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ICT in Healthcare
Nawanan Theera-Ampornpunt
October 21, 2016
2
2003 M.D. (First-Class Honors)
2011 Ph.D. (Health Informatics), Univ. of Minnesota
Lecturer, Department of Community Medicine
Faculty of Medicine Ramathibodi Hospital
Mahidol University
Interests: Health IT for Quality of Care, Social Media
IT Management, Security & Privacy
nawanan.the@mahidol.ac.th
SlideShare.net/Nawanan
นวนรรน ธีระอัมพรพันธุ์ (Nawanan Theera-Ampornpunt)
Line ID: NawananT
Introduction
3
 The Road to Digitizing Healthcare
 What is a “Smart Hospital”?
 Toward a “Smart” Hospital
Outline
4
Health &
Health Information
5
Let’s take a look at
these pictures...
6Image Source: https://en.wikipedia.org/wiki/Industrial_robot (KUKA Roboter GmbH)
“Smart” Manufacturing
7
Image Sources: http://isarapost.net/home/?p=17760
http://www.telecomjournalthailand.com/ตอบโจทย์โมเดลทางธุรกิจ/
“Smart” Banking
8ER - Image Source: nj.com
Healthcare (On TV)
9
(At an undisclosed hospital)
Healthcare (Reality)
10
• 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
Why Healthcare Isn’t (Yet) “Smart”?
11
But...Are We That Different?
Input Process Output
Transfer
Banking
Value-Add
- Security
- Convenience
- Customer Service
Location A Location B
12
Input Process Output
Assembling
Manufacturing
Raw Materials Finished
Goods
Value-Add
- Innovation
- Design
- QC
But...Are We That Different?
13
Input Process Output
Patient Care
Health care
Sick Patient Well Patient
Value-Add
- Technology & medications
- Clinical knowledge & skilled providers
- Quality of care; process improvement
- Customer service
- Information
But...Are We That Different?
14
• Large variations & contextual dependence
Input Process Output
Patient
Presentation
Decision-
Making
Biological
Responses
Standardizing Healthcare
15
The World of Smart Machines
Image Sources: http://www.ibtimes.com/google-deepminds-alphago-
program-defeats-human-go-champion-first-time-ever-2283700
http://deepmind.com/
16
Digitizing Healthcare
Image Source: http://www.bloomberg.com/bw/stories/2005-03-27/cover-image-the-digital-hospital
17
“To computerize
the hospital”
“To go paperless”
“To become a
Digital Hospital”
“To Have
EHRs”
Why Adopting Health IT?
18
• “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)
Some “Smart” Quotes
19
Being Smart #1:
Stop Your
“Drooling Reflex”!!
20
Being Smart #2:
Focus on Information &
Process Improvement,
Not Technology
21
If not “Digital Hospital”
or “Paperless Hospital”
Then What Should We
Aspire to Be?
“Smart Hospital”
23
So How is
a “Smart Hospital”
Different from a Digital or
Paperless Hospital?
24
Healthcare 4.0?
25
Healthcare 1.0
• Thai Traditional Medicine in the Ancient Times
Healthcare 1.0 - 4.0 is the speaker’s personal opinion and may not represent official views of the Ministry of Public Health
Image & Caption Source: http://kanchanapisek.or.th/kp6/sub/book/book.php?book=33&chap=8&page=t33-8-detail.html
http://kanchanapisek.or.th/kp6/sub/book/book.php?book=33&chap=8&page=t33-8-infodetail02.html
การย่อยขนาดตัวยาสมุนไพร โดยใช้ครกตาและหินบดยา
ของโรงศิริราชพยาบาล (ปัจจุบันคือ โรงพยาบาลศิริราช)
คนไทยสมัยก่อนมักให้บุคคลในครอบครัวบีบนวดได้
26
Healthcare 2.0
• Modern (Western) Medicine
Healthcare 1.0 - 4.0 is the speaker’s personal opinion and may not represent official views of the Ministry of Public Health
Image & Caption Source: http://kanchanapisek.or.th/kp6/sub/book/book.php?book=33&chap=8&page=t33-8-detail.html
http://kanchanapisek.or.th/kp6/sub/book/book.php?book=33&chap=8&page=t33-8-infodetail02.html
27
Healthcare 3.0
• Quality-Driven Healthcare
Healthcare 1.0 - 4.0 is the speaker’s personal opinion and may not represent official views of the Ministry of Public Health
Image & Caption Source: http://kanchanapisek.or.th/kp6/sub/book/book.php?book=33&chap=8&page=t33-8-detail.html
http://kanchanapisek.or.th/kp6/sub/book/book.php?book=33&chap=8&page=t33-8-infodetail02.html
28
Healthcare 4.0
• Smart Healthcare & Smart Hospital
Healthcare 1.0 - 4.0 is the speaker’s personal opinion and may not represent official views of the Ministry of Public Health
Image & Caption Source: http://kanchanapisek.or.th/kp6/sub/book/book.php?book=33&chap=8&page=t33-8-detail.html
http://kanchanapisek.or.th/kp6/sub/book/book.php?book=33&chap=8&page=t33-8-infodetail02.html
29
So What Is
Smart Healthcare?
