Information and Communication Technologies Transform the Practice of Medicine

Information and
Communication
Technologies
Transform the
Practice of
Medicine
ANDREW STRANIERI
TONY SAHAMA
Queensland University of
Technology, Australia
PATHIRAGE KAMAL PERERA
IIM, University of Colombo

Overview
▪ Co-existence of medical systems
▪ Healthcare globally is in crisis
▪ Technologies are getting cheaper and more powerful
▪ eHealth is transforming health care by:
▪ Tele-medicine
▪ Electronic Health Records
▪ Standards in eHealth
▪ Decision Support Systems
▪ Data mining in Health
▪ Healthcare system is transforming:
▪ Global
▪ Patients are becoming empowered
▪ Privacy and Security challenges
▪ Cultural change challenges
© Stranieri and Sahama 2014

Presenters and Contributors
▪ Associate Professor Andrew Stranieri. Health Informatics Researcher.
Federation University, Australia
a.stranieri@federation.edu.au
▪ Dr Tony Sahama. Health Informatics Researcher. Queensland University
of Technology, Australia http://staff.qut.edu.au/staff/sahama
t.sahama@qut.edu.au
▪ Dr Pathirage Kamal Perera. Indigenous clinician, researcher and
academic. Institute for Indigenous Medicine, University of Colombo, Sri
Lanka

Health Care Trends
Co-existence of medical
systems

Co-existence of Allopathic and Other Medical
Systems
Ingestive Remedial Energetic Other
Herbal Medicine Massage Acupuncture Dietary advice
Nutritional Medicine Reflexology Aromatherapy Yoga
Homeopathy Shiatsu Reiki Art therapy
Naturopathy Acupressure Magnet therapy Music therapy
Ayurveda Chiropractic Spiritual Healing Qi gong

Global trend: Co-existence of Allopathic and Other
Medical Systems
▪ Co-existence means:
▪ Patients anywhere in the world can
access health care from any tradition
▪ Not necessarily, integrative medicine
Golden, I., Stranieri, A., Sahama, T, Pilapitiya, S., Siribaddana, S., and Vaughan, S. 2014 Informatics to support patient choice
between diverse medical systems to IEEE HEALTHCOM 2014 - 1st International Workshop on Secure and Privacy-Aware Information
Management in eHealth
Stranieri, A and Vaughan, S (2011) Coalescing Medical Systems: A Challenge for Health Informatics in a Global World in Smith, A and
Maeder, A. 2010. (eds) Studies in Health Technology and Informatics Volume 161, 2010
Andrew Stranieri and Tony Sahama. Eds. (2012) Proceedings of the 3rd International Conference on Holistic Medicine ICHM 2013
Nov 17-19 2012. Sri Lanka. University of Colombo. ISBN 978-955-0460-39-7
▪ Examples
▪ Germans access Ayurvedic treatment in Sri
Lanka
▪ Australians access TCM specialists

Impact of co-existence
▪ Medical systems will ‘compete’
with each other compelling each
to demonstrate their
effectiveness
▪ The geographical ‘reach’ of each
medical system is larger than
ever
▪ Some medical systems will
inevitably decline
Indicator Indicator
Shortage of
HCP
Malawi has
250 doctors for
16 million
6 week wait for
General
Practitioner in
regional
Australia
Rise of Chronic
diseases
Diabetes in
Australia 17%
Diabetes in Sri
Lanka over
12%
Cost of health
care
Australia 12%
of GDP
US 17% of
GDP
Equity
Indigenous
Australians life
expectancy 20
years less
In US, low
income

Co-existence: patients need information to choose
▪ How do patients choose:
Emergency Palliative Acute Chronic
Effectiveness 10 5 8 7
Empathy 1 7 3 10
Empowerment 1 7 4 10
Accessibility 5 3 6 4
Philosophical 1 6 4 8
Privacy 3 7 7 7

Global trend: Co-existence of Allopathic and Other
Medical Systems
▪ Co-existence will continue because
▪ Emerging super economies of China
and India have strong traditional
medicines
▪ TCM, Others already popular in the
West, WM already popular in East
▪ TCM, others (in West) provides good
models of patient empowerment
▪ Chronic (lifestyle) conditions resistant
to WM
▪ Challenges/Research
▪ How to support patients to choose a medical
system ?
▪ How to ensure Ayurveda ‘competes’ effectively
with other systems?
▪ How to ensure Ayurveda is accessible to
patients outside Sri Lanka ?

