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ICT in Healthcare

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Presented at the Faculty of Nursing, Thammasat University, Rangsit Campus on October 21, 2016

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ICT in Healthcare

  1. 1. ICT in Healthcare Nawanan Theera-Ampornpunt October 21, 2016
  2. 2. 2 2003 M.D. (First-Class Honors) 2011 Ph.D. (Health Informatics), Univ. of Minnesota Lecturer, Department of Community Medicine Faculty of Medicine Ramathibodi Hospital Mahidol University Interests: Health IT for Quality of Care, Social Media IT Management, Security & Privacy nawanan.the@mahidol.ac.th SlideShare.net/Nawanan นวนรรน ธีระอัมพรพันธุ์ (Nawanan Theera-Ampornpunt) Line ID: NawananT Introduction
  3. 3. 3  The Road to Digitizing Healthcare  What is a “Smart Hospital”?  Toward a “Smart” Hospital Outline
  4. 4. 4 Health & Health Information
  5. 5. 5 Let’s take a look at these pictures...
  6. 6. 6Image Source: https://en.wikipedia.org/wiki/Industrial_robot (KUKA Roboter GmbH) “Smart” Manufacturing
  7. 7. 7 Image Sources: http://isarapost.net/home/?p=17760 http://www.telecomjournalthailand.com/ตอบโจทย์โมเดลทางธุรกิจ/ “Smart” Banking
  8. 8. 8ER - Image Source: nj.com Healthcare (On TV)
  9. 9. 9 (At an undisclosed hospital) Healthcare (Reality)
  10. 10. 10 • 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”?
  11. 11. 11 But...Are We That Different? Input Process Output Transfer Banking Value-Add - Security - Convenience - Customer Service Location A Location B
  12. 12. 12 Input Process Output Assembling Manufacturing Raw Materials Finished Goods Value-Add - Innovation - Design - QC But...Are We That Different?
  13. 13. 13 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?
  14. 14. 14 • Large variations & contextual dependence Input Process Output Patient Presentation Decision- Making Biological Responses Standardizing Healthcare
  15. 15. 15 The World of Smart Machines Image Sources: http://www.ibtimes.com/google-deepminds-alphago- program-defeats-human-go-champion-first-time-ever-2283700 http://deepmind.com/
  16. 16. 16 Digitizing Healthcare Image Source: http://www.bloomberg.com/bw/stories/2005-03-27/cover-image-the-digital-hospital
  17. 17. 17 “To computerize the hospital” “To go paperless” “To become a Digital Hospital” “To Have EHRs” Why Adopting Health IT?
  18. 18. 18 • “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) Some “Smart” Quotes
  19. 19. 19 Being Smart #1: Stop Your “Drooling Reflex”!!
  20. 20. 20 Being Smart #2: Focus on Information & Process Improvement, Not Technology
  21. 21. 21 If not “Digital Hospital” or “Paperless Hospital” Then What Should We Aspire to Be?
  22. 22. “Smart Hospital”
  23. 23. 23 So How is a “Smart Hospital” Different from a Digital or Paperless Hospital?
  24. 24. 24 Healthcare 4.0?
