resolving the health care crisis; health informatics for holistic medicine
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Resolving the health care crisis; health informatics for holistic medicine. . Andrew Stranieri Centre for Informatics and Applied Optimisation, University of Ballarat, Victoria . Tony Sahama Queensland University of Technology, Queensland. Health informatics research. - PowerPoint PPT PresentationTRANSCRIPT
Resolving the health care crisis; health informatics for holistic
medicine.
Andrew StranieriCentre for Informatics
and Applied Optimisation, University of Ballarat,
Victoria
Tony Sahama
Queensland University of Technology, Queensland
Health informatics research
Health informatics research
• Holistic Medicine informatics (with Uni Colombo, QUT, ICHM 2012)
• Data mining Cardiovascular disease, TCM (with CSU)
• Online Dispute Resolution in Health (with Deakin)• Decision Support for cancer patients, multi-
disciplinary groups• Smart Information Portal (with Monash)
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Health informatics: transforming health care
TechnologiesTelemedicineDecision support systemsData miningStandards for interoperabilityInformation systemsSimulationElectronic Health Record
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Backdrop: Health care is in crisisAustralia spends 9% of GDP on health
More chronic illnesses, diabetes, CVD. No cure ;
Increasing costs of medical advances;
Problems with health workforce supply and distribution – HCP flock to major cities of developed countries ;
Persistent concerns about the quality and safety of health services;
Achieving equity in health
1 billion people never see a doctor
Information Communication Technologies are transforming Health
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Backdrop: Diverse medical systems are prevalent
Body-person. Physical (WM, TCM, N, H, AM) Psychological (WM, H, TCM, AM, N), Spiritual (AM, H) Energetic (TCM, AM)
Illness. Caused by external agent (WM, AM, TCM) Caused by internal imbalance (TCM, AM)
Practitioner-patient relationship• Passive.............................Active
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CAM are prevalant in the West (Dawn and Upchurch 2005, Hastings and Torada 2009, Lim et al 2005)
Western Medicine growing in prevalence outside West (Hesketh and Zhu 1997; Chua and Furnham 2008)
Diverse medical systems are popular
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Backdrop: Co-existence of diverse medical systems
TCM and Ayervedic prevalence enhanced by emerging economies of China and India
Homeopathy already quite popular in many Western countries
CAM (in West) arguably provides good models of patient empowerment
Allopathic is very expensive. Few countries can afford 10%GDP on health
Chronic (lifestyle) conditions resistant to Allopathic Many colleges of CAM around the world
All systems co-exist as diverse but equally regarded practices
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How/When will patients select a medical system ?
Which practitioner»Treatment effectiveness»Empathy (Dose of doctor)»Empowerment (Patient centred care)»Practicalities (Availability, Cost)
Open research question: How to support patients to make a decision about which system?
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Health informatics: transforming health care
TechnologiesTelemedicineDecision support systemsData miningStandards for interoperabilityInformation systemsSimulationElectronic Health Record
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Health informatics: transforming health care
TrendsToward more preventative health careToward more participatory health careToward co-existence of medical systems
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Empowering patients Telemedicine Access HCP remotely by video conference https://gp2u.com.au/
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Tele-dentistry UB Consortium Pilot. Nursing home to Dentist for
Cost effective treatment plans
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HD3D Pilot project Tele-oncology
Oncologist and patient with nurse. Record consultation onto DVD
Tele-psychiatry HD3D Specialist psychiatrist for fine motor
movements Tele-wound management
Nurse in home uploads a 3D image of a wound for a wound specialist to assess
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HD3D Pilot project Tele-wound. Automated depth assessment
Open Research question: Identify image processing applications within holistic medicines
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Remote surgery
Japan/Korea Arata et al 2007World Congress on Medical Physics and Biomedical Engineering 2006
IFMBE Proceedings Volume 14, 2007, pp 3065-3068. A remote surgery experiment between Japan-Korea using the minimally invasive surgical system
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Telemedicine for holistic medicine Acupuncture at sea. Information Technology in Alternative Medicine. 2010. Bernard Fong, A. C. M. Fong, C. K. LiMindfulness by telehealth. Measuring mindfulness: which aspects of mindfulness change following a brief telehealth intervention for PTSD? B Niles1*, A Seligowski1 and A Silberbogen2 BMC Complementary and Alternative Medicine 2012, 12(Suppl 1):P191 doi:10.1186/1472-6882-12-S1-P191Open Research question: Identify which practices within holistic medicines can appropriately be performed by Tele-health
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Decision support systems
• Systems that encode knowledge, use an inference and reach a conclusion. Examples:
• Intensive Care Unit Ballarat Hospital. Knowledge from experienced nurses in a DSS for training
• DSS for inferring supportive care (relationship, spiritual, financial, transport, etc) needs of cancer patients
• DSS for inferring pathology lab test diagnosis •
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Supportive care needs DSS• Typically with Quality of Life instruments but;• Difficult to fit QOL instruments into busy HCP workflows • Difficult to engage patients. Non interactive, always the same questions. • Not customised for local settings. Questions validated over large populations cannot be modified
• Our approach: DSS;• DSS infers needs, and infers appropriate referrals. Report adds value to HCP • Interactive. Patients/carers online, at home, dynamic questions. • Can be customised for local settings. Eg no referrals to psychologists if none around. Question content and nuances evolves locally
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Decision support systems in holistic medicine
CAMEO (2012) helps cancer patients identify useful CAM evidenced based
Zhou et al (2012) TCM DSS for Syndrome differentiation and diagnosis
Wang et al (2008) Self learning system for TCM diagnosis
Vithoulkas Compass DSS for helping homeopathy practitioners select remedies http://www.vithoulkas.com/en/books-study/vithoulkas-compass.html
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Decision support systems in holistic medicine: open questions
How best to represent knowledge for DSS given high level of tacit knowledge in many holistic medicine systems?
