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    Healthcare services using ic ts nazrul haider Healthcare services using ic ts nazrul haider Presentation Transcript

    • Healthcare Services using ICTs Status, Challenges and Opportunities A.K.M. Nazrul Haider December 01, 2011 www.e-asia.org
    • Conflict of Interest Disclosure A.K.M. Nazrul Haider Has no real or apparent conflicts of interest to report
    • Thinking about the future Key trends … 1. POPULATION: The world population growth will slow, with large differences between regions. Rapidly aging population, increased shifts to urban areas 2. ECONOMIES: The global economy will grow significantly, shift to the East and toward Services 3. CORPORATIONS: Companies will become more global, networked, learning-based and have a greater focus on corporate responsibility 4. GLOBAL FLOWS: The flows of people, natural resources, capital, and knowledge will be changing in volume and direction 5. INNOVATIONS: Current technological developments can be extrapolated into life-changing innovations of the future
      • Thinking about the future
      • Key trends …
      • Health
      • LIFE EXPECTANCY: We will all live longer and the gender gap will narrow
      • CAUSES OF DEATH: The number of deaths from non-communicable diseases and injuries will increase
      • DISEASES: There will be a transition from infectious to chronic diseases, but HIV/AIDS will remain a notable exception
      • MEDICAL SERVICES: Healthcare will become increasingly expensive with a widening gap between rich and poor and a serious deficit of health workers
      • MEDICINES: New medical technologies, substances, and vaccinations will ensure better health. More personalized medicines will offer tailor-made care
    • Thinking about the future Key trends … Environment 1. CLIMATE & ATMOSPHERE: The earth’s temperature will increase and sea levels will rise. Increase in greenhouse gas emissions and more extreme weather 2. ENERGY: Energy consumption will grow, especially in Asia. Continued fossil fuel dominance, despite widespread use of renewable and greener technologies 3. WATER: Water consumption will rise, primarily for non-irrigation use, causing greater water scarcity and more conflicts 4. ECOSYSTEMS & BIODIVERSITY: More forests and grasslands will be converted to cropland. Rising number of species will become extinct 5. ENVIRONMENTAL POLICY: Environmental regulation will increase and become stricter. Global agreements will be marked by economic incentives
    • Doctor Patient System Changing Healthcare …
    • “ We all make mistakes – doctors, nurses, pharmacists, and every other health care worker – and these errors are inevitable so it's important that we set up SYSTEMS to protect patients.”  
      • Sir Peter Mansfield
      • Nobel Laureate in Medicine
    • “ We all make mistakes – doctors, nurses, pharmacists, and every other health care worker – and these errors are inevitable so it's important that we set up SYSTEMS to protect patients.”  
      • Sir Peter Mansfield
      • Nobel Laureate in Medicine
      Paper-Less Film-Less
    • “ We all make mistakes – doctors, nurses, pharmacists, and every other health care worker – and these errors are inevitable so it's important that we set up SYSTEMS to protect patients.”  
      • Sir Peter Mansfield
      • Nobel Laureate in Medicine
      Paper-Less Film-Less Error-Less
    • Healthcare “ Information ” SUPPLY SIDE DEMAND SIDE PUSH PULL
    •  
    • Improved Information Flow will Prevent Death and Suffering
    • Complexity of Health Care Health Care Insurance Medical Devices Pharma HC Research HC Delivery Others
    • PACT
    • Shifting power of Technology … Convergence of Computer and Mobile devices Penetration of Internet
    • EHR Functional Model EHR PMR EPR EMR CMR
      • Patient Empowerment
      • Manage their own health care through prevention & life style change
      • Educating patients in safety practices
      • Making use of IT to disseminate knowledge, standard for disease management & support clinical research
    • m-Health
      • HC Information System… ROI [DRIP Syndrome]
      • Improvement in Productivity
      • VAS for Care Providers
      • Exploit the Technology to reach remote
      • Optimization of Costs
      • Above all, Knowledge Creation (SPOC)
    • The Workflow …
      • The Power of ICT…
      • Create Paper-Less and Film-Less Environment
      • Automation, Integration and Knowledge creation
      • Enable connected environment
      • Conform to Standards
      • Bolster Communication …
    • Tenerife disaster (KLM 4805 and Pan Am 1736) March 27, 1977 Communication Error
    •  
    •  
      • Plendil  Ca channel blocker to treat angina
      • Isordil  long acting nitrate used to treat angina
      • Zestril  ACE to treat high BP and heart failure
      • 50% said it is Plendil , one-third Isordil and rest Zestril
      • Physician actually prescribed 120 Tabs of Isordil  dose 20mg every 6 hours.