  25. 25. 25 Healthcare 1.0 • Thai Traditional Medicine in the Ancient Times Healthcare 1.0 - 4.0 is the speaker’s personal opinion and may not represent official views of the Ministry of Public Health Image & Caption Source: http://kanchanapisek.or.th/kp6/sub/book/book.php?book=33&chap=8&page=t33-8-detail.html http://kanchanapisek.or.th/kp6/sub/book/book.php?book=33&chap=8&page=t33-8-infodetail02.html การย่อยขนาดตัวยาสมุนไพร โดยใช้ครกตาและหินบดยา ของโรงศิริราชพยาบาล (ปัจจุบันคือ โรงพยาบาลศิริราช) คนไทยสมัยก่อนมักให้บุคคลในครอบครัวบีบนวดได้
  26. 26. 26 Healthcare 2.0 • Modern (Western) Medicine Healthcare 1.0 - 4.0 is the speaker’s personal opinion and may not represent official views of the Ministry of Public Health Image & Caption Source: http://kanchanapisek.or.th/kp6/sub/book/book.php?book=33&chap=8&page=t33-8-detail.html http://kanchanapisek.or.th/kp6/sub/book/book.php?book=33&chap=8&page=t33-8-infodetail02.html
  27. 27. 27 Healthcare 3.0 • Quality-Driven Healthcare Healthcare 1.0 - 4.0 is the speaker’s personal opinion and may not represent official views of the Ministry of Public Health Image & Caption Source: http://kanchanapisek.or.th/kp6/sub/book/book.php?book=33&chap=8&page=t33-8-detail.html http://kanchanapisek.or.th/kp6/sub/book/book.php?book=33&chap=8&page=t33-8-infodetail02.html
  28. 28. 28 Healthcare 4.0 • Smart Healthcare & Smart Hospital Healthcare 1.0 - 4.0 is the speaker’s personal opinion and may not represent official views of the Ministry of Public Health Image & Caption Source: http://kanchanapisek.or.th/kp6/sub/book/book.php?book=33&chap=8&page=t33-8-detail.html http://kanchanapisek.or.th/kp6/sub/book/book.php?book=33&chap=8&page=t33-8-infodetail02.html
  29. 29. 29 So What Is Smart Healthcare?
  30. 30. 30 Smart Healthcare For Policymakers? Image Source: http://healthdata.moph.go.th/kpi/2557/ProvinceKpiTopicListAll.php?provincecode=99
  31. 31. 31 Smart Healthcare For Health Promoters? Image Source: http://www.hiso.or.th/hiso/picture/reportHealth/ThaiHealth2014/thai2014_3.pdf
  32. 32. 32 Smart Healthcare For Clinicians? Image Source: http://www.medscape.com/viewarticle/780298
  33. 33. 33 Smart Healthcare For Patients & Consumers? Image Source: Agence France-Presse/Getty Images
  34. 34. 34 So What Exactly Is Smart Healthcare? Image Source: http://cdn2.hubspot.net/hub/134568/file-1208368053-jpg/6-blind-men-hans.jpg
  35. 35. 35 The Road to Digitizing Healthcare  What is a “Smart Hospital”?  Toward a “Smart” Hospital Outline
  36. 36. 36 Microsoft Health Future Vision
  37. 37. 37 Connecting People to a Healthy Future With Personalized Care – Kaiser Permanente https://www.youtube.com/watch?v=gxz9ZVvduGc
  38. 38. 38 Back to something simple...
  39. 39. 39 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?
  40. 40. 40 • 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
  41. 41. 41 Information is Everywhere in Healthcare
  42. 42. 42 “Information” in Medicine Shortliffe EH. Biomedical informatics in the education of physicians. JAMA. 2010 Sep 15;304(11):1227-8.
