There are inefficiencies in healthcare systems related to appointments. Access to same day appointments can be difficult, with only 50% of patients in Norway and 42% in the United States able to get them. Standards and digital tools may help address these issues by improving coordination of care and sharing of information across providers. Patient summaries that include appointment and care history could help navigate healthcare systems and coordinate care among different specialists and organizations. Further development of standards is needed to unlock health data and fuel innovation that improves productivity, quality of care, and patient experience with appointments.
Opening Keynote"From Patient to Population: Providing Optimal Care - The Role for Technology"
Ronald Paulus, MD, MBA
President & CEO
Mission Health System
Presentation made by Celia Ingham Clark National Director for Reducing Premature Mortality, at Improving access to seven day services. Southampton 25 March 2015
Kate Silvester, a healthcare systems engineer, discusses the challenges of working with data and statistical techniques for real-time monitoring of care quality.
IMS Health Clinical Trial Optimization SolutionsQuintilesIMS
IMS Health's Linda T. Drumright, general manager, Clinical Trial Optimization Solutions presents at the 3rd Annual Patient Recruitment & Retention Summit 2014 - San Francisco, CA
Opening Keynote"From Patient to Population: Providing Optimal Care - The Role for Technology"
Ronald Paulus, MD, MBA
President & CEO
Mission Health System
Presentation made by Celia Ingham Clark National Director for Reducing Premature Mortality, at Improving access to seven day services. Southampton 25 March 2015
Kate Silvester, a healthcare systems engineer, discusses the challenges of working with data and statistical techniques for real-time monitoring of care quality.
IMS Health Clinical Trial Optimization SolutionsQuintilesIMS
IMS Health's Linda T. Drumright, general manager, Clinical Trial Optimization Solutions presents at the 3rd Annual Patient Recruitment & Retention Summit 2014 - San Francisco, CA
Access the webinar here:
http://bit.ly/1eio3ka
Purpose of the Call:
1.Discuss the results of the pan-Canadian survey of existing practices with respect to the use of technology to support Medication Reconciliation (MedRec)
2.Describe the steps and considerations for transitioning to electronic MedRec (eMedRec)
3.Identify factors that support and impede successful migration of paper MedRec to eMedRec.
4.Discuss the lessons learned from research and other organizations.
5.Introduce the toolkit to support healthcare providers in making a safe and effective transition from paper MedRec to eMedRec.
Purpose of the Webinar
1.Describe the process of developing an undergraduate MedRec IPE Event involving > 480 senior Medicine, Pharmacy and Nursing students;
2.Explain the logistics of conducting the event in multiple venues and urban/remote locations;
3.Discuss the successes and challenges of communicating MedRec patient safety concepts through this process; and
4.Describe future opportunities for enhancing undergraduate MedRec training in an interprofessional environment.
Watch the webinar recording: http://bit.ly/1fSqsqv
Purpose of the Call:
Women's College Hospital is an academic ambulatory hospital. The speaker will share their hospital’s journey as they sought to implement best practices for medication reconciliation from other settings customized for the ambulatory environment.
Read more and watch the webinar recording: http://bit.ly/1sxHIUP
Director of Strategy and Development, Australian Commission on Safety and Quality in Healthcare.
Presentation given at "Health Literacy Network: Crossing Disciplines, Bridging Gaps", November 26, 2013. The University of Sydney.
Dr Ian Sturgess: Optimising patient journeysNuffield Trust
In this slideshow Dr Ian Sturgess, Director at IMP Healthcare consultancy, explores how we can better understand admitted flow streams and optimise patient journeys.
Dr Sturgess spoke at the Nuffield Trust ‘Reducing the length of stay’ event in September2014.
Two of the New York metro area’s largest provider organizations will share their experiences leveraging HIE as one of many tools to decrease fragmentation of care and improve patients’ experiences across acute and post-acute care settings for patients undergoing elective surgeries. Representatives from NYULMC and VNSNY will summarize their efforts to redesign more personalized specific care pathways and the central role played by the implementation of real-time data exchange to provide a seamless transfer of clinical data between providers caring for the patient at the time of discharge and throughout the post-acute period.
• Kathleen Mullaly - Senior Director for Clinical Operations, Department of Network Integration, NYU Langone Medical Center
• Amy Weiss - Director for Strategic Account Development, Integrated Delivery Systems, Visiting Nurse Service of New York (VNSNY)
New York eHealth Collaborative Digital Health Conference
November 18, 2014
•Understand the Accreditation Canada requirements for medication reconciliation at discharge
•Learn from the experience of patients and receiving healthcare providers
•Gain insight into practical strategies for communicating accurate medication information at discharge
READ MORE: http://bit.ly/1ja1gxY
Dr David Maltz: The challenge of length of stayNuffield Trust
In this slideshow, Dr David Maltz, of The Oak Group, explores the challenge of length of stay and opportunities for improvement.
Dr Maltz spoke at the Nuffield Trust ‘Reducing the length of stay’ event in September 2014.