30
Smart Healthcare For Policymakers?
Image Source: http://healthdata.moph.go.th/kpi/2557/ProvinceKpiTopicListAll.php?provincecode=99
31
Smart Healthcare For Health Promoters?
Image Source: http://www.hiso.or.th/hiso/picture/reportHealth/ThaiHealth2014/thai2014_3.pdf
32
Smart Healthcare For Clinicians?
Image Source: http://www.medscape.com/viewarticle/780298
33
Smart Healthcare For Patients & Consumers?
Image Source: Agence France-Presse/Getty Images
34
So What Exactly Is Smart Healthcare?
Image Source: http://cdn2.hubspot.net/hub/134568/file-1208368053-jpg/6-blind-men-hans.jpg
35
The Road to Digitizing Healthcare
 What is a “Smart Hospital”?
 Toward a “Smart” Hospital
Outline
36
Microsoft Health Future Vision
37
Connecting People to a Healthy Future With
Personalized Care – Kaiser Permanente
https://www.youtube.com/watch?v=gxz9ZVvduGc
38
Back to
something simple...
39
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)
What Clinicians Want?
40
• 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
41
Information is Everywhere in Healthcare
42
“Information” in Medicine
Shortliffe EH. Biomedical informatics in the education of physicians. JAMA.
2010 Sep 15;304(11):1227-8.
43
43
WHO (2009)
Components of Health Systems
44
44
WHO (2009)
WHO Health System Framework
45
• 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/
Being “Smart” in Healthcare
46
• Efficient
–Faster care
–Time & cost savings
–Reducing unnecessary tests
• Equitable
–Access to providers & knowledge
• Patient-Centered
–Empowerment & better self-care
Being “Smart” in Healthcare
47
(IOM, 2001)(IOM, 2000) (IOM, 2011)
Landmark Institute of Medicine Reports
48
• To Err is Human (IOM, 2000) reported
that:
– 44,000 to 98,000 people die in U.S.
hospitals each year as a result of
preventable medical mistakes
– Mistakes cost U.S. hospitals $17 billion to
$29 billion yearly
– Individual errors are not the main problem
– Faulty systems, processes, and other
conditions lead to preventable errors
Patient Safety
49
Summary of These Reports
• 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
50
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
To Err is Human 1: Attention
51Image Source: Suthan Srisangkaew, Department of Pathology, Facutly of Medicine Ramathibodi Hospital
To Err is Human 2: Memory
52
• Cognitive Errors - Example: Decoy Pricing
The Economist Purchase Options
• Economist.com subscription $59
• Print subscription $125
• Print & web subscription $125
Ariely (2008)
16
0
84
The Economist Purchase Options
• Economist.com subscription $59
• Print & web subscription $125
68
32
# of
People
# of
People
To Err is Human 3: Cognition
53
• It already happens....
(Mamede et al., 2010; Croskerry, 2003; Klein,
2005; Croskerry, 2013)
What If This Happens in Healthcare?
54
Klein JG. Five pitfalls in decisions about diagnosis and prescribing. BMJ. 2005 Apr 2;330(7494):781-3.
“Everyone makes mistakes. But our reliance on
cognitive processes prone to bias makes
treatment errors more likely than we think”
Cognitive Biases in Healthcare
55
• Medication Errors
–Drug Allergies
–Drug Interactions
• Ineffective or inappropriate treatment
• Redundant orders
• Failure to follow clinical practice guidelines
Common Errors
56
Being Smart #3:
“To Err is Human”
57
External Memory
Knowledge Data
Long Term Memory
Knowledge Data
Inference
DECISION
PATIENT
Perception
Attention
Working
Memory
CLINICIAN
Elson, Faughnan & Connelly (1997)
Clinical Decision Making
58
Example of “Alerts & Reminders”
Reducing Errors through “Alerts & Reminders”
59
Why We Need ICT
in Healthcare?
#1: Because information is
everywhere in healthcare
60
Why We Need ICT
in Healthcare?
#2: Because healthcare is
error-prone and technology
can help
61http://www.dplindbenchmark.com/wp-content/uploads/2013/02/HHRI-Our-Health-Care-River.pdf
Fragmented Healthcare
62
Why We Need ICT
in Healthcare?
