Overview of Health Informatics and Disease Surveillance System
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Overview of Health Informatics and Disease Surveillance System

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Overview of Health Informatics and Disease Surveillance System Overview of Health Informatics and Disease Surveillance System Presentation Transcript

  • Overview of Health Informatics & Disease Surveillance System Nawanan Theera-Ampornpunt, M.D., Ph.D. Aug. 22, 2013 SlideShare.net/Nawanan
  • A VISION FOR HEALTH CARE
  • eHealth Health Information Exchange (HIE) Hospital A Hospital B Clinic C Government Lab Patient at Home
  • CHALLENGES IN COMPUTERIZING HEALTH CARE
  • Manufacturing Image Source: Guardian.co.uk
  • Banking Image Source: Cablephet.com
  • Health care ER - Image Source: nj.com
  • 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 time
  • Engineer’s View Input Process Output Transfer Banking Value-Add - Security - Convenience - Customer Service Location A Location B
  • Input Process Output Assembling Manufacturing Raw Materials Finished Goods Value-Add - Innovation - Design - QC Engineer’s View
  • Engineer’s View Input Process Output Patient Care Health care Sick Patient Well Patient Value-Add - Technology & medications - Clinical knowledge & skills - Quality of care; process improvement - Information
  • Why Health care Isn’t Like Any Others? • Large variations & contextual dependence Input Process Output Patient Presentation Decision- Making Biological Responses
  • Information is Everywhere in Medicine Shortliffe EH. Biomedical informatics in the education of physicians. JAMA. 2010 Sep 15;304(11):1227-8.
  • The Anatomy of Health IT Health  Information Technology Goal Value‐Add Means
  • HEALTH IT: AN OVERVIEW
  • Various Forms of Health IT Hospital Information System (HIS) Computerized Provider Order Entry (CPOE) Electronic Health Records (EHRs) Picture Archiving and Communication System (PACS)
  • Still Many Other Forms of Health IT m-Health Health Information Exchange (HIE) Biosurveillance Information Retrieval Telemedicine & Telehealth Images from Apple Inc., Geekzone.co.nz, Google, Microsoft, PubMed.gov, and American Telecare, Inc. Personal Health Records (PHRs)
  • 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 time
  • Is There A Role for Health IT? (IOM, 2001)(IOM, 2000)
  • Landmark IOM Reports: Summary • Humans are not perfect and are bound to  make errors • High‐light 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/safety
  • 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 to be in  any clinician’s brain, and the short time  during a visit makes it worse • Practice guidelines are put “on‐the‐shelf” • “To err is human”
  • Image Source: aafp.org To Err Is Human • Lack of Attention
  • 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, 2009
  • The Anatomy of Health IT Revisited Health  Information Technology Goal Value‐Add Means
  • Ultimate Goals of Health IT •Individual’s Health •Population’s Health •Organization’s Health
  • Dimensions of Quality Health Care • Safety • Timeliness • Effectiveness • Efficiency • Equity • Patient‐centeredness (IOM, 2001)
  • Documented Benefits of Health IT • Literature suggests improvement through – Guideline adherence – Better documentation – Practitioner decision making or process of care  – Medication safety – Patient surveillance & monitoring – Patient education/reminder – Cost  savings and better financial performance
  • Fundamental Theorem of Informatics (Friedman, 2009)
  • HEALTH INFORMATICS
  • Wisdom Knowledge Information Data Data-Information-Knowledge-Wisdom Contextualization/ Interpretation Processing/ Synthesis/ Organization Judgment
  • Definitions of Health Informatics • Biomedical & Health Informatics (Formerly known as Medical 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)
  • Summary About M/B/H Informatics • Focuses more on information, not technology • Task-oriented view: Collection Processing Storage Utilization Communication /Dissemination/ Presentation
  • M/B/H Informatics As A Field (Shortliffe, 2002)
  • M/B/H Informatics As A Field (Hersh, 2009)
  • M/B/H Informatics and Other Fields Biomedical/ Health Informatics Computer & Information Science Engineering Cognitive & Decision Science Social Sciences (Psycholog y, Sociology, Linguistics, Law & Ethics) Statistics & Research Methods Medical Sciences & Public Health Management Library Science, Information Retrieval, KM And More!
  • The Intersection Clinical Informatics Public Health Informatics Consumer Health Informatics Patients & Consumers Providers & Patients Policy-Makers, Payers, Public (Also providers)
  • HEALTH INFORMATION EXCHANGE & DISEASE SURVEILLANCE
  • eHealth Health Information Exchange (HIE) Hospital A Hospital B Clinic C Government Lab Patient at Home
  • Standards: Why? • The Large N Problem N = 2, Interface = 1 # Interfaces = N(N-1)/2 N = 3, Interface = 3 N = 5, Interface = 10 N = 100, Interface = 4,950
  • Functional Semantic Syntactic How Standards Support Interoperability Technical Standards (TCP/IP, encryption, security) Exchange Standards (HL7 v.2, HL7 v.3 Messaging, HL7 CDA, DICOM) Vocabularies, Terminologies, Coding Systems (ICD-10, ICD-9, CPT, SNOMED CT, LOINC) Information Models (HL7 v.3 RIM, ASTM CCR, HL7 CCD) Standard Data Sets Functional Standards (HL7 EHR Functional Specifications) Some may be hybrid: e.g. HL7 v.3, HL7 CCD Unique ID
  • U.S. Health Information Exchange • Regional Health Information Organizations (RHIOs) • State e-Health initiatives • Nationwide Health Information Network (NHIN) • Still ongoing efforts, but with significant progress
  • Other Public Health Informatics Applications • e-Health & m-Health – m-Health in disaster management: #ThaiFlood • Data reporting to government agencies – Claims & reimbursements – Diseases – Utilization statistics – Quality measures – etc. • Biosurveillance (case reporting vs. predictive) • Epidemiologic & health services research
  • Thailand’s Biosurveillance Source: www.biophics.org
  • Google Flu Trends Source: Google.org/FluTrends
  • Summary • Health informatics as a discipline • Health IT comes in various forms & useful in various settings • HIE is “vision” toward HEALTH for many informaticians • Disease surveillance systems one form of Health IT • May or may not rely on HIE