ehealth Challenges

7 Dec 2012

eHealth Challenges
Iris Thiele Isip Tan MD, MSc, FPCP, FPSEM
Chief, UP College of Medicine Medical Informatics Unit
Associate Professor 4, UP College of Medicine
Section of Endocrinology, Diabetes & Metabolism,
Philippine General Hospital

“Unitron Sky Walker” by pasukaru76,
http://www.ﬂickr.com/photos/pasukaru76/6271854325/
Saturday, December 8, 12

http://www.engineeringchallenges.org/cms/8996/9221.aspx

Provide energy
Restore & Develop carbon
from fusion
improve urban sequestration
infrastructure methods

Make solar Advance
energy personalized
economical learning

Prevent Engineer Reverse-
nuclear better engineer
terror medicines the brain

Provide Advance
access to health
clean water informatics
Secure Manage the
cyberspace nitrogen cycle
Enhance
virtual reality
Engineer the tools
of scientiﬁc
discovery “jigsaw puzzle” by spekulator, http://www.sxc.hu/photo/944284

Kulikowski et al. AMIA
Board white paper: deﬁnition of
biomedical informatics and speciﬁcation of core
competencies for graduate education in the discipline.
J Am Med Inform Assoc 2012;19:931-8.

Electronic
Medical Record

Systems for improved
patient education
and compliance

eHealth
Challenges Data mining
for medical
Center for Development of knowledge
Advanced Computing (India)
Image from katerha,
http://www.ﬂickr.com/photos/katerha/5021019816/

Electronic
Medical Record

eHealth
Challenges
Center for Development of
Image from katerha,

http://www2.fraserhealth.ca/media/how%20hazardous%20is%20healthcare%202.jpg

To Err is Human:
Adverse Building a Safer Health System
events Institute of Medicine 1999

2.9% 6.6-13.6%

Ooops
mortality
Colorado 44,000 -
& Utah
98,000 50%
3.7% deaths/year Medical
New York
Errors

http://www.youtube.com/watch?v=7Ks3hezVSIM


Electronic Medical Record (EMR)

Core application for patient-
specific information

EMR: Challenges

Structured data entry vs free text

Y N Visual disturbances
Y N Eye itching
Y N Eye pain

EMR: Challenges
Universally agreed-on medical vocabulary
or standard terminology


EMR: Challenges
• Protection of
patient privacy and
confidentiality
–Health Insurance
Portability and
Accountability Act
(1996)


Good information
Michael E. DeBakey, MD
is the best medicine.

http://youtu.be/2ikjOSmqpyo


EMR: Challenges

Usability
Integrate EMR into busy clinical workflow


“NextGen is unusable”
by juhansonin,
http://www.ﬂickr.com/photos/
juhansonin/3857845956/


EMR: Challenges
Optimal computing device
for the clinical setting?


Incident record

Data generated when
individual interacts with HCP

Patient record
A series of incident records
generated by speciﬁc HCP

Health record

All patient records generated
over an individual’s lifetime by
all HCPs who provide services
http://www.hc-sc.gc.ca/ohih-bsi/

http://youtu.be/Lo_3qOejQzI


EMR: Challenges
• Standards: to facilitate integration of
data, especially across systems from
different vendors

–Digital Imaging &
Communications in
Medicine (DICOM)
–Health Level 7 (HL7)


http://www.emrindustry.com/index.php/will-next-generation-emrs-be-platform-stack-of-apps/


“The utopic future of medicine will
seamlessly combine data from your daily
apps and personalize a health treatment
plan based on the life you actually live.”

http://www.carepractice.com/emr-needs-a-kick-in-the-app-hole/

http://vimeo.com/38063992


“As opposed to the doctor-centric, curative
model of the past, the future is going to be
patient-centric and proactive.”
Elias A. Zerhouni MD, NIH Director
Dec 2007

Image by JD Hancock
http://www.ﬂickr.com/photos/jdhancock/4100030094/

“Movement in which networked patients
shift from being mere passengers to
responsible drivers of their health ...
providers encourage and
value them as full partners”
Society for Participatory Medicine

Image by Liz Grace
http://www.ﬂickr.com/photos/liz-grace/5078868809/

Participatory Medicine

Personal Health Record
• Provider-owned and • Patient-owned
provider-maintained software program
digital summary – Patient can enter,
– Read-only for patient organize, retrieve own
– Access to lab results health information
through a password- – Web-based i.e. Google
protected Web site Health, Microsoft
– Commercial EHRs offer HealthVault
digital summaries
through patient portals

Endsley et al. An Introduction to Personal Health
Records http://www.afp.org/fpm

Personal Health Record
• Portable, interoperable digital file
–Selected, clinically relevant health data can be
managed, secured and transferred
–Platforms: Smart cards, PDAs, cellphones,
USB-compatible devices

Endsley et al. An Introduction to Personal Health Records
http://www.afp.org/fpm

No longer ﬁll out forms
Authentication
Protection from fraud if lost
Rapid access to previously unavailable information
Paperwork for health record transfers are eliminated
Electronic prescriptions can be stored on the card


Systems for improved
patient education
and compliance

eHealth
Challenges
Center for Development of
Image from katerha,

http://www.chaindrugreview.com/front-page/newsbreaks/thrifty-white-introduces-smart-cap-to-spur-rx-compliance

http://www.ama-assn.org/amednews/2010/05/10/bisb0510.htm


Gamification
use of game play mechanisms
for non-game applications

http://www.imedicalapps.com/2011/08/2011-mobile-health-world-congress-gamiﬁcation-health-care/

http://www.informationweek.com/healthcare/mobile-wireless/10-wearable-health-tech-devices-to-watch

eHealth
Challenges Data mining
for medical
Center for Development of knowledge
Image from katerha,

Slide from presentation of Desikan et al, 2011 Siam International Conference on Data Mining

We are drowning in
data but starving for
knowledge!

clinical decision
support

healthcare resource
management

“toes” by basheertome, http://www.ﬂickr.com/photos/basheertome/7001981033/


Challenges in Data
Mining for Healthcare

data set from various
data sources

bias from
heterogeneous data

missing values, noise
and outliers
protection of security,
integrity and privacy

Pink Sherbet photography, http://www.ﬂickr.com/photos/pinksherbet/4621820292/


Thank You
http://www.endocrine-witch.net
@endocrine_witch

Image from http://wthr.frumph.net/


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