  43. 43. 43 43 WHO (2009) Components of Health Systems
  44. 44. 44 44 WHO (2009) WHO Health System Framework
  45. 45. 45 • 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
  46. 46. 46 • Efficient –Faster care –Time & cost savings –Reducing unnecessary tests • Equitable –Access to providers & knowledge • Patient-Centered –Empowerment & better self-care Being “Smart” in Healthcare
  47. 47. 47 (IOM, 2001)(IOM, 2000) (IOM, 2011) Landmark Institute of Medicine Reports
  48. 48. 48 • To Err is Human (IOM, 2000) reported that: – 44,000 to 98,000 people die in U.S. hospitals each year as a result of preventable medical mistakes – Mistakes cost U.S. hospitals $17 billion to $29 billion yearly – Individual errors are not the main problem – Faulty systems, processes, and other conditions lead to preventable errors Patient Safety
  49. 49. 49 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
  50. 50. 50 Image Source: (Left) http://docwhisperer.wordpress.com/2007/05/31/sleepy-heads/ (Right) http://graphics8.nytimes.com/images/2008/12/05/health/chen_600.jpg To Err is Human 1: Attention
  51. 51. 51Image Source: Suthan Srisangkaew, Department of Pathology, Facutly of Medicine Ramathibodi Hospital To Err is Human 2: Memory
  52. 52. 52 • Cognitive Errors - Example: Decoy Pricing The Economist Purchase Options • Economist.com subscription $59 • Print subscription $125 • Print & web subscription $125 Ariely (2008) 16 0 84 The Economist Purchase Options • Economist.com subscription $59 • Print & web subscription $125 68 32 # of People # of People To Err is Human 3: Cognition
  53. 53. 53 • It already happens.... (Mamede et al., 2010; Croskerry, 2003; Klein, 2005; Croskerry, 2013) What If This Happens in Healthcare?
  54. 54. 54 Klein JG. Five pitfalls in decisions about diagnosis and prescribing. BMJ. 2005 Apr 2;330(7494):781-3. “Everyone makes mistakes. But our reliance on cognitive processes prone to bias makes treatment errors more likely than we think” Cognitive Biases in Healthcare
  55. 55. 55 • Medication Errors –Drug Allergies –Drug Interactions • Ineffective or inappropriate treatment • Redundant orders • Failure to follow clinical practice guidelines Common Errors
  56. 56. 56 Being Smart #3: “To Err is Human”
  57. 57. 57 External Memory Knowledge Data Long Term Memory Knowledge Data Inference DECISION PATIENT Perception Attention Working Memory CLINICIAN Elson, Faughnan & Connelly (1997) Clinical Decision Making
  58. 58. 58 Example of “Alerts & Reminders” Reducing Errors through “Alerts & Reminders”
  59. 59. 59 Why We Need ICT in Healthcare? #1: Because information is everywhere in healthcare
  60. 60. 60 Why We Need ICT in Healthcare? #2: Because healthcare is error-prone and technology can help
  61. 61. 61http://www.dplindbenchmark.com/wp-content/uploads/2013/02/HHRI-Our-Health-Care-River.pdf Fragmented Healthcare
  62. 62. 62 Why We Need ICT in Healthcare? #3: Because access to high-quality patient information should improve care
  63. 63. 63 Why We Need ICT in Healthcare? #4: Because healthcare at all levels is fragmented & in need of process improvement
  64. 64. 64 Documented Values of Health IT • Guideline adherence • Better documentation • Practitioner decision making or process of care • Medication safety • Patient surveillance & monitoring • Patient education/reminder
  65. 65. 65 Being Smart #4: Link IT Values to Quality (Including Safety)
  66. 66. 66 Use of information and communications technology (ICT) in health & healthcare settings Source: The Health Resources and Services Administration, Department of Health and Human Service, USA Slide adapted from: Dr. Boonchai Kijsanayotin Health IT
  67. 67. 67 Use of information and communications technology (ICT) for health; Including • Treating patients • Conducting research • Educating the health workforce • Tracking diseases • Monitoring public health. Sources: 1) WHO Global Observatory of eHealth (GOe) (www.who.int/goe) 2) World Health Assembly, 2005. Resolution WHA58.28 Slide adapted from: Mark Landry, WHO WPRO & Dr. Boonchai Kijsanayotin eHealth
  68. 68. 68 eHealth  Health IT Slide adapted from: Dr. Boonchai Kijsanayotin eHealth & Health IT
  69. 69. 69 Health Information Technology Goal Value-Add Tools Health IT: What’s in a Word?
