Apps in the clinical domain
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James Tattersall, HANDIHealth, Leeds workshop
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Apps in the clinical domain
- 1. Apps in the clinical domain: what doesn’t work, what might and why James Tattersall Leeds teaching hospitals NHS trust, Mediqal Health Informatics Limited jamestattersall@nhs.net
- 2. Clinical work • Healthcare is mostly information management. • Physicians do nothing else apart from information management.
- 3. Medical information • Safety critical. • Complex. • Viewed from different perspectives – Clinical Specialists – Clinical Generalists – Administrators – Patients – Carers
- 4. Workflow huma n acqui trea re t
- 5. • “Trusts want systems that are tailored to their particular organisation, not standardised systems.” – Implementation and adoption of nationwide electronic health records in secondary care in England: qualitative analysis of interim results from a prospective national evaluation. Robertson et. al. BMJ 2010;341:c4564
- 9. Ideal graph
- 10. My clinic
- 15. eWINDIP
- 16. Focused presentation of all data
- 17. Reflect work of department
- 18. Dynamic forms
- 19. Table 1; A simple clinical database designed using the traditional relational model. Object tables Drug Patients ingredient Staff patientID Drugs staff ID Surname drugID s staff name drug name ingredientID Firstname staff type cost ingredient date of birth date appointed units of name Address Hospital number doseID Lookup tables Procedure Dose types frequencie Units of dose proceduretypeI Route of s units of doseID D frequencyID units of dose administration procedure frequency name routeID name name route procedure code times per day Drug Event prescriptions Drug Prescription tables Procedures Clinics Blood pressures Admissions ID procedureID clinicID patientID Blood pressure ID admission ID patientID patientID date started patientID patientID date date date stopped date date admitted procedure typeID clinic typeID drugID systolic date discharged procedure note clinic note dose diastolic reason for admission staffID performing staffID entered units of doseID staffID entered discharge summary staffID entered frequencyID staffID entered routeID staffID entered staffID stopped date entered
- 20. Metadata Fact tables tables classID ObjectID name ClassID parent_classID Patient name Is a type of Smith, John person groupID name classID Blood pressure EventID Describes a ObjectID patient date Systolic 01/07/2007 groupID attribute attributeID belongs to blood pressure group eventID attributeID Systolic attributeID eventID numeric name attributeID value 126 datatype Systolic date value Units Numeric mmHg valueID Maximum 300 text value Value table valueID name object value
- 21. Relational database, thousands of tables
- 22. Principle • The components of the Reference Model are like LEGO brick specifications • Archetypes = instructions/designs constraining the use of LEGO pieces to create meaningful structures Information model Instances Archetype A Archetype B
- 24. Audience participation • Requirements for blood pressure management.
- 25. Blood pressure management • Measurement • Automatic capture • Posture • Setting (clinic, admission, home) • Cause • Genetics • Family history • Associated medical conditions • Blood tests, screening. • Allergies • Co-morbidities • Drug history • Prescription • Risk, cost, benefit.
- 26. Human genome • 23 chromosomes • 25,000 genes. • 3.2 billion base pairs • 800 megabytes of data. • Since individual genomes vary by less than 1% from each other, the variations of a given human's genome from a common reference can be losslessly compressed to roughly 4 megabytes.