On November 17, 2015 the ICU Collaborative Faculty held a National Call to determine the 2016 National Improvement Initiative. Two topics were presented: Dr. Yoanna Skrobik advocated on the side of Pain, Agitation and Delirium. Dr. Claudio Martin and Cathy Mawdsley advocated for working on End of Life Care. Callers voted at the end of the call and chose the new topic led by Dr. Skrobik: Managing “PAD” in your ICU patient: assessment, treatment and prevention.
7DS Board Assurance Framework: Planning or June 2019 submissionNHS England
This webinar will provide:
• Key lessons learned from review of 7DS Board Assurance Framework (BAF) return in February
• Information on how to prepare for the next submission by 28th June 2019
• An opportunity to raise questions
Purpose of the call:
To learn about:
•successful strategies and approaches to engage patients and caregivers in MedRec,
•how teams effectively dialogue with patients and their caregivers on the benefits of having an accurate medication list, and
•the development of paper and electronic tools and resources created for patients and their caregivers to create and maintain their medication lists.
Watch the webinar http://bit.ly/1fnE61V
Purpose of the Call:
Horizon, Moncton, NB will:
1.Demonstrate the timeline for the development of a provincial bilingual medication reconciliation form and process
2.Identify how technology provided an avenue for a multi-site team collaboration
3.Distinguish the key elements in a provincial bilingual medication reconciliation form
Saskatoon Health Region Home Care, SK will:
1.Share how they developed a nurse driven, paper-based MedRec program to support home care clients in medication management.
2.Outline their current MedRec process
3.Showcase their current Med Rec/BPMH form and data collection form for the audit process.
Watch the recording here: http://bit.ly/1fOTJwt
Providers know that successful care coordination is key to enhancing patient outcomes and better personalizing their experience. At its root, care coordination starts with effective communication, and healthcare organizations are increasingly turning to innovative technology solutions to solve their needs. To improve their care teams’ communication, coordination, and data capture capabilities, two of New York City’s leading healthcare organizations worked with two cutting edge tech solutions providers to design and implement innovative pilots as a part of the New York Digital Health Accelerator program. Utilizing real-life case studies, the panelists will discuss the design and implementation of the pilots, and lessons learned from their participation in the program.
• Anuj Desai - Vice President of Market Development, New York eHealth Collaborative
• Joseph Mayer, MD - Founder & CEO, Cureatr Inc.
• Patricia Meisner, MS, MBA - CEO & Co-Founder, ActualMeds
• Ken Ong, MD, MPH - Chief Medical Informatics Officer, New York Hospital Queens
• Victoria Tiase, MSN, RN - Director, Informatics Strategy, NewYork-Presbyterian Hospital
New York eHealth Collaborative Digital Health Conference
November 17, 2014
Objectives:
1.To review the need for increased efforts to implement research evidence into bedside practice.
2.To review the need for measurement to identify gaps between best practice and actual practice.
3.To demonstrate why there is a need for increased knowledge translation efforts in critical care and how aCKTION Net proposes to fill this need.
Click the link to view the video http://bit.ly/YpJWTC
Game of documentation, Winter is coming Surviving ICD10Nick van Terheyden
Accurate clinical documentation is a prerequisite for high quality patient care, medical record and billing compliance,
accuracy of quality metrics, and support of revenue cycle and HIM functions. While current EMRs address many of the issues surrounding
aggregation of clinical data, they present significant challenges to physicians especially as they try to capture accurate and the clinically
relevant information necessary to deliver high quality care. The resulting smorgasbord of content is left to CDI specialists and HIM staff to
review abstract and assess for completeness and compliance. Additionally as ICD-10 implementation require increasingly complex and
detail content with specific terminology to meet the more detailed coding requirements placing a burden on everyone involved in the care
and capture of clinical patient information.
Public Reporting as a Catalyst for Better Consumer DecisionsATLAS Conference
Greater efficiency in the process of matching patients to appropriate providers is vital to achieving the Triple Aim. As patients research and choose among appropriate providers, sound decision-making will depend on the accessibility of high-quality data that enables them to make meaningful, actionable comparisons. Online public-reporting tools, such as those published by U.S. News, CMS and others, serve as venues for consumer decision-making. Driven by current trends in data transparency, rapid advances in public reporting can be anticipated. This presentation will outline several recent and expected future developments in the evolution of key public-reporting tools, and discuss their role in facilitating patient engagement and access to appropriate care.
Access the webinar here:
http://bit.ly/1eio3ka
Purpose of the Call:
1.Discuss the results of the pan-Canadian survey of existing practices with respect to the use of technology to support Medication Reconciliation (MedRec)
2.Describe the steps and considerations for transitioning to electronic MedRec (eMedRec)
3.Identify factors that support and impede successful migration of paper MedRec to eMedRec.
4.Discuss the lessons learned from research and other organizations.
5.Introduce the toolkit to support healthcare providers in making a safe and effective transition from paper MedRec to eMedRec.
