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Application of ICT for Health in Clinical Settings
The document provides an overview of the application of information and communication technologies (ICT) in clinical health settings. It discusses how health information is integral to healthcare and how ICT can help address issues like medical errors by improving access to patient data and care coordination. The speaker has experience implementing health IT systems and is a lecturer on health informatics. They will cover topics like the role of ICT in healthcare delivery and management, health informatics as a field of study, Thailand's national eHealth initiatives, and current trends shaping the use of technology in medicine.
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Similar to Application of ICT for Health in Clinical Settings
Application of ICT for Health in Clinical Settings
- 1. Application of ICTfor Health in Clinical Settings Kasetsart University April 2, 2015 Nawanan Theera-Ampornpunt, M.D., Ph.D. Department of Community Medicine Faculty of Medicine Ramathibodi Hospital SlideShare.net/Nawanan
- 2. 2 2003 M.D. (First-ClassHonors) (Ramathibodi) 2009 M.S. in Health Informatics (U of MN) 2011 Ph.D. in Health Informatics (U of MN) • Deputy Executive Director for Informatics (CIO/CMIO) Chakri Naruebodindra Medical Institute • Lecturer, Department of Community Medicine Faculty of Medicine Ramathibodi Hospital Mahidol University [email protected] SlideShare.net/Nawanan http://groups.google.com/group/ThaiHealthIT Introduction
- 3. 3 Outline • Health &Health Information • Health IT & eHealth • Health Informatics as a Discipline • Thailand’s eHealth Situation • Current Forces
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- 5. 5 Let’s take alook at these pictures...
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- 8. 8ER - ImageSource: nj.com Healthcare (on TV)
- 9. 9 (At an undisclosednearby hospital) Healthcare (Reality)
- 10. 10 • Life-or-Death • Difficultto 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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- 12. 12 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) What Clinicians Want?
- 13. 13 • 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. High Quality Care
- 14. 14 Information is Everywherein Healthcare
- 15. 15 “Information” in Medicine ShortliffeEH. Biomedical informatics in the education of physicians. JAMA. 2010 Sep 15;304(11):1227-8.
- 16. 16 16 WHO (2009) Components ofHealth Systems
- 17. 17 17 WHO (2009) WHO HealthSystem Framework
- 18. 18 Outline Health & HealthInformation • Health IT & eHealth • Health Informatics as a Discipline • Thailand’s eHealth Situation • Current Forces
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- 20. 20 (IOM, 2001)(IOM, 2000)(IOM, 2011) Landmark IOM Reports
- 21. 21 • To Erris 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 errors Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US: Regulating Healthcare - Lecture d Patient Safety
- 22. 22 • Humans arenot 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 IOM Reports Summary
- 23. 23 Image 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
- 24. 24Image Source: SuthanSrisangkaew, Department of Pathology, Facutly of Medicine Ramathibodi Hospital To Err is Human 2: Memory
- 25. 25 • Cognitive Errors- Example: Decoy Pricing The Economist Purchase Options • Economist.com subscription $59 • Print subscription $125 • Print & web subscription $125 Ariely (2008) 16 0 84 The Economist Purchase Options • Economist.com subscription $59 • Print & web subscription $125 68 32 # of People # of People To Err is Human 3: Cognition
- 26. 26 • It alreadyhappens.... (Mamede et al., 2010; Croskerry, 2003; Klein, 2005; Croskerry, 2013) What If This Happens in Healthcare?
