Dr. T. Bedirhan Üstün World Health Organization Classifications, Terminologies, Standards What is “Health Information”? What is “Health” ? at is “Health Information System”
What is health information?
Aug 23, 2014
How do we define Health? Is WHO definition sufficient to operationalize and measure health domains? How do we compare data across health domains? Can we set up a "stock exchange" type of conversion utility to make use of different sources of data?
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- What is Health Information? What is Health ? What is Health Information System ? Dr. T. Bedirhan stn World Health Organization Classifications, Terminologies, Standards
- Caveats Views expressed in this presentation are those of B. stn They do not necessarily represent the policies of conflict of interests declared: Presenter believes in: Scientific Methods, ICF, Ontologies, Turkeys
- Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity Source: WHOs Constitution, 1948
- The universe of well-being Other domains of well-being Education Employment Environment etc. Health domains of well-being Seeing Walking Remembering etc.
- Defining Health Concept: What is it? Core definition Formulation: Content Operational characteristics Boundaries: well-being? links with disability inclusion and exclusion terms Context: what is it in relation to what is the framework Intended use for clinical purposes / public health priority setting.
- History of Health in the World 243 BC: plague in China 800 s : smallpox in Japan 1090s: dysentery in Palestine 1340s: "Black Death" in Europe 1830s: cholera worldwide 191719: influenza worldwide 1996- 2014 SARS, H1N1 http://www.mla-hhss.org/histlink.htm
- Health Indicators Maternal Mortality Neonatal Mortality Infant Mortality Child Mortality Adult Mortality A g e -specific Mortality Cause-specific Mortality Stillbirth rate Risk factors http://www.who.int/gho/publications/world_health_statistics
- Death - Life CLASSIFICATIONS ,TERMINOLOGIES, STANDARDS BUILDING BLOCKS OF HEALTH INFORMATION
- Between BIRTH a n d DEATH NewYorker Jack Ziegler (2000)
- Definition of an Elephant A pillar A huge fan A rope A huge mass A pointed hard horn A bad smell
- Health as a C o n t i n u u m in M u l t i p l e Dimensions Seeing Functions 10/20 Mild-Moderate vision impairment: Needs eye glasses, contact lenses 2/20 Severe vision impairment: Needs operation 1/20 Complete vision impairment (blind): Needs assistance pension, device, assistant environmental modifications
- A vector model combination of multiple vectors of functioning Cognition Social Activities Selfcare Work Mobility Vision Hearing
- Mobility Spectrum M u l t i p l e S U B Dimensions Sitting Crawling Getting out of the bed Bending body parts Standing Walking long distance inside the house/residence Running long distance Climbing Lifting objects Using tools - vehicles Assistive devices
- a full picture of health
- HEALTH can be M E A S U R E D M u l t i p l e domain functioning levels by age (World Health Surveys, 2003 n > 250.000)
- Health C o n t i n u u m can be used for interventions Vision 60 50 Population 40 Blind 30 Cataract Operation Eyeglasses/ Contact lenses 20 10 0 1 2 3 4 5 Functioning level 6 7 8
- Functioning Health
- Health Functioning Health IS NOT opposite of DEATH DISEASE Health is about your LIFE How do you life your life How are you ? How do you FUNCTION? Health is FUNCTIONING
- Out of Plato's Cave Measuring "latent" traits Mobility Seeing Hearing Cognition Communication
- Health / Functioning has M u l t i p l e DIMENSIONs Moving Seeing Hearing Eating . . Relating Socializing
- World Health Assembly, 2001 Endorse and publish ICF use the ICF in Member States in: research surveillance reporting Joint use with ICD Operational subsets: surveys clinical encounters Periodic revision
- ICF 1. Main volume with glossary - Full version 9999 cat. - Short version 99 cat. 2. Clinical Descriptions & Assessment Guidelines 3. Online access - CD Rom 4. Other versions - Children and Youth 5. Dedicated Assessment Tools - Checklists - WHO DAS 2.0 CLASSIFICATIONS & TERMINOLOGY
