This document provides an overview of health information technology (HIT) and its role in healthcare. It discusses how healthcare is complex, information-rich, and prone to errors. HIT can help improve quality, safety, and efficiency by providing timely access to information, facilitating guidelines and best practices, and reducing errors. However, simply implementing technology does not guarantee benefits - the focus should be on using technology to achieve goals like improved outcomes, safety, and patient-centered care. While HIT offers opportunities, its impact may vary depending on context, and it does not solve all healthcare issues.
Eysenbach: eHealth: Transforming the dynamics of a complex health systemGunther Eysenbach
Keynote for the Australian 10th Annual Health Care Congress ( http://www.webcitation.org/5Vlz9j0HO ) in Sydney, 27th - 29th February 2008. Keynote contains a run-down of what ehealth is all about, and then focusses a fair bit on Personal Health Records (PHR 2.0) and Personal Health Applications. This is partly because the new Australian government under its new prime minister Kevin Rudd has set a couple of priorities for reforming health care, among them is "focussing on preventative health care and health promotion to help keep Australians healthy and out of hospital", which is a goal that can - in my opinion - be attained or at least greatly supported with Personal Health Records, or more specifically with what I call second generation PHRs or PHR 2.0. Contains screenshots of our Healthbook (TM) project, which was subsequently mentioned mentioned in the preliminary report of the 2020 Summit to the Prime Minister in Australia, see http://gunther-eysenbach.blogspot.com/search/label/healthbook
Eysenbach: eHealth: Transforming the dynamics of a complex health systemGunther Eysenbach
Keynote for the Australian 10th Annual Health Care Congress ( http://www.webcitation.org/5Vlz9j0HO ) in Sydney, 27th - 29th February 2008. Keynote contains a run-down of what ehealth is all about, and then focusses a fair bit on Personal Health Records (PHR 2.0) and Personal Health Applications. This is partly because the new Australian government under its new prime minister Kevin Rudd has set a couple of priorities for reforming health care, among them is "focussing on preventative health care and health promotion to help keep Australians healthy and out of hospital", which is a goal that can - in my opinion - be attained or at least greatly supported with Personal Health Records, or more specifically with what I call second generation PHRs or PHR 2.0. Contains screenshots of our Healthbook (TM) project, which was subsequently mentioned mentioned in the preliminary report of the 2020 Summit to the Prime Minister in Australia, see http://gunther-eysenbach.blogspot.com/search/label/healthbook
Theera-Ampornpunt N. Informatics in emergency medicine: a brief introduction. In: The International Conference in Emergency Medicine: Challenges in Emergency Medicine: It’s Time for Change!; 2012 Jan 30 - Feb 1; Bangkok, Thailand. Bangkok (Thailand): Mahidol University, Faculty of Medicine Ramathibodi Hospital; 2012 Feb.
Introduction to Health Informatics and Health Information Technology (Part 2)...Nawanan Theera-Ampornpunt
Presented at the Health Informatics and Health Information Technology Course, Doctor of Philosophy and Master of Science Programs in Data Science for Health Care (International Program), Faculty of Medicine Ramathibodi Hospital, Mahidol University on October 3, 2017
Introduction to Health Informatics and Health IT in Clinical Settings (Part 2...Nawanan Theera-Ampornpunt
Presented at the 10th Healthcare CIO Certificate Program, Ramathibodi School of Hospital Management, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on February 17, 2020
New Normal, New Future - Free Download E bookkevin brown
Healthcare is shifting from the traditional provider-centric,
in-patient setting to patient-centric, virtual consultations
with increased remote care monitoring. This transition
has prompted the need for MedTech industry to relook
at the products they develop and enhance value in care
delivery.
The COVID-19 pandemic has increased the use of
digital health technologies, and the need to develop
innovative devices or systems that support virtual
health. The last couple of years have seen increased
use of wearables, mobile and app-based technologies
along with data and analytics have been transforming
healthcare delivery.
Advancements in healthcare technologies like
Artificial Intelligence (AI), Virtual Reality and Augmented
Reality 3D-printing, robotics and nanotechnology are
shaping the future of healthcare. This technology boom
is helping address disease and medical conditions
through provision of cheaper, faster and more effective
solutions for diseases.
Presented at the Master of Science and Doctor of Philosophy Programs in Data Science for Healthcare and Clinical Informatics, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on October 4, 2021
Introduction to Health Informatics and Health IT (Part 2) (February 10, 2021)Nawanan Theera-Ampornpunt
Presented at the 11th Healthcare CIO Certificate Program, School of Hospital Management, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on February 10, 2021
Medical Simulation Market to Reach US$ 2.50 Billion by 2022Amy Williams
The medical simulation market is expected to exceed more than US$ 2.50 Billion by 2022; Growing at a CAGR of more than 15% in the given forecast period.