- 27. 27 Mamede S, vanGog 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. Cognitive Biases in Healthcare
- 28. 28 Croskerry P. Theimportance of cognitive errors in diagnosis and strategies to minimize them. Acad Med. 2003 Aug;78(8):775-80. Cognitive Biases in Healthcare
- 29. 29 Klein JG. Fivepitfalls 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” Cognitive Biases in Healthcare
- 30. 30 • Medication Errors –DrugAllergies –Drug Interactions • Ineffective or inappropriate treatment • Redundant orders • Failure to follow clinical practice guidelines Common Errors
- 31. 31 Why We NeedICT in Healthcare? #1: Because information is everywhere in healthcare
- 32. 32 Why We NeedICT in Healthcare? #2: Because healthcare is error-prone and technology can help
- 33. 33 Why We NeedICT in Healthcare? #3: Because access to high-quality patient information improves care
- 34. 34 Why We NeedICT in Healthcare? #4: Because healthcare at all levels is fragmented & in need of process improvement
- 35. 35 Use of informationand communications technology (ICT) in health & healthcare settings Source: The Health Resources and Services Administration, Department of Health and Human Service, USA Slide adapted from: Dr. Boonchai Kijsanayotin Health IT
- 36. 36 Use of informationand 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 & Dr. Boonchai Kijsanayotin eHealth
- 37. 37 eHealth HealthIT Slide adapted from: Dr. Boonchai Kijsanayotin eHealth & Health IT
- 38. 38 HIS All information abouthealth eHealth HMIS mHealth Tele- medicine Slide adapted from: Karl Brown (Rockefeller Foundation), via Dr. Boonchai Kijsanayotin More Terms...
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- 40. 40 All componentsare essential All components should be balanced Slide adapted from: Dr. Boonchai Kijsanayotin eHealth Components: WHO-ITU Model
- 41. 41 Hospital Information System(HIS) Computerized Provider Order Entry (CPOE) Electronic Health Records (EHRs) Picture Archiving and Communication System (PACS) Screenshot Images from Faculty of Medicine Ramathibodi Hospital, Mahidol University Various Forms of Health IT
- 42. 42 mHealth Biosurveillance Telemedicine & Telehealth Images fromApple 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
- 43. 43 • Guideline adherence •Better documentation • Practitioner decision making or process of care • Medication safety • Patient surveillance & monitoring • Patient education/reminder Documented Values of Health IT
- 44. 44 • Master PatientIndex (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) Some Hospital IT - Enterprise-wide
- 45. 45 • 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 Some Hospital IT - Departmental Systems
- 46. 46 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
- 47. 47 Computerized Provider OrderEntry (CPOE)
- 48. 48 Values • No handwriting!!! •Structured data entry: Completeness, clarity, fewer mistakes (?) • No transcription errors! • Streamlines workflow, increases efficiency Computerized Provider Order Entry (CPOE)
- 49. 49 • The realplace 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)
- 50. 50 – 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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- 54. 54Image Source: http://geekdoctor.blogspot.com/2008/04/designing-ideal-electronic-health.html SomeOther CDS - Abnormal Lab Highlights
- 55. 55 External Memory Knowledge Data LongTerm Memory Knowledge Data Inference DECISION PATIENT Perception Attention Working Memory CLINICIAN Elson, Faughnan & Connelly (1997) Clinical Decision Making & CDS
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- 57. 57Image Source: englishmoviez.com Riseof the Machines
- 58. 58 • CDS asa 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
- 59. 59 The “Human Factor” •Alert fatigue Unintended Consequences of Health IT
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- 61. 61 Hospital A HospitalB Clinic C Government Lab Patient at Home The Big Picture: Health Information Exchange (HIE)
- 62. 62 Outline Health & HealthInformation Health IT & eHealth • Health Informatics as a Discipline • Thailand’s eHealth Situation • Current Forces
- 63. 63 Health Informatics as aDiscipline
- 64. 64 M/B/H Informatics AsA Field (Shortliffe, 2002)
- 65. 65(Hersh, 2009) M/B/H InformaticsAs a Discipline
- 66. 66 Biomedical/ Health Informatics Computer & Information Science Engineering Cognitive & Decision Science Social Sciences (Psychology, Sociology, Linguistics, Law & Ethics) Statistics & Research MethodsMedical Sciences & Public Health Management Library Science, Information Retrieval, KM And More! M/B/H Informatics & Other Fields
- 67. 67 Outline Health & HealthInformation Health IT & eHealth Health Informatics as a Discipline • Thailand’s eHealth Situation • Current Forces
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- 69. 69 eHealth in Thailand:The current status. Stud Health Technol Inform 2010;160:376–80, Presented at MedInfo2010 South Africa Thailand’s eHealth: 2010
- 70. 70Slide adapted from:Dr. Boonchai Kijsanayotin Thailand: Unbalanced Development
- 71. 71 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: Dr. Boonchai Kijsanayotin eHealth Development Model
- 72. 72Slide adapted from:Dr. Boonchai Kijsanayotin Thailand’s eHealth Development
- 73. 73 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
- 74. 74 Section 1 HospitalProfile Section 2 IT Adoption & Use Profile Section 3 Respondent’s Information Thailand’s Health IT Adoption
- 75. 75 • 4 of1,302 hospitals ineligible • Response rate 69.9% Characteristic Overall Responding Hospitals Non- Responding Hospitals N of eligible hospitals 1,298 908 390 Bed size** 106.9 117.5 82.9 Public status** Private Public 24.0% 76.0% 17.4% 82.6% 39.2% 60.8% Geography* Central East North Northeast South West 33.4% 7.5% 11.1% 27.1% 15.3% 5.6% 31.1% 7.8% 13.5% 26.9% 14.9% 5.8% 39.0% 6.7% 5.4% 27.7% 16.2% 5.1% *p < 0.01, **p < 0.001. Nationwide Survey Results
- 76. 76Pongpirul et al.,2004 Vendor/Product Distribution (2004)
- 77.
