Informatics in Emergency Medicine:         A Brief Introduction    Nawanan Theera-Ampornpunt, MD, PhD           Faculty of...
Outline    • Introduction about Biomedical & Health Informatics    • Emergency Medicine & Implications for Informatics    ...
Biomedical & Health Informatics     • “[T]he field that is concerned with the optimal       use of information, often aide...
DIKW Pyramid                    Wisdom                   Knowledge                   Information                      Data4
Informatics As A Field5                            Shortliffe (2002)
Because Information is Everywhere...6
Emergency Departments (ED)    • Prone to errors because of      – Urgent nature      – Limited & at times unreliable patie...
Informatics Roles in Emergency Medicine    • Provide patient information critical to care    • Information improves qualit...
Why Adopting Health IT?    “To Go paperless”         “To Computerize”      “To Get a HIS”                                 ...
Dimensions of Quality Healthcare       •   Safety       •   Timeliness       •   Effectiveness       •   Efficiency       ...
Better Information Delivery Improves     •   Safety (prevent allergies)     •   Timeliness (have access to information ear...
IT as Tools for Process Redesign     •   Safety (no handwriting!!, allergies/DI alerts)     •   Timeliness (faster interna...
Because... “To Err Is Human”13
To Err Is Human     • Lack of Attention14                         Image Source: aafp.org
To Err Is Human     • Cognitive Errors - Example: Decoy Pricing                                            # of         Th...
What If This Happens in Healthcare? • It already happens....     (Mamede et al., 2010; Croskerry, 2003; Klein, 2005) • Wha...
Clinical Decision Support Systems (CDSSs)                          PATIENT                         Perception      CLINICI...
Clinical Decision Support Systems (CDSSs)                          PATIENT                         Perception      CLINICI...
Clinical Decision Support Systems (CDSSs)                          PATIENT                         Perception      CLINICI...
Clinical Decision Support Systems (CDSSs)                          PATIENT                                       Drug-Drug...
Clinical Decision Support Systems (CDSSs)     • CDSS as a replacement or supplement of       clinicians?       – The demis...
Electronic Health Records (EHRs)      • Electronic documentation of patient care by        providers      • Sometimes defi...
Electronic Health Record (EHR) Systems      • Are they just electronic documentation?                History   Diag-   Tre...
Benefits of Health IT     • Literature suggests improvement in health care       through        – Guideline adherence (Shi...
Functions that Should be Part of EHR Systems      •   Computerized Medication Order Entry      •   Computerized Laboratory...
Health Information Exchange (HIE)                     Government     Hospital A                     Hospital B            ...
Personal Health Records (PHRs)     • “An electronic application through which individuals can       access, manage and sha...
Types of PHRs     • Patient portal from a provider’s EHRs (“tethered” PHRs)     • Online PHRs        – Stand-alone        ...
Use Cases of PHRs     • Data entry/update by patients     • Data retrieval by providers        – With patient’s consent   ...
Mobile Health (mHealth) • Exponential increase in mobile devices • Technology penetration in rural, underserved   settings...
mHealth & Social Media in Disaster Management • Communication, coordination & collaboration   tools for relief workers, di...
What Happened in Thailand in 2011?                      • Unusually heavy rainfalls                      • Flooding began ...
Impact              • 800+ deaths              • Many millions affected              • Residences, businesses,            ...
mHealth & Social Media in Thailand’s Flooding • Situation monitoring tools (central government)34                         ...
mHealth & Social Media in Thailand’s Flooding • Situation monitoring tools (local BKK government)35                       ...
mHealth & Social Media in Thailand’s Flooding • Non-governmental information dissemination36                              ...
mHealth & Social Media in Thailand’s Flooding • Preparedness, Educational & Advocacy Tools37                              ...
mHealth & Social Media in Thailand’s Flooding • Healthcare provider & MoPH coordination38                       https://ww...
mHealth & Social Media in Thailand’s Flooding • Simply to tell the world how we are doing...39   Ayutthaya Hospital, late ...
mHealth & Social Media in Thailand’s Flooding • Simply to tell the world how we are doing...40   Ayutthaya Hospital, late ...
Biosurveillance41
Google Flu Trends (Biosurveillance)42                                  Source: Google.org/FluTrends
Conclusion • Health IT and informatics    – Provide information for high quality emergency care    – Have potential to tra...
Questions?44
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Informatics in Emergency Medicine: A Brief Introduction (Presentation)

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Theera-Ampornpunt N. Information and technology: emergency medical informatics. Presented at: The International Conference in Emergency Medicine: Challenges in Emergency Medicine: It’s Time for Change!; 2012 Feb 1; Bangkok, Thailand. Invited speaker.

