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The role of IS/IT in healthcare

                          Session 1: Seminar Medical
                                         Informatics
    Rogier van de Wetering, PhD



    1Dept.of Information and Computing Sciences, Utrecht University,
    The Netherlands




                                                        Utrecht, April 29, 2011
1
Outline


     Key developments in healthcare


     Types of systems


     Trends and developments


     Benefits of IS/IT




2
Vision Microsoft on the Future of
                                        healthcare




    “We always
    overestimate the
    change that will occur
    in the next two years
    and underestimate the
    change that will occur
    in the next ten.”

    --Bill Gates Jr.




3
Key developments in healthcare from an
             international context

     Ageing             Growing costs
    population          of healthcare           Individuals
                                              more engaged
                                               in decisions
                                              and purchases




        E-prevention           Providers         Providers
        programs will           develop       develop new
        reduce future        management        services to
         healthcare          information of   clients (product
                                                 and quality
          spending            performance       information)




                              Development
                               of service
                             innovations to
                             enhance care
                                and cure
4
Current healthcare systems


     Inefficient


     Fragmented


     Quality issues


     Expensive


    What about IT?




5
International Comparison of Spending on
               Health, 1980–2007




            Source: Davis et al., How the performance of the U.S.
            health care system compares internationally. The common
            wealth fund (2010). See also OECD.org

6
7
                                                                                                                                        14




                                                                                                                    10
                                                                                                                                   12
                                                                                                                                             16
                                                                                                                                                                                  18




                                                                            0
                                                                                        6
                                                                                                    8




                                                                                2
                                                                                    4
                                                                                                                                                                                       % GDP
                                                           United States                                                                      16,0

                                                                 France                                                          11,2

                                                             Switzerland                                                     10,7

                                                                 Austria                                                     10,5

                                                               Germany                                                       10,5

                                                                 Canada                                                     10,4

                                                              Belgium 1                                                   10,2

                                                            Netherlands                                                9,9

                                                                Portugal                                               9,9

                                                          New Zealand 1                                                9,8

                                                               Denmark                                                9,7

                                                                 Greece                                             9,7




1. Current expenditure. Source: OECD Health Data 2010.
                                                                Sweden                                              9,4

                                                                 Iceland                                         9,1

                                                                    Italy                                        9,1
                                                                                                                                                  Public expenditure on health




                                                                   Spain                                        9,0

                                                                  OECD                                          9,0

                                                                 Ireland                                      8,7

                                                         United Kingdom                                       8,7

                                                               Australia                                      8,5

                                                                Norway                                        8,5

                                                                 Finland                                   8,4

                                                                  Japan                                   8,1
                                                                                                                                                  Private expenditure on health




                                                         Slovak Republic                                7,8

                                                                Hungary                             7,3

                                                            Luxembourg                              7,2

                                                          Czech Republic                          7,1

                                                                 Poland                           7,0
                                                                                                                                                                                                  other OECD country on healthcare




                                                                   Chile                          6,9

                                                                  Korea                       6,5

                                                                 Turkey                     6,0
                                                                                                                                                                                               The United States spends more than any




                                                                 Mexico                 5,9
Health reform legislation should improve
    the affordability of insurance and access to
                    care in the US




             Source: Davis et al., How the performance of the U.S. health
             care system compares internationally. The common wealth fund
             (2010). See also OECD.org

8
Overview of various types of IS/IT

     Electronic health records (ePR/eMR)
     Computerized provider order entry (CPOE)
     Decision and diagnostic support (e.g. CAD/CAR)
     Advanced visualization tools
     Enterprise-wide image management systems (i.e. PACS)
     Prescribing systems
     E-Health / consumer informatics / educational
     Surgical simulation and modeling
     Mobile computing
     Tele-medicine
     Administration
     Data exchange networks (e.g. XDS-i, IHE)
     Knowledge discovery/mining and retrieval systems
    (Cf. Haux, 2010; Chaundry, 2006; Huang, 2010)


9
Extracted clusters from 16 medical informatics
      journals, appearing between 2005 and 2008
            Organization, application,
            and evaluation of health IS




           Signal and data analysis




                                                                                        Medical knowledge representa -
                                                                                        tion

                                Source: M. J. Schuemie1 et al., Mapping the Domain of
                                Medical Informatics. Methods Inf Med 2009; 48: 76–83

10
Hype Cycle for Healthcare Provider
         Applications and Systems




11
There are many possible benefits and
     costs of implementing health information
                    technology

      Effects of health IS/IT (Cf. Chaundry, 2006):
         Quality
         Efficiency
         Costs


      Challenges for the future:
         Interoperability of medical data
         Adoption rates of IS/IT
         Misalignment of incentives for its use


     Key question remains: How to apply IT effectively?




