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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)](https://image.slidesharecdn.com/healthitforexecutives-180510145435/75/Health-IT-for-Executives-28-2048.jpg)
Uploaded byNawanan Theera-Ampornpunt
Health IT for Executives
The document discusses using future technology with executives in the era of Industry 4.0. It describes a lecture on medical governance certification for senior executives. The speaker has a PhD in health informatics and is an assistant dean and community medicine professor. He discusses why healthcare is not yet "smart" like manufacturing due to its complex and varied nature. Health IT can help improve quality by supporting clinical decisions, documenting care, and reducing errors through alerts. However, technology also poses risks like alert fatigue if not implemented carefully with a focus on users and processes.
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Health IT for Executives
- 1. การใช้เทคโนโลยีอนาคตกับผู้บริหารในยุค 4.0 บรรยายในหลักสูตรประกาศนียบัตรธรรมาภิบาลทางการแพทย์ สาหรับผู้บริหารระดับสูง รุ่นที่6 นพ.นวนรรน ธีระอัมพรพันธุ์ 12 พฤษภาคม 2561
- 2. 2 2546 แพทยศาสตรบัณฑิต (เกียรตินิยมอันดับ1) 2554 Ph.D. (Health Informatics), Univ. of Minnesota ผู้ช่วยคณบดีฝ่ายสารสนเทศ อาจารย์ ภาควิชาเวชศาสตร์ชุมชน คณะแพทยศาสตร์โรงพยาบาลรามาธิบดี มหาวิทยาลัยมหิดล ความสนใจ: Health IT for Quality of Care, IT Management, Security & Privacy, Social Media in Healthcare [email protected] SlideShare.net/Nawanan แนะนาตัว
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- 4. 4 Let’s take alook at these pictures...
- 5. 5Image Source: https://en.wikipedia.org/wiki/Industrial_robot(KUKA Roboter GmbH) “Smart” Manufacturing
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- 7. 7ER - ImageSource: nj.com Healthcare (On TV)
- 8. 8 (At an undisclosedhospital) Healthcare (Reality)
- 9. 9 • Life-or-Death • Difficultto 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”?
- 10. 10 But...Are We ThatDifferent? Input Process Output Transfer Banking Value-Add - Security - Convenience - Customer Service Location A Location B
- 11. 11 Input Process Output Assembling Manufacturing RawMaterials Finished Goods Value-Add - Innovation - Design - QC But...Are We That Different?
- 12. 12 Input Process Output PatientCare 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?
- 13. 13 • Large variations& contextual dependence Input Process Output Patient Presentation Decision- Making Biological Responses Standardizing Healthcare
- 14. 14 The World ofSmart Machines Image Sources: http://www.ibtimes.com/google-deepminds-alphago- program-defeats-human-go-champion-first-time-ever-2283700 http://deepmind.com/
- 15. 15 Digitizing Healthcare Image Source:http://www.bloomberg.com/bw/stories/2005-03-27/cover-image-the-digital-hospital
- 16. 16 “To computerize the hospital” “Togo paperless” “To become a Digital Hospital” “To Have EHRs” Why Adopting Health IT?
- 17. 17 • “Don’t implementtechnology 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
- 18. 18 Being Smart #1: StopYour “Drooling Reflex”!!
- 19. 19 Being Smart #2: Focuson Information & Process Improvement, Not Technology
- 20. 20 ถ้าไม่เป็น “Digital Hospital” หรือ“Paperless Hospital” แล้วจะให้เราเป็นอะไร?
- 21.
- 22. 22 แล้ว “Smart Hospital” ต่างจากDigital หรือ Paperless Hospital ตรงไหน?
- 23. 23 Connecting People toa Healthy Future With Personalized Care – Kaiser Permanente https://www.youtube.com/watch?v=gxz9ZVvduGc
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- 25. 25 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?
- 26. 26 • 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
- 27. 27 My personal storyon why we need doctors to implement health IT
- 28. 28 Biomedical & HealthInformatics • “[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)
- 29. 29(Shortliffe, 2002) Spectrum ofBiomedical & Health Informatics
- 30. 30 Information is Everywherein Healthcare
- 31. 31 31 WHO (2009) Components ofHealth Systems
- 32. 32 • Safe –Drug allergies –MedicationReconciliation • 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
- 33. 33 • Efficient –Faster care –Time& cost savings –Reducing unnecessary tests • Equitable –Access to providers & knowledge • Patient-Centered –Empowerment & better self-care Being “Smart” in Healthcare
- 34. 34 (IOM, 2001)(IOM, 2000)(IOM, 2011) Landmark Institute of Medicine Reports
- 35. 35 • To Erris 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
- 36. 36 Summary of TheseReports • 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
- 37. 37 • Medication Errors –DrugAllergies –Drug Interactions • Ineffective or inappropriate treatment • Redundant orders • Failure to follow clinical practice guidelines Common Errors
- 38. 38 Being Smart #3: “ToErr is Human”
- 39. 39 External Memory Knowledge Data LongTerm Memory Knowledge Data Inference DECISION PATIENT Perception Attention Working Memory CLINICIAN Elson, Faughnan & Connelly (1997) Clinical Decision Making
- 40. 40 Example of “Alerts& Reminders” Reducing Errors through “Alerts & Reminders”
- 41. 41 Documented Values ofHealth IT • Guideline adherence • Better documentation • Practitioner decision making or process of care • Medication safety • Patient surveillance & monitoring • Patient education/reminder
- 42. 42 Being Smart #4: LinkIT Values to Quality (Including Safety)
- 43.
