Overview of Health Informatics and Disease Surveillance System

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Overview of Health Informatics and Disease Surveillance System

  1. 1. Overview of Health Informatics & Disease Surveillance System Nawanan Theera-Ampornpunt, M.D., Ph.D. Aug. 22, 2013 SlideShare.net/Nawanan
  2. 2. A VISION FOR HEALTH CARE
  3. 3. eHealth Health Information Exchange (HIE) Hospital A Hospital B Clinic C Government Lab Patient at Home
  4. 4. CHALLENGES IN COMPUTERIZING HEALTH CARE
  5. 5. Manufacturing Image Source: Guardian.co.uk
  6. 6. Banking Image Source: Cablephet.com
  7. 7. Health care ER - Image Source: nj.com
  8. 8. 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
  9. 9. Engineer’s View Input Process Output Transfer Banking Value-Add - Security - Convenience - Customer Service Location A Location B
  10. 10. Input Process Output Assembling Manufacturing Raw Materials Finished Goods Value-Add - Innovation - Design - QC Engineer’s View
  11. 11. 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
  12. 12. Why Health care Isn’t Like Any Others? • Large variations & contextual dependence Input Process Output Patient Presentation Decision- Making Biological Responses
  13. 13. Information is Everywhere in Medicine Shortliffe EH. Biomedical informatics in the education of physicians. JAMA. 2010 Sep 15;304(11):1227-8.
  14. 14. The Anatomy of Health IT Health  Information Technology Goal Value‐Add Means
  15. 15. HEALTH IT: AN OVERVIEW
  16. 16. Various Forms of Health IT Hospital Information System (HIS) Computerized Provider Order Entry (CPOE) Electronic Health Records (EHRs) Picture Archiving and Communication System (PACS)
  17. 17. 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)
  18. 18. 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
  19. 19. Is There A Role for Health IT? (IOM, 2001)(IOM, 2000)
  20. 20. 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
  21. 21. 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”
  22. 22. Image Source: aafp.org To Err Is Human • Lack of Attention
  23. 23. 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
  24. 24. The Anatomy of Health IT Revisited Health  Information Technology Goal Value‐Add Means
  25. 25. Ultimate Goals of Health IT •Individual’s Health •Population’s Health •Organization’s Health
  26. 26. Dimensions of Quality Health Care • Safety • Timeliness • Effectiveness • Efficiency • Equity • Patient‐centeredness (IOM, 2001)
  27. 27. 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
  28. 28. Fundamental Theorem of Informatics (Friedman, 2009)
  29. 29. HEALTH INFORMATICS
  30. 30. Wisdom Knowledge Information Data Data-Information-Knowledge-Wisdom Contextualization/ Interpretation Processing/ Synthesis/ Organization Judgment
  31. 31. 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)
  32. 32. Summary About M/B/H Informatics • Focuses more on information, not technology • Task-oriented view: Collection Processing Storage Utilization Communication /Dissemination/ Presentation
  33. 33. M/B/H Informatics As A Field (Shortliffe, 2002)
  34. 34. M/B/H Informatics As A Field (Hersh, 2009)
  35. 35. 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!
  36. 36. The Intersection Clinical Informatics Public Health Informatics Consumer Health Informatics Patients & Consumers Providers & Patients Policy-Makers, Payers, Public (Also providers)
  37. 37. HEALTH INFORMATION EXCHANGE & DISEASE SURVEILLANCE
  38. 38. eHealth Health Information Exchange (HIE) Hospital A Hospital B Clinic C Government Lab Patient at Home
  39. 39. 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
  40. 40. 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
  41. 41. 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
  42. 42. 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
  43. 43. Thailand’s Biosurveillance Source: www.biophics.org
  44. 44. Google Flu Trends Source: Google.org/FluTrends
  45. 45. 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

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