#3: Because access to
high-quality patient information
should improve care
63
Why We Need ICT
in Healthcare?
#4: Because healthcare at
all levels is fragmented &
in need of process
improvement
64
Documented Values of Health IT
• Guideline adherence
• Better documentation
• Practitioner decision making or
process of care
• Medication safety
• Patient surveillance &
monitoring
• Patient education/reminder
65
Being Smart #4:
Link IT Values to
Quality (Including Safety)
66
Use of information and communications
technology (ICT) in health & healthcare
settings
Source: The Health Resources and Services Administration, Department of Health
and Human Service, USA
Slide adapted from: Dr. Boonchai Kijsanayotin
Health IT
67
Use of information and communications
technology (ICT) for health; Including
• Treating patients
• Conducting research
• Educating the health workforce
• Tracking diseases
• Monitoring public health.
Sources: 1) WHO Global Observatory of eHealth (GOe) (www.who.int/goe)
2) World Health Assembly, 2005. Resolution WHA58.28
Slide adapted from: Mark Landry, WHO WPRO & Dr. Boonchai Kijsanayotin
eHealth
68
eHealth  Health IT
Slide adapted from: Dr. Boonchai Kijsanayotin
eHealth & Health IT
69
Health
Information
Technology
Goal
Value-Add
Tools
Health IT: What’s in a Word?
70
Hospital Information System (HIS) Computerized Physician Order Entry (CPOE)
Electronic
Health
Records
(EHRs)
Picture Archiving and
Communication System
(PACS)
Various Forms of Health IT
71
m-Health
Health Information
Exchange (HIE)
Biosurveillance
Telemedicine &
Telehealth
Images from Apple Inc., Geekzone.co.nz, Google, PubMed.gov, and American Telecare, Inc.
Personal Health Records
(PHRs)
Health IT Beyond Hospitals
72
Health IT for Medication Safety
Ordering Transcription Dispensing Administration
CPOE
Automatic
Medication
Dispensing
Electronic
Medication
Administration
Records
(e-MAR)
Barcoded
Medication
Administration
Barcoded
Medication
Dispensing
73
Hospital A Hospital B
Clinic C
Government
Lab Patient at Home
Health Information Exchange
74
My Life-Long Dream...
75WHO & ITU
Achieving Health Information Exchange (HIE)
76
• The Large N Interfaces Problem
N = 2, Interface = 1
# Interfaces = N(N-1)/2
N = 3, Interface = 3
N = 5, Interface = 10
N = 100, Interface = 4,950
Standards: Why?
77
นวนรรน ธีระอัมพรพันธุ์. ตำนำนควำมเชื่อและข้อเท็จจริงเกี่ยวกับมำตรฐำนสำรสนเทศทำงสุขภำพ. ใน: Health
Data Standards Expo: From Reimbursement to Clinical Excellence; 2011 Aug 8-9; Bangkok,
Thailand. Bangkok (Thailand): Mahidol University, Faculty of Medicine Ramathibodi Hospital;
2011 Aug.
http://www.slideshare.net/nawanan/myths-and-truths-on-health-information-standards
Myths & Truths on Standards
78
Myths
• We don’t need standards
• Standards are IT people’s jobs
• We should exclude vendors from this
• We need the same software to share data
• We need to always adopt international
standards
• We need to always use local standards
Theera-Ampornpunt (2011)
Myths & Truths on Standards
79
Being Smart #5:
Go for Systems that Use
Standards, Not a Unified,
Conquer-the-World System
Image Source: http://www.denofgeek.com/movies/avengers/37236/why-loki-was-cut-from-avengers-age-of-ultron
80
The Road to Digitizing Healthcare
What is a “Smart Hospital”?
 Toward a “Smart” Hospital
Outline
81
A Smart Machine: DeepMind
Image Sources: http://www.ibtimes.com/google-deepminds-alphago-
program-defeats-human-go-champion-first-time-ever-2283700
http://deepmind.com/
82Image Source: socialmediab2b.com
Another Smart Machine: IBM’s Watson
83Image Source: englishmoviez.com
Rise of the Machines?
84Image Source: amazon.com
Smart Phones, Dumb People?
85
Smart Hospital,
Dumb...?
86
Clinical Decision Support Systems
• CDSS as a replacement or supplement of
clinicians?
– The demise of the “Greek Oracle” model (Miller & Masarie, 1990)
The “Greek Oracle” Model
The “Fundamental Theorem” Model
Friedman (2009)
Wrong Assumption
Correct Assumption
87
Being Smart #6:
Don’t Replace
Human Users.
Use ICT to Help Them
Perform Smarter & Better.
