6-005-1430-Keeppanasseril

Medicine and web 3.0 - A wishlist Arun Keepanasseril, BDS, MDS (Prosthodontics) Msc e Health candidate McMaster University Hamilton Canada

Some problems faced by clinicians in the information era• Information overload• Interruptions.• Technology adaptation

Information overload - Reasons• Rapid production of information• The ease of duplication and transmission .• An increase in the available channels of incoming information.

Information overload - Reasons• Contradictions and inaccuracies in available information• A lack of a method for comparing and processing different kinds of information• The pieces of information are unrelated or do not have any overall structure to reveal their relationships

Total Number of Articles per Year, PubMed Database, 1990-2009900,000 845,175800,000700,000600,000500,000400,000300,000200,000100,000 0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Growth of PubMed citations from 1986 to 2010. Lu Z Database 2011;2011:baq036© The Author(s) 2011. Published by Oxford University Press.

Why search? • 0.07 - 1.85 questions per patient visit.Kahane S, Stutz E, Aliarzadeh B.Must we appear to be all-knowing?: patients and family physicians perspectives oninformation seeking during consultations Can Fam Physician. 2011 Jun;57(6):e228-36

Information seeking behaviorHC Coumou-How do primary care physicians seek answers to clinical questions? A literature review. J Med Libr Assoc. 2006 Jan;94(1):55-60

Medical Literature Pubmed Proquest PsychinfoCINAHL Cochrane MD Consult Global Health EMBASE AMED Fragmented repositories

Medical LiteratureSpecialized search strategies

Fragmented + Specialized =

Anatomy of Literature search Overview of general user interactions with PubMed (or similar systems) for searching biomedical literature. Lu Z Database 2011;2011:baq036© The Author(s) 2011. Published by Oxford University Press.

Lit search=Wargame?

PUBMED

Evidence based resources

Web 2.day• High recall, low precision• Results highly sensitive to vocab.• Results are single web pages.

Super search

Super search•Contextual.• Comprehensive.• Easy• Fast

Zhiyong Lu: PubMed and beyond: a survey of web toolsfor searching biomedicalliterature, Database, Vol. 2011, Article ID baq036, doi:10.1093/database/baq03

8 in 10 Internet users have looked online for health information.

“Year of the Empowered Patient.” - 2011.• Challenge a doctor’s treatment/diagnosis,• Ask a physician to change a treatment,• Discuss information found online with a physician,• Use the Internet instead of seeing a doctor• Made a healthcare decision because of online information.

Consumer information online• Unreliable.• No contextual information• Likely to confuse the patient and the doctor at times!

Some times what consumers need are answers

For the consumer• Authentic Information relevant to their unique condition.• Easy to understand presentation

Improved Health Information

Traditional clinical trials • Expensive • Time consuming

ALLHAT Trial• 42,418 patients• 623 ofﬁces and clinics• 4 drugs• 5 year follow up• 120 million USD• 8 years from start to ﬁnish

Figure courtesy Scientiﬁc American

Gigantic distributed database with hidden data Figure courtesy Scientiﬁc American

Can semantics ﬁnd a way to use them for research, could replace the expensive clinical trials whenever possible?

Semantic aided clinical research

Unintended consequences of EHR• More/New Work for • Changes in Communication Clinicians Patterns and Practices• Workﬂow Issues • Negative Emotions• Never Ending System • Generation of New Kinds of Demands Errors• Problems Related to Paper • Unexpected and Unintended Persistence Changes in Institutional http://www.ohsu.edu/academic/dmice/research/cpoe/unintended_consequences.php

Semantic-aware Electronic Health Records• Intelligent patient summary.• Detection of medication conﬁcts• Diagnosis support• Chronic disease monitoring• De Potter P, Debevere P, Mannens E. Next generation assisting clinical applications by using semantic-aware electronic health records. 2009;

Context aware applications • Entities sense and automatically adapt to their changing contexts. • Personalized, context-aware services in real- time to improve patient safety and quality of care.USING ONTOLOGY TO SUPPORT CONTEXT AWARENESS IN HEALTHCARE :Wen Yao1, Chao-Hsien Chu, Akhil Kumar, Zang Li

Enhanced clinical workﬂow

Thank you

6-005-1430-Keeppanasseril

by med20su on Sep 17, 2011

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