Health Care Trends
Healthcare globally is in
crisis

Global Trend : Health Care Crisis
▪ Shortage of health care
professionals particularly
▪ In rural areas
▪ In emerging countries
▪ Rise of Chronic diseases
▪ Costs
▪ Equity
▪ Quality of healthcare-medical
errors
Indicator Indicator
Shortage of HCP
Malawi has 250
doctors for 16
million
6 week wait for
General Practitioner
in regional Australia
Rise of Chronic
diseases
Diabetes in Australia
17%
Diabetes in Sri
Lanka over 12%
Cost of health care
Australia 12% of
GDP
US 17% of GDP
Equity
Indigenous
Australians life
expectancy 20 years
less
In US, low income
Medical errors

Global Trend : Health Care Crisis
▪ Shortage of health care
professionals
particularly
▪ In rural areas
▪ In emerging countries
▪ Rise of Chronic diseases
▪ Costs
▪ Equity
▪ Quality of healthcare-
medical errors
Armstrong, B.K., Gillespie, J.A., Leeder, S.R., Rubin, G.L., &
Russell, L.M., (2007). Challenges in health and health care
for Australia. Med J Aust 2007; 187 (9): 485-489. Retrieved
on the 16/6/2011 from
http://www.mja.com.au/public/issues/187_09_051107/ar
m11047_fm.html

eHealth
Technologies are getting
more powerful and cheaper

Technological Maturity
0
100
200
300
400
500
600
1940 1950 1960 1970 1980 1990 2000 2010 2020
TechnologicalMaturity
Year
Technology Trend
DB
Desktop
Internet
OS
AI

0
100
200
300
400
500
600
1940 1950 1960 1970 1980 1990 2000 2010 2020
TechnologicalMaturity
Year
Technology Trend
DB
Desktop
Internet
OS
AI
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
2004 2006 2008 2010
Proportion of people using the Internet for health purposes in each employment
status
Full Time Work
Part Time Work
Retired/ Disabled
Others (including
unemployed and
students)
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
2004 2006 2008 2010
Proportion of people using the Internet for health purposes in each age
category
<30
31-45
46-60
>60
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
2004 2006 2008 2010
Proportion of people using the Internet for health purposes by gender
Male
Female

eHealth
Information and
Communication Technologies
(eHealth) are transforming the
practice of health care

A broad description
“eHealth aspires to be a secure unobtrusive, ubiquitous
and cost effective means for technology to improve the
quality of healthcare delivery by meeting the individual
needs of a complex stakeholder network”.
(Black and Sahama 2014)
16

eHealth innovations
• Telemedicine. Practice of health care where patient and practitioner are remote
• Electronic Health Record. Virtual record of every health event a patient has
through life
• Online information. Easy access online to information about health, condition,
physicians, other patients
• Decision Support System. Software that helps less experienced health care
professions make decisions like specialists
• Simulation, Computer Games. Software that simulates health care phenomena
• Data mining. The automated analysis of large healthcare datasets

Impact of the global trends
on healthcare

Impact on Healthcare
• World is in a Healthcare Crisis
• Co-existence of Allopathic and
Other Medical Systems
• Technologies are getting
cheaper and more powerful
• eHealth is transforming the
practice of healthcare
• Patient empowerment, choice
• Privacy, security challenges
• Disruption to the health care
professions
• Challenges to legal systems
TRENDS IMPACT

Healthcare practice is changing
• Patients seek information to:
• Validate doctors decisions
• Self diagnose
• Find relevant health care professionals
• Health care organisations:
• Pressure to be efficient. Do more with fewer resources
• New professional sub-division eg Cancer Nurse Practitioner. Nurse who is trained to
practice as a doctor for cancer.