88
Some Risks of Clinical Decision Support Systems
• Alert Fatigue
Unintended Consequences of Health IT
89
Workarounds
Unintended Consequences of Health IT
90
Being Smart #7:
Health IT Also Have
Risks &
Unintended Consequences
91
Balanced Focus of Informatics
Technology
ProcessPeople
92
Being Smart #8:
Balance Your Focus
(People, Process, Technology)
93The sailboat image source: Uwe Kils via http://en.wikipedia.org/wiki/Sailing
The destination
The boat
The sailor(s) &
people on board
The tailwind The headwind
The direction
The speed
The past journey
The sea
The sail
The current location
IT & Organizational Context
94
Being Smart #9:
Know Your Context &
Align IT with that Context
95
A 900-Bed University Hospital
Vision To be a leading hospital in
Asia with excellence in
healthcare services, education,
and research
A 200-Bed Private Hospital
Vision To be a leading High Tech
High Touch hospital in Thailand
Vision, Mission & IT Strategies
96
Carr (2004) Carr (2003)
IT as “The Sail”
97
Strategic
Operational
ClinicalAdministrative
LIS
Health Information ExchangeBusiness
Intelligence
Word
Processor
Social
Media
PACS
4 Quadrants of Hospital IT
Personal Health Records
Clinical Decision Support Systems
Computerized Physician Order Entry
Electronic Health Records
Admission-Discharge-Transfer
Master Patient Index
Enterprise Resource Planning
Vendor-Managed Inventory
Customer Relationship Management
98
Being Smart #10:
Identify Your
Strategic IT Assets
99
People
Techno-
logy
Process
“The Sailors”
100
A 900-Bed University Hospital
• Average age of personnel at 42
years (range 20-65)
• IT department consists of new,
young members and senior
members who developed the first
version of its systems
• Doctors are highly individualistic,
most also practice in private
hospitals, high turn-over rate
• Nurses and other professions often
view doctors as hospital’s “elites”
and often have heated debates
with them
A 200-Bed Private Hospital
• Average age of personnel at 32
years (range 20-57)
• Strong IT department
• Doctors typically don’t interact
with other staff, income is the
main motivator
• Executives are highly respected
by all professions as visionary
and high-performing
“The Sailors”
101Ash et al. (2003)
The “Special People”
102Ash et al. (2003)
• Administrative
Leadership Level
–CEO
•Provides top level
support and vision
•Holds steadfast
•Connects with the
staff
•Listens
•Champions
– CIO
• Selects champions
• Gains support
• Possesses vision
• Maintains a thick skin
– CMIO
• Interprets
• Possesses vision
• Maintains a thick skin
• Influences peers
• Supports the clinical support
staff
• Champions
The “Special People”
103Ash et al. (2003)
• Clinical Leadership
Level
– Champions
• Necessary
• Hold steadfast
• Influence peers
• Understand other
physicians
– Opinion leaders
• Provide a balanced
view
• Influence peers
– Curmudgeons
• “Skeptic who is
usually quite vocal in
his or her disdain of
the system”
• Provide feedback
• Furnish leadership
– Clinical advisory
committees
• Solve problems
• Connect units
The “Special People”
104Ash et al. (2003)
• Bridger/Support level
–Trainers & support
team
•Necessary
•Provide help at the
elbow
•Make changes
•Provide training
•Test the systems
–Skills
•Possess clinical
backgrounds
•Gain skills on the
job
•Show patience,
tenacity, and
assertiveness
The “Special People”
105
Being Smart #11:
Manage Your
“Special People” Well
106
A True Story of Failure to
Involve Users in Hospital IT
Implementation
107
Being Smart #12:
Involve Users Early &
Intensively in Your Process
108
Image source: Jeremy Kemp via http://en.wikipedia.org/wiki/Hype_cycle
http://www.gartner.com/technology/research/methodologies/hype-cycle.jsp
Gartner Hype Cycle
109
Rogers (2003)
Rogers’ Diffusion of Innovations:
Adoption Curve
110
• Communications of project plans & progresses
• Workflow considerations
• Management support of IT projects
• Common visions
• Shared commitment
• Multidisciplinary user involvement
• Project management
• Training
• Innovativeness
• Organizational learning
Theera-Ampornpunt (2009, 2011)
Success Factors of Hospital IT Adoption
111
Being Smart #13:
Work Smartly with
Smart People
112
To become a smart hospital, you must
• Know what is “smart” all about
• Know how to use smart machines
together with smart people
• Manage both of them smartly
Summary
113
2003 M.D. (First-Class Honors)
2011 Ph.D. (Health Informatics), Univ. of Minnesota
Lecturer, Department of Community Medicine
Faculty of Medicine Ramathibodi Hospital
Mahidol University
Interests: Health IT for Quality of Care, Social Media
IT Management, Security & Privacy
nawanan.the@mahidol.ac.th
SlideShare.net/Nawanan
นวนรรน ธีระอัมพรพันธุ์ (Nawanan Theera-Ampornpunt)
Line ID: NawananT
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ICT in Healthcare

  • 1. ICT in Healthcare Nawanan Theera-Ampornpunt October 21, 2016
  • 2. 2 2003 M.D. (First-Class Honors) 2011 Ph.D. (Health Informatics), Univ. of Minnesota Lecturer, Department of Community Medicine Faculty of Medicine Ramathibodi Hospital Mahidol University Interests: Health IT for Quality of Care, Social Media IT Management, Security & Privacy nawanan.the@mahidol.ac.th SlideShare.net/Nawanan นวนรรน ธีระอัมพรพันธุ์ (Nawanan Theera-Ampornpunt) Line ID: NawananT Introduction
  • 3. 3  The Road to Digitizing Healthcare  What is a “Smart Hospital”?  Toward a “Smart” Hospital Outline
  • 5. 5 Let’s take a look at these pictures...
