for Mahi

1. Development & Management
of Information Systems
in Healthcare
Nawanan Theera‐Ampornpunt, M.D., Ph.D.
Sep. 13, 2014
For Mahidol University Faculty of ICT
SlideShare.net/Nawanan

2. 2
Introduction
2003 M.D. (1st-Class Honors) Ramathibodi
2009 M.S. (Health Informatics) University of Minnesota
2011 Ph.D. (Health Informatics) University of Minnesota
2012 Certified HL7 CDA Specialist
Currently
• Instructor, Department of Community Medicine, Ramathibodi
• Deputy Executive Director for Informatics (CIO), Chakri Naruebodindra
Medical Institute, Faculty of Medicine Ramathibodi Hospital
Contacts
nawanan.the@mahidol.ac.th
SlideShare.net/Nawanan
www.tc.umn.edu/~theer002
groups.google.com/group/ThaiHealthIT

3. 3
Your
Introduction

4. 4
My Personal Journey
on
Health Informatics

5. 5
Outline
Healthcare & Health IT
Health IT Applications in Hospitals
Development & Management of
Information Systems in Healthcare

6. 6
Health care &
Health IT

7. 7
Manufacturing
Image Source: Guardian.co.uk

8. 8
Banking
Image Source: Cablephet.com

9. 9
Health care
ER ‐ Image Source: nj.com

10. 10
Why Health care Isn’t Like Any Others?
 Life‐or‐Death
 Many & varied stakeholders
 Strong professional values
 Evolving standards of care
 Fragmented, poorly‐coordinated systems
 Large, ever‐growing & changing body of
knowledge
 High volume, low resources, little time

11. 11
Why Health care Isn’t Like Any Others?
 Large variations & contextual dependence
Input Process Output
Patient
Decision‐
Presentation
Making
Biological
Responses

12. 12
But...Are We That Different?
Banking
Input Process Output
Transfer
Location A Location B
Value‐Add
‐ Security
‐ Convenience
‐ Customer Service

13. 13
But...Are We That Different?
Manufacturing
Input Process Output
Assembling
Raw
Materials
Finished
Goods
Value‐Add
‐ Innovation
‐ Design
‐ QC

14. 14
But...Are We That Different?
Health care
Input Process Output
Sick Patient Patient Care
Well Patient
Value‐Add
‐ Technology & medications
‐ Clinical knowledge & skills
‐ Quality of care; process improvement
‐ Information

15. 15
Why Adopting Health IT?
“To Go paperless” “To Computerize”
“Digital Hospital”
“To Modernize”
“To Get a HIS”
“To Have EMRs”
“To Share data”

16.  “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)
16
Some Quotes

17. 17
What Clinicians Want?
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)

18. 18
High Quality Care
Safe
Timely
Effective
Efficient
Equitable
Patient‐Centered
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. IOM (2001)

19. 19
Information is Everywhere in Health Care

20. 20
Class Exercise
How information
systems & ICT can
contribute toward high
quality care?

21. 21
Achieving Quality Care with Information
Safe
 Drug allergies
 Medication Reconciliation
Timely
 Complete information at point of care
Effective
 Better clinical decision‐making

22. 22
Achieving Quality Care with Information
Efficient
 Faster care
 Time & cost savings
 Reducing unnecessary tests
Equitable
 Access to providers & knowledge
Patient‐Centered
 Empowerment & better self‐care

23. 23
That’s Where Health IT
Plays A Role...