Status of eHealth around the
world

eHealth in allopathic medicine around the world
WESTERN MEDICINE
▪ Gorillas. Big ehealth spending but health
outcomes not great. Slow, hard to change
▪ USA
▪ Canada
▪ UK
▪ Australia
▪ Deer. Nimble, quick to change. Smaller
spending. Faster changes
▪ Denmark
▪ New Zealand
▪ Beginning to adopt Slovenia
▪ Not yet adopting. Emerging regions? (e.g.,
South East-Asian countries)
INDIGENOUS, AYURVEDIC
▪ Not yet much eHealth

eHealth for Ayerveda
Tele-medicine

Telehealth. Two kinds
• Synchronous.
• Doctor in one place, patient in another at the same time use
video conference using internet.
• Usually higher definition than skype,viber.
• Sometimes with digital equipment eg digital stethoscope
• Asynchronous. Store and Forward
• Doctor in one place, patient in another at different times
Health care professional uploads images, videos for
specialists to access when they can

TeleHealth: Examples
• http://www.hd3dtelemedicine.com.au/
• Tele-dentistry into aged
care facilities
• Tele-psychiatry with 3D
Immersion

eHealth: More telemedicine
• http://www.hd3dtelemedicine.com.au/
• Tele-wound. Nurses in
home to specialists
• Store and Forward
• Tele-oncology. Oncologist
to Cancer nurse
• 2D video conferencing. Vidyo

Tele-health for Ayurveda
▪Challenges/Research
▪ Tele-health consultations with foreign patients in their own
country following or before Indigenous/Ayurvedic treatment
▪ Tele-Ayurvedic consultations between practitioners all over Sri
Lanka and Specialists in Colombo
▪ Tele-Ayurvedic consultations between remote patients around
Sri Lanka and Specialists
▪ Tele-consultations in the field to help train
Indigenous/Ayurvedic physicians

Tele-health References
HD3D Telemedicine. www.hd3dtelemedicine.com.au
MARIÑO R, Clarke K, Manton DJ, Stranieri A, Collmann R, Kellet H, Borda A.
Teleconsultation and telediagnosis for oral health assessment: an Australian perspective.
In: K Raghavan, S Kumar (Eds.). Teledentistry. Springer. (In press). 2014
Stranieri, A., Collmann, R and Borda, A. (2012) High Definition 3D Telemedicine: the next
frontier? Global Telehealth. Australian Telehealth Society
PulseIT http://www.pulseitmagazine.com.au/

eHealth for Ayurveda
Electronic Health Records

eHealth: Electronic Health Record
Virtual, online record of every health event a person encounters from
before birth to after death
Currently, data is stored in each organization’s databases (or paper
files) inaccessible to others
Leads to lost data, medical errors, patient/carer frustration
Hospital
database
GP
database
Dentist
database
Pharmacy
database
Psychologist
database
…

eHealth: Private Database
Distributed database architecture for establishing an electronic health
record
Hospital
database
GP
database
Dentist
database
Pharmacy
database
Psychologist
database
…
Private Microsoft Healthvault
https://www.healthvault.com/lk/en
DEMO
Public Personally controlled electronic
health record
http://www.ehealth.gov.au/ DEMO

9

Stakeholder Requirements
Healthcare Provider
Requirements
Patient
Requirements
Sweet spot!
Concerned over the
safety of their
sensitive
information and
possible breaches of
privacy
Expect better,
faster, easy access
to as much
information as
possible
10

Empowering, yet limited
However:
60% of GPs will never
use the eHealth
records (Source: Online Poll by Australian Doctor
Magazine July 2013)
Perception that it
does not make the
practitioner’s job
easier
Practitioner’s may
not have full access
to clinical data
Litigation concerns
for practitioners
PCEHR data is
collected by the
government who
own all IP rights
Source:
https://www.surveymonkey.
com/s/pcehrconsultation
An Australian Perspective
PCEHR provides patient controlled access to summary patient information
Opt-in model
Event summary (critical information only)
12

National E-Health Transition Authority, "NEHTA BluePrint," 13 August 2010.© Stranieri and Sahama 2014

