Personalized Disease Management:  Hope for Thyroid Cancer Survivors. Sunil Nair Dalhousie University Health Informatics HI...
Thyroid Cancer Adapted from Oncology Interactive Education Series DTC
“ Thyroid Cancer is the most rapidly increasing cancer among Canadians” <ul><li>Males -  4.9%  per year 1994-2003; </li></...
Why is Thyroid Cancer Important <ul><li>Improved detection  –  Early Diagnosis </li></ul><ul><li>Effective  Modern Treatme...
Thyroid Cancer Care Algorithm
DTC- Long-Term Disease Management <ul><li>Chronic Disease Management </li></ul><ul><ul><li>“ a  multi-disciplinary ,  cont...
Knowledge support needed for <ul><li>Thyroid Cancer survivors in long-term follow up –  patient empowerment  and  Self Man...
Barriers to Effective Long-term Thyroid Cancer Management <ul><li>Primary Care Providers unable to follow Practice Guideli...
Long-term Thyroid Cancer Management  <ul><li>Patient Empowerment </li></ul><ul><ul><li>“ an individual being an active mem...
Chronic Care Model  (Wagner et al. 1999) Thyroid Cancer Survivors Community Resources Health System Self Management Suppor...
Decision Support at point-of-care <ul><li>Access to  EMR </li></ul><ul><li>Computerized  CPG </li></ul><ul><li>CPOE </li><...
How can KM Applications help <ul><li>Interactive Health Communication Applications ( IHCAs ) </li></ul><ul><li>Developing ...
Interactive Health Communication Applications (IHCAs) <ul><li>“ The interaction of patient-provider via Information techno...
Developing Machine readable CPG <ul><li>Several  Modeling methodologies  exists </li></ul><ul><ul><li>GEM, GLIF, EON, Prot...
Challenges of Computerized CPG Adaptation <ul><li>Non-Interoperable Collaboration tools and systems </li></ul><ul><li>Unde...
Decision Aids in Cancer <ul><li>Patients Participation in decision making </li></ul><ul><ul><li>Encourages patient-centere...
Challenges in Decision Aids <ul><li>Content Description </li></ul><ul><ul><li>Priorities vary </li></ul></ul><ul><ul><li>C...
Application of Semantic Web Community of Thyroid Cancer Survivors Population of Experts in Thyroid cancer; Care providers;...
Semantic Web of Healthcare Knowledge <ul><li>Adaptive Patient-Specific Healthcare plans </li></ul>Adapted from “Adaptable ...
Semantic Web Translation Limitations <ul><li>New and evolving technology </li></ul><ul><ul><li>Gaps in Standardization & I...
Future direction <ul><li>Personalized Patient focused Programs </li></ul><ul><ul><li>To benefit participants with lower se...
Acknowledgement <ul><li>Dr. Murali Rajaraman </li></ul><ul><li>Assistant Professor </li></ul><ul><li>Department of Radiati...
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Personalized Disease Management - Thyroid Cancer - Knowledge Management - Sunil Nair Health Informatics Dalhousie University

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Transcript of "Personalized Disease Management - Thyroid Cancer - Knowledge Management - Sunil Nair Health Informatics Dalhousie University"

  1. 1. Personalized Disease Management: Hope for Thyroid Cancer Survivors. Sunil Nair Dalhousie University Health Informatics HINF6230 March 26, 2008
  2. 2. Thyroid Cancer Adapted from Oncology Interactive Education Series DTC
  3. 3. “ Thyroid Cancer is the most rapidly increasing cancer among Canadians” <ul><li>Males - 4.9% per year 1994-2003; </li></ul><ul><li>Females - 10.4% per year since 1997 </li></ul><ul><li>Annual Rate of Increase - >5% </li></ul><ul><li>Highest 5-yr Relative Survival Rate (RSR) - 96% </li></ul><ul><li>Recurrence Rate – up to 20% </li></ul>“ Cancer Care Ontario: Cancer in Young Adults in Canada, Canada, 2006.” “ National Cancer Institute of Canada: Canadian Cancer Statistics 2007.”
  4. 4. Why is Thyroid Cancer Important <ul><li>Improved detection – Early Diagnosis </li></ul><ul><li>Effective Modern Treatment </li></ul><ul><li>Mortality rate very low </li></ul><ul><li>High chance of recurrence </li></ul>Increasing number of young cancer survivors who need lifelong care & support.