Purpose of the Webinar
1.Describe the process of developing an undergraduate MedRec IPE Event involving > 480 senior Medicine, Pharmacy and Nursing students;
2.Explain the logistics of conducting the event in multiple venues and urban/remote locations;
3.Discuss the successes and challenges of communicating MedRec patient safety concepts through this process; and
4.Describe future opportunities for enhancing undergraduate MedRec training in an interprofessional environment.
Watch the webinar recording: http://bit.ly/1fSqsqv
Purpose of the Call:
Women's College Hospital is an academic ambulatory hospital. The speaker will share their hospital’s journey as they sought to implement best practices for medication reconciliation from other settings customized for the ambulatory environment.
Read more and watch the webinar recording: http://bit.ly/1sxHIUP
Director of Strategy and Development, Australian Commission on Safety and Quality in Healthcare.
Presentation given at "Health Literacy Network: Crossing Disciplines, Bridging Gaps", November 26, 2013. The University of Sydney.
Dr Ian Sturgess: Optimising patient journeysNuffield Trust
In this slideshow Dr Ian Sturgess, Director at IMP Healthcare consultancy, explores how we can better understand admitted flow streams and optimise patient journeys.
Dr Sturgess spoke at the Nuffield Trust ‘Reducing the length of stay’ event in September2014.
Two of the New York metro area’s largest provider organizations will share their experiences leveraging HIE as one of many tools to decrease fragmentation of care and improve patients’ experiences across acute and post-acute care settings for patients undergoing elective surgeries. Representatives from NYULMC and VNSNY will summarize their efforts to redesign more personalized specific care pathways and the central role played by the implementation of real-time data exchange to provide a seamless transfer of clinical data between providers caring for the patient at the time of discharge and throughout the post-acute period.
• Kathleen Mullaly - Senior Director for Clinical Operations, Department of Network Integration, NYU Langone Medical Center
• Amy Weiss - Director for Strategic Account Development, Integrated Delivery Systems, Visiting Nurse Service of New York (VNSNY)
New York eHealth Collaborative Digital Health Conference
November 18, 2014
•Understand the Accreditation Canada requirements for medication reconciliation at discharge
•Learn from the experience of patients and receiving healthcare providers
•Gain insight into practical strategies for communicating accurate medication information at discharge
READ MORE: http://bit.ly/1ja1gxY
Dr David Maltz: The challenge of length of stayNuffield Trust
In this slideshow, Dr David Maltz, of The Oak Group, explores the challenge of length of stay and opportunities for improvement.
Dr Maltz spoke at the Nuffield Trust ‘Reducing the length of stay’ event in September 2014.
On November 17, 2015 the ICU Collaborative Faculty held a National Call to determine the 2016 National Improvement Initiative. Two topics were presented: Dr. Yoanna Skrobik advocated on the side of Pain, Agitation and Delirium. Dr. Claudio Martin and Cathy Mawdsley advocated for working on End of Life Care. Callers voted at the end of the call and chose the new topic led by Dr. Skrobik: Managing “PAD” in your ICU patient: assessment, treatment and prevention.
7DS Board Assurance Framework: Planning or June 2019 submissionNHS England
This webinar will provide:
• Key lessons learned from review of 7DS Board Assurance Framework (BAF) return in February
• Information on how to prepare for the next submission by 28th June 2019
• An opportunity to raise questions
Purpose of the call:
To learn about:
•successful strategies and approaches to engage patients and caregivers in MedRec,
•how teams effectively dialogue with patients and their caregivers on the benefits of having an accurate medication list, and
•the development of paper and electronic tools and resources created for patients and their caregivers to create and maintain their medication lists.
Watch the webinar http://bit.ly/1fnE61V
Purpose of the Call:
Horizon, Moncton, NB will:
1.Demonstrate the timeline for the development of a provincial bilingual medication reconciliation form and process
2.Identify how technology provided an avenue for a multi-site team collaboration
3.Distinguish the key elements in a provincial bilingual medication reconciliation form
Saskatoon Health Region Home Care, SK will:
1.Share how they developed a nurse driven, paper-based MedRec program to support home care clients in medication management.
2.Outline their current MedRec process
3.Showcase their current Med Rec/BPMH form and data collection form for the audit process.
Watch the recording here: http://bit.ly/1fOTJwt
Providers know that successful care coordination is key to enhancing patient outcomes and better personalizing their experience. At its root, care coordination starts with effective communication, and healthcare organizations are increasingly turning to innovative technology solutions to solve their needs. To improve their care teams’ communication, coordination, and data capture capabilities, two of New York City’s leading healthcare organizations worked with two cutting edge tech solutions providers to design and implement innovative pilots as a part of the New York Digital Health Accelerator program. Utilizing real-life case studies, the panelists will discuss the design and implementation of the pilots, and lessons learned from their participation in the program.
• Anuj Desai - Vice President of Market Development, New York eHealth Collaborative
• Joseph Mayer, MD - Founder & CEO, Cureatr Inc.
• Patricia Meisner, MS, MBA - CEO & Co-Founder, ActualMeds
• Ken Ong, MD, MPH - Chief Medical Informatics Officer, New York Hospital Queens
• Victoria Tiase, MSN, RN - Director, Informatics Strategy, NewYork-Presbyterian Hospital
New York eHealth Collaborative Digital Health Conference
November 17, 2014
Objectives:
1.To review the need for increased efforts to implement research evidence into bedside practice.
