IT for MDs (Part 1) Nawanan Theera‐Ampornpunt, MD, PhD                    Feb. 13, 2013      Faculty of Medicine Ramathibo...
A Few Words About Me...    2003 M.D. (1st-Class Honors) Ramathibodi (Rama 33)    2009 M.S. (Health Informatics) University...
IT Competencies    Internet & E‐mail    Literature searches & EBM    Preparing presentation slides    Bibliographic to...
Today’s Contents    Healthcare & Health IT    Health IT Applications in Hospitals4
Health care &       Health IT5
Manufacturing6                   Image Source: Guardian.co.uk
Banking7             Image Source: Scbcareers.scb.co.th
Health care8                 ER ‐ Image Source: nj.com
Why Health care Isn’t Like Any Others?      Life‐or‐Death      Many & varied stakeholders      Strong professional valu...
Why Health care Isn’t Like Any Others?      Large variations & contextual dependence            Input       Process      ...
But...Are We That Different?                   Banking       Input         Process            Output                      ...
But...Are We That Different?                  Manufacturing      Input           Process      Output       Raw           A...
But...Are We That Different?                     Health care       Input               Process                     Output ...
Information is Everywhere in Health Care14
Various Forms of Health IT     Hospital Information System (HIS)     Computerized Provider Order Entry (CPOE)             ...
Still Many Other Forms of Health IT                                                                               Health I...
Why Adopting Health IT?     “To Go paperless”         “To Computerize”       “To Get a HIS”                               ...
Some Quotes  “Don’t implement technology just for    technology’s sake.”  “Don’t make use of excellent technology.    Ma...
Health IT: What’s In A Word?     Health                     Goal     Information               Value‐Add     Technology   ...
Dimensions of Quality Healthcare      Safety      Timeliness      Effectiveness      Efficiency      Equity      Pat...
Value of Health IT     Guideline adherence      Better documentation      Practitioner decision making or        proces...
Fundamental Theorem of Informatics22                                      (Friedman, 2009)                                ...
Is There A Role for Health IT?23                                    (IOM, 2000)
Landmark IOM Reports     (IOM, 2000)   (IOM, 2001)24
Landmark IOM Reports: Summary      Humans are not perfect and are bound to make        errors      Highlight problems in...
Why We Need Health IT      Health care is very complex (and inefficient)      Health care is information‐rich      Qual...
To Err Is Human      Perception errors27                          Image Source: interaction‐dynamics.com
To Err Is Human      Lack of Attention                                  Image Source: aafp.org28
To Err Is Human      Cognitive Errors - Example: Decoy Pricing                                              # of      The...
What If This Happens in Healthcare? It already happens....     (Mamede et al., 2010; Croskerry, 2003; Klein, 2005) What ...
Adoption of Health IT: Assumptions     Adoption       Use        Outcomes31
U.S.’s Efforts on Health IT Adoption                                  ?     “...We will make wider use of electronic recor...
U.S. Adoption of Health IT     Ambulatory (Hsiao et al, 2009)               Hospitals (Jha et al, 2010)                   ...
We Need “Change”     “...we need to upgrade our medical      records by switching from a paper to      an electronic syste...
The Birth of “Meaningful Use”           “...Our recovery plan will invest in      electronic health records and new techno...
American Recovery & Reinvestment Act      Contains HITECH Act       (Health Information Technology for Economic and      ...
What is in the HITECH Act?37                           (Blumenthal, 2010)
“Meaningful Use”                                             “Meaningful Use”      Pumpkin                                ...
“Meaningful Use” of Health IT                                                           Better      Stage 1               ...
Adoption Studies: Descriptive Aspect                             2004                                    Pongpirul et al. ...
Q & A...     Download Slides     SlideShare.net/Nawanan     Contacts            nawanan.the@mahidol.ac.th            www.t...
References      Ariely D. Predictably irrational: the hidden forces that shape our decisions. New York City        (NY):H...
References      Institute of Medicine, Board on Health Care Services, Committee on Data Standards for        Patient Safe...
References      Klein JG. Five pitfalls in decisions about diagnosis and prescribing. BMJ. 2005 Apr        2;330(7494):78...
