1.Overview of Health Informatics & Disease Surveillance System Nawanan Theera-Ampornpunt, M.D., Ph.D. Aug. 22, 2013 SlideShare.net/Nawanan

2. A VISION FOR HEALTH CARE 3. eHealth Health Information Exchange (HIE) Hospital A Hospital B Clinic C Government Lab Patient at Home 4. CHALLENGES IN COMPUTERIZING HEALTH CARE 5. Manufacturing Image Source: Guardian.co.uk 6. Banking Image Source: Cablephet.com 7. Health care ER - Image Source: nj.com 8. Why Health care Isnt Like Any Others? 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 9. Engineers View Input Process Output Transfer Banking Value-Add - Security - Convenience - Customer Service Location A Location B 10. Input Process Output Assembling Manufacturing Raw Materials Finished Goods Value-Add - Innovation - Design - QC Engineers View 11. Engineers View Input Process Output Patient Care Health care Sick Patient Well Patient Value-Add - Technology & medications - Clinical knowledge & skills - Quality of care; process improvement - Information 12. Why Health care Isnt Like Any Others? Large variations & contextual dependence Input Process Output Patient Presentation Decision- Making Biological Responses 13. Information is Everywhere in Medicine Shortliffe EH. Biomedical informatics in the education of physicians. JAMA. 2010 Sep 15;304(11):1227-8. 14. The Anatomy of Health IT Health Information Technology Goal ValueAdd Means 15. HEALTH IT: AN OVERVIEW 16. Various Forms of Health IT Hospital Information System (HIS) Computerized Provider Order Entry (CPOE) Electronic Health Records (EHRs) Picture Archiving and Communication System (PACS) 17. 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) 18. Why Health care Isnt Like Any Others? 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 19. Is There A Role for Health IT? (IOM, 2001)(IOM, 2000) 20. Landmark IOM Reports: Summary Humansarenotperfectandareboundto makeerrors HighlightproblemsintheU.S.healthcare systemthatsystematicallycontributesto medicalerrorsandpoorquality Recommendsreformthatwouldchange howhealthcareworksandhow technologyinnovationscanhelpimprove quality/safety 21. Why We Need Health IT Healthcareisverycomplex(andinefficient) Healthcareisinformationrich Qualityofcaredependsontimely availability&qualityofinformation Clinicalknowledgebodyistoolargetobein anycliniciansbrain,andtheshorttime duringavisitmakesitworse Practiceguidelinesareputontheshelf Toerrishuman 22. Image Source: aafp.org To Err Is Human Lack of Attention 23. 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 24. The Anatomy of Health IT Revisited Health Information Technology Goal ValueAdd Means 25. Ultimate Goals of Health IT IndividualsHealth PopulationsHealth Organizations Health 26. Dimensions of Quality Health Care Safety Timeliness Effectiveness Efficiency Equity Patientcenteredness (IOM, 2001) 27. Documented Benefits of Health IT Literaturesuggestsimprovementthrough Guidelineadherence Betterdocumentation Practitionerdecisionmakingorprocessofcare Medicationsafety Patientsurveillance&monitoring Patienteducation/reminder Costsavingsandbetterfinancialperformance 28. Fundamental Theorem of Informatics (Friedman, 2009) 29. HEALTH INFORMATICS 30. Wisdom Knowledge Information Data Data-Information-Knowledge-Wisdom Contextualization/ Interpretation Processing/ Synthesis/ Organization Judgment 31. Definitions of Health Informatics Biomedical & Health Informatics (Formerly known as Medical Informatics) [T]he field that is concerned with the optimal use of information, often aided by the use of technology, to improve individual health, health care, public health, and biomedical research (Hersh, 2009) [T]he application of the science of information as data plus meaning to problems of biomedical interest (Bernstam et al, 2010) 32. Summary About M/B/H Informatics Focuses more on information, not technology Task-oriented view: Collection Processing Storage Utilization Communication /Dissemination/ Presentation 33. M/B/H Informatics As A Field (Shortliffe, 2002) 34. M/B/H Informatics As A Field (Hersh, 2009) 35. M/B/H Informatics and Other Fields Biomedical/ Health Informatics Computer & Information Science Engineering Cognitive & Decision Science Social Sciences (Psycholog y, Sociology, Linguistics, Law & Ethics) Statistics & Research Methods Medical Sciences & Public Health Management Library Science, Information Retrieval, KM And More! 36. The Intersection Clinical Informatics Public Health Informatics Consumer Health Informatics Patients & Consumers Providers & Patients Policy-Makers, Payers, Public (Also providers) 37. HEALTH INFORMATION EXCHANGE & DISEASE SURVEILLANCE 38. eHealth Health Information Exchange (HIE) Hospital A Hospital B Clinic C Government Lab Patient at Home 39. Standards: Why? The Large N Problem N = 2, Interface = 1 # Interfaces = N(N-1)/2 N = 3, Interface = 3 N = 5, Interface = 10 N = 100, Interface = 4,950 40. Functional Semantic Syntactic How Standards Support Interoperability Technical Standards (TCP/IP, encryption, security) Exchange Standards (HL7 v.2, HL7 v.3 Messaging, HL7 CDA, DICOM) Vocabularies, Terminologies, Coding Systems (ICD-10, ICD-9, CPT, SNOMED CT, LOINC) Information Models (HL7 v.3 RIM, ASTM CCR, HL7 CCD) Standard Data Sets Functional Standards (HL7 EHR Functional Specifications) Some may be hybrid: e.g. HL7 v.3, HL7 CCD Unique ID 41. U.S. Health Information Exchange Regional Health Information Organizations (RHIOs) State e-Health initiatives Nationwide Health Information Network (NHIN) Still ongoing efforts, but with significant progress 42. Other Public Health Informatics Applications e-Health & m-Health m-Health in disaster management: #ThaiFlood Data reporting to government agencies Claims & reimbursements Diseases Utilization statistics Quality measures etc. Biosurveillance (case reporting vs. predictive) Epidemiologic & health services research 43. Thailands Biosurveillance Source: www.biophics.org 44. Google Flu Trends Source: Google.org/FluTrends 45. Summary Health informatics as a discipline Health IT comes in various forms & useful in various settings HIE is vision toward HEALTH for many informaticians Disease surveillance systems one form of Health IT May or may not rely on HIE