- 78. 78 Estimate (Partial orComplete Adoption) Nationwide Basic EHR, outpatient 86.6% Basic EHR, inpatient 50.4% Basic EHR, both settings 49.8% Comprehensive EHR, outpatient 10.6% Comprehensive EHR, inpatient 5.7% Comprehensive EHR, both settings 5.3% Order entry of medications, outpatient 96.5% Order entry of medications, inpatient 91.4% Order entry of medications, both settings 90.2% Order entry of all orders, outpatient 88.6% Order entry of all orders, inpatient 81.7% Order entry of all orders, both settings 79.4% Health IT Adoption Estimates
- 79. 79 • High ITadoption rates • Drastic changes in adoption landscape • Local context might play a role – Supply Side – Demand Side • International Comparison – Relatively higher adoption THAIS: Discussion
- 80. 80 Outline Health & HealthInformation Health IT & eHealth Health Informatics as a Discipline Thailand’s eHealth Situation • Current Forces
- 81.
- 82. 82 International • Technology Trends •Standards & Interoperability Trends • eHealth Successes & Failures – UK NHS – US Meaningful Use – Nordic Countries • International eHealth Networks – International Medical Informatics Association (IMIA) – American Medical Informatics Association (AMIA) – Asia eHealth Information Network (AeHIN) Current Forces
- 83. 83 URGES Member States: (1)to consider, as appropriate, options to collaborate with relevant stakeholders, including national authorities, relevant ministries, health care providers, and academic institutions, in order to draw up a road map for implementation of ehealth and health data standards at national and subnational levels; (2) to consider developing, as appropriate, policies and legislative mechanisms linked to an overall national eHealth strategy, in order to ensure compliance in the adoption of ehealth and health data standards by the public and private sectors, as appropriate, and the donor community, as well as to ensure the privacy of personal clinical data; http://apps.who.int/gb/ebwha/pdf_files/WHA66/A66_R24-en.pdf World Health Assembly Resolution WHA66.24 (2013) on eHealth Standardization & Interoperability
- 84. 84 (3) to considerways for ministries of health and public health authorities to work with their national representatives on the ICANN Governmental Advisory Committee in order to coordinate national positions towards the delegation, governance and operation of health-related global top-level domain names in all languages, including “.health”, in the interest of public health; http://apps.who.int/gb/ebwha/pdf_files/WHA66/A66_R24-en.pdf World Health Assembly Resolution WHA66.24 (2013) on eHealth Standardization & Interoperability
- 85. 85 Domestic • Thailand’s HealthInsurance Trends • Increased Hospital IT Adoption • Demands for Data & Information Exchange in Thailand’s Healthcare • Thailand’s e-Transaction Trends • Consumer IT Behavior Trends Current Forces
- 86. 86 Outline Health & HealthInformation Health IT & eHealth Health Informatics as a Discipline Thailand’s eHealth Situation Current Forces
- 87. 87Image Source: http://twinstrivia.com/2013/05/20/the-road-to-minnesota-is-long-and-hard/ TheJourney Beyond: A Long and Winding Road