Support Dementia: using wearable assistive technology and analysing real-time data (Fehmida Mohamedali and Nasser Matoorian)
Interactive Technologies and Games (ITAG) Conference 2016
Health, Disability and EducationDates: Wednesday 26 October 2016 - Thursday 27 October 2016 Location: The Council House, NG1 2DT
Theera-Ampornpunt N. Informatics in emergency medicine: a brief introduction. In: The International Conference in Emergency Medicine: Challenges in Emergency Medicine: It’s Time for Change!; 2012 Jan 30 - Feb 1; Bangkok, Thailand. Bangkok (Thailand): Mahidol University, Faculty of Medicine Ramathibodi Hospital; 2012 Feb.
Introduction to Health Informatics and Health Information Technology (Part 2)...Nawanan Theera-Ampornpunt
Presented at the Health Informatics and Health Information Technology Course, Doctor of Philosophy and Master of Science Programs in Data Science for Health Care (International Program), Faculty of Medicine Ramathibodi Hospital, Mahidol University on October 3, 2017
Introduction to Health Informatics and Health IT in Clinical Settings (Part 2...Nawanan Theera-Ampornpunt
Presented at the 10th Healthcare CIO Certificate Program, Ramathibodi School of Hospital Management, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on February 17, 2020
New Normal, New Future - Free Download E bookkevin brown
Healthcare is shifting from the traditional provider-centric,
in-patient setting to patient-centric, virtual consultations
with increased remote care monitoring. This transition
has prompted the need for MedTech industry to relook
at the products they develop and enhance value in care
delivery.
The COVID-19 pandemic has increased the use of
digital health technologies, and the need to develop
innovative devices or systems that support virtual
health. The last couple of years have seen increased
use of wearables, mobile and app-based technologies
along with data and analytics have been transforming
healthcare delivery.
Advancements in healthcare technologies like
Artificial Intelligence (AI), Virtual Reality and Augmented
Reality 3D-printing, robotics and nanotechnology are
shaping the future of healthcare. This technology boom
is helping address disease and medical conditions
through provision of cheaper, faster and more effective
solutions for diseases.
Presented at the Master of Science and Doctor of Philosophy Programs in Data Science for Healthcare and Clinical Informatics, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on October 4, 2021
Introduction to Health Informatics and Health IT (Part 2) (February 10, 2021)Nawanan Theera-Ampornpunt
Presented at the 11th Healthcare CIO Certificate Program, School of Hospital Management, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on February 10, 2021
Medical Simulation Market to Reach US$ 2.50 Billion by 2022Amy Williams
The medical simulation market is expected to exceed more than US$ 2.50 Billion by 2022; Growing at a CAGR of more than 15% in the given forecast period.
Support Dementia: using wearable assistive technology and analysing real-time data (Fehmida Mohamedali and Nasser Matoorian)
Interactive Technologies and Games (ITAG) Conference 2016
Health, Disability and EducationDates: Wednesday 26 October 2016 - Thursday 27 October 2016 Location: The Council House, NG1 2DT
Presented at "Hospital Management 2015" Program, Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand on August 18, 2015
Presented at the 7th Healthcare CIO Program, Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand on July 8, 2016
Presented at the Data Science for Healthcare Graduate Programs, Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on October 7, 2019
Presented at the 9th Healthcare CIO Certificate Program, School of Hospital Management, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on March 4, 2019
Presented at the 8th Healthcare CIO Certificate Program, Ramathibodi Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University on March 12, 2018
Presented at the Master of Science and Doctor of Philosophy Programs in Data Science for Healthcare and Clinical Informatics, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on October 12, 2020
Presented at the BDMS Golden Jubilee Scientific Conference 2022 "BDMS Beyond 50 years: Looking towards the centennial," Bangkok Dusit Medical Services Public Company Limited (BDMS), Bangkok, Thailand on October 19, 2022
Presented at The Thai Medical Informatics Association Annual Conference and The National Conference on Medical Informatics (TMI-NCMedInfo) 2021, Bangkok, Thailand on November 26, 2021
Presented at the Master of Science Program in Medical Epidemiology and the Doctor of Philosophy Program in Clinical Epidemiology, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on November 25, 2021
Presented at the Master of Science and Doctor of Philosophy Programs in Data Science for Healthcare and Clinical Informatics, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on November 15, 2021
Consumer Health Informatics, Mobile Health, and Social Media for Health: Part...Nawanan Theera-Ampornpunt
Presented at the Master of Science and Doctor of Philosophy Programs in Data Science for Healthcare and Clinical Informatics, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on November 10, 2021
Consumer Health Informatics, Mobile Health, and Social Media for Health: Part...Nawanan Theera-Ampornpunt
Presented at the Master of Science and Doctor of Philosophy Programs in Data Science for Healthcare and Clinical Informatics, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on November 10, 2021
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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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.
