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Clinical Informatics

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Presentation at the Rizal Medical Center Postgraduate Course. 9 Oct 2019, Unilab Bayanihan Hall.

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Clinical Informatics

  1. 1. Iris Thiele Isip Tan MD, MSc Professor 3, UP College of Medicine Chief, UP Medical Informatics Unit CLINICAL INFORMATICS
  2. 2. What? Why? How? is clinical informatics learn informatics can informatics improve healthcare
  3. 3. It’s not just computers! Kulikowski et al. J Am Med Inform Assoc 2012;19:931–938.
  4. 4. Kulikowski et al. J Am Med Inform Assoc 2012;19:931–938.
  5. 5. Kulikowski et al. J Am Med Inform Assoc 2012;19:931–938.
  6. 6. Kulikowski et al. J Am Med Inform Assoc 2012;19:931–938.
  7. 7. “ Clinical informaticians transform health care by analyzing, designing, implementing, and evaluating information and communication systems that enhance individual and population health outcomes, improve patient care, and strengthen the clinician-patient relationship. ” – Gardner RM et al JAMIA 2009;16:153-157
  8. 8. Gardner RM et al JAMIA 2009;16:153-157
  9. 9. Kulikowski et al. J Am Med Inform Assoc 2012;19:931–938. MSc Health Informatics (UP Manila) Medical Informatics track (UPCM) Bioinformatics track (CAS)
  10. 10. What? Why? How? is clinical informatics learn informatics can informatics improve healthcare
  11. 11. “We are drowning in information and starving for knowledge.” Rutherford D. Rogers http://www.infogineering.net/data-information-knowledge.htm
  12. 12. Building a Health Information Infrastructure Why electronic health records? by InfowayInfoRoute https://youtu.be/Lo_3qOejQzI
  13. 13. National eHealth Vision Philippines Photo by Doun, https://flic.kr/p/b5WFRK By 2020, eHealth will enable widespread access to health care services, health information and securely share and exchange patient information in support of safer, quality health care, more equitable and responsive health system for all the Filipino people by transforming the way information is used to plan, manage, deliver and monitor health services.
  14. 14. IT-enabled health services By 2020 Philippine Health Information Exchange (PHIE) implementation EMR certification IT in all public health facilities National eHealth Vision
  15. 15. Rule VIII. Governance & Accountablity Sec. 36 All health service providers and insurers are required to maintain a health information system on enterprise resource planning, human resource information system, electronic health records and electronic prescription log consistent with standards set by the DOH and Philhealth in consultation with the DICT and the NPC … RA 11223 Universal Healthcare Act
  16. 16. RA 11223 Universal Healthcare Act Rule VIII. Governance & Accountablity Sec. 36 PhilHealth shall use its contracts to incentivize the incorporation of HIS, automation of clinical information, improvement of data quality, integration and use of telemedicine, and participation in regional or national health information networks.
  17. 17. Art 4. Sec 3.3 Program Educational Objectives With additional training, graduates of the MD program may pursue any of the following careers to include: • General medical practitioner • Clinical specialist • Researcher/Medical Scientist/Innovator • Health professions teacher • Health administrator • Health information manager • Health economist • Health policy maker CHED Memorandum Order 18 Series of 2016
  18. 18. Art 5. Sec 6.3 Minimum Curricular Content The minimum curricular content regardless of the curriculum design shall include the following: • Research, evidence-based medicine and medical informatics CHED Memorandum Order 18 Series of 2016
  19. 19. What? Why? How? is clinical informatics learn informatics can informatics improve healthcare
  20. 20. Patient Safety & Clinical Informatics Assemble a complete picture of the patient, including tracking the course of disease and the effect of therapies over time Kilbridge PM & Classen DC. JAMIA 2008;15(4):397-407
  21. 21. Patient Safety & Clinical Informatics Kilbridge PM & Classen DC. JAMIA 2008;15(4):397-407 Assembling the relevant medical knowledge
  22. 22. REAL-WORLD DATA: Information on health care that is derived from multiple sources outside typical clinical research settings, including electronic health records (EHRs), claims and billing data, product and disease registries, and data gathered through personal devices and health applications. NEJM 2016;375(23):2293-7
  23. 23. Patient Safety & Clinical Informatics Kilbridge PM & Classen DC. JAMIA 2008;15(4):397-407 Assembling the relevant medical knowledge Enhance adherence of clinical practice to tenets of EBM: prompting adherence to protocols/guidelines via computerized order entry
  24. 24. Kilbridge PM & Classen DC. JAMIA 2008;15(4):397-407 Patient Safety & Clinical Informatics Applying timely and accurate knowledge of medicine to the patient’s current condition