  70. 70. 70 Hospital Information System (HIS) Computerized Physician Order Entry (CPOE) Electronic Health Records (EHRs) Picture Archiving and Communication System (PACS) Various Forms of Health IT
  71. 71. 71 m-Health Health Information Exchange (HIE) Biosurveillance Telemedicine & Telehealth Images from Apple Inc., Geekzone.co.nz, Google, PubMed.gov, and American Telecare, Inc. Personal Health Records (PHRs) Health IT Beyond Hospitals
  72. 72. 72 Health IT for Medication Safety Ordering Transcription Dispensing Administration CPOE Automatic Medication Dispensing Electronic Medication Administration Records (e-MAR) Barcoded Medication Administration Barcoded Medication Dispensing
  73. 73. 73 Hospital A Hospital B Clinic C Government Lab Patient at Home Health Information Exchange
  74. 74. 74 My Life-Long Dream...
  75. 75. 75WHO & ITU Achieving Health Information Exchange (HIE)
  76. 76. 76 • The Large N Interfaces Problem N = 2, Interface = 1 # Interfaces = N(N-1)/2 N = 3, Interface = 3 N = 5, Interface = 10 N = 100, Interface = 4,950 Standards: Why?
  77. 77. 77 นวนรรน ธีระอัมพรพันธุ์. ตำนำนควำมเชื่อและข้อเท็จจริงเกี่ยวกับมำตรฐำนสำรสนเทศทำงสุขภำพ. ใน: Health Data Standards Expo: From Reimbursement to Clinical Excellence; 2011 Aug 8-9; Bangkok, Thailand. Bangkok (Thailand): Mahidol University, Faculty of Medicine Ramathibodi Hospital; 2011 Aug. http://www.slideshare.net/nawanan/myths-and-truths-on-health-information-standards Myths & Truths on Standards
  78. 78. 78 Myths • We don’t need standards • Standards are IT people’s jobs • We should exclude vendors from this • We need the same software to share data • We need to always adopt international standards • We need to always use local standards Theera-Ampornpunt (2011) Myths & Truths on Standards
  79. 79. 79 Being Smart #5: Go for Systems that Use Standards, Not a Unified, Conquer-the-World System Image Source: http://www.denofgeek.com/movies/avengers/37236/why-loki-was-cut-from-avengers-age-of-ultron
  80. 80. 80 The Road to Digitizing Healthcare What is a “Smart Hospital”?  Toward a “Smart” Hospital Outline
  81. 81. 81 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/
  82. 82. 82Image Source: socialmediab2b.com Another Smart Machine: IBM’s Watson
  83. 83. 83Image Source: englishmoviez.com Rise of the Machines?
  84. 84. 84Image Source: amazon.com Smart Phones, Dumb People?
  85. 85. 85 Smart Hospital, Dumb...?
  86. 86. 86 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
  87. 87. 87 Being Smart #6: Don’t Replace Human Users. Use ICT to Help Them Perform Smarter & Better.
