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Nawanan Theera-Ampornpunt, profile picture
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Digital Health (March 14, 2018)

Digital health technologies like electronic health records (EHRs) aim to make healthcare delivery more efficient, timely and effective. However, simply implementing technology for its own sake is not enough - technology must be used to truly transform clinical processes and improve patient outcomes. A "smart hospital" focuses on using information and digital tools to enhance clinical decision-making and support high quality care, rather than just replacing paper records. Health IT should help humans perform better rather than replace them.

Healthcare◦
Related topics:
Digital Health Overview•Smart Hospital Overview• Smart Health• Health Informatics•
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Digital Health 19th HA National Forum www.SlideShare.net/Nawanan นพ.นวนรรน ธีระอัมพรพันธุ์ 14 มีนาคม 2561
2 Health & Health Information
3Image Source: https://en.wikipedia.org/wiki/Industrial_robot (KUKA Roboter GmbH) “Smart” Manufacturing
4 Image Sources: http://isarapost.net/home/?p=17760 http://www.telecomjournalthailand.com/ตอบโจทย์โมเดลทางธุรกิจ/ “Smart” Banking
5ER - Image Source: nj.com Healthcare (On TV)
6 (At an undisclosed hospital) Healthcare (Reality)
7 • 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”?
8 Input Process Output Assembling Manufacturing Raw Materials Finished Goods Value-Add - Innovation - Design - QC Systems Perspective
9 Systems Perspective Input Process Output Transfer Banking Value-Add - Security - Convenience - Customer Service Location A Location B
10 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?
11 • Large variations & contextual dependence Input Process Output Patient Presentation Decision- Making Biological Responses Standardizing Healthcare
12 Digitizing Healthcare Image Source: http://www.bloomberg.com/bw/stories/2005-03-27/cover-image-the-digital-hospital
13 “To computerize the hospital” “To go paperless” “To become a Digital Hospital” “To have EHRs” Why Adopting Health IT?
14 • “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
15 Being Smart #1: Stop Your “Drooling Reflex”!!
16 Being Smart #2: Focus on Information & Process Improvement, Not Technology
17 ถ้าไม่เป็น “Paperless Hospital” แล้วจะให้เราเป็นอะไร?
“Smart Hospital”
19 แล้ว “Smart Hospital” ต่างจาก Paperless Hospital ตรงไหน?
20 Connecting People to a Healthy Future With Personalized Care – Kaiser Permanente https://www.youtube.com/watch?v=gxz9ZVvduGc
21 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?
22 • 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
23 23 WHO (2009) Components of Health Systems
24 • 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
25 • Efficient –Faster care –Time & cost savings –Reducing unnecessary tests • Equitable –Access to providers & knowledge • Patient-Centered –Empowerment & better self-care Being “Smart” in Healthcare
26 (IOM, 2001)(IOM, 2000) (IOM, 2011) Landmark Institute of Medicine Reports
27 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
28 Being Smart #3: “To Err is Human”
29 External Memory Knowledge Data Long Term Memory Knowledge Data Inference DECISION PATIENT Perception Attention Working Memory CLINICIAN Elson, Faughnan & Connelly (1997) Clinical Decision Making
30 Example of “Alerts & Reminders” Reducing Errors through “Alerts & Reminders”
31 Documented Values of Health IT • Guideline adherence • Better documentation • Practitioner decision making or process of care • Medication safety • Patient surveillance & monitoring • Patient education/reminder
32 Being Smart #4: Link IT Values to Quality (Including Safety)
33 Health Information Technology Goal Value-Add Tools Health IT: What’s in a Word?
34 • 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
35WHO & ITU Achieving eHealth/Digital Health/Smart Health
36 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/
37Image Source: socialmediab2b.com Another Smart Machine: IBM’s Watson
38Image Source: englishmoviez.com Rise of the Machines?
39 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
40 Being Smart #5: Don’t Replace Human Users. Use ICT to Help Them Perform Smarter & Better.
41 ความฝันอันสูงสุด... My Life-Long Dream...
42 Hospital A Hospital B Clinic D Policymakers Patient at Home Hospital C HIE Broker Health Information Exchange (HIE)
43 TEDxMahidolU Talk by Nawanan: “ATM in Healthcare”
44 Q&A SlideShare.net/Nawanan