Presented at the 50th Annual Scientific Meeting, The Heart Association of Thailand under the Royal Patronage of H.M. the King on March 23, 2018

1. Health IT for Cardiologists
50th Annual Scientific Meeting, The Heart Association of Thailand
Theme: “Cardiology 5.0”
Nawanan Theera-Ampornpunt
March 23, 2018

2. 2
2003 Doctor of Medicine (First-Class Honors)
2011 Ph.D. (Health Informatics), Univ. of Minnesota
Assistant Dean for Policy and Informatics
Lecturer, Department of Community Medicine
Faculty of Medicine Ramathibodi Hospital,
Mahidol University
Interests: Health IT for Quality of Care,
IT Management, Security & Privacy
nawanan.the@mahidol.ac.th
SlideShare.net/Nawanan
Introduction

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Health &
Health Information

4. 4
Let’s take a look at
these pictures...

5. 5Image Source: https://en.wikipedia.org/wiki/Industrial_robot (KUKA Roboter GmbH)
“Smart” Manufacturing

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Image Sources: http://isarapost.net/home/?p=17760
http://www.telecomjournalthailand.com/ตอบโจทย์โมเดลทางธุรกิจ/
“Smart” Banking

7. 7ER - Image Source: nj.com
Healthcare (On TV)

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(At an undisclosed hospital)
Healthcare (Reality)

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• 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”?

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

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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?

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• Large variations & contextual dependence
Input Process Output
Patient
Presentation
Decision-
Making
Biological
Responses
Standardizing Healthcare

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Digitizing Healthcare
Image Source: http://www.bloomberg.com/bw/stories/2005-03-27/cover-image-the-digital-hospital

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“To computerize
the hospital”
“To go paperless”
“To become a
Digital Hospital”
“To have
EHRs”
Why Adopting Health IT?

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• “Don’t implement technology just for
technology’s sake.”
• “Don’t make use of excellent technology.
Make excellent use of technology.”
• “Health care IT is not a panacea for all that
ails medicine.” (Hersh, 2004)
Some “Smart” Quotes

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Being Smart #1:
Stop Your
“Drooling Reflex”!!

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Being Smart #2:
Focus on Information &
Process Improvement,
Not Technology

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If Not
“Paperless Hospital”
Then What?

19. “Smart Hospital”

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And How Does
“Smart Hospital”
Differ from
Paperless Hospital?

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Connecting People to a Healthy Future With
Personalized Care – Kaiser Permanente
https://www.youtube.com/watch?v=gxz9ZVvduGc

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Back to
something simple...

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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?

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• 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

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Information is Everywhere in Healthcare

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26
WHO (2009)
Components of Health Systems

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(IOM, 2001)(IOM, 2000) (IOM, 2011)
Landmark Institute of Medicine Reports

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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

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Being Smart #3:
“To Err is Human”

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External Memory
Knowledge Data
Long Term Memory
Knowledge Data
Inference
DECISION
PATIENT
Perception
Attention
Working
Memory
CLINICIAN
Elson, Faughnan & Connelly (1997)
Clinical Decision Making

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Example of “Alerts & Reminders”
Reducing Errors through “Alerts & Reminders”

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Documented Values of Health IT
• Guideline adherence
• Better documentation
• Practitioner decision making or
process of care
• Medication safety
• Patient surveillance &
monitoring
• Patient education/reminder

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Being Smart #4:
Link IT Values to
Quality (Including Safety)

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Health
Information
Technology
Goal
Value-Add
Tools
Health IT: What’s in a Word?

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

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m-Health
Health Information
Exchange (HIE)
Biosurveillance
Telemedicine &
Telehealth
Images from Apple Inc., Geekzone.co.nz, Google, PubMed.gov, and American Telecare, Inc.
Personal Health Records
(PHRs)
Health IT Beyond Hospitals

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Health IT for Medication Safety
Ordering Transcription Dispensing Administration
CPOE
Automatic
Medication
Dispensing
Electronic
Medication
Administration
Records
(e-MAR)
Barcoded
Medication
Administration
Barcoded
Medication
Dispensing

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Health Information Exchange (HIE)
Hospital A Hospital B
Clinic D
Policymakers
Patient
at Home
Hospital C
HIE Broker

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My Life-Long Dream...

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Search YouTube: TEDx Nawanan

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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/

42. 42Image Source: socialmediab2b.com
Another Smart Machine: IBM’s Watson

43. 43Image Source: englishmoviez.com
Rise of the Machines?

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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

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Being Smart #5:
Don’t Replace
Human Users.
Use ICT to Help Them
Perform Smarter & Better.

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Some Risks of Clinical Decision Support Systems
• Alert Fatigue
Unintended Consequences of Health IT

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Being Smart #6:
Health IT Also Have
Risks &
Unintended Consequences

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Q&A
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