Australian e-Health Research Centre Anthony Maeder Professor in Health Informatics University of Western Sydney Health Services – a major focus for e-Health.

Australian e-Health Research Centre

Anthony Maeder

Professor in Health Informatics

University of Western Sydney

Health Services– a major focus for e-Health research


Australian Healthcare “Vital Statistics”

• 2003/04 $78.6 billion which is 9.7% GDP • Governments fund 68% of this spend

• Health employs 570,000 people• Chronic workforce shortages

• Health sector growing at 5.5% per year• Hospital admissions up 9% (public), 30% (private) in 5 years• Prescriptions up 41% in 10 years


Important Drivers in Healthcare

• Rapidly ageing population: over 65s will double 2004-2051• Chronic diseases: cancer and multiple co-morbidities• Diabetes and obesity: dramatic increases population-wide• New technologies increase costs: gene, stem cell, nanotech…

• Maintaining “hope and trust” on which all health care is based• Increased consumer expectations• Deployment of new models of care• Transforming data into knowledge


Government Information Economy Strategy

A connected and responsive government• Meeting users needs• Establishing connected service delivery• Achieving value for money• Enhancing public sector capability

Issues for health• Privacy and security are paramount• Choice of service delivery models• Interoperability and data utilization• More informed consumers• Innovative technologies• Safety, Quality, Efficiency• Governance and accountability


COAG Initiatives

National Health & Hospital Reform Commission

1. The Commission will provide advice on the framework for the next Australian Health Care Agreements, including robust performance benchmarks in areas such as elective surgery, aged and transition care and quality of care.

2. The Commission will report on a long-term health reform plan to provide sustainable improvements in the performance of the health system.


COAG National Health Reform Plan Focus Areas

a. Reduce inefficiencies generated by cost-shifting, blame-shifting and buck passing

b. Better integrate and coordinate care across all aspects of the health sector, particularly between primary care and hospital services around key measurable outputs for health

c. Bring a greater focus on prevention to the health system

d. Better integrate acute services and aged care services and improve the transition between hospital and aged care

e. Improve frontline care to better promote health lifestyles and prevent and intervene early in chronic illness

f. Improve the provision of health services in rural areas

g. Improve Indigenous health outcomes

h. Provide a well qualified and sustainable health workforce into the future


NeHTA

Over 3 – 5 years will implement:• National patient and provider identifiers• Snomed CT – global terminology for health data• Structured privacy framework• Shared e-health record system

Therefore new services will be needed for hospitals, doctors, state and federal health systems


What is needed for Quality Healthcare?

Healthcare Quality is defined by several dimensions…• Safety

• Appropriateness

• Access

• Consumer centredness

• Effectiveness

• Efficiency

Health professionals need to have appropriate competencies to support this agenda

How does e-Health support this agenda?


Health Services Approach

e-Health must help us deliver (as a minimum):• Shared e-health records • Decision support tools• Forecasting of patient flows• Ability to review pathways and compliance with guidelines• Modelling new service delivery processes and structures• Analysis of disease patterns and treatment responses


Australian e-Health Research Strategic Areas

• Large scale data integration (e.g. federated databases)• Web services to facilitate data aggregation and analysis• Privacy / security / trusted storage and communications


Extracting Meaning from Data - Cancer StagingHISTORY

Left upper lobe and partial chest wall.

MACROSCOPIC

One specimen received.The specimen is labelled "left upper lobe and partial chest wall" and consists of a left upper lobe measuring 155 x 100 x 45 mm. On the lateral aspect of the lung there is attached chest wall and ribs measuring 60 x 60 mm. Deep to this on sectioning, there is a white sclerotic mass measuring 45 x 42 x 40 mm. Surrounding the tumour there is obstructive pneumonitis. No other lesions are identified on sectioning of the lung. The chest wall will be decalcified and a further report will be issued.

MICROSCOPIC

Sections show a poorly differentiated adenocarcinoma which in most areas comprises sheets of large cells with vesicular nuclei, prominent nucleoli and moderate amounts of eosinophilic cytoplasm. Focally within the tumour there is a cribriform architecture and occasional cells contain mucin vacuoles. Areas of necrosis are present. Tumour invades the overlying thickened pleura and foci of lymphatic permeation are noted within this pleural tissue. Lymphatic invasion is also noted within pulmonary parenchyma. However no metastases are found in peribronchial lymph nodes. No vascular invasion is seen, although thrombus is noted within a vascular space towards the inferior aspect of the tumour. Tumour does not appear to extend up to chest wall structures, but a further report will follow when sections of these are examined. Distant lung parenchyma shows mild centriacinar emphysema.

Pathology Report Staging Guidelines


Enhancing Data - SNOMED CT Usage


Alzheimer’s Disease PIB-PET Study

Cohort of 200 patients (age > 60 years)• 40 patients with Mild AD• 40 patients with Mild Cognitive Impairment (MCI)• 120 normal elderly controls (NC)

Clinical neuropsychological evaluation• Mini Mental State Examination (MMSE)• Clinical Dementia Rating (CDR)

PET scans• PIB PET• FDG PET• Blood sampling for A measurement

MRI scans• 3D high resolution data• Anatomical information• Diffusion weighted imaging

MRI T1-weighted MRI T2-weighted

C11-PIB PET

FDG PET




• Telemedicine tools• Skills training tools• Machine learning tools


Building Cases from CT images

From 3D CT…. …. to colon model


Comparison of real and simulated colonoscopy

Real colonoscopy CSIRO simulated colonoscopy


Integration of Haptic Device into Simulator




• Telemedicine tools• Skills training tools• Machine learning tools

• Image analysis • Sensor enabled environments• In depth skills in maths, stats, visual analytics etc. for

Healthcare system modeling and prediction


Efficient Management of Inpatient Beds

Inpatient beds = elective admissions + acute care episodes

Project premise:

EDs may seem chaotic, but admissions are predictable.


Analysing ED Presentations 2002-2007

Toowoomba:

(Pop Growth 1.3%)

Gold Coast:

(Pop Growth 3.3%)

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Comparison to Existing Prediction Modelling

• Existing Predictions vs New Model

Modelling for Periods % Error with Existing Predictions

%Error with New Model

12/7/06 – 20/5/07 (n=171 days)

20.5% 11.1%

12/7/06 – 9/9/07 (n=261 days)

19.1% 11.1%

12/7/06 – 20/1/08(n=335 days)

30.4%(effect of opening new ED wing)

11.8%

Contact UsPhone: 07 325 33600

Email: [email protected] Web: www.csiro.au

Thank you

Australian e-Health Research Centre Anthony Maeder Professor in Health Informatics University of Western Sydney Health Services – a major focus for e-Health.

Documents

health privacy

health employs

health lifestyles

ehealth research slide

provision of health

sustainable health workforce

health system d

federal health systems