For internal meeting of the Executive Committee of Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University
People & Organizational Issues in Health IT Implementation (February 24, 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 24, 2021
IT Governance & Management in Healthcare Organizations: Part 1 (October 19, 2...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 October 19, 2020
IT Governance & Management in Healthcare Organizations: Part 2 (October 19, 2...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 October 19, 2020
People & Organizational Issues in Health IT Implementation (February 26, 2020)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 19, 2020
Presented at the 11th Healthcare CIO Certificate Program, School of Hospital Management, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on February 16, 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 October 12, 2020
Presented at the 8th Healthcare CIO Certificate Program, Ramathibodi Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University on March 13, 2018
People & Organizational Issues in Health IT Implementation (February 24, 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 24, 2021
IT Governance & Management in Healthcare Organizations: Part 1 (October 19, 2...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 October 19, 2020
IT Governance & Management in Healthcare Organizations: Part 2 (October 19, 2...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 October 19, 2020
People & Organizational Issues in Health IT Implementation (February 26, 2020)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 19, 2020
Presented at the 11th Healthcare CIO Certificate Program, School of Hospital Management, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on February 16, 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 October 12, 2020
Presented at the 8th Healthcare CIO Certificate Program, Ramathibodi Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University on March 13, 2018
Introduction to Health Informatics and Health IT in Clinical Settings (Part 3...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 19, 2020
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
Information Technology Management in Healthcare Organizations: Part 1 (Octobe...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 October 20, 2021
Introduction to Health Informatics and Health IT (Part 1) (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
Presented at the 8th Healthcare CIO Certificate Program, Ramathibodi Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University on March 12, 2018
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
Presented at the 8th Healthcare CIO Certificate Program, Ramathibodi Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University on March 12, 2018
Theera-Ampornpunt N. Global or glocal e-Health approaches in Asia: what is new or next? Presented at: Globalizing Asia: Health Law, Governance, and Policy - Issues, Approaches, and Gaps!; 2012 Apr 16-18; Bangkok, Thailand.
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 10, 2017
Presented at the Intermediate Certificate Courses - Good Governance for Medical Executives, King Prajadhipok's Institute and the Medical Council of Thailand, Bangkok, Thailand on March 13, 2021
Introduction to Health Informatics and Health IT in Clinical Settings (Part 3...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 19, 2020
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
Information Technology Management in Healthcare Organizations: Part 1 (Octobe...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 October 20, 2021
Introduction to Health Informatics and Health IT (Part 1) (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
Presented at the 8th Healthcare CIO Certificate Program, Ramathibodi Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University on March 12, 2018
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
Presented at the 8th Healthcare CIO Certificate Program, Ramathibodi Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University on March 12, 2018
Theera-Ampornpunt N. Global or glocal e-Health approaches in Asia: what is new or next? Presented at: Globalizing Asia: Health Law, Governance, and Policy - Issues, Approaches, and Gaps!; 2012 Apr 16-18; Bangkok, Thailand.
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 10, 2017
Presented at the Intermediate Certificate Courses - Good Governance for Medical Executives, King Prajadhipok's Institute and the Medical Council of Thailand, Bangkok, Thailand on March 13, 2021
Departmental Information Systems and Management Information Systems in Health...Nawanan Theera-Ampornpunt
Theera-Ampornpunt N. Departmental information systems and management information systems in healthcare organizations. Presented at: Faculty of ICT, Mahidol University; 2012 Feb 8; Bangkok, Thailand.
A presentation in February 2011 presented at the Ramathibodi Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University in Bangkok, Thailand. Presentation partly in English and partly in Thai.
Theera-Ampornpunt N. Health informatics: the next “stethoscope” in healthcare. Presented at: Intelligent logistics for innovation hospitals; 2010 Dec 23; Faculty of Engineering, Mahidol University, Thailand. Invited speaker, in Thai.
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 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
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
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
Presented at the Healthcare CEO50 Certificate Program, School of Hospital Management, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on October 4, 2021
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
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
9. 9
Why Healthcare Isn’t Like Any Others
• 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
10. 10
But...Are We That Different?
Banking
Input Process Output
Transfer
Location A Location B
Value-Add
- Security
- Convenience
- Customer Service
11. 11
But...Are We That Different?