2.To review the need for measurement to identify gaps between best practice and actual practice.
3.To demonstrate why there is a need for increased knowledge translation efforts in critical care and how aCKTION Net proposes to fill this need.
Click the link to view the video http://bit.ly/YpJWTC
Game of documentation, Winter is coming Surviving ICD10Nick van Terheyden
Accurate clinical documentation is a prerequisite for high quality patient care, medical record and billing compliance,
accuracy of quality metrics, and support of revenue cycle and HIM functions. While current EMRs address many of the issues surrounding
aggregation of clinical data, they present significant challenges to physicians especially as they try to capture accurate and the clinically
relevant information necessary to deliver high quality care. The resulting smorgasbord of content is left to CDI specialists and HIM staff to
review abstract and assess for completeness and compliance. Additionally as ICD-10 implementation require increasingly complex and
detail content with specific terminology to meet the more detailed coding requirements placing a burden on everyone involved in the care
and capture of clinical patient information.
Public Reporting as a Catalyst for Better Consumer DecisionsATLAS Conference
Greater efficiency in the process of matching patients to appropriate providers is vital to achieving the Triple Aim. As patients research and choose among appropriate providers, sound decision-making will depend on the accessibility of high-quality data that enables them to make meaningful, actionable comparisons. Online public-reporting tools, such as those published by U.S. News, CMS and others, serve as venues for consumer decision-making. Driven by current trends in data transparency, rapid advances in public reporting can be anticipated. This presentation will outline several recent and expected future developments in the evolution of key public-reporting tools, and discuss their role in facilitating patient engagement and access to appropriate care.
Medical Related information reconciliation when a patient sees many providers or transfers between health facilities is challenging. Lack of updated and correct information is a key concern for patient safety during a health and illness trajectory [1]. Errors, near misses and adverse medication events are too common, particularly whne transfers between hospitals, nursing home and home are frequent, or engagement of multiple specialties is common [2]. Lack of effective informatics support can be harmful to a person’s health, leading to suffering, increased use of health care resources and increased costs.
As a case for interactive discussion, we have chosen information exchanges related to medication, prescription-based as well as over the counter drugs. This challenging chain of activities includes: (a) prescribing on paper or electronically by several medical specialists, (b) transcribing by sending and interpreting prescriptions in the pharmacy, (c) dispensing medication by brand name or generic substitution, (d) acquiring over the counter medication, (e) administering medication as a user, and (f) observing effects and side-effects. The risk of missing information leading to mistakes in the chain of activities in medication management is likely to increase as complex medication regimes become common due to demographic developments, co-morbidities or more personalized treatment. Potentials in patient activation and relevant informatics tools for medication reconciliation need further exploration.
Anne MOEN Institute for Health and Society, Faculty of Medicine, University of Oslo, NORWAY
Catherine CHRONAKI HL7 Foundation, Brussels, BELGIUM
Christian NØHR, Aalborg University, DENMARK
Line Helen LINSTAD Norwegian Center for eHealth Research, Tromsø, NORWAY
Petter HURLEN Akershus University Hospital, NORWAY
REAL WORLD DATA SOURCES AND APPLICATIONS IN HEALTH OUTCOMES RESEARCH ClinosolIndia
Health outcomes research aims to assess the real-world effectiveness, safety, and value of healthcare interventions. In recent years, the availability and utilization of real-world data (RWD) have significantly contributed to advancing health outcomes research. This paper explores the various sources of real-world data and their applications in health outcomes research.
Real-world data refers to data collected outside of controlled clinical trials, often generated through routine healthcare delivery, electronic health records (EHRs), claims databases, registries, wearable devices, and patient-reported outcomes. These data sources provide a wealth of information on patient characteristics, treatment patterns, healthcare utilization, and clinical outcomes in real-world settings.
Developing and implementing clinical standards for seven day servicesNHS Improving Quality
Celia Ingham Clark National Director: Reducing Premature Mortality. Slides from Celia's presentation from the 7 Day Services events West Midlands 11th June and East Midlands 12th June 2014
Patient summaries defined as the minimal set of health information that needs to be conveyed for patient safety in the context of emergency or unplanned care were initially introduced in a European context in the cross-border setting across member states of the European Union. Quite complex and high impact emergency situations involve young children and their parents. Then, shifting to a patient-centric perspective, patient summaries make sense in the hands of active and empowered parents and carers. This workshop builds on the work of the Trillium-II project that aims to scale-up use of patient summaries and the work of the MOCHA project which is analyzing health policies for children in 30 European states. The expected outcome of the workshop is to identify challenges and propose recommendations for further coordinated action where digital health policies interface with standards, with clear objectives, actions and intended benefits.
Can patient summaries help in the emergency department?
What are the challenges? What are the opportunities?
How can we overcome barriers?
Can patient summaries help in Health information exchange?