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
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
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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
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
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2 Case Reports of Gastric Ultrasound
1. 1
Health IT: The Big Picture
Nawanan Theera-Ampornpunt, MD, PhD
Healthcare CIO Program, Ramathibodi Hospital Administration School
Jul 10, 2014 SlideShare.net/Nawanan
Except
where citing
other works
6. 6
• 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
Why Health care Isn’t Like Any Others?
7. 7
• Large variations & contextual dependence
Why Health care Isn’t Like Any Others?
Input Process Output
Patient
Presentation
Decision-
Making
Biological
Responses
8. 8
But...Are We That Different?
Input Process Output
Transfer
Banking
Value-Add
- Security
- Convenience
- Customer Service
Location A Location B
10. 10
But...Are We That Different?
Input Process Output
Patient Care
Health care
Sick Patient Well Patient
Value-Add
- Technology & medications
- Clinical knowledge & skills
- Quality of care; process improvement
- Information
11. 11
Information is Everywhere in Medicine
Shortliffe EH. Biomedical informatics in the education of
physicians. JAMA. 2010 Sep 15;304(11):1227-8.
12. 12
The Anatomy of Health IT
Health
Information
Technology
Goal
Value‐Add
Means
13. 13
Various Forms of Health IT
Hospital Information System (HIS) Computerized Provider Order Entry (CPOE)
Electronic
Health
Records
(EHRs)
Picture Archiving and
Communication System
(PACS)
14. 14
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, Microsoft, PubMed.gov, and American Telecare, Inc.
Personal Health Records
(PHRs)
15. 15
• 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
Why Health care Isn’t Like Any Others?
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
• 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.
19. 19
Information is Everywhere in Healthcare
Shortliffe EH. Biomedical informatics in the education of
physicians. JAMA. 2010 Sep 15;304(11):1227-8.
22. 22
Landmark IOM Reports: Summary
• Humans are not perfect and are bound to
make errors
• High‐light 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
23. 23
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 to be in
any clinician’s brain, and the short time
during a visit makes it worse
• “To err is human”
• Practice guidelines are put “on‐the‐shelf”
24. 24
Image Source: (Left) http://docwhisperer.wordpress.com/2007/05/31/sleepy-heads/
(Right) http://graphics8.nytimes.com/images/2008/12/05/health/chen_600.jpg
To Err is Human 1: Attention
25. 25Image Source: Suthan Srisangkaew, Department of Pathology, Facutly of Medicine Ramathibodi Hospital, Mahidol University
To Err is Human 2: Memory
26. 26
To Err is Human 3: Cognition
• Cognitive Errors - Example: Decoy Pricing
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Ariely (2008)
16
0
84
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68
32
# of
People
# of
People
27. 27
• It already happens....
(Mamede et al., 2010; Croskerry, 2003;
Klein, 2005)
• What if health IT can help?
What If This Happens in Healthcare?
28. 28
Cognitive Biases in Healthcare
Mamede S, van Gog T, van den Berge K, Rikers RM, van Saase JL, van Guldener C, Schmidt HG. Effect of
availability bias and reflective reasoning on diagnostic accuracy among internal medicine residents. JAMA.
2010 Sep 15;304(11):1198-203.
29. 29
Cognitive Biases in Healthcare
Croskerry P. The importance of cognitive errors in diagnosis and strategies to minimize them.
Acad Med. 2003 Aug;78(8):775-80.
30. 30
Cognitive Biases in Healthcare
Klein JG. Five pitfalls in decisions about diagnosis and prescribing. BMJ. 2005 Apr 2;330(7494):781-3.
“Everyone makes mistakes. But our
reliance on cognitive processes prone to
bias makes treatment errors more likely
than we think”
31. 31
• Medication Errors
–Drug Allergies
–Drug Interactions
• Ineffective or inappropriate treatment
• Redundant orders
• Failure to follow clinical practice guidelines
Common Errors
32. 32
We need “Change”
“...we need to upgrade our medical
records by switching from a paper to
an electronic system of record
keeping...”