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IT for MDs (Part 1)

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IT for MDs (Part 1)

  1. 1. IT for MDs (Part 1) Nawanan Theera‐Ampornpunt, MD, PhD Feb. 13, 2013 Faculty of Medicine Ramathibodi Hospital SlideShare.net/Nawanan
  2. 2. A Few Words About Me... 2003 M.D. (1st-Class Honors) Ramathibodi (Rama 33) 2009 M.S. (Health Informatics) University of Minnesota 2011 Ph.D. (Health Informatics) University of Minnesota Currently • Acting for Deputy Chief, Health Informatics Division, Ramathibodi Contacts nawanan.the@mahidol.ac.th SlideShare.net/Nawanan www.tc.umn.edu/~theer002 groups.google.com/group/ThaiHealthIT2
  3. 3. IT Competencies Internet & E‐mail Literature searches & EBM Preparing presentation slides Bibliographic tools  Manuscript preparation  Statistical analysis  Health IT and Informatics3
  4. 4. Today’s Contents Healthcare & Health IT Health IT Applications in Hospitals4
  5. 5. Health care &  Health IT5
  6. 6. Manufacturing6 Image Source: Guardian.co.uk
  7. 7. Banking7 Image Source: Scbcareers.scb.co.th
  8. 8. Health care8 ER ‐ Image Source: nj.com
  9. 9. Why Health care Isn’t Like Any Others?  Life‐or‐Death  Many & varied stakeholders  Strong professional values  Evolving standards of care  Fragmented, poorly‐coordinated systems  Large, ever‐growing & changing body of  knowledge  High volume, low resources, little time9
  10. 10. Why Health care Isn’t Like Any Others?  Large variations & contextual dependence Input Process Output Patient  Decision‐ Biological  Presentation Making Responses10
  11. 11. But...Are We That Different? Banking Input Process Output Transfer Location A Location B Value‐Add ‐ Security ‐ Convenience ‐ Customer Service11
  12. 12. But...Are We That Different? Manufacturing Input Process Output Raw  Assembling Finished  Materials Goods Value‐Add ‐ Innovation ‐ Design ‐ QC12
  13. 13. But...Are We That Different? Health care Input Process Output Sick Patient Patient Care Well Patient Value‐Add ‐ Technology & medications ‐ Clinical knowledge & skills ‐ Quality of care; process improvement ‐ Information13
  14. 14. Information is Everywhere in Health Care14
  15. 15. Various Forms of Health IT Hospital Information System (HIS) Computerized Provider Order Entry (CPOE) Electronic  Health  Records  Picture Archiving and  (EHRs) Communication System  (PACS)15
  16. 16. Still Many Other Forms of Health IT Health Information  Exchange (HIE) m‐Health Biosurveillance Personal Health Records  (PHRs) Telemedicine &  Information Retrieval Telehealth16 Images from Apple Inc., Geekzone.co.nz, Google, PubMed.gov, and American Telecare, Inc.
  17. 17. Why Adopting Health IT? “To Go paperless” “To Computerize” “To Get a HIS” “Digital Hospital” “To Have EMRs” “To Modernize” “To Share data”17
  18. 18. Some Quotes  “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)18
  19. 19. Health IT: What’s In A Word? Health Goal Information Value‐Add Technology Tools19
  20. 20. Dimensions of Quality Healthcare Safety Timeliness Effectiveness Efficiency Equity Patient‐centeredness20 (IOM, 2001)
  21. 21. Value of Health IT Guideline adherence  Better documentation  Practitioner decision making or  process of care  Medication safety  Patient surveillance &  monitoring  Patient education/reminder21
  22. 22. Fundamental Theorem of Informatics22 (Friedman, 2009) (Friedman, 2009)
  23. 23. Is There A Role for Health IT?23 (IOM, 2000)
  24. 24. Landmark IOM Reports (IOM, 2000) (IOM, 2001)24
  25. 25. Landmark IOM Reports: Summary  Humans are not perfect and are bound to make  errors  Highlight problems in the U.S. health care system  that systematically contributes to medical errors and  poor quality  Recommends reform that would change how health  care works and how technology innovations can  help improve quality/safety25
  26. 26. Why We Need Health IT  Health care is very complex (and inefficient)  Health care is information‐rich  Quality of care depends on timely availability &  quality of information  Clinical knowledge body is too large  Short time during a visit  Practice guidelines are put “on‐the‐shelf”  “To err is human”26
  27. 27. To Err Is Human  Perception errors27 Image Source: interaction‐dynamics.com
  28. 28. To Err Is Human  Lack of Attention Image Source: aafp.org28
  29. 29. 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 68 32 Ariely (2008) • Print & web subscription $12529
