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Nawanan Theera-Ampornpunt, MD, PhD
Healthcare CIO Program
Ramathibodi Hospital Administration School
Aug. 30, 2013 SlideSh...
Stakeholders in Health Care
Patient
Providers
Policy-
Makers
Public
Payers
Diagram modified from Supachai Parchariyanon’s ...
The Intersection
Clinical
Informatics
Public
Health
Informatics
Consumer
Health
Informatics
Patients &
Consumers
Providers...
Public Policy in Informatics: A US’s Case
1991: IOM’s CPR Report published
1996: HIPAA enacted
2000-2001: IOM’s To Err Is ...
Political Support Behind Health IT
“...We will make wider use of electronic records and other
health information technolog...
U.S. Adoption of Health IT
• U.S. lags behind other Western countries
(Schoen et al, 2006;Jha et al, 2008)
• Money and mis...
President Obama Backs Health IT
“...Our recovery plan will invest in
electronic health records and new technology
that wil...
American Recovery & Reinvestment Act
 Contains HITECH Act
(Health Information Technology for
Economic and Clinical Health...
U.S. National Leadership
David Blumenthal, MD, MPP
National Coordinator for
Health Information
Technology
(2009 - 2011)
Fa...
What is in HITECH Act?
Blumenthal D. Launching HITECH. N Engl J Med. 2010 Feb 4;362(5):382-5.
“Meaningful Use”
“Meaningful Use”
of a Pumpkin
Pumpkin
Image Source & Idea Courtesy of Pat Wise at HIMSS, Oct. 2009
“Meaningful Use” of Health IT
Stage 1
- Electronic capture of
health information
- Information sharing
- Data reporting
St...
Health Information Exchange (HIE)
Hospital A Hospital B
Clinic C
Government
Lab Patient at Home
Health Information Exchange in the U.S.
 Regional Health Information Organizations
(RHIOs)
 State e-Health initiatives
...
Other Public Health Informatics Applications
 e-Health & m-Health
 m-Health in disaster management: #ThaiFlood
 Data re...
Google Flu Trends
Source: Google.org/FluTrends
Thailand’s Biosurveillance
Source: www.biophics.org
Consumer Health Informatics (CHI)
 “The field devoted to informatics from a
consumer view.” (Hersh, 2009)
M/B/H Informatics As A Field
(Hersh, 2009)
Examples of Areas within
Consumer Health Informatics
Image Source: http://www.webmd.com/
Examples of Areas within
Consumer Health Informatics
Image Source: http://www.greatdreams.com/cancer-cure.htm
Examples of Areas within
Consumer Health Informatics
Image Source: http://www.hon.ch/, http://socialmarketing.blogs.com/r_...
Examples of Areas within
Consumer Health Informatics
Image Source: http://michaelcarusi.com/2012/01/01/when-you-should-not...
Examples of Areas within
Consumer Health Informatics
Image Source: http://ucedtech.wikispaces.com/Welcome
mHealth
http://whqlibdoc.who.int/publications/2011/9789241564250_eng.pdf
Examples of Areas within
Consumer Health Informatics
Image Source: http://nutrition.about.com/od/recipesmenus/ss/learnlabe...
Class Exercise
Roles of ICT in Consumer Health Informatics
 Access to information
 Networking opportunities
 Education/Self-study
 Pe...
Issues in Consumer Health Informatics
 Health literacy & IT literacy
 Cultural diversity & sensitivity
 Usability, info...
Personal Health Records (PHRs)
 “An electronic application through which individuals can
access, manage and share their h...
Types of PHRs
 Patient portal from a provider’s EHRs
(“tethered” PHRs)
 Online PHRs
 Stand-alone
 Can be integrated wi...
PHRs and Other Systems
(Tang et al., 2006)
Ideal PHRs
 Integrated
 Accessible
 Secure
 Comprehensive
 Accurate & current
 Patient able to
manage sharing &
upda...
Use Cases of PHRs
 Data entry/update by patients
 Data retrieval by providers
 With patient’s consent
 “Break-the-glas...
Data in PHRs
(Tang et al., 2006)
(Tang et al., 2006)
Other IT for Consumer Health
Traditional Web
 MedlinePlus
 Other sites
Social Media
 The Usuals: MySpace, Facebook, Twi...
