Presented at the 19th HA National Forum on March 14, 2018

1. Digital Health
19th HA National Forum
www.SlideShare.net/Nawanan
นพ.นวนรรน ธีระอัมพรพันธุ์
14 มีนาคม 2561

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Health &
Health Information

3. 3Image Source: https://en.wikipedia.org/wiki/Industrial_robot (KUKA Roboter GmbH)
“Smart” Manufacturing

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Image Sources: http://isarapost.net/home/?p=17760
http://www.telecomjournalthailand.com/ตอบโจทย์โมเดลทางธุรกิจ/
“Smart” Banking

5. 5ER - Image Source: nj.com
Healthcare (On TV)

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(At an undisclosed hospital)
Healthcare (Reality)

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• Life-or-Death
• Difficult to automate human decisions
– Nature of business
– Many & varied stakeholders
– Evolving standards of care
• Fragmented, poorly-coordinated systems
• Large, ever-growing & changing body of
knowledge
• High volume, low resources, little time
Why Healthcare Isn’t (Yet) “Smart”?

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Input Process Output
Assembling
Manufacturing
Raw Materials Finished
Goods
Value-Add
- Innovation
- Design
- QC
Systems Perspective

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Systems Perspective
Input Process Output
Transfer
Banking
Value-Add
- Security
- Convenience
- Customer Service
Location A Location B

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Input Process Output
Patient Care
Health care
Sick Patient Well Patient
Value-Add
- Technology & medications
- Clinical knowledge & skilled providers
- Quality of care; process improvement
- Customer service
- Information
But...Are We That Different?

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• Large variations & contextual dependence
Input Process Output
Patient
Presentation
Decision-
Making
Biological
Responses
Standardizing Healthcare

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Digitizing Healthcare
Image Source: http://www.bloomberg.com/bw/stories/2005-03-27/cover-image-the-digital-hospital

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“To computerize
the hospital”
“To go paperless”
“To become a
Digital Hospital”
“To have
EHRs”
Why Adopting Health IT?

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• “Don’t implement technology just for technology’s sake.”
• “Don’t make use of excellent technology.
Make excellent use of technology.”
(Tangwongsan, Supachai. Personal communication, 2005.)
• “Health care IT is not a panacea for all that ails
medicine.” (Hersh, 2004)
• “One of the failures in health IT implementation is to
view it as an IT project, not a clinical transformation
project.”
Some “Smart” Quotes

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Being Smart #1:
Stop Your
“Drooling Reflex”!!

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Being Smart #2:
Focus on Information &
Process Improvement,
Not Technology

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ถ้าไม่เป็น
“Paperless Hospital”
แล้วจะให้เราเป็นอะไร?

18. “Smart Hospital”

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แล้ว “Smart Hospital”
ต่างจาก Paperless Hospital
ตรงไหน?

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Connecting People to a Healthy Future With
Personalized Care – Kaiser Permanente
https://www.youtube.com/watch?v=gxz9ZVvduGc

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To treat & to care
for their patients
to their best
abilities, given
limited time &
resources
Image Source: http://en.wikipedia.org/wiki/File:Newborn_Examination_1967.jpg (Nevit Dilmen)
What Clinicians Want?

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• Safe
• Timely
• Effective
• Patient-Centered
• Efficient
• Equitable
Institute of Medicine, Committee on Quality of Health Care in America. Crossing the quality
chasm: a new health system for the 21st century. Washington, DC: National Academy
Press; 2001. 337 p.
High Quality Care

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23
WHO (2009)
Components of Health Systems

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• Safe
–Drug allergies
–Medication Reconciliation
• Timely
–Complete information at point of
care
• Effective
–Better clinical decision-making
Image Source: http://www.flickr.com/photos/childrensalliance/3191862260/
Being “Smart” in Healthcare

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• Efficient
–Faster care
–Time & cost savings
–Reducing unnecessary tests
• Equitable
–Access to providers & knowledge
• Patient-Centered
–Empowerment & better self-care
Being “Smart” in Healthcare

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(IOM, 2001)(IOM, 2000) (IOM, 2011)
Landmark Institute of Medicine Reports

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Summary of These Reports
• Humans are not perfect and are bound to
make errors
• Highlight problems in U.S. health care
system that systematically contributes to
medical errors and poor quality
• Recommends reform
• Health IT plays a role in improving patient
safety

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Being Smart #3:
“To Err is Human”

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External Memory
Knowledge Data
Long Term Memory
Knowledge Data
Inference
DECISION
PATIENT
Perception
Attention
Working
Memory
CLINICIAN
Elson, Faughnan & Connelly (1997)
Clinical Decision Making

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Example of “Alerts & Reminders”
Reducing Errors through “Alerts & Reminders”

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Documented Values of Health IT
• Guideline adherence
• Better documentation
• Practitioner decision making or
process of care
• Medication safety
• Patient surveillance &
monitoring
• Patient education/reminder

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Being Smart #4:
Link IT Values to
Quality (Including Safety)

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Health
Information
Technology
Goal
Value-Add
Tools
Health IT: What’s in a Word?

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• Safe
• Timely
• Effective
• Patient-Centered
• Efficient
• Equitable
Institute of Medicine, Committee on Quality of Health Care in America. Crossing the quality
chasm: a new health system for the 21st century. Washington, DC: National Academy
Press; 2001. 337 p.
High Quality Care

35. 35WHO & ITU
Achieving eHealth/Digital Health/Smart Health

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A Smart Machine: DeepMind
Image Sources: http://www.ibtimes.com/google-deepminds-alphago-
program-defeats-human-go-champion-first-time-ever-2283700
http://deepmind.com/

37. 37Image Source: socialmediab2b.com
Another Smart Machine: IBM’s Watson

38. 38Image Source: englishmoviez.com
Rise of the Machines?

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Clinical Decision Support Systems
• CDSS as a replacement or supplement of
clinicians?
– The demise of the “Greek Oracle” model (Miller & Masarie, 1990)
The “Greek Oracle” Model
The “Fundamental Theorem” Model
Friedman (2009)
Wrong Assumption
Correct Assumption

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Being Smart #5:
Don’t Replace
Human Users.
Use ICT to Help Them
Perform Smarter & Better.

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ความฝันอันสูงสุด...
My Life-Long Dream...

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Hospital A Hospital B
Clinic D
Policymakers
Patient
at Home
Hospital C
HIE Broker
Health Information Exchange (HIE)

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TEDxMahidolU Talk by Nawanan: “ATM in Healthcare”

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Q&A
SlideShare.net/Nawanan