  • 6. 6Image Source: https://en.wikipedia.org/wiki/Industrial_robot (KUKA Roboter GmbH) “Smart” Manufacturing
  • 8. 8ER - Image Source: nj.com Healthcare (On TV)
  • 9. 9 (At an undisclosed hospital) Healthcare (Reality)
  • 10. 10 • 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 Why Healthcare Isn’t (Yet) “Smart”?
  • 11. 11 But...Are We That Different? Input Process Output Transfer Banking Value-Add - Security - Convenience - Customer Service Location A Location B
  • 12. 12 Input Process Output Assembling Manufacturing Raw Materials Finished Goods Value-Add - Innovation - Design - QC But...Are We That Different?
  • 13. 13 Input Process Output Patient Care Health care Sick Patient Well Patient Value-Add - Technology & medications - Clinical knowledge & skilled providers - Quality of care; process improvement - Customer service - Information But...Are We That Different?
  • 14. 14 • Large variations & contextual dependence Input Process Output Patient Presentation Decision- Making Biological Responses Standardizing Healthcare
  • 15. 15 The World of Smart Machines Image Sources: http://www.ibtimes.com/google-deepminds-alphago- program-defeats-human-go-champion-first-time-ever-2283700 http://deepmind.com/
  • 16. 16 Digitizing Healthcare Image Source: http://www.bloomberg.com/bw/stories/2005-03-27/cover-image-the-digital-hospital
  • 17. 17 “To computerize the hospital” “To go paperless” “To become a Digital Hospital” “To Have EHRs” Why Adopting Health IT?
  • 18. 18 • “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) Some “Smart” Quotes
  • 19. 19 Being Smart #1: Stop Your “Drooling Reflex”!!
  • 20. 20 Being Smart #2: Focus on Information & Process Improvement, Not Technology
  • 21. 21 If not “Digital Hospital” or “Paperless Hospital” Then What Should We Aspire to Be?
  • 23. 23 So How is a “Smart Hospital” Different from a Digital or Paperless Hospital?
  • 25. 25 Healthcare 1.0 • Thai Traditional Medicine in the Ancient Times Healthcare 1.0 - 4.0 is the speaker’s personal opinion and may not represent official views of the Ministry of Public Health Image & Caption Source: http://kanchanapisek.or.th/kp6/sub/book/book.php?book=33&chap=8&page=t33-8-detail.html http://kanchanapisek.or.th/kp6/sub/book/book.php?book=33&chap=8&page=t33-8-infodetail02.html การย่อยขนาดตัวยาสมุนไพร โดยใช้ครกตาและหินบดยา ของโรงศิริราชพยาบาล (ปัจจุบันคือ โรงพยาบาลศิริราช) คนไทยสมัยก่อนมักให้บุคคลในครอบครัวบีบนวดได้
  • 26. 26 Healthcare 2.0 • Modern (Western) Medicine Healthcare 1.0 - 4.0 is the speaker’s personal opinion and may not represent official views of the Ministry of Public Health Image & Caption Source: http://kanchanapisek.or.th/kp6/sub/book/book.php?book=33&chap=8&page=t33-8-detail.html http://kanchanapisek.or.th/kp6/sub/book/book.php?book=33&chap=8&page=t33-8-infodetail02.html
  • 27. 27 Healthcare 3.0 • Quality-Driven Healthcare Healthcare 1.0 - 4.0 is the speaker’s personal opinion and may not represent official views of the Ministry of Public Health Image & Caption Source: http://kanchanapisek.or.th/kp6/sub/book/book.php?book=33&chap=8&page=t33-8-detail.html http://kanchanapisek.or.th/kp6/sub/book/book.php?book=33&chap=8&page=t33-8-infodetail02.html
  • 28. 28 Healthcare 4.0 • Smart Healthcare & Smart Hospital Healthcare 1.0 - 4.0 is the speaker’s personal opinion and may not represent official views of the Ministry of Public Health Image & Caption Source: http://kanchanapisek.or.th/kp6/sub/book/book.php?book=33&chap=8&page=t33-8-detail.html http://kanchanapisek.or.th/kp6/sub/book/book.php?book=33&chap=8&page=t33-8-infodetail02.html
  • 29. 29 So What Is Smart Healthcare?