  30. 30. What If This Happens in Healthcare? It already happens.... (Mamede et al., 2010; Croskerry, 2003; Klein, 2005) What if health IT can help?30
  31. 31. Adoption of Health IT: Assumptions Adoption Use Outcomes31
  32. 32. U.S.’s Efforts on Health IT Adoption ? “...We will make wider use of electronic records and  other health information technology, to help control  costs and reduce dangerous  medical errors.” President George W. Bush Sixth State of the Union Address, January 31, 200632 Source: Wikisource.org Image Source: Wikipedia.org
  33. 33. U.S. Adoption of Health IT Ambulatory (Hsiao et al, 2009) Hospitals (Jha et al, 2010) Basic EHRs w/ notes 9.2% Comprehensive EHRs 2.7% CPOE for medications 34% • U.S. lags behind other Western countries  (Schoen et al, 2006;Jha et al, 2008) • Money and misalignment of benefits is the biggest  reason33
  34. 34. We Need “Change” “...we need to upgrade our medical  records by switching from a paper to  an electronic system of record  keeping...” President Barack Obama June 15, 200934
  35. 35. The Birth of “Meaningful Use” “...Our recovery plan will invest in  electronic health records and new technology  that will reduce errors, bring down costs,  ensure privacy, and save lives.” President Barack Obama Address to Joint Session of Congress February 24, 200935 Source: WhiteHouse.gov
  36. 36. American Recovery & Reinvestment Act  Contains HITECH Act (Health Information Technology for Economic and  Clinical Health Act)  ~ 20 billion dollars for Health IT investments  Incentives & penalties for providers36
  37. 37. What is in the HITECH Act?37 (Blumenthal, 2010)
  38. 38. “Meaningful Use” “Meaningful Use”  Pumpkin of a Pumpkin38 Image Source & Idea Courtesy of Pat Wise at HIMSS, Oct. 2009
  39. 39. “Meaningful Use” of Health IT Better  Stage 1 Stage 3 Health ‐ Electronic capture of  health information ‐ Information sharing Stage 2 Use of  ‐ Data reporting EHRs to  Use of EHRs improve  to improve  outcomes processes of  care39 (Blumenthal, 2010)
  40. 40. Adoption Studies: Descriptive Aspect 2004 Pongpirul et al.  (2004) 2011 Theera‐ Ampornpunt (unpublished)40
  41. 41. Q & A... Download Slides SlideShare.net/Nawanan Contacts nawanan.the@mahidol.ac.th www.tc.umn.edu/~theer002 groups.google.com/group/ThaiHealthIT41
  42. 42. References  Ariely D. Predictably irrational: the hidden forces that shape our decisions. New York City  (NY):HarperCollins; 2008. 304 p.  Blumenthal D. Launching HITECH. N Engl J Med. 2010 Feb 4;362(5):382‐5.  Croskerry P. The importance of cognitive errors in diagnosis and strategies to minimize them.  Acad Med. 2003 Aug;78(8):775‐80. 81 p.  Friedman CP. A "fundamental theorem" of biomedical informatics. J Am Med Inform Assoc.  2009 Apr;16(2):169‐70.  Hersh W. Health care information technology: progress and barriers. JAMA. 2004 Nov  10:292(18):2273‐4.42
  43. 43. References  Institute of Medicine, Board on Health Care Services, Committee on Data Standards for  Patient Safety. Key Capabilities of an electronic health record system: letter report [Internet].  Washington, DC: National Academy of Sciences;2003.  31 p. Available from: http://www.nap.edu/catalog/10781.html  Institute of Medicine, Committee on Quality of Health Care in America. To err is human:  building a safer health system. Kohn LT, Corrigan JM, Donaldson MS, editors. Washington, DC:  National Academy Press;2000. 287 p.  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.43
  44. 44. References  Klein JG. Five pitfalls in decisions about diagnosis and prescribing. BMJ. 2005 Apr  2;330(7494):781‐3.  Mamede S, van Gog T, van den Berge K, Rikers RM, van Saase JL, van Guldener C, Schmidt HG.  Effect of availability bias and reflective reasoning on diagnostic accuracy among internal  medicine residents. JAMA. 2010 Sep 15:304(11):1198‐203.  Miller RA, Masarie FE. The demise of the "Greek Oracle" model for medical diagnostic  systems. Methods Inf Med. 1990 Jan;29(1):1‐2.   Pongpirul K, Sriratana S. Computerized information system in hospitals in Thailand: a national  survey. J Health Sci. 2005 Sep‐Oct;14(5):830‐9. Thai.  Schoen C, Osborn R, Huynh PT, Doty M, Puegh J, Zapert K. On the front lines of care: primary  care doctors’ office systems, experiences, and views in seven countries. Health Aff (Millwood).  2006;25(6):w555‐71.44
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