12
X–Ray Exam without PACS: an inefficient
                   process
                                                                                                 GEYM
                                                                                                     S


                                                                                                         CT




         Patient               Previous Exams                Patient Data
        Registered             hung in Reading               Re–Entered                  Exam Performed
                                    Room                    at Acq Device




        Develop                  Quality                   Hang       Radiologist Read        Un–Hang Films
         Film                   Assurance                  Films     Dictate & Approve        & Attach Report




           Send Films &                      Retrieve Films &
                                                                       Re–assemble            Return Films
         Report to Referring                Report to Referring
                                                                       Film Jacket            to File Room
             Physician                          Physician




13
X–Ray Exam with PACS: an efficient
                 process
                                                   GEYM
                                                       S


                                                           CT




       Patient
      Registered                             Exam Performed




                               Radiologist Read
                              Dictate & Approve




        Referring Physician
         Accesses Report
            and Films




14
Final remarks

      Need for IS/IT in healthcare


      Classifications of systems


      Broad impact of IS/IT




15

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The Role of Information Systems in Healthcare

  • 1. The role of IS/IT in healthcare Session 1: Seminar Medical Informatics Rogier van de Wetering, PhD 1Dept.of Information and Computing Sciences, Utrecht University, The Netherlands Utrecht, April 29, 2011 1
  • 2. Outline  Key developments in healthcare  Types of systems  Trends and developments  Benefits of IS/IT 2
  • 3. Vision Microsoft on the Future of healthcare “We always overestimate the change that will occur in the next two years and underestimate the change that will occur in the next ten.” --Bill Gates Jr. 3
  • 4. Key developments in healthcare from an international context Ageing Growing costs population of healthcare Individuals more engaged in decisions and purchases E-prevention Providers Providers programs will develop develop new reduce future management services to healthcare information of clients (product and quality spending performance information) Development of service innovations to enhance care and cure 4
  • 5. Current healthcare systems  Inefficient  Fragmented  Quality issues  Expensive What about IT? 5
  • 6. International Comparison of Spending on Health, 1980–2007 Source: Davis et al., How the performance of the U.S. health care system compares internationally. The common wealth fund (2010). See also OECD.org 6
  • 7. 7 14 10 12 16 18 0 6 8 2 4 % GDP United States 16,0 France 11,2 Switzerland 10,7 Austria 10,5 Germany 10,5 Canada 10,4 Belgium 1 10,2 Netherlands 9,9 Portugal 9,9 New Zealand 1 9,8 Denmark 9,7 Greece 9,7 1. Current expenditure. Source: OECD Health Data 2010. Sweden 9,4 Iceland 9,1 Italy 9,1 Public expenditure on health Spain 9,0 OECD 9,0 Ireland 8,7 United Kingdom 8,7 Australia 8,5 Norway 8,5 Finland 8,4 Japan 8,1 Private expenditure on health Slovak Republic 7,8 Hungary 7,3 Luxembourg 7,2 Czech Republic 7,1 Poland 7,0 other OECD country on healthcare Chile 6,9 Korea 6,5 Turkey 6,0 The United States spends more than any Mexico 5,9
  • 8. Health reform legislation should improve the affordability of insurance and access to care in the US Source: Davis et al., How the performance of the U.S. health care system compares internationally. The common wealth fund (2010). See also OECD.org 8
  • 9. Overview of various types of IS/IT  Electronic health records (ePR/eMR)  Computerized provider order entry (CPOE)  Decision and diagnostic support (e.g. CAD/CAR)  Advanced visualization tools  Enterprise-wide image management systems (i.e. PACS)  Prescribing systems  E-Health / consumer informatics / educational  Surgical simulation and modeling  Mobile computing  Tele-medicine  Administration  Data exchange networks (e.g. XDS-i, IHE)  Knowledge discovery/mining and retrieval systems (Cf. Haux, 2010; Chaundry, 2006; Huang, 2010) 9
  • 10. Extracted clusters from 16 medical informatics journals, appearing between 2005 and 2008 Organization, application, and evaluation of health IS Signal and data analysis Medical knowledge representa - tion Source: M. J. Schuemie1 et al., Mapping the Domain of Medical Informatics. Methods Inf Med 2009; 48: 76–83 10
  • 11. Hype Cycle for Healthcare Provider Applications and Systems 11
  • 12. There are many possible benefits and costs of implementing health information technology  Effects of health IS/IT (Cf. Chaundry, 2006):  Quality  Efficiency  Costs  Challenges for the future:  Interoperability of medical data  Adoption rates of IS/IT  Misalignment of incentives for its use Key question remains: How to apply IT effectively? 12
  • 13. X–Ray Exam without PACS: an inefficient process GEYM S CT Patient Previous Exams Patient Data Registered hung in Reading Re–Entered Exam Performed Room at Acq Device Develop Quality Hang Radiologist Read Un–Hang Films Film Assurance Films Dictate & Approve & Attach Report Send Films & Retrieve Films & Re–assemble Return Films Report to Referring Report to Referring Film Jacket to File Room Physician Physician 13
  • 14. X–Ray Exam with PACS: an efficient process GEYM S CT Patient Registered Exam Performed Radiologist Read Dictate & Approve Referring Physician Accesses Report and Films 14
  • 15. Final remarks  Need for IS/IT in healthcare  Classifications of systems  Broad impact of IS/IT 15