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
2. 2
Overview
striving for the triple win in health care
fine balancing act for costs, efficiency, and quality
emerging blended models of care placing
appointments at the center of productivity
remote vs face-to-face; scheduled vs. drop-in;
group vs individual appointments
augmented with patient-generated data; patient- and
provider-facing apps; personal health records
redefining participation, productivity,
professionalism, accountability
role of eStandards
Exploring healthcare inefficiencies: the case of health care appointments August 24, 2017, Hangzhou, China
3. 3
Access to appointments
unable to get same day appointments:
50% Norway, 41% Sweden, 42% United states, 19% NL
40-64% after hours without going to emergency, 25% NL
NL Consult app before access to GP
Is this telling about, which health system is better?
August 24,
2017,Exploring healthcare inefficiencies: the case of health care appointments
Source: 2016 commonwealth survey in 11 countries.
http://www.commonwealthfund.org/~/media/files/publications/fund-report/2016/jan/1857_mossialos_intl_profiles_2015_v7.pdf
4. 4
Chinese appointment app in Hangzhou…
Exploring healthcare inefficiencies: the case of health care appointments
Select Doctor,
Date, and Time,
receive
confirmation
by SMS
5. 5
A Chinese emergency appointment
experience at MedInfo2017
August 24,
2017,Exploring healthcare inefficiencies: the case of health care appointments
6. 6
Connected Care in the US
and the Patient Experience
August 24, 2017, Hangzhou, ChinaExploring healthcare inefficiencies: the case of health care appointments
http://surescripts.com/connectedpatient/default.html
7. 7
Exploring healthcare inefficiencies:
the case of health care appointments
Catherine Chronaki - introduction
Petter Hurlen – complex and simple cases
Jan Petersen – environment in Denmark
Morten Brunn-Rasmussen – Danish appointment
Anne Moen – zooming out
Discussion – can standards help reduce inefficiencies and
increase quality in blended models of complex care?
Exploring healthcare inefficiencies: the case of health care appointments August 24, 2017, Hangzhou, China
11. # Care Visits
1 GP Every now and then
2 Cardiologist 1 Twice a year, private
Lab tests 1 week before, private lab
3 Cardiologist 2 Every two year, Hospital 1
Lab tests 1 week before, Hospital 1 lab
Admission Fasting before
4 Vascular surgeon 4 times a year, Hospital 2
CT scan 1 week before / cancel, Hosp.2
5 Physiology Same day as 3, Hospital 2
12. # Care Visits
1 GP Every now and then
2 Cardiologist 1 Twice a year, private
Lab tests 1 week before, private lab
3 Cardiologist 2 Every two year, Hospital 1
Lab tests 1 week before, Hospital 1 lab
Admission Fasting before
4 Vascular surgeon 4 times a year, Hospital 2
CT scan 1 week before / cancel, Hosp.2
5 Physiology Same day as 3, Hospital 2
6 Nephrologist Every six weeks, Hospital 3
Lab tests 4 days before, at Hospital 3 lab
7 Haemathologist Twice a year, Hospital 3
Lab tests 4 days before, at Hospital 3 lab
8 Neurologist Once a year, Hospital 3
Cognitive test Same day, Hospital 3
SUM 30-40 appointments/year
13. # Care Visits
1 GP Every now and then
2 Cardiologist 1 Twice a year, private
Lab tests 1 week before, private lab
3 Cardiologist 2 Every two year, Hospital 1
Lab tests 1 week before, Hospital 1 lab
Admission Fasting before
4 Vascular surgeon 4 times a year, Hospital 2
CT scan 1 week before / cancel, Hosp.2
5 Physiology Same day as 3, Hospital 2
6 Nephrologist Every six weeks, Hospital 3
Lab tests 4 days before, at Hospital 3 lab
7 Haemathologist Twice a year, Hospital 3
Lab tests 4 days before, at Hospital 3 lab
8 Neurologist Once a year, Hospital 3
Cognitive test Same day, Hospital 3
SUM 30-40 appointments/year
9 Home nurse Three times a day
14. # Care Visits
1 GP Every now and then
2 Cardiologist 1 Twice a year, private
Lab tests 1 week before, private lab
3 Cardiologist 2 Every two year, Hospital 1
Lab tests 1 week before, Hospital 1 lab
Admission Fasting before
4 Vascular surgeon 4 times a year
CT scan 1 week before / cancel
5 Physiology Same day as 3, Hospital 2
6 Nephrologist Every six weeks, Hospital 3
Lab tests 4 days before, at Hospital 3 lab
7 Hematologist Twice a year, Hospital 3
Lab tests 4 days before, at Hospital 3 lab
8 Neurologist Once a year, Hospital 3
Cognitive test Same day, Hospital 3
SUM 30-40 appointments/year
9 Home nurse Three times a day
15. For Jon –
the appointment
is
the care process
For Olav –
the appointment
is an element in
the care processes
Jon
Olav,
and Nora
16. The Danish experiences
Jan Petersen, Chief Consultant
MedCom, Denmark
Exploring healthcare inefficiencies:
the case of health care appointments
17. 17
What is MedCom?
