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![51
But...
• “Don’t implement technology just for technology’s
sake.”
• “Don’t make use of excellent technology.
Make excellent use of technology.”
(Tangwongsan, Supachai. Personal communication, 2005.)
• “Health care IT is not a panacea for all that ails
medicine.” (Hersh, 2004)
• “We worry, however, that [electronic records] are
being touted as a panacea for nearly all the ills of
modern medicine.”
(Hartzband & Groopman, 2008)](https://image.slidesharecdn.com/principlesofhealthitapplicationinhealthcare-210216110223/75/Introduction-to-Health-Informatics-and-Health-IT-Part-2-February-10-2021-51-2048.jpg)
Uploaded byNawanan Theera-Ampornpunt
Introduction to Health Informatics and Health IT (Part 2) (February 10, 2021)
This document provides an overview of principles of health IT application in healthcare. It discusses how healthcare is different from other industries due to its life-or-death nature, many stakeholders, and fragmented systems. It then explains how health IT can help address issues like errors, lack of information access, and inefficient processes through functions like computerized provider order entry, electronic health records, and health information exchange. The document also reviews landmark reports on medical errors and the need for healthcare reform using health IT.
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Similar to Introduction to Health Informatics and Health IT (Part 2) (February 10, 2021)
Introduction to Health Informatics and Health IT (Part 2) (February 10, 2021)
- 1. 1 Principles of HealthIT Application in Healthcare Nawanan Theera-Ampornpunt, MD, PhD For Healthcare CIO Certificate Program, Ramathibodi School of Management Feb 10, 2021 SlideShare.net/Nawanan Except where citing other works
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- 4. 4 Health care ER -Image Source: nj.com
- 5. 5 (At an undisclosednearby hospital) Health care
- 6. 6 • Life-or-Death • Many& varied stakeholders • Strong professional values • Evolving standards of care • Fragmented, poorly-coordinated systems • Large, ever-growing & changing body of knowledge • High volume, low resources, little time Why Health care Isn’t Like Any Others?
- 7. 7 But...Are We ThatDifferent? Input Process Output Transfer Banking Value-Add - Security - Convenience - Customer Service Location A Location B
- 8. 8 Input Process Output Assembling Manufacturing Raw Materials Finished Goods Value-Add -Innovation - Design - QC But...Are We That Different?
- 9. 9 But...Are We ThatDifferent? Input Process Output Patient Care Health care Sick Patient Well Patient Value-Add - Technology & medications - Clinical knowledge & skills - Quality of care; process improvement - Information
- 10. 10 • Large variations& contextual dependence Why Health care Isn’t Like Any Others? Input Process Output Patient Presentation Decision- Making Biological Responses
- 11. 11 Information is Everywherein Medicine Shortliffe EH. Biomedical informatics in the education of physicians. JAMA. 2010 Sep 15;304(11):1227-8.
- 12. 12 “Information” in Medicine ShortliffeEH. Biomedical informatics in the education of physicians. JAMA. 2010 Sep 15;304(11):1227-8.
- 13. 13 13 13 WHO (2009) WHO SixBuilding Blocks of Health System
- 14. 14 14 14 WHO (2009) WHO HealthSystem Framework
- 15. 15 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
- 16. 16 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
- 17. 17 eHealth HealthIT Slide adapted from: Dr. Boonchai Kijsanayotin eHealth & Health IT
- 18. 18 The Anatomy ofHealth IT Health Information Technology Goal Value-Add Means
- 19. 19 Various Forms ofHealth IT Hospital Information System (HIS) Computerized Provider Order Entry (CPOE) Electronic Health Records (EHRs) Picture Archiving and Communication System (PACS)
- 20. 20 Still Many OtherForms of Health IT m-Health Health Information Exchange (HIE) Biosurveillance Information Retrieval Telemedicine & Telehealth Images from Apple Inc., Geekzone.co.nz, Google, Microsoft, PubMed.gov, and American Telecare, Inc. Personal Health Records (PHRs)
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- 22. 22 What Clinicians Want? Totreat & 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)
- 23. 23 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.
- 24. 24 Information is Everywherein Healthcare Shortliffe EH. Biomedical informatics in the education of physicians. JAMA. 2010 Sep 15;304(11):1227-8.
