Leveraging Clinical IT for Dengue: Opportunities for Tomorrow

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Leveraging Clinical IT for Dengue: Opportunities for Tomorrow

  1. 1. LEVERAGING CLINICAL ITFOR DENGUE: OPPORTUNITIES FOR TOMORROW SlideShare.Net/Nawanan Nawanan Theera-Ampornpunt, M.D., Ph.D.
  2. 2. Outline Background Clinical Management of Dengue Roles of Health IT in Dengue Summary
  3. 3. Dengue: Epidemiology Most rapidly spreading mosquito-borne viral disease in the world 30-fold increase in incidence in the last 50 years Epidemic dengue spread to new areas Substantial burden on health sector & economy WHO Dengue Guidelines for Diagnosis, Treatment, Prevention and Control (2009)
  4. 4. Dengue: Prevention & Control Dengue surveillance Case management Outbreak response Integrated vector management Social mobilization & communication Research Resolution SEA/RC61/R5 of WHO Regional Committee for South-East Asia (2008) WHO Dengue Guidelines for Diagnosis, Treatment, Prevention and Control (2009)
  5. 5. Dengue: Clinical Management WHO Dengue Guidelines for Diagnosis, Treatment, Prevention and Control (2009), adapted from Yip (1980)
  6. 6. Dengue: Clinical Decisions Diagnosis & differential diagnosis Investigations Phase & severity Disposition: To send back home or to admit Monitoring of patient status Fluid management & transfusion decisions Management of complications
  7. 7. Dengue: Differential diagnosisFebrile Phase Flu-like syndromes Illnesses with a rash Diarrheal diseases Illnesses with neurological manifestationsCritical Phase Infectious Malignancies Others (e.g. acute abdomen, metabolic conditions, hematologic disorders) WHO Dengue Guidelines for Diagnosis, Treatment, Prevention and Control (2009)
  8. 8. Dengue: Admission Criteria WHO Dengue Guidelines for Diagnosis, Treatment, Prevention and Control (2009)
  9. 9. Dengue: Management Guidelines WHO Dengue Guidelines for Diagnosis, Treatment, Prevention and Control (2009)
  10. 10. Fluid Management in Compensated Shock WHO Dengue Guidelines for Diagnosis, Treatment, Prevention and Control (2009)
  11. 11. Fluid Management in Hypotensive Shock WHO Dengue Guidelines for Diagnosis, Treatment, Prevention and Control (2009)
  12. 12. Imagine This Scenario Not enough sleep Image Source: aafp.org
  13. 13. “To Err Is Human” Lack of attention Easily distracted Limited memory Difficulty putting relevant information together (information overload?) Inappropriate decisions (lapses, cognitive errors) Poor decisions under pressure (emergencies) Difficulty in monitoring & triage of patients
  14. 14. Roles of Health IT Assists in documentation & assessments Reminds or alerts Servers as external memory Better visualizations / information presentations Suggests management options Guidelines at the point of care Patient monitoring
  15. 15. Example of “Alerts & Reminders”
  16. 16. Clinical Decision Support Systems PATIENT PerceptionCLINICIAN AttentionLong Term Memory External Memory Working Memory Knowledge Data Knowledge Data Inference DECISION
  17. 17. Roles of Health IT in Dengue Clinical Management Online templates for complete patient assessment & documentation Alerts & Reminders Decision support tools to offer recommendations in case management Electronic disease reporting Information integration for early detection of an outbreak
  18. 18. Clinical Decision Support Systems PATIENT Improved Guidelines & information Perception ReferencesCLINICIAN presentations Alerts & (graphs, tracking Attention Reminders, tools, etc.) TemplatesLong Term Memory External Memory Working Memory Knowledge Data Knowledge Data Inference - Differential Dx - Treatment DECISION Recommendations
  19. 19. Google Flu TrendsSource: Google.org/FluTrends
  20. 20. Disease Surveillance Google Flu Trends uses search engine keywords (non-clinical data)  Accuratefor practical purposes of detection of possible outbreaks (not confirmation) Imagine how it would be if we use clinical data (e.g. chief complaints, diagnoses in ER/clinics). Would it help us respond faster?
  21. 21. Opportunities for Tomorrow Dengue management relatively straightforward, easy to implement as logic Improved IT infrastructure within hospitals & clinics  Hospital information systems & electronic health records common (high adoption)  Can be leveraged for better dengue management within those settings
  22. 22. Infrastructure:22 EHR Adoption in Thai Hospitals Theera-Ampornpunt (2011)
  23. 23. Adoption Estimates: THAIS 201123 Estimate (Partial or Complete Adoption) Nationwide Basic EHR, combined inpatient & outpatient 49.8% settings Comprehensive EHR, combined 5.3% order entry of medications, combined 90.2% order entry of all orders, combined 79.4% Theera-Ampornpunt (2011)
  24. 24. Current State of IT Use in Dengue Focus more on IT use in surveillance & outbreak detection Some uses in patient education, teleconsultations, predictive modeling, & basic research Few studies on use of health IT to manage dengue in clinical settings
  25. 25. Summary (1) Dengue is an important epidemic Management involves various steps & criteria, maybe complicated for non-experts Errors inevitable for inexperienced providers
  26. 26. Summary (2) Health IT can be used to provide better care, e.g. through decision support Opportunities exist for use of IT in dengue Call for more focus on development & evaluation of IT uses in clinical management of dengue

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