4. Ishan Mukherji 4
Stakeholders in
Health Care
Patient
Provider
Policy
makers
Public
Payers
• Directly benefits from
improved quality of care
• Knowledge gap between
patient & providers
• Needs to satisfy many “bosses”
• Faces up-front costs in health IT
investments
• Long-term benefits depend on
payment schemes
• Concerns about resource allocation &
community’s well-being, but not
necessarily individual patients
• Require data for
policy-making
• Limited budget
• Often face
bureaucracies
• Highly political
• High bargaining power
• Benefit with improved
quality in fee-for-service
5. • A health information is defined as :
“A mechanism for the collection, processing,
analysis and transmission of information required
for organizing and operating health services, and
also for research and training”.
(WHO 1974)
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• Medical informatics began to take off in the US in the 1950s
with the rise of the microchip and computers. The earliest use
of computation for medicine was for Dental projects in the
1950s at the United States National Bureau of Standards by
Robert Ledley.
• The next step in the mid 1950s were the development of
expert systems such as MYCIN and INTERNIST-I. In 1965,
the National Library of Medicine started to use MEDLINE
and MEDLARS.
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• At this time, Neil Pappalardo, Curtis Marble, and Robert
Greenes developed MUMPS (Massachusetts General
Hospital Utility Multi-Programming System) in Octo
Barnett’s Laboratory of Computer Science at Massachusetts
General Hospital in Boston.
• In the 1970s and 1980s it was the most commonly used
programming language for clinical applications.
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• Homer R. Warner, one of the fathers of medical
informatics, founded the Department of Medical
Informatics at the University of Utah in 1968.
• In the 1970s a growing number of commercial vendors
began to market practice management and electronic
medical records systems.
• Although many products existed only a small number of
health practitioners used fully featured electronic health care
records systems.
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• In 1996, regulating privacy and medical record
transmission, created the impetus for large numbers of
physicians to move towards using EMR software,
primarily for the purpose of secure medical billing.
13. The Infrastructure for Informatics
• Electronic medical records.
• Data capture.
• Computable representations of the medical literature
• Diagnosis.
• Decision support for health care professionals.
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14. • Systems for improved patient education and compliance.
• Continuing medical education
• Demonstration of effectiveness.
• Mining data for new medical knowledge.
• Universal access to these technologies.
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• The primary objective of a health information system is to
provide reliable, relevant, up-to-date, adequate, timely and
reasonably complete information for health managers at all
levels (i.e., central, intermediate and local) and at the sharing
of technical and scientific (including bibliographical)
information by all health personnel participating in the health
services of a country.
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• To provide at periodic intervals, data that will show the
general performance of the health services.
• To assist planners in studying their current functioning and
trends in demand and work load.
18. INFORMATION SKILLS
• Communicating effectively.
• Structuring information with a particular focus on the patient
record, is shown to be dependent upon the task at hand, the
channel used to communicate the message, and the agent who will
receive the message.
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• Questioning others to find information is essential in clinical
practice to fill the ever present gaps in every individual’s
knowledge;
• Searching for knowledge describes the broader strategic
process of knowing where to ask questions, evaluating
answers, and refining questions in the light of previous
actions.
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• Making Decisions occurs when all the available information needed
has been assembled using the other informatics skills, and attempts
to come up with the best alternative to solve a problem like selecting
a treatment, based both upon the evidence from science, as well as
the wishes and needs of individuals
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A WHO Expert Committee identified the following requirements:
• System should be population based.
• Avoid the unnecessary collection of data.
• Employ functional and operational terms.
• Should be problem oriented.
• Should express information briefly and imaginatively.
• Should make provision for the feedback of data.
23. Components of a health information
• Demography and vital events
• Environmental health statistics
• Health status: mortality, morbidity, quality of life.
• Health resources: manpower, money, material, skills, knowledge, time.
• Utilization and non-utilization of health services: attendance, admissions.
• Financial statistics (cost, expenditure) related to the particular objective.
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• To measure the health status of the people and to quantify their health
problems and health care needs.
• For local, national and international comparisons of health status.