- 25. 25 (IOM, 2001) (IOM, 2000)(IOM, 2011) Landmark IOM Reports
- 26. 26 Landmark IOM Reports:Summary • Humans are not perfect and are bound to make errors • High-light problems in the U.S. health care system that systematically contributes to medical errors and poor quality • Recommends reform that would change how health care works and how technology innovations can help improve quality/safety
- 27. 27 Why We NeedHealth IT • Health care is very complex (and inefficient) • Health care is information-rich • Quality of care depends on timely availability & quality of information • Clinical knowledge body is too large to be in any clinician’s brain, and the short time during a visit makes it worse • “To err is human” • Practice guidelines are put “on-the-shelf”
- 28. 28 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
- 29. 29 Image Source: SuthanSrisangkaew, Department of Pathology, Facutly of Medicine Ramathibodi Hospital, Mahidol University To Err is Human 2: Memory
- 30. 30 To Err isHuman 3: Cognition • 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
- 31. 31 • It alreadyhappens.... (Mamede et al., 2010; Croskerry, 2003; Klein, 2005) • What if health IT can help? What If This Happens in Healthcare?
- 32. 32 • Medication Errors –DrugAllergies –Drug Interactions • Ineffective or inappropriate treatment • Redundant orders • Failure to follow clinical practice guidelines Common Errors
- 33. 33 We need “Change” “...weneed to upgrade our medical records by switching from a paper to an electronic system of record keeping...” President Barack Obama June 15, 2009
- 34. 34 The Anatomy ofHealth IT Revisited Health Information Technology Goal Value-Add Means
- 35. 35 Ultimate Goals ofHealth IT •Individual’s Health •Population’s Health •Organization’s Health
- 36. 36 Dimensions of QualityHealth Care • Safety • Timeliness • Effectiveness • Efficiency • Equity • Patient-centeredness (IOM, 2001)
- 37. 37 CLASS EXERCISE #2 Foreach of Institute of Medicine’s 6 dimensions of quality health care, suggest ways health IT can help. Safety Timeliness Effectiveness Efficiency Equity Patient-centeredness
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- 39. 39 Safety • Legible handwriting •Proper display of patient information (e.g. abnormal labs) • Alerts – Drug-Allergy Checks – Drug-Drug Interaction Checks – Drug-Lab Interaction Checks • Dose calculator • Prevention of medication errors • Timely information – Histories – Diagnoses/Problem List – Labs – Medication List
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- 41. 41 Timeliness • Timely informationfor emergencies, transfers, normal visits – Histories – Diagnoses/Problem List – Labs – Medication List • Effective communications between providers • Effective triage & patient monitoring
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- 43. 43 Effectiveness • Reminders/advice for –Guideline adherence – Preventive care – Specialist consults • Templates/forms – Order sets – Care planning, nursing assessments & interventions, nursing documentation • Availability of patient information • Continuity of care (even in referrals) • Effective display of information (e.g. graphs, user-friendly screens) • Assistance in decision-making (e.g. differential diagnosis) • Access to evidence/references at the point of care
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- 45. 45 Efficiency • Fast/lean/efficient processesof care – Automation -> faster care, fewer workers – Process redesigns/reengineering (e.g. parallel processes/access) – Changes in role assignments -> productivity gains or more time for patient • Predictable patterns/“Just-in-time” (staffing, resource allocation, inventory, bed management) • Flexibility “Organizational slacks” (buffers) • Drug-formulary checks & policy enforcement • Reduction of redundant tests • Efficient management of bed occupancy/hospital capacity • Cost-savings & time-savings from preventable errors • Space-savings (e.g. medical records, PACS) • Effective communications
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- 47. 47 Equity • Reduction ofbarriers to care, improved access to care – Physical barriers (telemedicine, tele-consultation) – Structural barriers (information exchange among hospitals) – Functional barriers (information access by patients, networks of patients) – Cultural barriers (tailored information for different patients)
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- 49. 49 Patient-Centeredness • Patient’s accessto – Own clinical information – General health information – Tailored health information • Patient engagement/compliance • Patient empowerment – Patients’ networking & knowledge sharing • Patient satisfaction with quality & efficient care • Patient’s control of information (privacy)