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Informatics in Emergency Medicine: A Brief Introduction (Presentation)

  1. 1. Informatics in Emergency Medicine: A Brief Introduction Nawanan Theera-Ampornpunt, MD, PhD Faculty of Medicine Ramathibodi Hospital http://www.slideshare.net/nawanan Feb 1, 2012
  2. 2. Outline • Introduction about Biomedical & Health Informatics • Emergency Medicine & Implications for Informatics • Informatics Applications in Emergency Medicine – EHRs & HIE – PHRs – mHealth – Biosurveillance • Conclusion2
  3. 3. 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) • “[T]he application of the science of information as data plus meaning to problems of biomedical interest” (Bernstam et al, 2010)3
  4. 4. DIKW Pyramid Wisdom Knowledge Information Data4
  5. 5. Informatics As A Field5 Shortliffe (2002)
  6. 6. Because Information is Everywhere...6
  7. 7. Emergency Departments (ED) • Prone to errors because of – Urgent nature – Limited & at times unreliable patient history – Time & resource constraints • Scale & unpredictability of mass casualties & disasters make it worse • 32% of ED visits had information gaps which can lead to prolonged ED stay (Stiell et al., 2003)7
  8. 8. Informatics Roles in Emergency Medicine • Provide patient information critical to care • Information improves quality & efficiency of care in ED, at least for some conditions (e.g., Theera-Ampornpunt et al., 2009; Overhage et al., 2002; Connelly et al., 2012) • Role of health information exchange (HIE) highlighted • IT as transformational tools that improve care processes8
  9. 9. Why Adopting Health IT? “To Go paperless” “To Computerize” “To Get a HIS” “Digital Hospital” “To Have EMRs” “To Modernize”9 “To Share data”
  10. 10. Dimensions of Quality Healthcare • Safety • Timeliness • Effectiveness • Efficiency • Equity • Patient-centeredness10 IOM (2001)
  11. 11. Better Information Delivery Improves • Safety (prevent allergies) • Timeliness (have access to information early) • Effectiveness (information for decision-making) • Efficiency (prevent unnecessary/redundant lab) • Equity • Patient-centeredness11
  12. 12. IT as Tools for Process Redesign • Safety (no handwriting!!, allergies/DI alerts) • Timeliness (faster internal processes) • Effectiveness (CDSS alerts & reminders) • Efficiency (faster care, better patient flow, better bed management)12
  13. 13. Because... “To Err Is Human”13
  14. 14. To Err Is Human • Lack of Attention14 Image Source: aafp.org
  15. 15. To Err Is Human • Cognitive Errors - Example: Decoy Pricing # of The Economist Purchase Options People • Economist.com subscription $59 16 • Print subscription $125 0 • Print & web subscription $125 84 # of The Economist Purchase Options People • Economist.com subscription $59 6815 • Print & web subscription $125 32 Ariely (2008)
  16. 16. What If This Happens in Healthcare? • It already happens.... (Mamede et al., 2010; Croskerry, 2003; Klein, 2005) • What if health IT can help?16
  17. 17. Clinical Decision Support Systems (CDSSs) PATIENT Perception CLINICIAN Attention Long Term Memory External Memory Working Memory Knowledge Data Knowledge Data Inference17 DECISION From a teaching slide by Don Connelly, 2006
  18. 18. Clinical Decision Support Systems (CDSSs) PATIENT Perception CLINICIAN Abnormal lab Attention highlights Long Term Memory External Memory Working Memory Knowledge Data Knowledge Data Inference18 DECISION
  19. 19. Clinical Decision Support Systems (CDSSs) PATIENT Perception CLINICIAN Drug-Allergy Attention Checks Long Term Memory External Memory Working Memory Knowledge Data Knowledge Data Inference19 DECISION
  20. 20. Clinical Decision Support Systems (CDSSs) PATIENT Drug-Drug Perception Interaction CLINICIAN Checks Attention Long Term Memory External Memory Working Memory Knowledge Data Knowledge Data Inference20 DECISION
  21. 21. Clinical Decision Support Systems (CDSSs) • 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”21 Friedman (2009)
  22. 22. Electronic Health Records (EHRs) • Electronic documentation of patient care by providers • Sometimes defined as longitudinal records of a patient’s health care22
  23. 23. Electronic Health Record (EHR) Systems • Are they just electronic documentation? History Diag- Treat- ... & PE nosis ments • Or do they have some other values?23