• For planning, administration and effective management of health
services and programs.
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• For assessing whether health services are accomplishing their
objectives in term of their effectiveness and efficiency.
• For assessing the attitudes and degree of satisfaction of the
beneficiaries with the health system .
• For research into particular problems of health and disease.
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Stage 2:
Use of
EHRs to
improve
processes
of care
Stage 3:
Use of
EHRs to
improve
outcomes
Stage 1
-Electronic capture of
health information
-Information sharing
-Data reporting
29. Electronic health records
• An electronic health record (EHR), or electronic medical
record (EMR), refers to the systematized collection of patient
and population electronically-stored health information in a digital
format.
• These records can be shared across different health care settings,
such as through network connected, enterprise-wide information
systems or other information networks and exchanges
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30. EHR Data
• Demographics
• Medical history
• Medication and allergies
• Immunization status
• Laboratory test results
• Radiology images
• Vital signs
• Personal statistics like age and
weight
• Billing information
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31. Benefits of EHR
• Less paperwork and fewer storage issues
• Increased quality of care
• Financial Incentives
• Increased Efficiency and Productivity
• Better Patient Care
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32. Quantifiable Information
• Census
• Registration of vital events
• Notification of diseases
• Disease registrations
• Record linkage
• Epidemiological surveillance
• Health service records
• Environmental health data
• Health manpower statistics
• Population surveys
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33. Non quantifiable information
• Health planners and decision makers require a lot of non-
quantifiable information, for instance, information on health
policies, health legislation, public attitudes, program costs,
procedures and technology.
• There should be proper storage, processing and dissemination of
information.
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• eHealth (also written e-health) is a relatively recent term for healthcare
practice which is supported by electronic processes and
communication.
• The term can encompass a range of services that are at the edge of
medicine/healthcare and information technology.
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• mHealth (also written as m-health or sometimes mobile health) is a recent
term for medical and public health practice supported by mobile devices,
such as mobile phones, patient monitoring devices and other wireless devices.
• mHealth applications include:
• Use of mobile devices in collecting community and clinical health data.
• Delivery of healthcare information to practitioners, researchers, and patients.
• Real-time monitoring of patient vital signs, and direct provision of care (via
mobile telemedicine).
38. Subdomains of health care informatics
• Clinical informatics
• Nursing informatics
• Imaging informatics
• Consumer health informatics
• Public health informatics
• Dental informatics
• Clinical research informatics
• Translational research informatics
• Bioinformatics
• Veterinary informatics
• Pharmacy informatics .
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Dental informatics is defined as “ Application of
computers and information science to improve
dental practice , research and program
administeration”
( Eisner , 1992 )
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• Dental informatics - specialty of Medical informatics.
• Medical informatics Dental informatics
• MEDLINE world’s largest biomedical literature database
applicable to all health care disciplines.
• Developing, implementing and evaluating complete computer-based dental
records is both a challenge and an opportunity for dental informatics.
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• Dental informatics saw significant development around the 1960s.
• Gradual increase in interest dental informatics, conducting of conferences and
symposiums.
1. Symposium on Second Generation Clinical Databases and the Electronic Dental
Record [1990].
2. International Conference on Computers in Clinical Dentistry [1991, 1992,1993].
3. International Conference on Computer Applications in Dental Education and
Practice [1994, 1999].
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• Early 1990s - some professional organizations
1. International Medical Informatics Association
2. The American Medical Informatics Association
3. American Dental Education Association
A key development was the initiation of funding for dental informatics training by the
National Institute of Dental and Craniofacial Research (NIDCR) in 1996, which for
the first time recognized the need for a formal education of dental informaticians
(Schleyer and Spallek, 2001).
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• The National Library of Medicine [NLM] had been funding similar training in medical
informatics since 1972.
• Currently, two dental informatics training programs are in operation
a) Columbia University - since 2000
b) University of Pittsburgh- since 2003
• They graduate approximately one or two trainees per year
47. PRIMARY GOALS OF DENTAL
INFORMATICS
Improve treatment
outcomes
Preserve and improve
oral health
Improve diagnosis
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Secondary goals includes :
To make the delivery of dental care more efficient.