• MedCom is established in 1994.
• The Regions, Local Government and
the National government decided to
make MedCom permanent, with the
following aims:
• “MedCom shall contribute to the
development, testing, dissemination
and quality assurance of electronic
communication and information in the
health sector with a view to
supporting good practice in patient
care.”
– MedCom is financed by:
– The Ministry of Health
– The Danish Regions
– Local Government
Denmark/Municipalities
18. 18
Prerequisites for eHealth and standardization in Denmark
• Unique Person ID - life-long and multi-purpose since 1968
• National registration of hospital contacts since1976
• Legal authorization registry for health care professionals
• Health provider/organization registry since 2006
• National security services
• National health service – tax financed
• National it-strategies
• National classifications and terminology
• - and a multi-vendor policy within eHealth
• Combination unique to Denmark
19. 19
• A lot of work already done by international experts
• Open the Danish market for international vendors
• Make opportunities for the Danish vendors on the international market
• Maintaining a dynamic market – following new trends
Why international standards?
21. 21
The Danish Health Data Network
• Exchange of data:
• Messaging
– One-to-one
– One data provider - One data
consumer
• Web service
– One-to-many
– One data provider – Many data
consumers
• Index lookup
– Many data provider – Many data
consumers
22. 22
Complex / Simple patient’s appointments –
support for planning
• The cross-sector overview of patient
appointments will leverage:
– Quality of care – increased co-ordination
– Limit duplication of procedures
– Gain a rapid overview of the patient’s
appointments
– Patient can keep track of appointments
– Existing bookings can be seen in planning new
appointments
– Provides a rough overview regarding past and
planned health care services in the patient’s
care plan
• Appointments will be a part of the National
EHR overview for citizens and health care
professionals on The national Health Portal
sundhed.dk
https://sundhedsdatastyrelsen.dk/-/media/sds/filer/rammer-og-retningslinjer/digitaliseringsstrategi/digitally-support-complex-crosssector-patient-pathways.pdf?la=da
https://www.sundhed.dk/borger/service/om-sundheddk/ehealth-in-denmark/
23. 23
Multi-vendor > interoperability
• Interoperability – how to secure it in a multi-vendor
environment
– Common interfaces – standards – profiles
– Robust Internationale standards
– National consensus – including clinical and technical
co-operation in national profiling
– Testing and Certification of al vendor products
– Robust testing and certification operation (ISO 9001)
– Monitoring the use of MedCom approved standards
– Publishing which vendor passes the certification
24. 24
• Think small – disseminate big
• Only one challenge at a time
• Standardization by demand
• If you cannot explain your strategies/plans in
plain language – it will probably never work in
the real world
• Building the infrastructure along the way
• Define problem – choose the right tool
• There is no silver bullet!
Lessons learned
25. Exploring healthcare inefficiencies:
The case of health care appointments
Profiling international standards
Morten Bruun-Rasmussen
mbr@mediq.dk
MEDIQMEDINFO 2017. Hangzhou, China. August 24 2017.
26. Profile definition
MEDIQ
• A profile is a selection of definitions and
options from standards or other
specifications.
• Profiles provide developers a clear
implementation path.
• Profiles give purchasers a tool that
reduces the complexity and cost of
implementing interoperable systems.
27. Profiling process
MEDIQ
International
standard
International
profile
National
profile
• Broad coverage
• Not specific
• Not useful for implementation
• Not useful for daily operation
• For a specific use case
• Constrains are done
• Can be implemented
• Not useful for daily operation
• For a specific use case
• Further constrains are done
• Useful for implementation
• Useful for daily operation
30. Appointment data to be shared
MEDIQ
The data are discussed
and agreed in a group
with 20-25 people form
hospitals, municipalities,
general practitioner and
vendors
31. Appointment identification code
An unique appointment code, generated by the filler system
Patient
The person, who are booked for a health care service
Appointment requester
The organization/person who have ordered the appointment via the placer system
Appointment registrant
The organization/person who have booked the appointment via the filler system
Start date and time
Start date and time when the appointment is to take place
End date and time
End date and time when the appointment is to conclude
Health care organization
The responsible health care organization/person for the appointment
Location
The visit address for the appointment
Reason
The reason why the appointment is scheduled
Status
The status for the appointment (booked or deleted)
Appointment content
MEDIQ
32. 1. The profile can be implemented (in DK)
2. The profile are a constrain of the standards (no addition)
3. The original standard shall be used where possible
4. The used language shall be the same as the standard (English)
5. Datatypes in the standard shall be carried on in the profile
6. Danish agreed national coding shall be used in the profile
7. Mandatory data element in the standard shall also be
mandatory in the profile
8. Optional data elements in the standard shall be avoided in the
profile
9. Optional data in the standard can be mandatory in the profile
10. The use of an optional data element shall be well defined
11. The profile shall include a description of the intended use
12. The profile shall include information for future maintenance
Profiling: 10 commandments
MEDIQ
33. Anne Moen,
Faculty of Medicine, University of Oslo
Exploring health care inefficiencies:
the case of health care appointments
Collaboration – Coordination
34. Episodic encounter
• Defined problem – (sub) acute situation
– Clear start – stop
Series of interdependent encounters
• Interacting problems – co-morbidities,
– Team approach; activities – expertise – resources – services
• Activities to manage chronic condition(s)
– Monitor the disease – regular follow up by specialist(s)
– Trajectory of treatment and supported self – care
Appointment is either
35. Data elements - “appointments”
• Scheduled appointment ≠ used appointment
– Were the patient seen ?