  • 30. 30 Smart Healthcare For Policymakers? Image Source: http://healthdata.moph.go.th/kpi/2557/ProvinceKpiTopicListAll.php?provincecode=99
  • 31. 31 Smart Healthcare For Health Promoters? Image Source: http://www.hiso.or.th/hiso/picture/reportHealth/ThaiHealth2014/thai2014_3.pdf
  • 32. 32 Smart Healthcare For Clinicians? Image Source: http://www.medscape.com/viewarticle/780298
  • 33. 33 Smart Healthcare For Patients & Consumers? Image Source: Agence France-Presse/Getty Images
  • 34. 34 So What Exactly Is Smart Healthcare? Image Source: http://cdn2.hubspot.net/hub/134568/file-1208368053-jpg/6-blind-men-hans.jpg
  • 35. 35 The Road to Digitizing Healthcare  What is a “Smart Hospital”?  Toward a “Smart” Hospital Outline
  • 37. 37 Connecting People to a Healthy Future With Personalized Care – Kaiser Permanente https://www.youtube.com/watch?v=gxz9ZVvduGc
  • 39. 39 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) What Clinicians Want?
  • 40. 40 • 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
  • 42. 42 “Information” in Medicine Shortliffe EH. Biomedical informatics in the education of physicians. JAMA. 2010 Sep 15;304(11):1227-8.
  • 44. 44 44 WHO (2009) WHO Health System Framework
  • 45. 45 • 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/ Being “Smart” in Healthcare
  • 46. 46 • Efficient –Faster care –Time & cost savings –Reducing unnecessary tests • Equitable –Access to providers & knowledge • Patient-Centered –Empowerment & better self-care Being “Smart” in Healthcare
  • 47. 47 (IOM, 2001)(IOM, 2000) (IOM, 2011) Landmark Institute of Medicine Reports
  • 48. 48 • To Err is Human (IOM, 2000) reported that: – 44,000 to 98,000 people die in U.S. hospitals each year as a result of preventable medical mistakes – Mistakes cost U.S. hospitals $17 billion to $29 billion yearly – Individual errors are not the main problem – Faulty systems, processes, and other conditions lead to preventable errors Patient Safety
  • 49. 49 Summary of These Reports • 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
  • 50. 50 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 To Err is Human 1: Attention
  • 51. 51Image Source: Suthan Srisangkaew, Department of Pathology, Facutly of Medicine Ramathibodi Hospital To Err is Human 2: Memory
  • 52. 52 • Cognitive Errors - Example: Decoy Pricing The Economist Purchase Options • Economist.com subscription $59 • Print subscription $125 • Print & web subscription $125 Ariely (2008) 16 0 84 The Economist Purchase Options • Economist.com subscription $59 • Print & web subscription $125 68 32 # of People # of People To Err is Human 3: Cognition
  • 53. 53 • It already happens.... (Mamede et al., 2010; Croskerry, 2003; Klein, 2005; Croskerry, 2013) What If This Happens in Healthcare?
