INFORMATIZACIJA V
ZDRAVSTVU
doc. dr. Matic Meglič, dr. med., MBA
Predstojnik Centra za Informatiko v Zdravstvu
NIJZ
ZA ZAČETEK: KOLIKO E- SMO?Pametni mobilniki?
Tablični računalniki?
Aplikacije za klinično delo (elektronski zdravstveni karton)?
App-i za diagnostiko, izračun tveganj, kazalnikov?
Wiki, klinično znanje? Medscape, MD Consult
Twitter? LinkedIn? (Facebook)
Vpliv tehnološkega razvoja
na zdravje in zdravstveni sistem:
• Dostopne tehnologije
• 24/7
• ‚The quantified self‘
• Opolnomočeni pacient
• Paradigma eJavnoZdravje
• Personalizirana medicina
• Big Data, Big Analytics
Meglič, NCCR2013
Kje lahko eZdravje pomaga?
• Pri vseh ključnih načinih ukrepanja– Preventiva (primarna, sekundarna, terciarna)
– Zdravljenje
xx x
Meglič, Brodnik, IGI2009
xx
blog.urbansedlar.com/
x
forbes.com
mladez.rs
ohgizmo.com
telecareconsulting.com
informaitonweek.com
x
Azmo the dragon
SLOVENSKE IZKUŠNJE
Aplikativna projekta eDepresija in eOskrba
Koordinacija
zdravljenja depresije
• Intervencija:
– Spletno/mobilno
okolje
– Koordinator oskrbe
– Klinična pravila
– Samoocenjevanje
– Opomniki
4
Enaki principi
• -koordinacija
oskrbe
• -kl. smernice
• -vključevanje pac.
eOskrba: KOPB, diabetes, hujšanje…
ALI STVARI DELUJEJO?
Izboljšanje simptomov
Število BDI na začetku SD BDI na koncu SDKontrole 10 28,70 8.34 17,80 7.91Primeri 12 29,50 8.15 7,97 8.05
t; P t = 0.23; P = .82 t = 2.33; P = .03
0
5
10
15
20
25
30
35
BDI na začetku BDI na koncu
Kontrole
Primeri
Razpoložljivi
primeri
Skupina
primerov
Skupina
kontrol
Zdravi na začetku 0/21 (0%) 0/25 (0%)
Zdravi na koncu 9/12 (75%) 1/10 (10%)
Meglic et al., JMIR 2010
INFORMATIKA IN
ZDRAVSTVENO VARSTVO
Meglič, Brodnik, IGI2009
Meglič, Brodnik, IGI2009
Ekspertni sistemi:
Triaža, ocena tveganja
Interakcije, KI zdravil
Diagnostična orodja ipd.
HIS, EZK LIS, PACS
Telemedicina,Koordinacija
Opolnomočenjepacienta
Podporna orodja (€, logistika, nabava,
poročanje
Dostop do znanja
Orodja za proces dela
Povezovanje do
pacienta, izvajalcev
Procesna orodja
Izmenjava dokumentov, podat
kov
eRecept
eNapotnica
eOdpustno pismo
eIzvid
ePoročilo/Obrazec
Poročanje -MZ-ZZZS-IVZ/ZZV
INFORMATIKA V JAVNEM
ZDRAVJU
Za kaj gre?
Nova paradigma: eJavnoZdravje
• Personalizacija
• Infomediacija in opolnomočenje
• Infodemiologija
PRILOŢNOSTI
®hackingalert
Skupine s
tveganim
vedenjem
Ciljane
kampanje
Vključevanje
uporabnikov
NOVO ZNANJE
• Frost et al. JMIR 2011
• taking certain drugs “off-
label“ with higher perceived
efficacy
• side effect of amitriptyline
(dry mouth) as the purpose
for taking the drug (e.g. to
treat excessive saliva).
Epidemiologija, nadzor
• Infodemiology, Infoveillance: new concepts in health / PH research
• web (search enginedata), patient social networks and microblogging platforms as source of knowledge andlive data
• integration and mining of data from various onlinesources to discover new clinical and population patterns i.e. diseaseoutbreaks and syndromicsurveillance
• Eysenbach 2009Eysenbach Infovigil, later Google Flu Trends
Twitter za nadzor izbruhov bolezni
• Signorini 2011, Kim 2012, both PLoS ONE: Influenza-like-illness
• ‚Twitter traffic can be used … to estimate disease activity in real time, i.e., 1–2 weeks faster than current practice allows‘
PREVENTIVA IN
PRESEJANJE:
Boljše razumevanje ciljne populacije
Who are our users?