Manufacturing
Input Process Output
Assembling
Raw
Materials
Finished
Goods
Value-Add
- Innovation
- Design
- QC
12. 12
But...Are We That Different?
Health care
Input Process Output
Sick Patient Patient Care
Well Patient
Value-Add
- Technology & medications
- Clinical knowledge & skills
- Quality of care; process improvement
- Information
13. 13
Recognizing Variations in Healthcare
• Large variations & contextual dependence
Input Process Output
Patient
Decision-
Presentation
Making
Biological
Responses
14. 14
Why Adopting Health IT?
“To Computerize”
“To Go paperless”
“To Have “Digital Hospital”
EMRs”
15. • “Don’t implement technology just for
technology’s sake.”
• “Don’t make use of excellent technology.
Make excellent use of technology.”
(Tangwongsan, Supachai. Personal communication, 2005.)
• “Health care IT is not a panacea for all that
ails medicine.” (Hersh, 2004)
15
Some Quotes
19. 19
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)
20. 20
• 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
22. 22
“Information” in Medicine
Shortliffe EH. Biomedical informatics in the education of physicians. JAMA.
2010 Sep 15;304(11):1227-8.
23. 23
23
23
Components of Health Systems
WHO (2009)
24. 24
Achieving Quality Care with ICT
• Safe
–Drug allergies
–Medication Reconciliation
• Timely
–Complete information at point of
care
• Effective
–Better clinical decision-making
Image Source: http://www.flickr.com/photos/childrensalliance/3191862260/
25. 25
Achieving Quality Care with ICT
• Efficient
–Faster care
–Time & cost savings
–Reducing unnecessary tests
• Equitable
– Access to providers & knowledge
• Patient-Centered
–Empowerment & better self-care
27. 27
IOM Reports Summary
• 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
28. To Err is Human 1: Attention
28 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
29. To Err is Human 2: Memory
29 Image Source: Suthan Srisangkaew, Department of Pathology, Facutly of Medicine Ramathibodi Hospital
30. 30
To Err is Human 1: Cognition
• Cognitive Errors - Example: Decoy Pricing
The Economist Purchase Options
• Economist.com subscription $59
• Print subscription $125
• Print & web subscription $125
Ariely (2008)
# of
People
16
0
84
The Economist Purchase Options
• Economist.com subscription $59
• Print & web subscription $125
# of
People
68
32
31. 31
Cognitive Biases in Healthcare
“Everyone makes mistakes. But our
reliance on cognitive processes prone to
bias makes treatment errors more likely
Klein JG. Five pitfalls in decisions about diagnosis and prescribing. BMJ. 2005 Apr
2;330(7494):781-3.
than we think”
32. 32
Common Errors
• Medication Errors
–Drug Allergies
–Drug Interactions
• Ineffective or inappropriate treatment
• Redundant orders
• Failure to follow clinical practice guidelines
34. 34
Clinical Decision Making &
Clinical Decision Support Systems (CDS)
External Memory
Knowledge Data
Long Term Memory
Knowledge Data
PATIENT
Perception
Attention
Working
Memory
Inference
DECISION
CLINICIAN
Elson, Faughnan & Connelly (1997)
35. 35
Reducing Errors through “Alerts & Reminders”
Example of
“Alerts &
Reminders”
36. 36
Why We Need ICT
in Healthcare?
#1: Because information is
everywhere in healthcare
37. 37
Why We Need ICT
in Healthcare?
#2: Because healthcare is
error-prone and technology
can help
38. 38
Why We Need ICT
in Healthcare?
#3: Because access to
high-quality patient
information improves care
39. 39
Why We Need ICT
in Healthcare?
#4: Because healthcare at
all levels is fragmented &
in need of process
improvement
40. 40
Documented Values of Health IT
• Guideline adherence
• Better documentation
• Practitioner decision making
or process of care
• Medication safety
• Patient surveillance &
monitoring
• Patient education/reminder
50. 50
1st Generation (~1987-2001)
• CIO: Dr. Suchart Soranasataporn
• Developed HIS from scratch
• Started from MPI, OPD, IPD,
Pharmacy, Billing, etc.