Accountable Systems
13

An IA Model: Accountable-eHealth Systems
14

Ehealth record for Ayurveda
▪Challenges/Research
▪ Indigenous/Ayurvedic Patient Management Software is
emerging
▪ Software for Indigenous/Ayurvedic hospitals exists
▪ Software for Ayurvedic physicians is emerging eg
http://www.sattvaayusoft.com/
▪ What is needed is affordable PMS for all physicians designed to
link to electronic health records and hospital systems
▪ Systematic studies to discover Ayurvedic physicians attitudes
to recording consultations and eHealth records

Standards
Role of Standards in
eHealth

eHealth: Standards
• Terminology standards. Names of health care concepts
are exactly the same around the world
• Messaging standards. The format of a message
from one computer to another is the standard so
variables don’t get mixed up

SNOMED-CT Terminology Standard
Rheumatoid Arthritis
Inflammatory Disorder
Clinical Finding
Root
19 branches
• ICD-10 International Classification
of Diseases
• Snomed-CT Ontology
http://www.ihtsdo.org/snomed-ct/
DEMO
• Ontology with 300,000 concepts
• Each concept has a unique Concept
ID

Messaging Standard: HL7
Syntactic Interoperability
• Data exchange between two
systems – process taking data
structured under one schema for
transformation to another
• How to ensure first names are not
confused with surnames, blood
pressure with age, etc
• Health Level 7 (HL7)
http://www.hl7.org/
DEMO
▪ AEHIN http://www.aehin.org/
GP
Email a
request
for blood
tests
Laboratory
Save the
request for
blood test
and send a
reply to the
GP

Messaging Standard: HL7
MSH|^~&|EPIC|EPICADT|SMS|SMSADT
|199912271408|CHARRIS|ADTÂ04|18
17457|D|2.5|
PID||0493575^^^2ÎD
1|454721||DOE^JOHN^^^^|DOE^JOHN^
^^^|19480203|M||B|254 MYSTREET
AVE^^MYTOWNÔH^44123ÛSA||(216)1
23-
4567|||M|NON|400003403~1129086|
NK1||ROE^MARIE^^^^|SPO||(216)123-
4567||EC|||||||||||||||||||||||||||
PV1||O|168
~219~C~PMA^^^^^^^^^||||277ÂLLEN
MYLASTNAME^BONNIE^^^^||||||||||
||2688684|||||||||||||||||||||||||
199912271408||||||002376853
GP
Email a
request
for blood
tests
Laboratory
Save the
request for
blood test
and send a
reply to the
GP

eHealth Standards for Ayurveda
CHALLENGES
• How can HL7 be deployed for
use in Ayurvedic messaging
CHALLENGES/Opportunities
• How to expand Snomed-CT
to include terms from
Ayurveda and other medical
systems
First meeting on
Ayurveda/Snomed
September 2014

DSS and CDSS
Role of Decision Support
Systems in general
and Clinical settings

Decision Support Systems
• Type 1 Provision of information that requires further processing and analysis by users
before a decision can be made.
• Type 2 Trend analysis of patients’ clinical status and/or clinical alerts.
• Type 3 Use of inference engines and a knowledge base to generate recommendations.
• Type 4 Systems with autonomous learning capabilities (e.g., case-based reasoning,
neural networks, discrimination analysis)
(CDSS) is an application that analyzes data to help healthcare
providers make clinical decisions.

Decision Support Systems: Applications
• Alerts and Reminders:
• Symptom management:
• Diagnostic Assistance:
• Prescription Support:
• Image Recognition and
Interpretation:
• Therapy Critiquing and
Planning:
• Training
• Other

eHR Data Sets
Data Handling Utility
Usage Checking Utility Accountability Utility
Message Handling Utility
Rules Management Utility
Consent Function
Accountability Function
IA Agent

HIS vs HIT

Proposed data warehouse model (Example: Cardiac Surgery) Multiple Profile Manager Overview
Sequence Diagram for Query Flow in Bucket Index using Bloom filter under AES-DAS model

eHealth: Online information
• Patient Empowerment Self diagnosis with internet information
• https://www.patientslikeme.com/
• http://www.healthdirect.gov.au/
• https://www.cochrane.org/