User behaviour
What content is relevant for ourusers?
PRIMER AKTIVNEGA
VKLJUČEVANJA
I‘M A FAN OF LIFEIzziv: osveščati splošno populacijo o tem, kako
zmanjšati tveganje za nastanek raka.
Način: Promocija JZ vsebin preko spletnih socialnih
omreţij z uporabo prijemov gamifikacije in
‚celebrity branding‘
The rise of Gamification - when humans beatcomputers ‚back‘
FOLDIT:…scientific advancement is possible if even a small fraction of the energy that goes into playing computer games can be channelled into scientific discovery.
Jeopardy
Rezultati
• App na voljo 3 mesece
• Splet: 166 16.800 like-ov
• App: 5.200 uporabnikov
Vpliv oglaševanja
0
500
1000
1500
2000
2500
Weekly Active Users Weekly 1-day, 7-day,and 30-day counts of users who haveengaged with your app or viewed your app(Unique Users)Daily Added App Daily New users of yourapp or connections to your Connect site.Follows acceptance of your Terms ofService. (Total count)Daily Removed App Daily Users removedpremissions for your app or connections toyour Connect site. (Total count)
App Start FB Adverts start
FB Adverts stop
FB Adverts start
FB Adverts stop
FB Adverts stop
FB Adverts start
User engagement
E-ZDRAVJE IN
RAZISKOVALNO DELO
IT services and tools to make a health careresearcher‘s life easier
• Knowledge discovery (onlinepublishing was the keyenabler for Open Access Model)– Smart filtering (i.e. PubMed)
and push notifications (usingemail, RSS, apps, twitter)
– Shared knowledge discovery(shared feeds, sharedreferences i.e. Mendeley)
• Collaboration– ResearchGate (connect)– FoldIT– http://nhshackday.com/
arstechnica.com
blog.library.si.edu/
IT services and tools to make a healthcare researcher‘s life easier (2)
• Access to new data sources online: – microblogging data, ‚live‘ trend analysis,
– Personal Health Data (the quantified self, onlineexcercise mapping)
– Social Networks in Health and Health Care (PLM)
• Interaction with research subjects– the connected human (Smartphones, tablets,
monitoring devices (wearable/ingestible/implantable)
– Ease of data acquisition: from Online Questionnaires, portable monitoring devices, RFID infrastructure, etc.
– New ways to interact and acquire data
Trial search tool for patients
Novi buzzword: Open Data
• Publicly available largedatasets
• Coupled with genericAPIs they are super easyto use and drill-down.
• http://www.openprescribing.org/• http://www.openhealthcare.org.uk/
• Efforts to open up pharma data.. Tough butthere are improvements.
eZdravje kot čarobna paličica?• Using the Internet for health purposes was
associated with slightly increased depression (due to increased rumination, unnecessary alarm, or over-attention to health problems) Bessière etal 2010 JMIR
• Suicide: phone (telemedicine) follow-upwas effective in reducing suicidal ideation but not effective in reducing actual self-harm
• The QALY gain by patients using telehealthin addition to usual care was similar to that by patients receiving usual care only, and total costs associated with the telehealth intervention were higher. Telehealth does not seem to be a cost effective addition to standard support and treatment.
Ko se ni izšlo…
Problem poslovnega modela:• Spletno arhiviranje (za
reference) – WebCitewww.webcitation.org
• Kolaborativno znanje (rak): caBIG(https://cabig.nci.nih.gov)
Problem dodane vrednosti:• Skoraj vsi PHRji:
GoogleHealth, MedGle, RevolutionHealth, NHS PHR, (HealthVault)
Ko se ni izšlo
Problem vgraditve klinične vsebine:• Diagnostika kožnih
sprememb: delujejo samo tiste, kjer specialist pregleda sliko
(Zlo?)raba v tržne namene:• Nike+
3 of 4 smartphone applications incorrectly
classified 30% or more of melanomas as
unconcerning. Reliance on these
applications … can delay the diagnosis of
melanoma and harm users.
ZA KONECNeizogibnost
Hitrost
Previdnost ni odveč – klinična
preizkušenost
Financiranje storitev?
Vabljeni k sodelovanju!