  • 54. 54 Klein JG. Five pitfalls in decisions about diagnosis and prescribing. BMJ. 2005 Apr 2;330(7494):781-3. “Everyone makes mistakes. But our reliance on cognitive processes prone to bias makes treatment errors more likely than we think” Cognitive Biases in Healthcare
  • 55. 55 • Medication Errors –Drug Allergies –Drug Interactions • Ineffective or inappropriate treatment • Redundant orders • Failure to follow clinical practice guidelines Common Errors
  • 56. 56 Being Smart #3: “To Err is Human”
  • 57. 57 External Memory Knowledge Data Long Term Memory Knowledge Data Inference DECISION PATIENT Perception Attention Working Memory CLINICIAN Elson, Faughnan & Connelly (1997) Clinical Decision Making
  • 58. 58 Example of “Alerts & Reminders” Reducing Errors through “Alerts & Reminders”
  • 59. 59 Why We Need ICT in Healthcare? #1: Because information is everywhere in healthcare
  • 60. 60 Why We Need ICT in Healthcare? #2: Because healthcare is error-prone and technology can help
  • 62. 62 Why We Need ICT in Healthcare? #3: Because access to high-quality patient information should improve care
  • 63. 63 Why We Need ICT in Healthcare? #4: Because healthcare at all levels is fragmented & in need of process improvement
  • 64. 64 Documented Values of Health IT • Guideline adherence • Better documentation • Practitioner decision making or process of care • Medication safety • Patient surveillance & monitoring • Patient education/reminder
  • 65. 65 Being Smart #4: Link IT Values to Quality (Including Safety)
  • 66. 66 Use of information and communications technology (ICT) in health & healthcare settings Source: The Health Resources and Services Administration, Department of Health and Human Service, USA Slide adapted from: Dr. Boonchai Kijsanayotin Health IT
  • 67. 67 Use of information and communications technology (ICT) for health; Including • Treating patients • Conducting research • Educating the health workforce • Tracking diseases • Monitoring public health. Sources: 1) WHO Global Observatory of eHealth (GOe) (www.who.int/goe) 2) World Health Assembly, 2005. Resolution WHA58.28 Slide adapted from: Mark Landry, WHO WPRO & Dr. Boonchai Kijsanayotin eHealth
  • 68. 68 eHealth  Health IT Slide adapted from: Dr. Boonchai Kijsanayotin eHealth & Health IT
  • 70. 70 Hospital Information System (HIS) Computerized Physician Order Entry (CPOE) Electronic Health Records (EHRs) Picture Archiving and Communication System (PACS) Various Forms of Health IT
  • 71. 71 m-Health Health Information Exchange (HIE) Biosurveillance Telemedicine & Telehealth Images from Apple Inc., Geekzone.co.nz, Google, PubMed.gov, and American Telecare, Inc. Personal Health Records (PHRs) Health IT Beyond Hospitals
  • 72. 72 Health IT for Medication Safety Ordering Transcription Dispensing Administration CPOE Automatic Medication Dispensing Electronic Medication Administration Records (e-MAR) Barcoded Medication Administration Barcoded Medication Dispensing
  • 73. 73 Hospital A Hospital B Clinic C Government Lab Patient at Home Health Information Exchange
  • 75. 75WHO & ITU Achieving Health Information Exchange (HIE)
  • 76. 76 • The Large N Interfaces Problem N = 2, Interface = 1 # Interfaces = N(N-1)/2 N = 3, Interface = 3 N = 5, Interface = 10 N = 100, Interface = 4,950 Standards: Why?
  • 77. 77 นวนรรน ธีระอัมพรพันธุ์. ตำนำนควำมเชื่อและข้อเท็จจริงเกี่ยวกับมำตรฐำนสำรสนเทศทำงสุขภำพ. ใน: Health Data Standards Expo: From Reimbursement to Clinical Excellence; 2011 Aug 8-9; Bangkok, Thailand. Bangkok (Thailand): Mahidol University, Faculty of Medicine Ramathibodi Hospital; 2011 Aug. http://www.slideshare.net/nawanan/myths-and-truths-on-health-information-standards Myths & Truths on Standards
  • 78. 78 Myths • We don’t need standards • Standards are IT people’s jobs • We should exclude vendors from this • We need the same software to share data • We need to always adopt international standards • We need to always use local standards Theera-Ampornpunt (2011) Myths & Truths on Standards
  • 79. 79 Being Smart #5: Go for Systems that Use Standards, Not a Unified, Conquer-the-World System Image Source: http://www.denofgeek.com/movies/avengers/37236/why-loki-was-cut-from-avengers-age-of-ultron
  • 80. 80 The Road to Digitizing Healthcare What is a “Smart Hospital”?  Toward a “Smart” Hospital Outline
  • 81. 81 A Smart Machine: DeepMind Image Sources: http://www.ibtimes.com/google-deepminds-alphago- program-defeats-human-go-champion-first-time-ever-2283700 http://deepmind.com/
  • 82. 82Image Source: socialmediab2b.com Another Smart Machine: IBM’s Watson
  • 84. 84Image Source: amazon.com Smart Phones, Dumb People?
  • 86. 86 Clinical Decision Support Systems • CDSS as a replacement or supplement of clinicians? – The demise of the “Greek Oracle” model (Miller & Masarie, 1990) The “Greek Oracle” Model The “Fundamental Theorem” Model Friedman (2009) Wrong Assumption Correct Assumption
  • 87. 87 Being Smart #6: Don’t Replace Human Users. Use ICT to Help Them Perform Smarter & Better.
