IT for MDs (Part 1) Nawanan Theera‐Ampornpunt, MD, PhD SlideShare.net/Nawanan Feb. 13, 2013 Faculty of Medicine Ramathibodi Hospital
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IT for MDs (Part 1)
Nawanan Theera‐Ampornpunt, MD, PhD
SlideShare.net/Nawanan
Feb. 13, 2013Faculty of Medicine Ramathibodi Hospital
2
A Few Words About Me...
2003 M.D. (1st-Class Honors) Ramathibodi (Rama 33)
2009 M.S. (Health Informatics) University of Minnesota
2011 Ph.D. (Health Informatics) University of Minnesota
Currently
• Acting for Deputy Chief, Health Informatics Division, Ramathibodi
Contacts
SlideShare.net/Nawanan
www.tc.umn.edu/~theer002
groups.google.com/group/ThaiHealthIT
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Internet & E‐mailLiterature searches & EBMPreparing presentation slidesBibliographic toolsManuscript preparationStatistical analysisHealth IT and Informatics
IT Competencies
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Healthcare & Health ITHealth IT Applications in Hospitals
Today’s Contents
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Health care & Health IT
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Manufacturing
Image Source: Guardian.co.uk
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Banking
Image Source: Scbcareers.scb.co.th
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Health care
ER ‐ Image Source: nj.com
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Life‐or‐DeathMany & 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?
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Large variations & contextual dependence
Why Health care Isn’t Like Any Others?
Input Process Output
Patient Presentation
Decision‐Making
Biological Responses
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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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But...Are We That Different?
Input Process Output
Patient Care
Health care
Sick Patient Well Patient
Value‐Add‐ Technology & medications‐ Clinical knowledge & skills‐ Quality of care; process improvement‐ Information
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Information is Everywhere in Health Care
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Various Forms of Health IT
Hospital Information System (HIS) Computerized Provider Order Entry (CPOE)
Electronic Health Records (EHRs)
Picture Archiving and Communication System
(PACS)
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Still Many Other Forms of Health IT
m‐Health
Health Information Exchange (HIE)
Biosurveillance
Information RetrievalTelemedicine &
Telehealth
Images from Apple Inc., Geekzone.co.nz, Google, PubMed.gov, and American Telecare, Inc.
Personal Health Records (PHRs)
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Why Adopting Health IT?
“To Computerize”“To Go paperless”
“Digital Hospital”
“To Modernize”
“To Get a HIS”
“To Have EMRs”
“To Share data”
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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 Quotes
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Health IT: What’s In A Word?
HealthInformationTechnology
Goal
Value‐Add
Tools
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SafetyTimelinessEffectivenessEfficiencyEquityPatient‐centeredness
Dimensions of Quality Healthcare
(IOM, 2001)
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Guideline adherenceBetter documentationPractitioner decision making or process of care
Medication safetyPatient surveillance & monitoring
Patient education/reminder
Value of Health IT
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Fundamental Theorem of Informatics
(Friedman, 2009)(Friedman, 2009)
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Is There A Role for Health IT?
(IOM, 2000)
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Landmark IOM Reports
(IOM, 2001)(IOM, 2000)
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Humans are not perfect and are bound to make errors
Highlight 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
Landmark IOM Reports: Summary
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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 Short time during a visit Practice guidelines are put “on‐the‐shelf” “To err is human”
Why We Need Health IT
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Perception errors
To Err Is Human
Image Source: interaction‐dynamics.com
28 Image Source: aafp.org
Lack of Attention
To Err Is Human
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Cognitive Errors - Example: Decoy Pricing
The Economist Purchase Options
• Economist.com subscription $59• Print subscription $125• Print & web subscription $125
Ariely (2008)
16084
The Economist Purchase Options
• Economist.com subscription $59• Print & web subscription $125
6832
# of People
# of People
To Err Is Human
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It already happens....(Mamede et al., 2010; Croskerry, 2003; Klein, 2005)
What if health IT can help?