  24. 24. Benefits of Health IT • Literature suggests improvement in health care through – Guideline adherence (Shiffman et al, 1999;Chaudhry et al, 2006) – Better documentation (Shiffman et al, 1999) – Practitioner decision making or process of care (Balas et al, 1996;Kaushal et al, 2003;Garg et al, 2005) – Medication safety (Kaushal et al, 2003;Chaudhry et al, 2006;van Rosse et al, 2009) – Patient surveillance & monitoring (Chaudhry et al, 2006) – Patient education/reminder (Balas et al, 1996) – Cost savings and better financial performance (Parente & Dunbar, 2001;Chaudhry et al, 2006;Amarasingham et al, 2009;Borzekowski, 2009)24
  25. 25. Functions that Should be Part of EHR Systems • Computerized Medication Order Entry • Computerized Laboratory Order Entry • Computerized Laboratory Results • Physician Notes • Patient Demographics • Problem Lists • Medication Lists • Discharge Summaries • Diagnostic Test Results • Radiologic Reports25 IOM (2003), Blumenthal et al (2006)
  26. 26. Health Information Exchange (HIE) Government Hospital A Hospital B Clinic C Lab Patient at Home26
  27. 27. Personal Health Records (PHRs) • “An electronic application through which individuals can access, manage and share their health information, and that of others for whom they are authorized, in a private, secure, and confidential environment.” (Markle Foundation, 2003) • “A PHR includes health information managed by the individual... This can be contrasted with the clinician’s record of patient encounter–related information [a paperchart or EHR], which is managed by the clinician and/or health care institution.” (Tang et al., 2006)27
  28. 28. Types of PHRs • Patient portal from a provider’s EHRs (“tethered” PHRs) • Online PHRs – Stand-alone – Can be integrated with EHRs from multiple providers (unidirectional/bidirectional data sharing) • Stand-alone PHRs – PC-based applications – USB Drive – CD-ROM or other data storage devices – Paper28
  29. 29. Use Cases of PHRs • Data entry/update by patients • Data retrieval by providers – With patient’s consent – “Break-the-glass” emergency access • Data update from EHRs • Privacy settings • Personalized patient education & reminders • Communications with providers29
  30. 30. Mobile Health (mHealth) • Exponential increase in mobile devices • Technology penetration in rural, underserved settings • Democratization of information access • Roles of social media30
  31. 31. mHealth & Social Media in Disaster Management • Communication, coordination & collaboration tools for relief workers, disaster managers, victims • Used heavily in – Haiti’s 2010 earthquake – Japan’s 2011 earthquake & tsunami – Thailand’s 2011 record flooding31
  32. 32. What Happened in Thailand in 2011? • Unusually heavy rainfalls • Flooding began in the north, continued  downstream to Gulf of Thailand • Dams insufficient capacity to handle the  amount of water • Severe flooding in ~ 1/3 of Thailand • Record flooding in 50 years Wikipedia32
  33. 33. Impact • 800+ deaths • Many millions affected • Residences, businesses, factories & industrial complexes, hospitals, etc. all affected • Historic sites damaged • Economic impact: (est.) $46 billion (World Bank)33 Thaiflood.com (10/28/2011)
  34. 34. mHealth & Social Media in Thailand’s Flooding • Situation monitoring tools (central government)34 http://www.kromchol.com/
  35. 35. mHealth & Social Media in Thailand’s Flooding • Situation monitoring tools (local BKK government)35 http://dds.bangkok.go.th/Canal/
  36. 36. mHealth & Social Media in Thailand’s Flooding • Non-governmental information dissemination36 http://www.thaiflood.com
  37. 37. mHealth & Social Media in Thailand’s Flooding • Preparedness, Educational & Advocacy Tools37 http://www.youtube.com/user/roosuflood
  38. 38. mHealth & Social Media in Thailand’s Flooding • Healthcare provider & MoPH coordination38 https://www.facebook.com/groups/mophwarroomcoordination/
  39. 39. mHealth & Social Media in Thailand’s Flooding • Simply to tell the world how we are doing...39 Ayutthaya Hospital, late October © Suthasinee Senasu, MD (2011)
  40. 40. mHealth & Social Media in Thailand’s Flooding • Simply to tell the world how we are doing...40 Ayutthaya Hospital, late October © Suthasinee Senasu, MD (2011)
  41. 41. Biosurveillance41
  42. 42. Google Flu Trends (Biosurveillance)42 Source: Google.org/FluTrends
  43. 43. Conclusion • Health IT and informatics – Provide information for high quality emergency care – Have potential to transform care processes (not just computerizing patient care) – Come in various forms (EHRs, CDSS, HIE, PHRs, mHealth, biosurveillance) • Increasing roles of health IT and informatics for tomorrow’s emergency and disaster management • New innovations & new uses of IT discovered43 through every emergency situation
  44. 44. Questions?44

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