24. 24
The Anatomy of the Word “Health IT”
Health
Information
Technology
Goal
Value‐Add
Tools

25. 25
Various Forms of Health IT
Hospital Information System (HIS) Computerized Provider Order Entry (CPOE)
Electronic
Health
Records
(EHRs)
Picture Archiving and
Communication System
(PACS)

26. 26
Still Many Other Forms of Health IT
m‐Health
Health Information
Exchange (HIE)
Biosurveillance
Information Retrieval
Telemedicine &
Telehealth
Images from Apple Inc., Geekzone.co.nz, Google, PubMed.gov, and American Telecare, Inc.
Personal Health Records
(PHRs)

27. 27
Value of Health IT (in Literature)
Guideline adherence
Better documentation
Practitioner decision making or
process of care
Medication safety
Patient surveillance &
monitoring
Patient education/reminder

28. 28
Fundamental Theorem of Informatics
Fri(eFdriemdamna (n2, 0200099))

29. 29
Is There A Role for Health IT?
IOM (2000)

30. 30
Landmark IOM Reports
IOM (2000) IOM (2001)

31. 31
Landmark IOM Reports: Summary
 Humans are not perfect and are bound to make
errors
 Highlight problems in the U.S. health care system
that systematically contributes to medical errors and
poor quality
 Recommends reform that would change how health
care works and how technology innovations can
help improve quality/safety

32. 32
Summary: Why We Need Health IT
 Health care is very complex (and inefficient)
 Health care is information‐rich
 Quality of care depends on timely availability &
quality of information
 Clinical knowledge body is too large
 Short time during a visit
 Practice guidelines are put “on‐the‐shelf”
 “To err is human”

33. To Err Is Human
Lack of Attention
33 Image Source: aafp.org

34. To Err Is Human
Human Brain’s Limited Memory
34 Image Source: Dr. Suthan Srisangkaew

35. 35
Common Errors
 Medication Errors
 Drug Allergies
 Drug Interactions
 Ineffective or inappropriate treatment
 Redundant orders
 Failure to follow clinical practice guidelines

36. 36
IT Management

37. 37
IT & Strategic Management
Vision (Goal)
Mission (Purpose)
Business Strategies
IT Strategies

38. 38
IT Strategies & Projects
 IT strategies support business strategies toward a
common vision & mission of the organization
 IT strategies are implemented as IT projects
 “Project Management” is a best‐practice
methodology to manage projects so they deliver
promised results on time and on budget

39. 39
Class Exercise
What are common
functions of an IT unit in
a healthcare organization?

40. 40
Components of IT
Hardware &
Network
IT
Software
Data
People,
Process &
Management

41. 41
Common IT Functions in
Healthcare Organizations
 Software development & acquisition
 Healthcare Service Delivery (Front Office)
 Back Office
 Infrastructure
 Systems administration
 Network administration
 Data management, analysis & reporting

42. 42
Software Acquisition
 In‐house Development
 Outsourced
 Standard Off‐the‐Shelf
 Standard Package with Customizations
 Personalized Solutions
 What are the pros & cons?
 How to determine the right approach?

43. 43
In‐house or Outsource?
A Ramathibodi journey

44. Software Development Process
44 Marchewka JT (2006)

45. 45
Software Development
Methodology
 Waterfall (Traditional Software Development)
http://en.wikipedia.org/wiki/Waterfall_model

46. 46
Software Development
Methodology
 Waterfall (Traditional Software Development)
 Agile Software Development
 Scrum
 Extreme Programming
 etc.
 Other methodologies

47. 47
Balanced Focus of Informatics
People
Techno‐
Process logy

48. 48
Summary
 Healthcare is complex
 Health IT can benefit healthcare through
 Information collection, presentatio & use
 Process improvement (e.g. reducing errors, improving quality of care)
 Management of IT is crucial to an organization’s success
 Balance of “People, Process & Technology”
 Strategic mindset
 IT Project management
 Various methods to acquire & develop information systems
 Know your organization (“context”)

49. 49
Q & A...
Download Slides
SlideShare.net/Nawanan
Contacts
nawanan.the@mahidol.ac.th
www.tc.umn.edu/~theer002
groups.google.com/group/ThaiHealthIT

50. 50
References
 Friedman CP. A "fundamental theorem" of biomedical informatics. J Am Med Inform Assoc.
2009 Apr;16(2):169‐70.
 Institute of Medicine, Committee on Quality of Health Care in America. To err is human:
building a safer health system. Kohn LT, Corrigan JM, Donaldson MS, editors. Washington, DC:
National Academy Press;2000. 287 p.
 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.