  • 88. 88 Some Risks of Clinical Decision Support Systems • Alert Fatigue Unintended Consequences of Health IT
  • 90. 90 Being Smart #7: Health IT Also Have Risks & Unintended Consequences
  • 91. 91 Balanced Focus of Informatics Technology ProcessPeople
  • 92. 92 Being Smart #8: Balance Your Focus (People, Process, Technology)
  • 93. 93The sailboat image source: Uwe Kils via http://en.wikipedia.org/wiki/Sailing The destination The boat The sailor(s) & people on board The tailwind The headwind The direction The speed The past journey The sea The sail The current location IT & Organizational Context
  • 94. 94 Being Smart #9: Know Your Context & Align IT with that Context
  • 95. 95 A 900-Bed University Hospital Vision To be a leading hospital in Asia with excellence in healthcare services, education, and research A 200-Bed Private Hospital Vision To be a leading High Tech High Touch hospital in Thailand Vision, Mission & IT Strategies
  • 96. 96 Carr (2004) Carr (2003) IT as “The Sail”
  • 97. 97 Strategic Operational ClinicalAdministrative LIS Health Information ExchangeBusiness Intelligence Word Processor Social Media PACS 4 Quadrants of Hospital IT Personal Health Records Clinical Decision Support Systems Computerized Physician Order Entry Electronic Health Records Admission-Discharge-Transfer Master Patient Index Enterprise Resource Planning Vendor-Managed Inventory Customer Relationship Management
  • 98. 98 Being Smart #10: Identify Your Strategic IT Assets
  • 100. 100 A 900-Bed University Hospital • Average age of personnel at 42 years (range 20-65) • IT department consists of new, young members and senior members who developed the first version of its systems • Doctors are highly individualistic, most also practice in private hospitals, high turn-over rate • Nurses and other professions often view doctors as hospital’s “elites” and often have heated debates with them A 200-Bed Private Hospital • Average age of personnel at 32 years (range 20-57) • Strong IT department • Doctors typically don’t interact with other staff, income is the main motivator • Executives are highly respected by all professions as visionary and high-performing “The Sailors”
  • 101. 101Ash et al. (2003) The “Special People”
  • 102. 102Ash et al. (2003) • Administrative Leadership Level –CEO •Provides top level support and vision •Holds steadfast •Connects with the staff •Listens •Champions – CIO • Selects champions • Gains support • Possesses vision • Maintains a thick skin – CMIO • Interprets • Possesses vision • Maintains a thick skin • Influences peers • Supports the clinical support staff • Champions The “Special People”
  • 103. 103Ash et al. (2003) • Clinical Leadership Level – Champions • Necessary • Hold steadfast • Influence peers • Understand other physicians – Opinion leaders • Provide a balanced view • Influence peers – Curmudgeons • “Skeptic who is usually quite vocal in his or her disdain of the system” • Provide feedback • Furnish leadership – Clinical advisory committees • Solve problems • Connect units The “Special People”
  • 104. 104Ash et al. (2003) • Bridger/Support level –Trainers & support team •Necessary •Provide help at the elbow •Make changes •Provide training •Test the systems –Skills •Possess clinical backgrounds •Gain skills on the job •Show patience, tenacity, and assertiveness The “Special People”
  • 105. 105 Being Smart #11: Manage Your “Special People” Well
  • 106. 106 A True Story of Failure to Involve Users in Hospital IT Implementation
  • 107. 107 Being Smart #12: Involve Users Early & Intensively in Your Process
  • 108. 108 Image source: Jeremy Kemp via http://en.wikipedia.org/wiki/Hype_cycle http://www.gartner.com/technology/research/methodologies/hype-cycle.jsp Gartner Hype Cycle
  • 109. 109 Rogers (2003) Rogers’ Diffusion of Innovations: Adoption Curve
  • 110. 110 • Communications of project plans & progresses • Workflow considerations • Management support of IT projects • Common visions • Shared commitment • Multidisciplinary user involvement • Project management • Training • Innovativeness • Organizational learning Theera-Ampornpunt (2009, 2011) Success Factors of Hospital IT Adoption
  • 111. 111 Being Smart #13: Work Smartly with Smart People
  • 112. 112 To become a smart hospital, you must • Know what is “smart” all about • Know how to use smart machines together with smart people • Manage both of them smartly Summary
  • 113. 113 2003 M.D. (First-Class Honors) 2011 Ph.D. (Health Informatics), Univ. of Minnesota Lecturer, Department of Community Medicine Faculty of Medicine Ramathibodi Hospital Mahidol University Interests: Health IT for Quality of Care, Social Media IT Management, Security & Privacy nawanan.the@mahidol.ac.th SlideShare.net/Nawanan นวนรรน ธีระอัมพรพันธุ์ (Nawanan Theera-Ampornpunt) Line ID: NawananT Q&A