– What happened in an appointment ?
• Type of appointment
– f2f consultation (traditional)
– Tests; prepare for f2f consultation
– eVisits – teleconsultation
• Time to appointment – access to care
– Urgency, maximum wait time
36. Coordination – Collaboration
• for citizen
– Coordination – self serve re. appointments
• Booking – single or multiple resources in encounter
• Overview of history and future plans
– Collaboration
• for health providers
– Coordination of resources
• Overview, continuity
– Collaboration – team approach
• Mobilizing resources, expertise & experience, tests
37. Appointment overview for ..
• Coordination of information
– Integrated data view or search in multiple screens
– Scheduled appointment ≠ used appointment
• Collaboration – sharing information
– Easy – to – use; complete/comprehensive information
– Granularity of information relative to logistic / clinical use
– Policy for cancellation – changes
• Coordination of care
– Benefit and beneficiaries
– Planning – seeing same team & resources ?
39. 39
Patient summaries: our navigator in the
health and social care ecosystem
“Bring the Power of Platforms to Health Care” using data to drive:
[Bush & Fox, HBR November 2016]
administrative automation
networked knowledge
resource orchestration
Elements to consider: appointments, technology, and productivity
virtual and f2f just-in-time appointments
Context: Patient summary as a window to a person’s health or
personal dashboard:
Medications, allergies, vaccinations
problems and procedures, labs, diagnostic imaging
recent or planned Encounters, implantable devices
advance directives
Exploring healthcare inefficiencies: the case of health care appointments
eStandards need to
• help build trust
• unlock the power of health data
• facilitate decision support
• navigate the health system
August 24, 2017, Hangzhou, China
40. 40
Connected Care in the US
and the Patient Summary promise
August 24, 2017, Hangzhou, ChinaExploring healthcare inefficiencies: the case of health care appointments
http://surescripts.com/connectedpatient/default.html
41. 41
Connected Care and the Patient
experience: organization coordination
For any two organizations to meaningfully coordinate care
on behalf of a patient, they must
know which patients they should be coordinating care for
know which providers those patients see
have procedures in place to determine when, how and
what patient information to communicate with each other
have the tools, processes, and technology to be able to
transfer and effectively use that information.
August 24, 2017, Hangzhou, ChinaExploring healthcare inefficiencies: the case of health care appointments
http://go.surescripts.com/hubfs/Whitepaper-all-healthcare-is-not-local-1.pdf
42. 42
eStandards –
eHealth Standards and Profiles in Action for Europe & Beyond
Vision of the global eHealth
ecosystem
people have navigation tools for
safe and informed health care
interoperability assets fuel
creativity, entrepreneurship, and
innovation
eStandards will:
nurture digital health innovation
strengthen Europe’s voice & impact
enable co-creation and trusted
provider-user relationships
Base Standards
Use Case based
Standards Sets
Assurance and
Testing
Live
Deployment
Feedback and
Maintenance
Tooling and
Education
Forums and
Monitoring
eStandards
Exploring healthcare inefficiencies: the case of health care appointments August 24, 2017, Hangzhou, China
43. 43
Innovation is where standards are most needed:
to unlock data for trust & flow
Today:
Massive health data accumulated in silo EHR systems serving documentation
purposes. We need to move from passive documentation to active use of
information and knowledge creation: activation!
Patient summaries defined at the macro level: cross-border exchange for emergency
or unplanned care at a national level. Need to address communities and individuals!
Standards and profiles address a predefined exchange of information. Need flexible
use of available content and structure, recognizing national, regional or local
jurisdictions trust & flow!
Shaping the future: Focus on the top level: systems of innovation!
Systems of record – documentation systems -EHRs
Systems of differentiation – profile based data exchange
Systems of innovation – unlock data and user experience
+
+
-
-
C
h
a
n
g
e
G
o
v
e
r
n
a
n
c
e
Exploring healthcare inefficiencies: the case of health care appointments
August 24, 2017, Hangzhou, China
44. 44
What do we need to make digital health work with
standards and interoperability?
Co-create
to make it real using
standards
Governance
to make it scale for
large-scale deployment
Alignment
to make it flourish in a
sustainable way
Exploring healthcare inefficiencies: the case of health care appointments August 24, 2017, Hangzhou, China
45. 45
HL7 FHIR appointment v3.0.1
https://www.hl7.org/fhir/appointment.html
August 24, 2017, Hangzhou, ChinaExploring healthcare inefficiencies: the case of health care appointments
46. 46
FHIR Appointment has Maturity level 3
Conditions:
(level 0)
FHIR resource or profile (artifact) has been published on the current build.