• Platform: Visual FoxPro
(UI, Logic, Database)
52. 52
Some Limitations of Visual FoxPro
• File-based DB, not real DBMS
– Performance Issues
• Not well designed indexing, concurrency controls
& access controls
• Indexes sensitive to network disruptions
• Single point of failures (no redundancy)
– Scalability Issues
• Database file size < 2GB
• Not service-oriented architecture
53. 53
1st-Generation Development Process
• Trials & errors
• Individuals or small teams
– Teams based on system modules
(OPD, IPD, Billing, etc.)
• Non-systematic, no documents
54. 54
2nd Generation (2001-2005)
• CIO: Dr. Piyamitr Sritara
• Developed CPOE for inpatients
medication orders
• Lab orders and lab results viewing
• Discharge summaries, etc.
• Enhanced existing HIS modules and add more
modules and departmental systems (e.g. LR, OR)
• Platform: Visual FoxPro (UI, Logic, Database)
55. 55
2nd Generation (2001-2005)
• Java or .NET?
• Open/cost-effective
vs. timely
development
• Technology survival?
• Decision: Defer &
continue using
Visual FoxPro
http://thinkunlimited.org/blog/wp-content/uploads/2012/10/Fork_in_the_road_sign.jpg
56. 56
2nd-Generation Development Process
• Small teams
– Teams based on system modules
(OPD, IPD, Billing, Pharmacy, Lab, etc.)
• Realized needs for systematic software
development process
• Started formal systems analysis & design
with some documents
58. 58
3rd Generation (2005-2011)
• Architectural changes: Used middleware (web services,
JBOSS, JCAPS)
• Implemented data exchange of lab & ADT data using
HL7 v.2 & v.3 messaging
• Enhanced existing HIS & add more functions
• SDMC becomes operational (2011)
• Platform:
– Web [Mainly Java] (UI)
– Web services (Logic)
– Oracle & Microsoft SQL Server (Database)
• Legacy platform: Visual FoxPro (UI, Logic, Database)
59. 59
3rd-Generation Development Process
• Small teams
– Teams based on system modules
(OPD, IPD, Billing, Pharmacy, Lab, etc.)
• Attempted systematic software
development process, with limited success
• Balancing quality development with timely
software delivery difficult
60. 60
4th Generation (2011-Present)
• CIO: Dr. Chusak Okaschareon
• Implemented CPOE for
outpatients (with gradual roll-out)
• Scanned Medical Records for
outpatients
• RamaEMR (portal & EMR
viewer for physicians and nurses
in OPD)
61. 61
4th Generation (2011-Present)
• Ongoing projects
– CMMI & high-quality software testing
– High-Performance Data Center & IT Services (ISO)
– Business intelligence
– Security
• Platform:
– Web [Mainly Java] (UI)
– Web services (Logic)
– Oracle & Microsoft SQL Server (Database)
• Legacy platform: Visual FoxPro (UI, Logic, DB)
62. 62
4th-Generation Development Process
• Project-based development
• Roles of “Business Analysts”
• From “silo” teams to “pooled” resources
– Business Analysis Team
– Systems Analysis Team
– Development Team
– Testing Teams
68. 68
Lesson #1
“Preemptive
Advantage” of Using
Health IT
69. 69
IT as a Strategic Advantage
Valuable ?
Resources/
capabilities
Non-Substitutable?
Rare ?
Inimitable ?
No
Competitive
Disadvantage
Yes
No Competitive
necessity
No
Competitive
parity
Yes
Yes
No
Preemptive
advantage
Yes
Sustainable
competitive
advantage
From a teaching slide by Nelson F. Granados, 2006 at University of Minnesota Carlson School of Management
70. 70
4 Quadrants of Hospital IT
Strategic
HIE
CDSS
Business
Intelligence
Social
Media
Administrative Clinical
Operational
CPOE
LIS
ADT
EHRs
ERP
VMI
PHRs
MPI
Word
Processor
PACS
CRM
Nawanan Theera-Ampornpunt
71. 71
Lesson #2
Customization vs.