How to support patients to choose between medical systems
Ripple down rules? :
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Data miningData mining = Statistics + Computer Science + Maths Discovering patterns from data
Adverse drug reaction Cystic Fibrosis Predictors. Quinn,
Stranieri, Yearwood, Gauditz 2010
Cardiovascular autonomic neuropathy - replacement tests
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Data mining to discover interactions
Quinn Weighted sum discoveryClinical Data warehouse – de Silva
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Data mining open questions
How to identify tasks in holistic medicine suitable for data mining?How to collect and pre-process data in standard ways to facilitate data mining?How to integrate clinical knowledge into data mining exercise?
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Simulation systemsQuality of Care
Virtual hospital SecondLife Imperial College London
Games for healthWII, UQ Distraction for burns victims
Simulation for education Knee surgery
http://www.edheads.org/activities/knee/ Virtual patient UB Miller et al SecondLife
Nursing (2009-10)Simulation for empowerment
Interactive DVD for people who stutter Meredith (2010)
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Ubiquitous health information
Patients Like Me http://
www.patientslikeme.com/ Cochrane Collaboration
http://www.cochrane.org/ Breast Cancer Online Health InSite Portal
http://www.healthinsite.gov.au/
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Standards
Data Storage- structure and content for an electronic health recordPrivacy, authentication, access control
Security StandardsRequired to identify the practices necessary to maintain confidentiality, integrity and appropriate availability of health information
Standards used for the interchange of data eg HL7IT system and network operations
Messaging StandardsRequired to establish the format and sequence of data during transmission
Data- description of data, structureClassification eg ICDNVocabulary eg SNOMEDTerminologies- Interface and Reference
Vocabulary StandardsRequired for information management and meaningful collection, exchange, storage and reuse of clinical data
IT system and network operations eg OSIDevice interoperabilitySystems interoperability Telecommunications
System StandardsRequired for interoperability, integration performance and availability
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Terminology standards SNOMED
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Terminology standards SNOMED
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OpenEHR arhetypes
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Open questions SNOMED
New work proposal for TCM in SNOMEDOpen question about SNOMED and
• Ayurveda• Homeopathy• Other holistic medicines
OpenEHR archetypes for holistic medicine
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Health informatics is based on allopathic medicine
Telemedicine, Decision support, Data mining, Electronic health record, Simulation
Co-existance of complementary medicine with allopathic medicine can also help alleviate the crisis
However, requires a concerted effort by health informaticians to ensure developments are applicable to Holistic medicine
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HL7 for CAM?1777.1220 : HL7 Segment : DG1 : Diagnosis Information
1777.1225 : HL7 Segment : EVN : Event Information
1777.1250 : HL7 Segment : MSH : Message Header
1777.1255 : HL7 Segment : NK1 : Next of Kin Information
1777.1260 : HL7 Segment : NTE : Notes and Comments
1777.1265 : HL7 Segment : OBR : Order Information
1777.1270 : HL7 Segment : OBX : Observation Information
1777.1275 : HL7 Segment : ORC : Order Common Information
1777.1280 : HL7 Segment : PD1 : Patient Demographic Information
1777.1295 : HL7 Segment : PID : Patient Information
1777.1300 : HL7 Segment : PR1 : Procedure Information
1777.1305 : HL7 Segment : PV1 : Patient Visit Information
1777.1800 : HL7 Event Summary
1777.1801 : HL7 Event : A01 : Admit Patient
1777.1802 : HL7 Event : A02 : Transfer Patient
1777.1803 : HL7 Event : A03 : Discharge Patient
1777.1804 : HL7 Event : A04 : Register Patient
1777.1805 : HL7 Event : A05 : Preadmit Patient
1777.1806 : HL7 Event : A06 : Transfer ?Outpatient to Inpatient
1777.1807 : HL7 Event : A07 : Transfer ?Inpatient to Outpatient
1777.1808 : HL7 Event : A08 : Update Patient
1777.1811 : HL7 Event : A11 : Cancel Admit
1777.1812 : HL7 Event : A12 : Cancel Transfer
1777.1813 : HL7 Event : A13 : Cancel Discharge
1777.1817 : HL7 Event : A17 : Bed Swap
1777.1818 : HL7 Event : A18 : Merge Patient
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Electronic health record In Australian NEHTA. PCEHR Microsoft Health Vault
http://www.healthvault.com/ Denmark
Bernstein 1995 US
Obama E H R by 2014
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Electronic health recordA virtual electronic record of every health event from before birth to after deathIntegrated so that every authorised health care professional can add to or access the record
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Electronic health record: More complaints
Patient empowerment means more queries, complaints, disputes
Online Dispute Resolution – argument structure based organisation of the dispute to help its resolution
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Electronic Health Record
Open question:Should CAM events be entered in an electronic health record? If so, how?
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Electronic Health Record
Open question:Should CAM events be entered in an electronic health record? If so, how?
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Conclusion
TechnologiesTelemedicineDecision support systemsData miningStandards for interoperabilityInformation systemsSimulationElectronic Health Record