The Future
Microsoft Health: Future Vision
http://www.microsoft.com/showcase/en/us/details/b112da1c-c918-
41ee-bb45-d6a553...
References
 Blumenthal D. Launching HITECH. N Engl J Med. 2010 Feb 4;362(5):382-5.
 Blumenthal D, Tavenner M. The “meani...
Personal Health Records and Consumer Health Informatics
Personal Health Records and Consumer Health Informatics
Personal Health Records and Consumer Health Informatics
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Transcript of "Personal Health Records and Consumer Health Informatics"

  1. 1. Nawanan Theera-Ampornpunt, MD, PhD Healthcare CIO Program Ramathibodi Hospital Administration School Aug. 30, 2013 SlideShare.net/Nawanan Except where  citing other works
  2. 2. Stakeholders in Health Care Patient Providers Policy- Makers Public Payers Diagram modified from Supachai Parchariyanon’s 4Ps Concept • High bargaining power • Benefit with improved quality in fee-for-service • Needs to satisfy many “bosses” • Faces up-front costs in health IT investments • Long-term benefits depend on payment schemes • Require data for policy-making • Limited budget • Often face bureaucracies • Highly political • Concerns about resource allocation & community’s well-being, but not necessarily individual patients • Directly benefits from improved quality of care • Knowledge gap between patient & providers
  3. 3. The Intersection Clinical Informatics Public Health Informatics Consumer Health Informatics Patients & Consumers Providers & Patients Policy-Makers, Payers, Public (Also providers)
  4. 4. Public Policy in Informatics: A US’s Case 1991: IOM’s CPR Report published 1996: HIPAA enacted 2000-2001: IOM’s To Err Is Human & Crossing the Quality Chasm published 2004: George W. Bush’s Executive Order establishing ONCHIT (ONC) 2009-2010: ARRA/HITECH Act & “Meaningful use” regulations
  5. 5. Political Support Behind Health IT “...We will make wider use of electronic records and other health information technology, to help control costs and reduce dangerous medical errors.” Source: Wikisource.org Image Source: Wikipedia.org President George W. Bush Sixth State of the Union Address January 31, 2006 ?
  6. 6. U.S. Adoption of Health IT • U.S. lags behind other Western countries (Schoen et al, 2006;Jha et al, 2008) • Money and misalignment of benefits is the biggest reason Ambulatory(Hsiao et al, 2009) Hospitals (Jha et al, 2009) Basic EHRs w/ notes 7.6% Comprehensive EHRs 1.5% CPOE 17%
  7. 7. President Obama Backs Health IT “...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, 2009 Source: WhiteHouse.gov
  8. 8. 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 providers
  9. 9. U.S. National Leadership David Blumenthal, MD, MPP National Coordinator for Health Information Technology (2009 - 2011) Farzad Mostashari, MD, ScM National Coordinator for Health Information Technology (2011 - 2013) Robert Kolodner, MD National Coordinator for Health Information Technology (2006 - 2009) David Brailer, MD, PhD National Coordinator for Health Information Technology (2004 - 2007) Office of the National Coordinator for Health Information Technology (ONC -- formerly ONCHIT) Photos courtesy of U.S. Department of Health & Human Services
  10. 10. What is in HITECH Act? Blumenthal D. Launching HITECH. N Engl J Med. 2010 Feb 4;362(5):382-5.