President Barack Obama
June 15, 2009
33. 33
The Anatomy of Health IT Revisited
Health
Information
Technology
Goal
Value‐Add
Means
34. 34
Ultimate Goals of Health IT
•Individual’s Health
•Population’s Health
•Organization’s Health
35. 35
Dimensions of Quality Health Care
• Safety
• Timeliness
• Effectiveness
• Efficiency
• Equity
• Patient‐centeredness
(IOM, 2001)
42. 42
Effectiveness
• Reminders/advice for
– Guideline adherence
– Preventive care
– Specialist consults
• Templates/forms
– Order sets
– Care planning, nursing assessments & interventions,
nursing documentation
• Availability of patient information
• Continuity of care (even in referrals)
• Effective display of information (e.g. graphs, user‐friendly
screens)
• Assistance in decision‐making (e.g. differential diagnosis)
• Access to evidence/references at the point of care
48. 48
Patient-Centeredness
• Patient’s access to
– Own clinical information
– General health information
– Tailored health information
• Patient engagement/compliance
• Patient empowerment
– Patients’ networking & knowledge sharing
• Patient satisfaction with quality & efficient care
• Patient’s control of information (privacy)
49. 49
Documented Benefits of Health IT
• Literature suggests improvement through
– Guideline adherence (Shiffman et al, 1999;Chaudhry et al, 2006)
– Better documentation (Shiffman et al, 1999)
– Practitioner decision making or process of care
(Balas et al, 1996;Kaushal et al, 2003;Garg et al, 2005)
– Medication safety
(Kaushal et al, 2003;Chaudhry et al, 2006;van Rosse et al, 2009)
– Patient surveillance & monitoring (Chaudhry et al, 2006)
– Patient education/reminder (Balas et al, 1996)
– Cost savings and better financial performance
(Parente & Dunbar, 2001;Chaudhry et al, 2006;Amarasingham et al, 2009;
Borzekowski, 2009)
58. 58
References
• Amarasingham R, Plantinga L, Diener‐West M, Gaskin DJ, Powe NR. Clinical information
technologies and inpatient outcomes: a multiple hospital study. Arch Intern Med.
2009;169(2):108‐14.
• Balas EA, Austin SM, Mitchell JA, Ewigman BG, Bopp KD, Brown GD. The clinical value of
computerized information services. A review of 98 randomized clinical trials. Arch Fam
Med. 1996;5(5):271‐8.
• Borzekowski R. Measuring the cost impact of hospital information systems: 1987‐1994. J
Health Econ. 2009;28(5):939‐49.
• Chaudhry B, Wang J, Wu S, Maglione M, Mojica W, Roth E, Morton SC, Shekelle PG.
Systematic review: impact of health information technology on quality, efficiency, and
costs of medical care. Ann Intern Med. 2006;144(10):742‐52.
• DeLone WH, McLean ER. Information systems success: the quest for the dependent
variable. Inform Syst Res. 1992 Mar;3(1):60‐95.
• Friedman CP. A "fundamental theorem" of biomedical informatics.
J Am Med Inform Assoc. 2009 Apr;16(2):169‐70.
• Garg AX, Adhikari NKJ, McDonald H, Rosas‐Arellano MP, Devereaux PJ, Beyene J, et al.
Effects of computerized clinical decision support systems on practitioner performance
and patient outcomes: a systematic review. JAMA. 2005;293(10):1223‐38.
• Hartzband P, Groopman J. Off the record‐‐avoiding the pitfalls of going electronic. N Engl
J Med. 2008 Apr 17;358(16):1656‐1658.
59. 59
References
• Hersh W. Health care information technology: progress and barriers. JAMA. 2004 Nov
10:292(18):2273‐4.
• 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.
• Kaushal R, Shojania KG, Bates DW. Effects of computerized physician order entry and
clinical decision support systems on medication safety: a systematic review. Arch. Intern.
Med. 2003;163(12):1409‐16.
• Parente ST, Dunbar JL. Is health information technology investment related to the
financial performance of US hospitals? An exploratory analysis. Int J Healthc Technol
Manag. 2001;3(1):48‐58.
• Shiffman RN, Liaw Y, Brandt CA, Corb GJ. Computer‐based guideline implementation
systems: a systematic review of functionality and effectiveness. J Am Med Inform Assoc.
1999;6(2):104‐14.
• Van Rosse F, Maat B, Rademaker CMA, van Vught AJ, Egberts ACG, Bollen CW. The effect
of computerized physician order entry on medication prescription errors and clinical
outcome in pediatric and intensive care: a systematic review. Pediatrics.
2009;123(4):1184‐90.