What If This Happens in Healthcare?
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Adoption of Health IT: Assumptions
Adoption Use Outcomes
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“...We will make wider use of electronic records and other health information technology, to help control
costs and reduce dangerous medical errors.”
U.S.’s Efforts on Health IT Adoption
Source: Wikisource.org Image Source: Wikipedia.org
President George W. BushSixth State of the Union Address, January 31, 2006
?
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U.S. Adoption of Health IT
• U.S. lags behind other Western countries (Schoen et al, 2006;Jha et al, 2008)
• Money and misalignment of benefits is the biggest reason
Ambulatory (Hsiao et al, 2009) Hospitals (Jha et al, 2010)
Basic EHRs w/ notes 9.2%Comprehensive EHRs 2.7%CPOE for medications 34%
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We Need “Change”
“...we need to upgrade our medical records by switching from a paper to an electronic system of record keeping...”
President Barack ObamaJune 15, 2009
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“...Our recovery plan will invest in electronic health records and new technology
that will reduce errors, bring down costs, ensure privacy, and save lives.”
President Barack ObamaAddress to Joint Session of Congress
February 24, 2009
The Birth of “Meaningful Use”
Source: WhiteHouse.gov
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Contains HITECH Act(Health Information Technology for Economic and Clinical Health Act)
~ 20 billion dollars for Health IT investments
Incentives & penalties for providers
American Recovery & Reinvestment Act
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What is in the HITECH Act?
(Blumenthal, 2010)
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“Meaningful Use”
“Meaningful Use” of a PumpkinPumpkin
Image Source & Idea Courtesy of Pat Wise at HIMSS, Oct. 2009
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“Meaningful Use” of Health IT
Stage 1‐ Electronic capture of health information‐ Information sharing‐ Data reporting
Stage 2
Use of EHRsto improve processes of care
Stage 3
Use of EHRs to improve outcomes
Better Health
(Blumenthal, 2010)
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Adoption Studies: Descriptive AspectPongpirul et al. (2004)
2011
Theera‐Ampornpunt(unpublished)
2004
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Q & A...
Download Slides
SlideShare.net/Nawanan
Contacts
www.tc.umn.edu/~theer002
groups.google.com/group/ThaiHealthIT
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Ariely D. Predictably irrational: the hidden forces that shape our decisions. New York City (NY):HarperCollins; 2008. 304 p.
Blumenthal D. Launching HITECH. N Engl J Med. 2010 Feb 4;362(5):382‐5. Croskerry P. The importance of cognitive errors in diagnosis and strategies to minimize them.
Acad Med. 2003 Aug;78(8):775‐80. 81 p. Friedman CP. A "fundamental theorem" of biomedical informatics. J Am Med Inform Assoc.
2009 Apr;16(2):169‐70. Hersh W. Health care information technology: progress and barriers. JAMA. 2004 Nov
10:292(18):2273‐4.
References
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Institute of Medicine, Board on Health Care Services, Committee on Data Standards for Patient Safety. Key Capabilities of an electronic health record system: letter report [Internet]. Washington, DC: National Academy of Sciences;2003. 31 p. Available from: http://www.nap.edu/catalog/10781.html
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.
References
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Klein JG. Five pitfalls in decisions about diagnosis and prescribing. BMJ. 2005 Apr 2;330(7494):781‐3.
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.
Miller RA, Masarie FE. The demise of the "Greek Oracle" model for medical diagnostic systems. Methods Inf Med. 1990 Jan;29(1):1‐2.
Pongpirul K, Sriratana S. Computerized information system in hospitals in Thailand: a national survey. J Health Sci. 2005 Sep‐Oct;14(5):830‐9. Thai.
Schoen C, Osborn R, Huynh PT, Doty M, Puegh J, Zapert K. On the front lines of care: primary care doctors’ office systems, experiences, and views in seven countries. Health Aff (Millwood). 2006;25(6):w555‐71.
References
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