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Health Informatics in Digital Healthcare 9th Thailand Pharmacy Congress: Smart Aging Life & Digital Pharmacy 4.0 นพ.นวนรรน ธีระอัมพรพันธุ18 พฤศจิกายน 2560
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Health Informatics in Digital Healthcare

Jan 21, 2018

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Page 1: Health Informatics in Digital Healthcare

Health Informatics in Digital Healthcare

9th Thailand Pharmacy Congress: Smart Aging Life & Digital Pharmacy 4.0

นพ.นวนรรน ธีระอัมพรพนัธุ์

18 พฤศจิกายน 2560

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2546 แพทยศาสตรบณัฑติ (เกยีรตนิิยมอนัดบั 1)

2554 Ph.D. (Health Informatics), Univ. of Minnesota

ผูช้ว่ยคณบดฝ่ีายนโยบายและสารสนเทศอาจารย์ ภาควชิาเวชศาสตรช์ุมชนคณะแพทยศาสตรโ์รงพยาบาลรามาธบิดี มหาวทิยาลยัมหดิล

ความสนใจ: Health IT for Quality of Care,

IT Management, Security & Privacy

[email protected]

SlideShare.net/Nawanan

แนะน ำตัว

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Health &

Health Information

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

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5Image Source: https://en.wikipedia.org/wiki/Industrial_robot (KUKA Roboter GmbH)

“Smart” Manufacturing

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6Image Sources: http://isarapost.net/home/?p=17760

http://www.telecomjournalthailand.com/ตอบโจทยโ์มเดลทางธรุกจิ/

“Smart” Banking

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7ER - Image Source: nj.com

Healthcare (On TV)

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(At an undisclosed hospital)

Healthcare (Reality)

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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 (Yet) “Smart”?

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But...Are We That Different?

Input Process Output

Transfer

Banking

Value-Add- Security- Convenience- Customer Service

Location A Location B

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Input Process Output

Assembling

Manufacturing

Raw Materials Finished Goods

Value-Add- Innovation- Design- QC

But...Are We That Different?

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Input Process Output

Patient Care

Health care

Sick Patient Well Patient

Value-Add- Technology & medications- Clinical knowledge & skilled providers- Quality of care; process improvement- Customer service- Information

But...Are We That Different?

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• Large variations & contextual dependence

Input Process Output

Patient Presentation

Decision-Making

Biological Responses

Standardizing Healthcare

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The World of Smart Machines

Image Sources: http://www.ibtimes.com/google-deepminds-alphago-

program-defeats-human-go-champion-first-time-ever-2283700

http://deepmind.com/

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Digitizing Healthcare

Image Source: http://www.bloomberg.com/bw/stories/2005-03-27/cover-image-the-digital-hospital

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“To computerize the hospital”

“To go paperless”

“To become a Digital Hospital”

“To Have EHRs”

Why Adopting Health IT?

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• “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)

Some “Smart” Quotes

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Being Smart #1:

Stop Your

“Drooling Reflex”!!

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Being Smart #2:

Focus on Information &

Process Improvement,

Not Technology

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ถ้าไม่เป็น “Digital Hospital” หรือ “Paperless Hospital”

แล้วจะให้เรำเป็นอะไร?

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“Smart Hospital”

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แล้ว “Smart Hospital” ต่างจาก Digital หรือ

Paperless Hospital ตรงไหน?

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Connecting People to a Healthy Future With Personalized Care – Kaiser Permanente

https://www.youtube.com/watch?v=gxz9ZVvduGc

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Back to something simple...

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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?

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• 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

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My personal story on

why we need doctors to

implement health IT

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Biomedical & Health Informatics

• “[T]he field that is concerned with the

optimal use of information, often

aided by the use of technology, to

improve individual health, health care,

public health, and biomedical

research” (Hersh, 2009)

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29(Shortliffe, 2002)

Spectrum of Biomedical & Health Informatics

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Information is Everywhere in Healthcare

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31

WHO (2009)

Components of Health Systems

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• Safe

– Drug allergies

– Medication Reconciliation

• Timely

– Complete information at point of

care

• Effective

– Better clinical decision-making

Image Source: http://www.flickr.com/photos/childrensalliance/3191862260/

Being “Smart” in Healthcare

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• Efficient

– Faster care

– Time & cost savings

– Reducing unnecessary tests

• Equitable

– Access to providers & knowledge

• Patient-Centered

– Empowerment & better self-care

Being “Smart” in Healthcare

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

Landmark Institute of Medicine Reports

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• 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 errors

Patient Safety

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Summary of These Reports

• 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

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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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Being Smart #3:

“To Err is Human”

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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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Example of “Alerts & Reminders”

Reducing Errors through “Alerts & Reminders”

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Documented Values of Health IT

• Guideline adherence

• Better documentation

• Practitioner decision making or process of care

• Medication safety

• Patient surveillance & monitoring

• Patient education/reminder

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Being Smart #4:

Link IT Values to

Quality (Including Safety)

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Health

Information

Technology

Goal

Value-Add

Tools

Health IT: What’s in a Word?

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Hospital Information System (HIS) Computerized Physician Order Entry (CPOE)

Electronic Health

Records (EHRs)

Picture Archiving and Communication System

(PACS)

Various Forms of Health IT

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m-Health

Health Information Exchange (HIE)

Biosurveillance

Telemedicine & Telehealth

Images from Apple Inc., Geekzone.co.nz, Google, PubMed.gov, and American Telecare, Inc.

Personal Health Records (PHRs)

Health IT Beyond Hospitals

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Health IT for Medication Safety

Ordering Transcription Dispensing Administration

CPOEAutomatic Medication Dispensing

Electronic Medication

Administration Records (e-MAR)

BarcodedMedication

Administration

BarcodedMedication Dispensing

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Hospital A Hospital B

Clinic C

Government

Lab Patient at Home

Health Information Exchange

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ความฝันอันสูงสุด...

My Life-Long Dream...

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50WHO & ITU

Achieving Health Information Exchange (HIE)

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A Smart Machine: DeepMind

Image Sources: http://www.ibtimes.com/google-deepminds-alphago-

program-defeats-human-go-champion-first-time-ever-2283700

http://deepmind.com/

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52Image Source: socialmediab2b.com

Another Smart Machine: IBM’s Watson

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53Image Source: englishmoviez.com

Rise of the Machines?

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Clinical Decision Support Systems

• 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

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Being Smart #5:

Don’t Replace Human Users.

Use ICT to Help Them Perform Smarter & Better.

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Some Risks of Clinical Decision Support Systems

• Alert Fatigue

Unintended Consequences of Health IT

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Workarounds

Unintended Consequences of Health IT

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Being Smart #6:

Health IT Also Have

Risks &

Unintended Consequences

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Balanced Focus of Informatics

Technology

ProcessPeople

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Being Smart #7:

Balance Your Focus (People, Process, Technology)

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Q&A

SlideShare.net/Nawanan