Health Information: PatientsLikeMe
• Self diagnosis with internet information • Quality of information varies

Health Information: Health Services Directory
Courtesy. Laurie Hawkins.
Health Consultant
Designed as
Software as a Service
so can readily be
deployed in an
emerging region
www.echannelling.comhttp://www.nhsd.com.au/© Stranieri and Sahama 2014

Health Information: Better Health Channel
Australian Government
funded project to maintain
a quality web site with up
to date and accurate
information
Very expensive to maintain

Health Information for Ayurveda
▪ Implement a Health Services
Directory in Sri Lanka.
▪ Discover how Sri Lankan’s
Exploration into the patterns of
access to online information in
Sri Lanka
▪ Establish a ‘Trusted’ Ayurveda
medicine repository of
information for interested
patients (English and other
languages)

eHealth: Remote Patient Monitoring
• Stream data from patients body
wirelesses sensor network to cloud
databases
• Health Care Professionals anywhere
can access the data
• Applications. Falls, Ventricular
fibrillation, post operative early
detection of sepsis
• Remote Patient Monitoring needs
new architectures
Balasubsamanian et al

Remote patient monitoring
challenges/opportunities for emerging regions
• Field test of remote patient monitoring architecture.
• Applications of remote patient monitoring eg early detection of sepsis
following hospital discharge.
• Collect physiological data from patients wearing sensors and correlate
with Ayurvedic assessments
• Automated Ayurvedic Pulse Detection

Remote patient monitoring Ayurvedic pulse
detection
Deepa, N., Ganesh, A., (2012) Optical sensor for Indian
Siddha Diagnosis System. Procedia Engineering 38 (
2012 ) 1126 – 1131
Joshi, R. R., 2005 Diagnostics Using Computational Nadi
Patterns. Mathematical and Computer Modelling 41
(2005) 33-47
Ullrich, S. and Kuhlen, T., Haptic Palpation for Medical
Simulation in Virtual Environments April 2012 (vol. 18
no. 4) pp. 617-625

Decision Support Systems: Tridhosa Assessment
Knowledge Based
System
Knowledge
Base
Inference
Engine
User
Facts
Expertise
Weight
below average for
my build.
average for my
build. above average for my build.
Weight loss
tend to lose weight
easily
maintain my weight
easily I gain weight easily
Skin
dry, rough,
especially in winter soft, ruddy oily, moist
Hair dry
fine, thin, reddish,
or prematurely gray thick, wavy
Skin
dry, rough,
especially in winter soft, ruddy oily, moist
Hair dry
fine, thin, reddish,
or prematurely gray thick, wavy
Body size slim medium large
bone Light, small bones, PrMedium bone structuLarge, broad shoulders, Heavy b
complexion Dark complexion, TanFair skin, sun burns eaWhite, pale, tans evenly
skin texture Dry, pigmentation anFreckles, many moles Soft, glowing and youthful
face shape Long, angular,Thin Heart-shaped,pointedLarge, round, Full
eyes Small, black, sunken, Yellow , bright, grey, Big, beautiful, blue, calm, loving
eye lashes Scanty eye lashes Moderate eye lashes Thick / Fused eye lashes
eye blinking Excessive Blinking Moderate blinking More or less stable

eHealth: Simulation
• Scenari-Aid www.scenariaid.com
• EdHeads http://www.edheads.org/activities/knee/
• SecondLife http://www.secondlife.com

Simulation for Ayurveda
• Design and implement simulations for
Ayurvedic medicine
• Simulation for education of Western
patients of Ayurvedic procedures

Data Mining
Data mining in Healthcare

Data mining
Extraction of potentially meaningful patterns from data (Frawley 91)

Data mining: medical applications
• Image retrieval and classification.
• Retrieve mammogram that are most similar to a current
image, benign that look malignant and malignant that look
benign. N-gram/neural network
Kulkarni, P., Stranieri, A., Kulkarni, S., Ugon, J., and Mittal, M.
2014. Hybrid Technique based on N-gram and Neural
Networks for Classification of Mammographic Images.
Second International Conference on Signal, Image
Processing and Pattern Recognition (SIPP 2014) in Wyatt, D
(Ed) Computer Sciences and Information Technology (CS&IT)
Vol 4. 297-306

Data mining for Ayurveda
Challenges and Opportunities
• Image analysis of tongue
Stranieri, Andrew & Sahama, Tony R. (2012) Data mining traditional
Chinese medicine (TCM) lessons learnt from mining in law and
allopathic medicine. In Song, Jian (Ed.) Proceedings of the 2012 IEEE
14th International Conference on e-Health Networking, Applications
and Services (Healthcom), IEEE, Beijing, China.