Standardization: Always
a Balancing Act
72. 72
Customization: A Tailor-Made Shirt
http://www.soloprosuccess.com/tailor-made-business-blueprint/
74. 74
Lesson #3
Build or Buy?: A
Context-Dependent,
but Serious Decision
75. 75
Build or Buy
Build/Homegrown
• Full control of software &
data
• Requires local expertise
• Expertise
retention/knowledge
management is vital
• Maybe cost-effective if
high degree of local
customizations or long-term
projection
Buy/Outsource
• Less control of software &
data
• Requires vendor
competence
• Vendor relationship
management is vital
• Maybe cost-effective
if economies of scale or
few customizations
76. 76
IT Outsourcing Decision Tree
No
Does service offer
competitive advantage?
Is external delivery
reliable and lower cost?
Keep Internal
Keep Internal
OUTSOURCE!
Yes
No
Yes
From a University of Minnesota teaching slide by Nelson F. Granados, 2006
77. 77
IT Outsourcing Decision
Tree: Ramathibodi’s Case
No
Does service offer
competitive advantage?
External delivery unreliable
• Non-Core HIS,
External delivery higher cost
• ERP maintenance/ongoing
customization
Is external delivery
reliable and lower cost?
Keep Internal
Keep Internal
OUTSOURCE!
Yes
No
Yes
From a teaching slide by Nelson F. Granados, 2006
Core HIS, CPOE
ERP initial
implementation,
PACS, RIS,
Departmental
systems
Strategic advantages
• Agility due to local workflow accommodations
• Secondary data utilization (research, QI)
• Roadmap to national leader in informatics (internal “lab”)
78. 78
IT Decision as “Marriage”
Image Source: http://charminarpearls.com/pearls/
80. Context
The current
location
The tailwind The headwind
The destination
The boat
The speed
The past
journey
The sailor(s) &
people on
board
The
direction
The sea
The sail
80 The sailboat image source: Uwe Kils via Wikimedia Commons
85. 85
Ramathibodi IT Workforce
• About 100 IT professionals (1:80)
– Health informaticians
– Business analysts
– Systems analysts
– Software developers
– Software testers
– Project managers
– Systems & network administrators
– Engineers & technicians
– Data analysts
– Help desk / user support agents
– Supporting staff
• Ratios of IT vs Health from Western countries: 1:50 - 1:60
86. 86
Building Workforce: Example
• HL7 Certified Specialists
Kevin
Asavanant
HL7 V3 RIM (2009)
Supachai
Parchariyanon
HL7 CDA (2010)
Nawanan
Sireerat
Theera-Ampornpunt
HL7 CDA (2012) 86
Srisiriratanakul
HL7 V3 RIM (2013)
94. 94
Lesson #7
Are we focusing too much
on operational IT, not
strategic & clinical IT?
95. 95
4 Quadrants of Hospital IT
Strategic
HIE
CDSS
Business
Intelligence
Social
Media
Administrative Clinical
Operational
CPOE
LIS
ADT
EHRs
ERP
VMI
PHRs
MPI
Word
Processor
PACS
CRM
Nawanan Theera-Ampornpunt
96. 96
Lesson #8.1
Even large hospitals still
face enormous IT
challenges.
97. 97
Lesson #8.2
Real-world hospital IT
management is messy,
difficult, tiring &
discouraging. Live with it...
98. 98
Lesson #9
Value of Teamwork &
Project Management
in IT Projects
99. 99
Teams & Outcomes
• Restructuring IT teams very
helpful in effective & efficient
software development
• Quality of software reflects
quality of the team and process
100. 100
Lesson #10
We can’t live without IT in
today’s healthcare.
101. 101
Summary
Ramathibodi hospital’s IT builds
upon its long history of
development and has offered
values to the organization, but it still
has a long way to go, and there is
no “perfect” implementation.
Large rooms for improvement.
104. 104
New IT Exec. Team Members
Aj.Marut Chantra, M.D.
Pediatrics
Aj.Arrug Wibulpolprasert, M.D.
Emergency Medicine
Aj.Ekawat Pasomsub, Ph.D.
Pathology
105. 105
Pipe Dream, False Hope,
or Possible Reality?
Let’s give it a try!