory
Knowledge Data
Long Term Memory
Knowledge Data
Inference
DECISION
PATIENT
Perception
Attention
WorkingMemory
CLINICIAN
Elson, Faughnan & Connelly (1997)
Clinical Decision Making
Clinical Practice Guideline
Reminders
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External Memory
Knowledge Data
Long Term Memory
Knowledge Data
Inference
DECISION
PATIENT
Perception
Attention
WorkingMemory
CLINICIAN
Elson, Faughnan & Connelly (1997)
Clinical Decision Making
Diagnostic/Treatment Expert Systems
68Image Source: socialmediab2b.com
IBM’s Watson
69Image Source: englishmoviez.com
Rise of the Machines?
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• CDSS as a replacement or supplement of clinicians?– The demise of the “Greek Oracle” model (Miller & Masarie, 1990)
The “Greek Oracle” Model
The “Fundamental Theorem” Model
Friedman (2009)
Wrong Assumption
Correct Assumption
Proper Roles of CDS
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Some risks• Alert fatigue
Unintended Consequences of Health IT
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Workarounds
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Outline
“Information” in HealthcareWhy We Need ICT in HealthcareHealth IT & eHealthSome ICT Applications• A Dream for Healthcare• Food for Thought for ICT Folks• Q&A
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Hospital A Hospital B
Clinic C
Government
Lab Patient at Home
Health Information Exchange (HIE)
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Standards & Interoperability in HIE
Technical Standards (TCP/IP, encryption,
security)
Exchange Standards (HL7 v.2, HL7 v.3 Messaging, HL7 CDA,
DICOM)
Vocabularies, Terminologies, Coding Systems (ICD-10, ICD-9,
CPT, SNOMED CT, LOINC)
Information Models (HL7 v.3 RIM, ASTM CCR, HL7 CCD)
Standard Data Sets
Functional Standards (HL7 EHRFunctional Specifications)
Some may be hybrid: e.g. HL7 v.3, HL7 CCD
Unique ID
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Hospital A Hospital B
Clinic C
Government
Lab Patient at Home
Message
Message
Message
MessageMessage
Message Exchange
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• As the second formally-trained M.D., Ph.D. in Health Informatics in Thailand, I am driven and socially obligated...
• To promote personal & population health through establishment of sustainable foundations for eHealth and strengthening of the field of Biomedical and Health Informatics in Thailand before my end of life.
• HIE is at the heart of my life-long dream
My “Mission in Life”
78http://www.ega.or.th/Content.aspx?m_id=94
Cloud: To Go or Not To Go?
79WHO mHealth Report: http://www.who.int/goe/publications/goe_mhealth_web.pdf
Roles of mHealth in Future Healthcare
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Outline
“Information” in HealthcareWhy We Need ICT in HealthcareHealth IT & eHealthSome ICT ApplicationsA Dream for Healthcare• Food for Thought for ICT Folks• Q&A
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• What will the future be for healthcare?• Where’s the roles of ICT professionals in
future healthcare?• How to leverage different perspectives &
strengths to achieve common goals?• How will we shape future healthcare
together?
Some Food for Thought
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Patients Are Counting on Us...
Image Source: http://www.flickr.com/photos/childrensalliance/3191862260/
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Intelligent & helpful robots
Intelligent humanistic robots in a human world
Machines that replace humans for a “better” world
HAL 9000 Data David NS-5
Dangerous killer machines
What ICT Will It Be?
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More Resources
• American Medical Informatics Association (AMIA)www.amia.org
• International Medical Informatics Association (IMIA)www.imia.org
• Thai Medical Informatics Association (TMI)www.tmi.or.th
• Asia eHealth Information Network (AeHIN)www.aehin.org
• ThaiHealthIT Google Groups Mailing Listhttp://groups.google.com/group/ThaiHealthIT
• Thai Health Informatics Academy
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Outline
“Information” in HealthcareWhy We Need ICT in HealthcareHealth IT & eHealthSome ICT ApplicationsA Dream for HealthcareFood for Thought for ICT Folks• Q&A