- Principles of ICF Universality Body Functions Impairments What the individual can do / does do Participation Scientific basis Activities Not particular impairment groups Equally applicable to everyone Represents health as multi-dimensional construct Active performance in society Environment Interaction of person with the environment Identification of barriers Identification of facilitators
- Key Concepts of Functioning & Disability BODY functions & Structures BODY Function/ ACTIVITIES PARTICIPATION PERSON Activities SOCIETY Participation Structure (impairment) (limitation) (restriction)
- ICF: MULTIDIMENSIONAL Functioning / disability concept BODY Function/ Structure (impairment) PERSON Activities (limitation) SOCIETY Participation (restriction)
- Minority Model vs Universal Model Certain impairment groups Categorical Uni-dimensional Everyone may have disability Continuum Multi-dimensional
- ICF Concepts Health Condition (disorder/disease) Impairment (function/structure) Activities (Activity Limitation) Environmental Factors Participation (Participation Restriction) Personal Factors
- What should this audience NOT be told? Human Functioning - not merely disability Universal Model - not a minority model Integrative Model - not merely medical or social Interactive Model - not linear progressive Parity - not etiological causality Context - inclusive - not person alone Cultural applicability - not western concepts Operational - not theory driven alone Life span coverage - not adult driven
- ICF as the Rosetta Stone Operational definitions Mapping across instruments Anchoring extent of difficulty with known calibrators Distinguishing health states, symptoms, functional abilities and performance International comparability
- Clinical Language " have been speaking prose without knowing it " Everything that is not poetry is prose "Good Heavens! For more than forty years I have been speaking prose without knowing it." Le Bourgeois Gentilhomme Molire (1670) Act 2 Scene 4 Theory Tools Practice
- Part 2: Measurement Challenges
- The ICF is the ruler "Unless we measure health, we cannot manage and improve health systems. The ICF is the ruler with which we will take precise measurements of health and disability. Dr Gro Harlem Brundtland Director General Emeritus, WHO
- Comparability of International Health Data VARIANCE min_max Mortality statistics 3x Health Survey data 68x Disability Survey data 40 60x
- N e N o ay ai n rw S p s n an d n d n y ed e er l S w th la rm a P o G e ly lt a It a M a Prevalence in % / YLDs Disability Prevalence in selected EU countries 35 30 25 20 15 10 5 0
- CLASSIFICATIONS & TERMINOLOGY BUILDING BLOCKS OF HEALTH INFORMATION
- Big Mac Index University Professor in Turkey gets University Professor in the Switzerland gets Big Mac in TR = 1.5 USD Big Mac in CH = 4 USD Salary = 2000 Big Macs in both 3000 USD. 8000 USD.
- Measuring Health What is measured reported Important domains of functioning Assessment Instruments What do you measure how do you measure? What are the scales ? Equivalence of measures? Conversion of units
- Health Information Exchange Map Questions to ICF Map response scale to ICF Qualifiers seek equivalence Use Modern Item Response Theory to achieve comparability between different tools
- WHODAS 2.0 ICF based assessment instrument for measuring health and disability Developed after extensive cross-cultural and psychometric testing 6 Domains Understanding the world around you Getting Around Self-Care Getting along with people Life activities (household, work) Participation in Society Advanced Scoring Domain and summary score Population norms No. of disability days in last month Available as Short version (12 items) Long version (36 items)
- WHO DAS 2.0 Responsiveness in subjects with depression Effect size 0 Outpatient care (Mexico City) Outpatient care (Ibadan, Nigeria) Outpatient care of elderly (London, UK) Primary health care (Seattle, USA) 0.5 1 0.8 0.74 N = 100 ( mean/ SD1) 1.5 SF-36 (MCS) 1.07 N = 60 N = 40 0.23 0.81 LHS 0.44 LHS 0.72 N = 73 1.32 WHO DAS II Comparator SF-36 (MCS)