  88. 88. 88 Some Risks of Clinical Decision Support Systems • Alert Fatigue Unintended Consequences of Health IT
  89. 89. 89 Workarounds Unintended Consequences of Health IT
  90. 90. 90 Being Smart #7: Health IT Also Have Risks & Unintended Consequences
  91. 91. 91 Balanced Focus of Informatics Technology ProcessPeople
  92. 92. 92 Being Smart #8: Balance Your Focus (People, Process, Technology)
  93. 93. 93The sailboat image source: Uwe Kils via http://en.wikipedia.org/wiki/Sailing The destination The boat The sailor(s) & people on board The tailwind The headwind The direction The speed The past journey The sea The sail The current location IT & Organizational Context
  94. 94. 94 Being Smart #9: Know Your Context & Align IT with that Context
  95. 95. 95 A 900-Bed University Hospital Vision To be a leading hospital in Asia with excellence in healthcare services, education, and research A 200-Bed Private Hospital Vision To be a leading High Tech High Touch hospital in Thailand Vision, Mission & IT Strategies
  96. 96. 96 Carr (2004) Carr (2003) IT as “The Sail”
  97. 97. 97 Strategic Operational ClinicalAdministrative LIS Health Information ExchangeBusiness Intelligence Word Processor Social Media PACS 4 Quadrants of Hospital IT Personal Health Records Clinical Decision Support Systems Computerized Physician Order Entry Electronic Health Records Admission-Discharge-Transfer Master Patient Index Enterprise Resource Planning Vendor-Managed Inventory Customer Relationship Management
  98. 98. 98 Being Smart #10: Identify Your Strategic IT Assets
  99. 99. 99 People Techno- logy Process “The Sailors”
  100. 100. 100 A 900-Bed University Hospital • Average age of personnel at 42 years (range 20-65) • IT department consists of new, young members and senior members who developed the first version of its systems • Doctors are highly individualistic, most also practice in private hospitals, high turn-over rate • Nurses and other professions often view doctors as hospital’s “elites” and often have heated debates with them A 200-Bed Private Hospital • Average age of personnel at 32 years (range 20-57) • Strong IT department • Doctors typically don’t interact with other staff, income is the main motivator • Executives are highly respected by all professions as visionary and high-performing “The Sailors”
  101. 101. 101Ash et al. (2003) The “Special People”
  102. 102. 102Ash et al. (2003) • Administrative Leadership Level –CEO •Provides top level support and vision •Holds steadfast •Connects with the staff •Listens •Champions – CIO • Selects champions • Gains support • Possesses vision • Maintains a thick skin – CMIO • Interprets • Possesses vision • Maintains a thick skin • Influences peers • Supports the clinical support staff • Champions The “Special People”
  103. 103. 103Ash et al. (2003) • Clinical Leadership Level – Champions • Necessary • Hold steadfast • Influence peers • Understand other physicians – Opinion leaders • Provide a balanced view • Influence peers – Curmudgeons • “Skeptic who is usually quite vocal in his or her disdain of the system” • Provide feedback • Furnish leadership – Clinical advisory committees • Solve problems • Connect units The “Special People”
  104. 104. 104Ash et al. (2003) • Bridger/Support level –Trainers & support team •Necessary •Provide help at the elbow •Make changes •Provide training •Test the systems –Skills •Possess clinical backgrounds •Gain skills on the job •Show patience, tenacity, and assertiveness The “Special People”
  105. 105. 105 Being Smart #11: Manage Your “Special People” Well
  106. 106. 106 A True Story of Failure to Involve Users in Hospital IT Implementation
  107. 107. 107 Being Smart #12: Involve Users Early & Intensively in Your Process
  108. 108. 108 Image source: Jeremy Kemp via http://en.wikipedia.org/wiki/Hype_cycle http://www.gartner.com/technology/research/methodologies/hype-cycle.jsp Gartner Hype Cycle
  109. 109. 109 Rogers (2003) Rogers’ Diffusion of Innovations: Adoption Curve
  110. 110. 110 • Communications of project plans & progresses • Workflow considerations • Management support of IT projects • Common visions • Shared commitment • Multidisciplinary user involvement • Project management • Training • Innovativeness • Organizational learning Theera-Ampornpunt (2009, 2011) Success Factors of Hospital IT Adoption
  111. 111. 111 Being Smart #13: Work Smartly with Smart People
  112. 112. 112 To become a smart hospital, you must • Know what is “smart” all about • Know how to use smart machines together with smart people • Manage both of them smartly Summary
  113. 113. 113 2003 M.D. (First-Class Honors) 2011 Ph.D. (Health Informatics), Univ. of Minnesota Lecturer, Department of Community Medicine Faculty of Medicine Ramathibodi Hospital Mahidol University Interests: Health IT for Quality of Care, Social Media IT Management, Security & Privacy nawanan.the@mahidol.ac.th SlideShare.net/Nawanan นวนรรน ธีระอัมพรพันธุ์ (Nawanan Theera-Ampornpunt) Line ID: NawananT Q&A

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