  25. 25. Clinical Decision Support Gather & make associations between pieces of information that may be missed because of sheer volume of data Bates et al JAMIA 2003;10:523-530
  26. 26. Buch et al. Diabet Med 2018;35:495-7. Clinical guidelines will be delivered through apps rather than static documents.
  27. 27. Kilbridge PM & Classen DC. JAMIA 2008;15(4):397-407 Patient Safety & Clinical Informatics Information systems to prevent, intercept and ameliorate harm Preventing mistakes
  28. 28. https://mysugr.com/mysugr-bolus-calculator/ Insulin on board Blood glucose Carbs Previous injections Carbs/insulin ratio Insulin correction factor Blood glucose target MySugr Bolus Calculator
  29. 29. https://www.uni-trier.de/index.php?id=44502&L=2 CASE-BASED REASONING Problem-solving paradigm in artificial intelligence Similar problems tend to have similar solutions Case base: collection of memorized chunks of experience (cases) Adaptive systems: new problem solving experience is retained and outdated experience is removed
  30. 30. Brown D et al. Temporal case-based reasoning for type 1 diabetes mellitus bolus insulin decision support. Artificial Intelligence in Medicine 2018;85:28-42. Focus on helping patient directly (instead of aiding the clinician) RETAINS all successful cases Derives bolus suggestion from similar cases
  31. 31. Brown D et al. Temporal case-based reasoning for type 1 diabetes mellitus bolus insulin decision support. Artificial Intelligence in Medicine 2018;85:28-42. CBR method can be adopted by insulin pumps, blood glucose monitors, PCs and as a web service
  32. 32. CBR service in the cloud opens possibility of case sharing between subjects Brown D et al. Temporal case-based reasoning for type 1 diabetes mellitus bolus insulin decision support. Artificial Intelligence in Medicine 2018;85:28-42.
  33. 33. Patient Safety & Clinical Informatics Kilbridge PM & Classen DC. JAMIA 2008;15(4):397-407 Assembling the relevant medical knowledge Enhance adherence of clinical practice to tenets of EBM: prompting adherence to protocols/guidelines via computerized order entry Clinical data mining to increase understanding of disease
  34. 34. Can we predict individuals’ medical diagnoses from language posted on social media? Merchant RA et al. doi.org/10.1371/journal.pone.0215476
  35. 35. Can we identify specific markers of disease from social media posts? Merchant RA et al. doi.org/10.1371/journal.pone.0215476 SOCIAL MEDIA + EMR
  36. 36. Merchant RA et al. doi.org/10.1371/journal.pone.0215476
  37. 37. Facebook alone Demographics alone Demographics and Facebook Medical Condition Prediction Strength Diabetes!! Merchant RA et al. doi.org/10.1371/journal.pone.0215476
  38. 38. All 21 medical condition categories were predictable from Facebook language beyond chance. 18 categories better predicted by demographics + Facebook language vs demographics. 10 categories better predicted by Facebook language vs demographics. Merchant RA et al. doi.org/10.1371/journal.pone.0215476
  39. 39. Merchant RA et al. doi.org/10.1371/journal.pone.0215476
  40. 40. Merchant RA et al. doi.org/10.1371/journal.pone.0215476
  41. 41. Merchant RA et al. doi.org/10.1371/journal.pone.0215476
  42. 42. SOCIALMEDIOME
  43. 43. What? Why? How? is clinical informatics learn informatics can informatics improve healthcare

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