Patient Empowerment
Patient empowerment,
policies, procedures and
protocols

Privacy and Security
Privacy and security including
managing the risk in particular
when exchanging health
information

Privacy and Security
A sociotechnical analysis
Tony Sahama , Leonie Simpson & Bill Lane
t.sahama@qut.edu.au

Privacy and Security in eHealth
 Information and Communication Technologies (ICT) have the potential to
improve many facets of modern healthcare service delivery
 The implementation of electronic health records (EHR) systems is a critical part of
an eHealth system
 Despite the potential gains, there are several obstacles that limit the wider
development of electronic health record systems
 Among these are the perceived threats to the security and privacy of patients’
health data, and a widely held belief that these cannot be adequately addressed.

Our Hypotheses
We hypothesise that the major concerns regarding eHealth security and privacy cannot be
overcome through the implementation of technology alone
Human dimensions must be considered when analysing the provision of the three
fundamental information security goals: confidentiality, integrity and availability
A sociotechnical analysis to establish the information security and privacy requirements
when designing and developing a given eHealth system is important and timely
A framework that accommodates consideration of the legislative requirements and
human perspectives in addition to the technological measures is useful in developing a
measurable and accountable eHealth system
Successful implementation of this approach would enable the possibilities, practicalities
and sustainabilities of proposed eHealth systems to be realised.

SECURITY AND PRIVACY FOR EHRs
① Critical Information Security Services
a) Confidentiality
b) Integrity
c) Availability
② Information States
a) Transmission
b) Storage
c) Processing
③ Security Measures
a) Technology
b) Policy & Practices
c) Education Training and Awareness
How do we understand these characteristics, attributes & measures as a Human?

Figure 1: Security measures for Information Dimensions [6]

LEGAL ISSUES FOR EHRs/SEHRs
 Privacy concerns
− Competing interests & emergency disclosure
− Data migration
− Non technical security breaches
− Function creep
 Ownership of & access to records
− Public HCPs – records subject to public access laws
− Private HCPs – records ‘owned’ by HCP
− SEHR systems may require participation agreements

LEGAL ISSUES FOR EHRs/SEHRs (cont…,)
 Intellectual property (copyright) issues
− Do EHRs constitute intellectual property?
− Who has copyright – HCP or Consumer?
 Governance arrangements for SEHR systems
− State governance
− Privatised governance (self regulation)
− SEHR systems may require participation agreements
 Consent models for SEHR systems
− Non consent model
− Implied consent – opt out model
− Implied consent + exceptions – opt out + exceptions
− Express consent model
− Express consent + exceptions – opt in + restrictions

Information accountability (IA) is a concept focused on appropriate-use of and
after-the-fact accountability for information usage
Transparency and the presence of accountability mechanisms are necessary to
build trust in the system and are also expected to act as a deterrent for intentional
misuse
eHealth systems built to follow the principles of IA are called Accountable-
eHealth (AeH) systems [13]
Figure 2 illustrates the role of IA in the eHealth domain. In this scenario, observe
how patients’ healthcare information might flow in the eHealth environment.

① The three main aspects of the IAF: Legal, Social and Technological and their interrelationships
are shown in Figures 3
② Accountable eHealth systems rely on appropriate legislation for the governance and regulatory
mechanisms to be established
③ AeH systems in the Australian context depends upon the establishment of an appropriate
underlying legal framework to adequately address a range of specific issues including
information ownership, access and control, data breach notification and broader issues
involved in the legal management of the system as a whole
④ The recent enactment of the Personally Controlled Electronic Health Records Act 2012 (Cth.)
⑤ And, advances but the implementation issues remain unresolved.

