Presented at the Siriraj International Conference in Medicine and Public Health 2016: Innovation in Health, Faculty of Medicine Siriraj Hospital, Mahidol University on June 13, 2016
9. 9
• Life-or-Death
• Difficult to 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
• Large variations & contextual dependence
Input Process Output
Patient
Presentation
Decision-
Making
Biological
Responses
Standardizing Healthcare
11. 11
The World of Smart Machines
Image Sources: http://www.ibtimes.com/google-deepminds-alphago-
program-defeats-human-go-champion-first-time-ever-2283700
http://deepmind.com/
14. 14
• “Don’t implement technology 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
23. 23
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?
24. 24
• 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
28. 28
• Safe
–Drug allergies
–Medication Reconciliation
• 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
29. 29
• Efficient
–Faster care
–Time & cost savings
–Reducing unnecessary tests
• Equitable
–Access to providers & knowledge
• Patient-Centered
–Empowerment & better self-care
Being “Smart” in Healthcare
31. 31
Summary of These Reports
• 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
32. 32
Image Source: (Left) http://docwhisperer.wordpress.com/2007/05/31/sleepy-heads/
(Right) http://graphics8.nytimes.com/images/2008/12/05/health/chen_600.jpg
To Err is Human 1: Attention
33. 33Image Source: Suthan Srisangkaew, Department of Pathology, Facutly of Medicine Ramathibodi Hospital
To Err is Human 2: Memory
34. 34
• Medication Errors
–Drug Allergies
–Drug Interactions
• Ineffective or inappropriate treatment
• Redundant orders
• Failure to follow clinical practice guidelines
Common Errors
35. 35
Documented Values of Health IT
• Guideline adherence
• Better documentation
• Practitioner decision making or
process of care
• Medication safety
• Patient surveillance &
monitoring
• Patient education/reminder
43. 43
Clinical Decision Support Systems
• 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
52. 52
Asia Pacific eHealth Efforts
Asia eHealth Information Network (AeHIN) Meetings
Health Information
Management Systems Society
(HIMSS) Asia Pacific Conferences
53. 53
• Piggyback on national agenda (e.g. Digital
Economy)
• Use WHO-ITU model as a guide
• Start with national eHealth governance
• Identify how IT adds value in healthcare
• Standards over apps
• Recognize value of “humans”
• Walk together with neighbors
How Should We Move Forward?
54. 54
• “Digital Health” doesn’t mean the goal is
digitizing everything. Rather, it means
Smart Health: using ICT smartly to
improve quality of care.
• Thailand is moving toward “Digital
Health”, slowly....
• Regional efforts are instrumental in
national progress
Summary