- OTHER Instruments Qualifier Thresholds: Fatigue 5th 25th 50th 95th Q oLR A _25 I stoo m uch effortto go outand see peopl t e C ES _20 Icoul notgetgoi d ng D E_07 Ifel thateverythi Idi w asan effort t ng d S F_4g D i you feelw orn out? d M FI Idi notfeellke eati m y appeti w aspoor _2 d i ng; te S F_4e D i you have a l ofenergy? d ot M FI Ifeelvery acti _3 ve M FI Ifeelti _5 red M FI P hysi l Ican take on a l _8 caly ot M FI Ifeelfi _1 t M FI _16 Iti easiy re l M FI _12 Iam rested Q oL10 Ihave to keep stoppi w hatIam doi to rest ng ng Q oLR A Ifeelti red w hateverIdo. M FI _20 Icoul notgetgoi d ng S F_4iD i you feelti d red? 0 2 4 6 8 1 1 1 1 1 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 0 2 4 6 8 CLASSIFICATIONS BUILDING BLOCKS OF HEALTH INFORMATION
- Can Modern IRT Help? give me a place to stand and I will move the earth
- Distribution of Final Scores for all respondents & response categories: 5 4 3 2 1 0 CI: 39 to 42* CI: 29 to 38 CI: 29 to 32 CI: 24 to 28 CI: 24 to 26 CI: 15 to 21
- Part 3: ICF Ontology
- Health Systems & Information Systems: Analog to Digital How do we optimize our health services
- Placing WHO Classifications in HIS & IT ICD ICF Mappings e-Health Record Systems ICHI Classifications Terminologies Population Health Clinical Births Deaths Diseases Disability Risk factors Administration Decision Support Scheduling Integration of care Resources Outcome Billing Reporting Cost Needs Outcome
- "One day I read a book and whole my life changed " ICF Ontology: Knowledge Representation Orhan Pamuk, Nobel Literature Laurate, 2006 Common sense/intuition Disciplined definitions
- Ontology (philosophy) Being And Nothingness An Essay in Phenomenological Ontology the Organization of Reality is an oxymoron !!!
- What is NOntology ? Ontology (computer science) the explicit operational description of the conceptualization of a domain Entities Atributes Values An ontology defines: a common vocabulary a shared understanding/exchange: among software agents between software and People to reuse data - information to introduce standards to allow interoperability among People ?
- Knowledge Representation the triad of things, thoughts and words (Ogden & Richards, 1923 ) APPLE TERM
- Genomic Data Gene Ontology 5
- The Picasso Test: Can you make computers understand ICF? Computers are stupid: ? They cannot ask questions They may if they can-- only give you answers. Pablo Picasso
- Teaching Computers the ICF We cannot teach anybody anything, we can only make them think Socrates Solving a Geometry Problem with Meno's Slave
- Siri: An Ontology-driven Application for the Masses
- How life changes
- Big Data !
- What is the use of Health Informatics? INPUTS Analytical process Computational Processing Data Information OUTPUT Knowledge Ontologies Mechanisms Statistics Interventions Aggregation Policies
- ICF ontology can provide the Infrastructure
- Part 4: Conclusions
- Conclusion # ICFOntology Development of Health Information Systems is the second most critical issue in Health Care today Integration of Functioning and Disability Information in HIS essential Mapping of Assessment Instruments to ICF Mapping between ICF and clinical terminologies (SNOMED-CT)
- ICF Vision Placing ICF in the Health Information Systems & IT Real on-line data capture & analysis for: clients providers decision-makers Develop linkages to health information bases: Population registry Insurance systems Health services Develop relation-standards, tools & exchange platforms Demonstrate feasibility and utility direct consumer access Service provision: volume and flow management, resource allocation Reporting: Needs, Outcomes, Costs
- Sharing Meaning across cultures Language Independence Common terminology ontology Underlying individual concepts Population construct (compound measure) Common structure Information models of personal health Information models for population health Common reporting methods Relative risk, absolute risk, attributable risk, etc. Assumption sets linked to purpose/meaning
- This can also help close the information gaps with digital outreach
- Interoperability
- Stock Exchange Health Information Exchange
- Questions & Answers [email protected] @ustunb
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