Figure 3: Information Accountability Framework [12]

eHEALTH PROCESSES AND PROTOCOLS
1. While the process of converting existing physical health documents and medical records to digital versions or
copies has begun, the development of effective large scale systems of EHRs is still a long way off
2. Public awareness and acceptance of EHRs is limited and the involvement of professionals (such as clinicians and
healthcare decision makers) in this EHR journey varies around the globe. In many places, the owners or
custodians of the medical/health data and information (e.g., PCEHR or PHR, EMR and EHR) are not yet clearly
identified. It is important that a physical person (e.g., human) is responsible for the contents of the digital
document (e.g, EHR, EMR & PHR)
3. The integrity and non-repudiation of these EHR documents and/or processes may be affected by the actions of
the responsible person. Addressing this represents an ongoing challenge in both HIT policy and the related
legislative debate
4. To better understand the information flow between public and professionals in a given eHealth scenario, we
present a graphical view of in a sociotechnical perspective, by integrating a human dimension (Figure 4)
5. This graphical depiction has global application, without prejudicing country specific legal and/or legislative
protocols.

EHR; PHR (PCEHR); EMR & IAF
▪PHR: is recognisable, individual information
stored, collected, shared and controlled by
individual (the public view)
▪EMR: is amended, updated PHRs that managed
by authorised clinicians and healthcare
organisation (the professional view)
▪IAF: is a concept focused on appropriate-use of
and after-the-fact accountability for information
usage.

A. We argue that an eHealth system should be designed to support improved
healthcare services and/or to enhance the quality of clinical decision making
processes
B. Such an eHealth system should consider the “critical pivotal point” (intersection
of PHR, EMR, EHR and IAF, marked as Ω in Figure 4), seriously, from the outset
of system design and development
C. We observe and hypothesise, such interconnections comprise with human
behaviour, information flow, [for example, the state of the information: is it in
storage, in transmission (being transferred from place to place) or in use (being
processed)], and information accountability measures are aspects the majority of
eHealth systems have failed to address [16].

① The three main aspects of the IAF: Legal, Social and Technological and their interrelationships are critical and
important
② We explores issues related to information privacy in the context of measures being adopted for shared EHR
systems in Australian context
③ EHR and SEHR systems must be designed so as to enhance security and minimise breaches. This is especially
so in the case of SEHR systems where issues of access and use accentuate security concerns. Despite legislative
initiatives designed to enhance security and minimise breaches, such as those outlined earlier, the integrity of
records cannot be achieved through the application of technology alone and is especially difficult in large-
scale schemes with a diverse user populations
④ We approach these issues from a sociotechnical approach - considering the perspectives of various
stakeholders: patients, health professionals and privacy advocates in order to form a ‘context sensitive health
informatics’ perspective. This approach is based on understanding information security and privacy measures
as ‘human factors’ when implementing eHealth scenarios.© Stranieri and Sahama 2014

▪ Shared electronic health record (SEHR)
▪ Understanding interaction between people and
information systems
▪ Policy and Practices related to Information Management
▪ Education and Training in the Security implications of
potential actions
▪ Legal Challenges…..!
untested legal initiatives
Requiring future study on EHR vs SEHR

Wrap up
▪ Co-existence of medical systems
▪ Healthcare globally is in crisis
▪ Technologies are getting cheaper and more powerful
▪ eHealth is transforming health care by:
▪ Tele-medicine
▪ Electronic Health Records and their Challenges and Benefits.
▪ Standards in eHealth; trends and application development Examples
▪ Decision Support Systems
▪ Data mining in Health
▪ Patient empowerment, policies, procedures and protocols
▪ Privacy and Security including managing the risk in particular when
exchanging health information.

Information and Communication Technologies Transform the Practice of Medicine

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to Information and Communication Technologies Transform the Practice of Medicine

Similar to Information and Communication Technologies Transform the Practice of Medicine (20)

Recently uploaded

Recently uploaded (20)

Information and Communication Technologies Transform the Practice of Medicine