- 44. 44 Hospital Information System(HIS) Computerized Physician Order Entry (CPOE) Electronic Health Records (EHRs) Picture Archiving and Communication System (PACS) Various Forms of Health IT
- 45. 45 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
- 46. 46 Health IT forMedication Safety Ordering Transcription Dispensing Administration CPOE Automatic Medication Dispensing Electronic Medication Administration Records (e-MAR) Barcoded Medication Administration Barcoded Medication Dispensing
- 47. 47 Health Information Exchange HospitalA Hospital B Clinic D Policymakers Patient at Home Hospital C HIE Broker
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- 49.
- 50. 50WHO & ITU AchievingHealth Information Exchange (HIE)
- 51. 51 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/
- 52. 52Image Source: socialmediab2b.com AnotherSmart Machine: IBM’s Watson
- 53. 53Image Source: englishmoviez.com Riseof the Machines?
- 54. 54 Clinical Decision SupportSystems • 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
- 55. 55 Being Smart #5: Don’tReplace Human Users. Use ICT to Help Them Perform Smarter & Better.
- 56. 56 Some Risks ofClinical Decision Support Systems • Alert Fatigue Unintended Consequences of Health IT
- 57.
- 58. 58 Being Smart #6: HealthIT Also Have Risks & Unintended Consequences
- 59. 59 Balanced Focus ofInformatics Technology ProcessPeople
- 60. 60 Being Smart #7: BalanceYour Focus (People, Process, Technology)
- 61. (Extra Slides) Telemedicine: Current Status& Issues นพ.นวนรรน ธีระอัมพรพันธุ์ คณะแพทยศาสตร์โรงพยาบาลรามาธิบดี มหาวิทยาลัยมหิดล 12 พ.ค. 2561
- 62. Thailand’s Healthtech Ecosystem Courtesyof Phongchai Petsanghan & Health Tech Startup Thailand (May 2018)
- 63. State of TeleHealth Dorsey& Topol (2015)
- 64. • Current Trends –Changefrom using telehealth to increase access to health care to providing convenience and reducing cost –Expansion of telehealth to chronic conditions –Migration of telehealth from hospitals and clinics to home and mobile devices State of TeleHealth Dorsey & Topol (2015)
- 65. • Limitations ofTelehealth –Reimbursement • Limited & fragmented insurance coverage of telehealth • Potential for excess health care utilization –Clinical issues • Patient-physician relationship • Quality of physical examination • Quality of care with remote visits than with in-person visits State of TeleHealth Dorsey & Topol (2015)
- 66. Dorsey & Topol(2015) • Limitations of Telehealth –Clinical issues (continued) •Potential for abuse (e.g. overprescribing of narcotics) •Fragmentation of care among multiple providers –Legal issues (e.g., state licensure, liability) –Social issues (digital divide) State of TeleHealth
- 67. Legal Issues • Privacy& Security Issues • Liability due to Risks of Medical Errors Misdiagnosis Delayed Diagnosis & Treatment Miscommunication & Information Reliability • Legal Compliance พรบ.สถานพยาบาล, พรบ.วิชาชีพ, พรบ.ยา, พรบ.เครื่องมือ แพทย์ ฯลฯ Legal Documentation
- 68. Legal Issues • Rolesof Professionals & Human-Technology Balance
- 69. Medical Practice Issues •Benefits of Telemedicine –Patient accessibility/Convenience/Engagement –Clinical outcomes (evidence still needed in most cases) –Reduced patient waiting time at the hospital –Improved logistics (Medications, Materials, Patients) –More longitudinal data for patient care
- 70. Medical Practice Issues •Risks of Telemedicine – Data accuracy, reliability & timeliness – Limitations of technology in medical practice – Diagnostic errors – Treatment delays – Miscommunication / Unrealistic expectations – Doctor-patient relationship & trust – Abuse – Provider burden – Legal compliance
- 71. Legal Aspect ofTelemedicine • Telemedicine เป็นการประกอบวิชาชีพเวชกรรม (หรือวิชาชีพอื่นๆ ที่เกี่ยวข้อง) หรือไม่ มีมาตรฐานกากับอย่างไร (Patient Care, Documentation) • Telemedicine ถูกบังคับโดย พรบ.สถานพยาบาลหรือไม่ • อุปกรณ์และเทคโนโลยี มีมาตรฐานกากับอย่างไร ถูกบังคับโดย พรบ.เครื่องมือแพทย์ หรือไม่ • กรณีมีข้อผิดพลาด/ผลเสียหายเกิดขึ้นจาก Telemedicine Practice ต้องรับผิดชอบ หรือไม่ ความรับผิดชอบอยู่กับใคร (ผู้สั่งการรักษา, ผู้ให้การรักษา, ผู้ป่วย, เจ้าของ ระบบ Telemedicine) • สามารถส่งยาทางไกลให้ผู้ป่วยได้หรือไม่ ถูกบังคับโดย พรบ.ยา, พรบ.วัตถุออกฤทธิ์ ต่อจิตและประสาท, พรบ.ยาเสพติดให้โทษ, พรบ.วิชาชีพเภสัชกรรม หรือไม่ อย่างไร • การดูแล Security & Privacy มีมาตรฐานอย่างไร
- 72.