  11. 11. “Meaningful Use” “Meaningful Use” of a Pumpkin Pumpkin Image Source & Idea Courtesy of Pat Wise at HIMSS, Oct. 2009
  12. 12. “Meaningful Use” of Health IT Stage 1 - Electronic capture of health information - Information sharing - Data reporting Stage 2 Use of EHRs to improve processes of care Stage 3 Use of EHRs to improve outcomes Better Health (Blumenthal D, 2010)
  13. 13. Health Information Exchange (HIE) Hospital A Hospital B Clinic C Government Lab Patient at Home
  14. 14. Health Information Exchange in the U.S.  Regional Health Information Organizations (RHIOs)  State e-Health initiatives  Nationwide Health Information Network (NHIN)  Still ongoing efforts, but with significant progress
  15. 15. 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
  16. 16. Google Flu Trends Source: Google.org/FluTrends
  17. 17. Thailand’s Biosurveillance Source: www.biophics.org
  18. 18. Consumer Health Informatics (CHI)  “The field devoted to informatics from a consumer view.” (Hersh, 2009)
  19. 19. M/B/H Informatics As A Field (Hersh, 2009)
  20. 20. Examples of Areas within Consumer Health Informatics Image Source: http://www.webmd.com/
  21. 21. Examples of Areas within Consumer Health Informatics Image Source: http://www.greatdreams.com/cancer-cure.htm
  22. 22. Examples of Areas within Consumer Health Informatics Image Source: http://www.hon.ch/, http://socialmarketing.blogs.com/r_craiig_lefebvres_social/2007/02/health_literacy.html
  23. 23. Examples of Areas within Consumer Health Informatics Image Source: http://michaelcarusi.com/2012/01/01/when-you-should-not-become-a-social-media-manager/
  24. 24. Examples of Areas within Consumer Health Informatics Image Source: http://ucedtech.wikispaces.com/Welcome
  25. 25. mHealth http://whqlibdoc.who.int/publications/2011/9789241564250_eng.pdf
  26. 26. Examples of Areas within Consumer Health Informatics Image Source: http://nutrition.about.com/od/recipesmenus/ss/learnlabels.htm
  27. 27. Class Exercise
  28. 28. Roles of ICT in Consumer Health Informatics  Access to information  Networking opportunities  Education/Self-study  Personalization  Effective & efficient communications  Empowerment  “User Experience”
  29. 29. Issues in Consumer Health Informatics  Health literacy & IT literacy  Cultural diversity & sensitivity  Usability, information presentation  Impact of ICT on behavioral modifications  Integration with provider’s systems  Information exchange & interoperability  Business model  Privacy & security
  30. 30. 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)
  31. 31. 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  Paper
  32. 32. PHRs and Other Systems (Tang et al., 2006)
  33. 33. Ideal PHRs  Integrated  Accessible  Secure  Comprehensive  Accurate & current  Patient able to manage sharing & update information  Engaging & educational  User-friendly, culturally & literacy appropriate The “Hub and Spoke” Model (Kaelber et al., 2008)
  34. 34. 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  Communications with providers
  35. 35. Data in PHRs (Tang et al., 2006) (Tang et al., 2006)
  36. 36. Other IT for Consumer Health Traditional Web  MedlinePlus  Other sites Social Media  The Usuals: MySpace, Facebook, Twitter  Blogs, forums  PatientsLikeMe Telemedicine & Telehealth  Home monitoring/recording devices  Tele-consultations, virtual visits  http://media.nstda.or.th/video/viewVideo.php?video_id=1273
  37. 37. The Future Microsoft Health: Future Vision http://www.microsoft.com/showcase/en/us/details/b112da1c-c918- 41ee-bb45-d6a553496168 NECTEC’s Smart Health http://media.nstda.or.th/video/viewVideo.php?video_id=1273
  38. 38. References  Blumenthal D. Launching HITECH. N Engl J Med. 2010 Feb 4;362(5):382-5.  Blumenthal D, Tavenner M. The “meaningful use” regulation for electronic health records. N Engl J Med. 2010 Aug 5;363(6):501-4.  Connecting for Health. The personal health working group final report. Markle Foundation; 2003 Jul 1.  Hsiao C, Beatty PC, Hing ES, Woodwell DA. Electronic medical record/electronic health record use by office-based physicians: United States, 2008 and preliminary 2009 [Internet]. 2009 [cited 2010 Apr 12]; Available from: http://www.cdc.gov/nchs/data/hestat/emr_ehr/emr_ehr.pdf  Jha AK, DesRoches CM, Campbell EG, Donelan K, Rao SR, Ferris TG, Shields A, Rosenbaum S, Blumenthal D. Use of electronic health records in U.S. hospitals. N Engl J Med. 2009;360(16):1628-38.  Kaelber DC, Jha AK, Johnston D, Middleton B, Bates DW. A research agenda for personal health records (PHRs). J Am Med Inform Assoc. 2008 Nov-Dec;15(6):729-36.  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.  Tang PC, Ash JS, Bates DW, Overhage JM, Sands DZ. Personal health records: definitions, benefits, and strategies for overcoming barriers to adoption. J Am Med Inform Assoc. 2006 Mar-Apr;13(2):121-6.
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