(level 1) the artifact produces
no warnings during the build process and
the responsible WG has indicated that they consider the artifact substantially complete
and ready for implementation
(level 2) the artifact has been
tested and successfully exchanged between at least three independently developed
systems leveraging at least 80% of the core data elements using semi-realistic data &
scenarios based on at least one of the declared scopes of the resource e.g. connectathon.
These interoperability results must have been reported to and accepted by the FMG
(level 3) the artifact has been
verified by the work group as meeting the Trial Use Quality Guidelines
subject to a round of formal balloting
has at least 10 implementer comments in the tracker from at least
3 organizations resulting in at least one substantive change
August 24, 2017, Hangzhou, ChinaExploring healthcare inefficiencies: the case of health care appointments
47. 47
Recommendations from
health market collaborative
Make explicit what each player is bringing to the effort
Establish shared aim
Don’t reinvent the wheel
Make it flexible
Prioritize on the basis of impact and difficulty
Expenditures and impact on patients
Level of complication and risk
Ease of standardization
Benefit to the health systems
Choose simple metrics and goals
Better, faster, more affordable care
Use one improvement methodology
Fix the business side
Source: The employer-led revolution, Big Idea, HBR July 2015 August 24, 2017, Hangzhou, ChinaExploring healthcare inefficiencies: the case of health care appointments
48. 48
Six Forces That Can Drive
Innovation—Or Kill It.
Players The friends and foes lurking in the health care system that can
destroy or bolster an innovation’s chance of success.
Funding The processes for generating revenue and acquiring capital, both of
which differ from those in most other industries.
Policy The regulations that pervade the industry, because incompetent or
fraudulent suppliers can do irreversible human damage.
Technology The foundation for advances in treatment and for innovations
that can make health care delivery more efficient and convenient.
Customers The increasingly engaged consumers of health care, for whom
the passive term “patient” seems outdated.
Accountability The demand from vigilant consumers and cost-pressured
payers that innovative health care products be not only safe and effective
but also cost-effective relative to competing products.
Source: HBR May 2006: Why innovation in health care is so hard
August 24, 2017, Hangzhou, ChinaExploring healthcare inefficiencies: the case of health care appointments
The increasing shortages in healthcare workforce make access to care a critical indicator for health system performance. Access to healthcare can be assessed by the time required to make a health care appointment when sick. Indicative results are offered by the 2013 and 2016 commonwealth survey in 11 countries [2,3]. In 2016, the number of people not able to get a same day appointment when sick was 50% in Norway and 41% in Sweden, 42% in the United States, compared with 19% in the Netherlands. Between 40 and 64% of adults struggled to find care after regular business hours without going to a hospital emergency department (The Netherlands at 25%, was the exception.) In all surveyed countries, patient engagement and chronic care management deficiencies were noted with at least one in five adults experiencing a care coordination problem.
Unnecessary paperwork and phone calls make Americans dread visiting the doctor more than other everyday tasks.
Simple model
Coordination with daily life is the main issue
Typical case in real life: One patient, 8 temas of doctors, one team of home nurses
Different hospitals, routines, labs. Preparations
Coordination between caregivers is the main issue
Typical case in real life: One patient, 8 temas of doctors, one team of home nurses
Different hospitals, routines, labs. Preparations
Coordination between caregivers is the main issue
Typical case in real life: One patient, 8 temas of doctors, one team of home nurses
Different hospitals, routines, labs. Preparations
Coordination between caregivers is the main issue
Typical case in real life: One patient, 8 temas of doctors, one team of home nurses
Different hospitals, routines, labs. Preparations
Coordination between caregivers is the main issue
We have been making systems for Pharmacies and for Jon
We must not forget Olav and his daughter.
Coordinate resources, -- Knot/Team and Not a Relay
Americans say doctors still walk into most appointments without critical information about their patients
Systems of record – SQL / CDA/CCD /
Systems of differentiation – IHE Profiles / PCHA/Continua Profiles
Systems of innovation – FHIR / OpenEHR Archetypes
To develop, deliver, test and deploy standards sets which are properly adapted to a dynamic healthcare system, we need a constant flow of interaction between three types of activities:
Co-creation between all relevant stakeholders
to make it real using standards
A supportive and appropriate governance system
to make it scale toward large-scale deployment
The flexibility to adapt and align as needs and requirements change
to make it stay in a sustainable way
the resource or profile (artifact) has been published on the current build. This level is synonymous with Draft.
PLUS the artifact produces no warnings during the build process and the responsible WG has indicated that they consider the artifact substantially complete and ready for implementation
PLUS the artifact has been tested and successfully exchanged between at least three independently developed systems leveraging at least 80% of the core data elements using semi-realistic data and scenarios based on at least one of the declared scopes of the resource (e.g. at a connectathon). These interoperability results must have been reported to and accepted by the FMG
PLUS the artifact has been verified by the work group as meeting the Trial Use Quality Guidelines and has been subject to a round of formal balloting; has at least 10 implementer comments recorded in the tracker drawn from at least 3 organizations resulting in at least one substantive change