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1 2 why is e_health so hard

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Hildegard McNicoll
Why is eHealth so hard?

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Healthcare realities …
Large and segmented
populations
Safety critical but distractible
environment
Generally poor IT infr...

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Healthcare is powered by information
To facilitate immediate care
To facilitate review of care
quality
To inform healthcar...

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1 2 why is e_health so hard

  1. 1. Hildegard McNicoll Why is eHealth so hard?
  2. 2. Healthcare realities … Large and segmented populations Safety critical but distractible environment Generally poor IT infrastructure Highly politicised Culturally nuanced Increasingly mobile ageing population Information governance issues
  3. 3. Healthcare is powered by information To facilitate immediate care To facilitate review of care quality To inform healthcare management To inform research
  4. 4. Why is health information so hard? Very different kinds of information Compressed, summarised information Reporting Making sense of complex care Large number of complex datatypes not just string, numeric, url, date
  5. 5. Biomedical concepts Symptoms, examination signs Lab tests, imaging results Illnesses, procedures Asthma Depression Appendicectomy Medications, devices Penicillin 250mg tablets Hip arthroplasty component
  6. 6. Documentation of care Immediate care context Diagnosis (name, dates, grade) Lab test (name, result) Medico-legal context Who, when, why, what, how
  7. 7. Compression and summarisation Registry and research coded diagnosis versus Y/N ‘Curated’ problem lists Remove ‘inactive’ or trivial problems Add new problems ? all problems From whose perspective?
  8. 8. Medication ‘dose syntax’ How can we capture a prescription like “Co-codamol 8mg/500mg/5ml oral suspension 5-10mls 4-6hourly for 7 days for pain, maximum 40mls daily” How can we cope with dose vs product prescribing
  9. 9. Medication ‘dose syntax’ How can we capture a prescription like “Co-codamol 8mg/500mg/5ml oral suspension 5-10mls 4-6hourly for 7 days for pain, maximum 40mls daily” How can we cope with dose vs product prescribing
  10. 10. Complex datatypes Coded terms Dates and times Durations ‘Ordinals’ Multimedia Proportions Quantities with units Interpretations
  11. 11. Task / workflow management Track progress of referral Referral requested Referral scheduled Referral performed Referral cancelled
  12. 12. External terminologies Medications / drug allergies: dm+d, RxNorm, proprietary Conditions, procedures: ICD-10, SNOMED-CT Lab tests/ analytes: LOINC, SNOMED-CT Organisation types, Sex / gender: Local/national admin terminologies
  13. 13. Health information is nasty
  14. 14. Health information is nasty Complexity is a challenge for any e-Health developer building APIs, messages building apps Need good requirements from clinicians How do we know they are widely applicable? How do we make sure that we capture and share that clinical knowledge?

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