overview of health it

Overview of Health IT

Nawanan Theera-Ampornpunt, M.D., Ph.D.Faculty of Medicine Ramathibodi Hospital

June 26, 2014

SlideShare.net/Nawanan

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Outline

• “Information” in Healthcare• Health IT & eHealth• Some Health IT Applications• A Dream for Healthcare• Q&A

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Let’s take a look at these pictures...

4Image Source: Guardian.co.uk

Manufacturing

5Image Source: http://www.oknation.net/blog/phuketpost/2013/10/19/entry-3

Banking

6ER - 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• Health IT & eHealth• Some Health IT Applications• A Dream for Healthcare• Q&A

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(IOM, 2001)(IOM, 2000) (IOM, 2011)

Landmark IOM Reports

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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

17Image 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

18Image 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

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Ariely (2008)

16084

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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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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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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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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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HealthInformationTechnology

Goal

Value-Add

Tools

Health IT: What’s in a Word?

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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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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

38Image 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

40Image 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

42Image 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


External Memory

Knowledge Data

Long Term Memory

Knowledge Data

Inference

DECISION

PATIENT

Perception

Attention

WorkingMemory

CLINICIAN

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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



Drug-Drug Interaction

Checks

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External Memory

Knowledge Data

Long Term Memory

Knowledge Data

Inference

DECISION

PATIENT

Perception

Attention

WorkingMemory

CLINICIAN



Clinical Practice Guideline

Reminders

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External Memory

Knowledge Data

Long Term Memory

Knowledge Data

Inference

DECISION

PATIENT

Perception

Attention

WorkingMemory

CLINICIAN



Diagnostic/Treatment Expert Systems

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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 HealthcareHealth IT & eHealthSome Health IT Applications• A Dream for Healthcare• 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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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 HealthcareHealth IT & eHealthSome Health IT ApplicationsA Dream for Healthcare• Q&A

overview of health it

Health & Medicine