Support research and education .
• Achievements – goals – lead to improved patients health care .
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• The trend toward problem-based learning and the
development of critical-thinking skills
•
Developed by dentists
Dentistry – problem based domain .
51. • Requisite features necessary to characterize a discipline:
A core of people who
conduct research and
publish in the
discipline.
An identifiable body
of literature: includes
books and
publications.
Professionals societies
and activities: includes
meetings and
conferences.
Educational programs
leading to certificates
or advanced degrees
Funded research
programs
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• A core of people - conduct and publish research in dental informatics exists.
• Review of the literature - since 1965 - approximately 3,500 authors -
published about 2,200 articles- related to dental informatics and computer
applications in dentistry - 420 journals and conference proceedings.
• Journals with significant numbers of informatics-related articles includes:
1. JADA 3. Journal of Dental Education
2. Dentomaxillofacial Radiology 4. British Dental Journal.
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• Currently - dental informatics has no mainstream journal of its
own .
• Appropriate - dental informatics - early stages of development.
• So at this point of time more importance has to placed in
educating people about the possibilities of dental informatics .
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• Currently - dental informatics- no dedicated professional society. Its
activities are integrated - associations like American Dental Education
Association and the American Medical Informatics Association.
• Evidence suggests - dental informatics research receives only limited
third-party funding - from the government, the military, foundations and
companies.
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• Dental informatics is a nascent discipline. To what degree it
can mature successfully depends on its ability to take
advantage of opportunities and overcome some significant
challenges.
57. 57
• DENTILINE – suggested by LIPTON in 1992.
• It is literature database similar to MEDLINE.
• It focuses mainly on dental issues , so as to make information delivery
more targeted to dental profession.
• Still to-date DENTILINE database system has not come into being.
• Presently search for all the dental journals are made in MEDLINE with
search interfaces like PubMed.
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• OPPORTUNITY : Dental informatics provides a universally accessible
patient records.
• CHALLENGE: There are no systems which has perfect balance between
accessibility and privacy of patient related information .
• OPPORTUNITY : Dental informatics provides many patients to enjoy a
high standard of oral health care.
• CHALLENGE : There are still variations in diagnosis and treatment
decisions made by dentists
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• Articles on dental informatics in major dental journals.
• Meetings and conferences .
• Society activities, University committees and focus groups .
• Computer courses .
• Dental informatics degree programs .
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• WHO has a long tradition of epidemiological survey methods
• WHO global data bank was established-1967.
• Emerged from gathering of information from surveys and growing
burden of dental caries, particularly notable in the industrialized
countries.
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• Surveys were motivated for the need for planning of oral health
services and organization of public health intervention programs.
• WHO has encouraged the member states to report information on
the disease level for international comparisons by use of standardized
methodology
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• To ensure high validity and reliability- basic instruments and record
forms in the collection of data
• High quality data through specification of clearly defined
examination procedures, training, calibration trials, for assessment
of intra and inter examiner variability
• Tools of oral epidemiology have been instrumental in the
establishment of oral health information systems world wide.
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• In 1996 , WHO established an internet online oral health
database, supported by WHO collaborating center in oral health
at Malmo university, Sweden, and the University of Nigita, Japan.
67. CONCLUSION
• Dentistry is a relatively small segment of the health care system. Thus, many
companies are hesitant to invest in research and development because the
potential payoff is constrained by the small size of the market.
• For instance, when only a few practices can exchange patient information
using computer-based patient records, the collective benefit is small.
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• When most practices use such interoperable CPRs, however, the
collective benefit is large. Globalization may improve this situation
because it increases potential markets. The growth of dental
informatics also is hampered because many of its benefits are hard to
measure, and achieving them requires significant upfront and ongoing
investments.
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• The current situation simply may be symptomatic of a profession finding
its way in informatics.
• An encouraging sign is the significant and increasing interest of many
influential stakeholders in dentistry.
• Hopefully, this interest can be channeled into concerted action that
benefits all of dentistry. Success, however, also is predicated on the level
of involvement of each practitioner.