- 50. 50 Documented Benefits ofHealth IT • Literature suggests improvement through – Guideline adherence (Shiffman et al, 1999;Chaudhry et al, 2006) – Better documentation (Shiffman et al, 1999) – Practitioner decision making or process of care (Balas et al, 1996;Kaushal et al, 2003;Garg et al, 2005) – Medication safety (Kaushal et al, 2003;Chaudhry et al, 2006;van Rosse et al, 2009) – Patient surveillance & monitoring (Chaudhry et al, 2006) – Patient education/reminder (Balas et al, 1996) – Cost savings and better financial performance (Parente & Dunbar, 2001;Chaudhry et al, 2006;Amarasingham et al, 2009; Borzekowski, 2009)
- 51. 51 But... • “Don’t implementtechnology just for technology’s sake.” • “Don’t make use of excellent technology. Make excellent use of technology.” (Tangwongsan, Supachai. Personal communication, 2005.) • “Health care IT is not a panacea for all that ails medicine.” (Hersh, 2004) • “We worry, however, that [electronic records] are being touted as a panacea for nearly all the ills of modern medicine.” (Hartzband & Groopman, 2008)
- 52. 52 Common “Goals” forAdopting HIT “Computerize” “Go paperless” “Digital Hospital” “Modernize” “Get a HIS” “Have EMRs” “Share data”
- 53. 53 The Common Denominator •HealthInformation Technology •Electronic Health Records •Health Information Exchange
- 54. 54 Some Misconceptions aboutHIT Current Environment Bad New, Modern, Electronic Environment Good If Then Always
- 55. 55 • Health ITas 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 Fundamental Theorem of Informatics
- 56. 56 Some risks • Alertfatigue Unintended Consequences of Health IT
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- 58. 58 Take-Home Messages • HealthIT has documented benefits to quality & efficiency of care • Implementing health IT will not automatically fix all problems • Health IT is not without risks • Find the ways health IT can help • Focus on the ultimate goals • Benefits of health IT may vary by context
- 59. 59 NEXT Health IT in ClinicalSettings
- 60. 60 References • Amarasingham R,Plantinga L, Diener-West M, Gaskin DJ, Powe NR. Clinical information technologies and inpatient outcomes: a multiple hospital study. Arch Intern Med. 2009;169(2):108-14. • Balas EA, Austin SM, Mitchell JA, Ewigman BG, Bopp KD, Brown GD. The clinical value of computerized information services. A review of 98 randomized clinical trials. Arch Fam Med. 1996;5(5):271-8. • Borzekowski R. Measuring the cost impact of hospital information systems: 1987-1994. J Health Econ. 2009;28(5):939-49. • Chaudhry B, Wang J, Wu S, Maglione M, Mojica W, Roth E, Morton SC, Shekelle PG. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann Intern Med. 2006;144(10):742-52. • DeLone WH, McLean ER. Information systems success: the quest for the dependent variable. Inform Syst Res. 1992 Mar;3(1):60-95. • Friedman CP. A "fundamental theorem" of biomedical informatics. J Am Med Inform Assoc. 2009 Apr;16(2):169-70. • Garg AX, Adhikari NKJ, McDonald H, Rosas-Arellano MP, Devereaux PJ, Beyene J, et al. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA. 2005;293(10):1223-38. • Hartzband P, Groopman J. Off the record--avoiding the pitfalls of going electronic. N Engl J Med. 2008 Apr 17;358(16):1656-1658.
- 61. 61 References • Hersh W.Health care information technology: progress and barriers. JAMA. 2004 Nov 10:292(18):2273-4. • Institute of Medicine, Committee on Quality of Health Care in America. To err is human: building a safer health system. Kohn LT, Corrigan JM, Donaldson MS, editors. Washington, DC: National Academy Press; 2000. 287 p. • 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. • Kaushal R, Shojania KG, Bates DW. Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review. Arch. Intern. Med. 2003;163(12):1409-16. • Parente ST, Dunbar JL. Is health information technology investment related to the financial performance of US hospitals? An exploratory analysis. Int J Healthc Technol Manag. 2001;3(1):48-58. • Shiffman RN, Liaw Y, Brandt CA, Corb GJ. Computer-based guideline implementation systems: a systematic review of functionality and effectiveness. J Am Med Inform Assoc. 1999;6(2):104-14. • Van Rosse F, Maat B, Rademaker CMA, van Vught AJ, Egberts ACG, Bollen CW. The effect of computerized physician order entry on medication prescription errors and clinical outcome in pediatric and intensive care: a systematic review. Pediatrics. 2009;123(4):1184-90.