      • Pharmacist read the prescription as Plendil and instructed patient to take 20mg every 6 hours
      • Unfortunately usual dose of Plendil is 10mg/day
      • Eight fold Overdose
      • Patient died within the week .
    •  
    •  
    •  
      • Tele-Health
      • Reaching Remote …
      • Choices …
      • Implementation Challenges …
    • Capsule Endoscopy
    • Interface Engine Radiology NM Pharmacy Lab EMR/HIS PACS Reporting Physician Office Nursing Floor
      • 22
      • 22
      • HL7 provides interoperable standards that improve care delivery, optimize workflow, reduce ambiguity, and enhance knowledge transfer among all of our stakeholders, including healthcare providers, government agencies, the vendor community, and patients.
      Health Level 7
      • 22
      • Messaging standards
      • HL7 – Clinical data
      • X12 – Financial data
      • – DICOM – Images
      • – IEEE – Bedside instruments
      • Terminology standards
      • – LOINC – Logical observation identifier names
      • and codes
      • – Drugs – RxNorm, NDF-RT
      • – Clinical – UMLS, SNOMED, NANDA, READ, ICD
      • 17
      Healthcare Standards
      • 32
      • CDISC Standards
      • Platform-independent data standards that enable information system interoperability to improve medical research and related areas of healthcare.
      • The mission of CDISC is to develop and support global,
      • platform-independent data standards that enable information
      • system interoperability to improve medical research and
      • related areas of healthcare.
      • BRIDG Standard
      • Protocol-driven research and its associated
      • regulatory artifacts ,
      • i.e. the data, organization, resources, rules, and processes
      • involved in the formal assessment of the utility, impact,
      • or other pharmacological, physiological, or psychological
      • effects of a drug, procedure, process, or device on a
      • human, animal, or other biologic subject or substance
      • plus all associated regulatory artifacts required for or
      • derived from this effort.
      • 66
      • Challenges …
        • One of the key barriers to automation of medical data is
        • the need for standards - the foundation of interoperability in
        • information interchange
        • Impact of Climate variability on Human Health
        • Seamless integration with all P’s
        • EHR  need for harmonization & meaningful use
        • eHealth & mHealth  reaching remote, geriatrics
        • PACT – Education and Training [revamping medical education curriculum]
      • 2
    •  
    • Thank You
    • Fusion
    • Fusing Anatomy and Function: historical Hand-drawn contours Software fusion CT PET x z y    Hardware fusion PET/CT Visual (mental) fusion CT PET
    • Referred for evaluation of left paracardiac mass Prior PET and CT performed few months earlier PET and CT retrospective registration Interpretation: Malignant
    • Referred for evaluation of left paracardiac mass Prior PET and CT performed few months earlier Combined PET/CT Interpretation: Benign
    • Viewing PET/CT on A PACS Workstation
    • Interpretation Issues-Possibility for Discrep. Original: PET: negative, CT: positive Addendum after review: PET: negative, CT: negative
    • Hardware Fusion: x-ray, CT, or MR
      • ~ 90% of anatomical imaging in oncology is CT
      • CT simulation used for RTP in radiation oncology
      • CT can be used for PET attenuation + scatter correction
      • FDG-PET widely used for functional oncology studies
      X-ray CT PET MR coronal axial coronal coronal anatomical imaging functional
    • Fusion imaging: hardware 1995-2008 CT console Somatom AR.SP PET console ECAT ART CT Fused image viewer PET
    • PET/CT Standard Sequence Topogram CT PET Upper limit Lower limit CT acquisition Scatter correction Attenuation correction FORE AWOSEM Fused PET/CT
    • Fused PET/CT provides more accurate localization of tumors, offers synergistic information from PET and CT and has an impact on clinical decision making Hardware fusion: anatomy + function CT anatomy PET function PET/CT
      • To image different aspects of disease
      • To identify non-specific tracer uptake
      • To facilitate image interpretation
      • To provide unique added value to both
      Why combine CT and PET?