  5. 5. Thyroid Cancer Care Algorithm
  6. 6. DTC- Long-Term Disease Management <ul><li>Chronic Disease Management </li></ul><ul><ul><li>“ a multi-disciplinary , continuum based approach that proactively addresses the patient and physician relationship and the preventive measures and evidence-based practice guidelines required to alter the natural course of the disease and improve overall health.” -Disease management Association of America </li></ul></ul><ul><li>Accurate Surveillance and Maintenance to check for possible recurrences </li></ul><ul><li>Follow-up (F/U) - Testing for Tg and WBS; </li></ul><ul><li>F/U is lifelong ( more than 30 yrs ) </li></ul><ul><li>F/U treatment is different for patients with low, intermediate and high risk. </li></ul><ul><li>F/U is done mainly at the primary care . </li></ul>
  7. 7. Knowledge support needed for <ul><li>Thyroid Cancer survivors in long-term follow up – patient empowerment and Self Management . </li></ul><ul><li>The Primary Care Practitioner at point of care for decision support </li></ul>
  8. 8. Barriers to Effective Long-term Thyroid Cancer Management <ul><li>Primary Care Providers unable to follow Practice Guidelines </li></ul><ul><li>Difficulties with active follow-up </li></ul><ul><li>Lack of care planning and coordination </li></ul><ul><li>Patients not informed about their disease </li></ul>
  9. 9. Long-term Thyroid Cancer Management <ul><li>Patient Empowerment </li></ul><ul><ul><li>“ an individual being an active member of his/her disease management team” </li></ul></ul><ul><ul><li>Patient-centered Care </li></ul></ul><ul><ul><li>Disease specific Patient education </li></ul></ul>
  10. 10. Chronic Care Model (Wagner et al. 1999) Thyroid Cancer Survivors Community Resources Health System Self Management Support Delivery System Support Decision Support Critical Information Support Informed Activated Patient Prepared, Proactive Practice team Productive Interactions Functional & Clinical outcomes
  11. 11. Decision Support at point-of-care <ul><li>Access to EMR </li></ul><ul><li>Computerized CPG </li></ul><ul><li>CPOE </li></ul><ul><li>Alerts & Reminders </li></ul><ul><li>Computerization of Referral, Scheduling and </li></ul><ul><li>Clinical results interpretation </li></ul>
  12. 12. How can KM Applications help <ul><li>Interactive Health Communication Applications ( IHCAs ) </li></ul><ul><li>Developing Machine readable CPG, CP </li></ul><ul><li>Decision Aids </li></ul><ul><li>Semantic Web </li></ul><ul><li>Web 2.0 </li></ul>
  13. 13. Interactive Health Communication Applications (IHCAs) <ul><li>“ The interaction of patient-provider via Information technology device to access and transmit health information and receive guidance and support on health related issue.” </li></ul>
  14. 14. Developing Machine readable CPG <ul><li>Several Modeling methodologies exists </li></ul><ul><ul><li>GEM, GLIF, EON, Protégé etc. </li></ul></ul><ul><li>XML used in implementation of CPG </li></ul><ul><ul><li>adds specific structure to text for content retrieving and presentation </li></ul></ul>
  15. 15. Challenges of Computerized CPG Adaptation <ul><li>Non-Interoperable Collaboration tools and systems </li></ul><ul><li>Undefined data sharing policy and standards </li></ul><ul><li>Information tailoring to specific user needs </li></ul><ul><li>Inadequate Infrastructure </li></ul><ul><li>Expensive </li></ul>
  16. 16. Decision Aids in Cancer <ul><li>Patients Participation in decision making </li></ul><ul><ul><li>Encourages patient-centered clinical model </li></ul></ul><ul><ul><li>Reduce patients uncertainty </li></ul></ul><ul><ul><li>Increase patients knowledge </li></ul></ul><ul><ul><li>Realistic expectations of outcomes </li></ul></ul>
  17. 17. Challenges in Decision Aids <ul><li>Content Description </li></ul><ul><ul><li>Priorities vary </li></ul></ul><ul><ul><li>Content Categorization </li></ul></ul><ul><ul><li>Simplifying Complex Information </li></ul></ul><ul><li>Presentation format </li></ul><ul><ul><li>Video, text, Notebook or Online </li></ul></ul><ul><li>Incorporating in to practice </li></ul><ul><li>Evaluation </li></ul><ul><ul><li>Understanding Risks </li></ul></ul>
  18. 18. Application of Semantic Web Community of Thyroid Cancer Survivors Population of Experts in Thyroid cancer; Care providers; Specialists Social Networks Blogs, Discussion forums, groups, Websites Thyroid cancer Survivor Information System Data Clustered By text, tags & Metadata Recommendation Engine Search Engine
  19. 19. Semantic Web of Healthcare Knowledge <ul><li>Adaptive Patient-Specific Healthcare plans </li></ul>Adapted from “Adaptable Personalized Care Planning via a Semantic Web Framework” – SSR Abidi & H Chen
  20. 20. Semantic Web Translation Limitations <ul><li>New and evolving technology </li></ul><ul><ul><li>Gaps in Standardization & Implementation </li></ul></ul><ul><li>Unavailability of Semantically annotated information source </li></ul><ul><li>Slow Performance of RDF, OWL </li></ul><ul><li>Lack of Standardized rule language </li></ul><ul><li>Cross community interactions </li></ul>
  21. 21. Future direction <ul><li>Personalized Patient focused Programs </li></ul><ul><ul><li>To benefit participants with lower self efficacy and health related quality of life </li></ul></ul><ul><li>Efficient Decision Support technologies </li></ul><ul><ul><li>Generating customized Content </li></ul></ul><ul><ul><li>System independency </li></ul></ul>A large number of Cancer Survivors , require repeated active treatment and have continuing need for cancer care resources and support services . “ National Cancer Institute of Canada: Canadian Cancer Statistics 2007.”
  22. 22. Acknowledgement <ul><li>Dr. Murali Rajaraman </li></ul><ul><li>Assistant Professor </li></ul><ul><li>Department of Radiation Oncology </li></ul><ul><li>Dalhousie University, CDHA </li></ul>
  23. 23. Thank you!
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