Overview of Hospital Information mHealth . Biosurveillance . Telemedicine & Telehealth . Images...

download Overview of Hospital Information mHealth . Biosurveillance . Telemedicine & Telehealth . Images from

of 50

  • date post

    08-Oct-2020
  • Category

    Documents

  • view

    0
  • download

    0

Embed Size (px)

Transcript of Overview of Hospital Information mHealth . Biosurveillance . Telemedicine & Telehealth . Images...

  • Overview of Hospital Information Systems

    บุญชัย กิจสนาโยธิน M.D., Ph.D.(Health Informatics)

    นวนรรน ธีระอัมพรพันธุ M.D., Ph.D.(Health Informatics)

    PHARMACY INFORMATICS EDUCATIONAL SERIES

    โครงการอบรมการพัฒนาและจัดการระบบขอมูลเภสัชกรรมในโรงพยาบาล

    : การเตรียมขอมูลยาเพ่ือการเบิกจาย

    วันที่ 18 มิถุนายน 2557

    คณะเภสัชศาสตร จุฬาลงกรณมหาวิทยาลัย

  • 2

    Outline

    • Healthcare & Information • Why We Need ICT in Healthcare • Health IT • Hospital Information Systems • Health Information Exchange • Q&A

  • 3

    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)

  • 4

    High Quality Care

    • 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.

  • 5

    Information is Everywhere in Healthcare

    Shortliffe EH. Biomedical informatics in the education of physicians. JAMA. 2010 Sep 15;304(11):1227-8.

  • 6

    Why We Need ICT in Healthcare?

    #1: Because information is everywhere in healthcare

  • 7

    (IOM, 2001) (IOM, 2000) (IOM, 2011)

    Landmark IOM Reports

    (IOM, 2003)

  • 8

    Patient Safety

    • 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 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US: Regulating Healthcare - Lecture d

  • 9

    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

  • 10 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

  • 11 Image Source: Suthan Srisangkaew, Department of Pathology, Facutly of Medicine Ramathibodi Hospital, Mahidol University

    To Err is Human 2: Memory

  • 12

    To Err is Human 3: Cognition

    • 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

  • 13

    Cognitive Biases in Healthcare

    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”

  • 14

    • Medication Errors

    – Drug Allergies

    – Drug Interactions

    • Ineffective or inappropriate treatment

    • Redundant orders

    • Failure to follow clinical practice guidelines

    Common Errors

  • 15

    Why We Need ICT in Healthcare?

    #2: Because healthcare is error-prone and technology

    can help

  • 16

    Why We Need ICT in Healthcare?

    #3: Because access to high-quality patient

    information improves care

  • 17

    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: Boonchai Kijsanayotin

    Health IT

  • 18

    Health Information Technology

    Goal

    Value-Add

    Tools

    Health IT: What’s in a Word?

  • 19

    • Patient’s Health • Population’s Health •Organization’s Health

    (Quality, Reputation & Finance)

    “Health” in “Health IT”

  • 20

    Hospital Information System (HIS) Computerized Provider Order Entry (CPOE)

    Electronic Health

    Records (EHRs)

    Picture Archiving and Communication System

    (PACS)

    Various Forms of Health IT

    Screenshot Images from Faculty of Medicine Ramathibodi Hospital, Mahidol University

  • 21

    mHealth

    Biosurveillance

    Telemedicine & Telehealth

    Images from Apple Inc., Geekzone.co.nz, Google, HealthVault.com and American Telecare, Inc.

    Personal Health Records (PHRs) and Patient Portals

    Still Many Other Forms of Health IT

  • 22

    • Guideline adherence • Better documentation • Practitioner decision making or

    process of care • Medication safety • Patient surveillance & monitoring • Patient education/reminder

    Values of Health IT

  • 23

    • Master Patient Index (MPI) • Admit-Discharge-Transfer (ADT) • Electronic Health Records (EHRs) • Computerized Physician Order Entry (CPOE) • Clinical Decision Support Systems (CDS) • Picture Archiving and Communication System

    (PACS) • Nursing applications • Enterprise Resource Planning (ERP) - Finance,

    Materials Management, Human Resources

    Enterprise-wide Hospital IT

  • 24

    • Pharmacy applications

    • Laboratory Information System (LIS)

    • Radiology Information System (RIS)

    • Specialized applications (ER, OR, LR, Anesthesia, Critical Care, Dietary Services, Blood Bank)

    • Incident management & reporting system

    Departmental IT in Hospitals

  • Hospital Information Systems EHR

    EMR PHR

    HIS - EHR – EMR – PHR relationship

    EHR= Electronic Health Record EMR= Electronic Medical Record PHR= Personal Health Record

  • 26

    Computerized Provider Order Entry (CPOE)

  • 27

    Values

    • No handwriting!!! • Structured data entry: Completeness, clarity,

    fewer mistakes (?) • No transcription errors! • Streamlines workflow, increases efficiency

    Computerized Provider Order Entry (CPOE)

  • 28

    Ordering Transcription Dispensing Administration

    CPOE Automatic Medication Dispensing

    Electronic Medication

    Administration Records (e-MAR)

    Barcoded Medication

    Administration

    Barcoded Medication Dispensing

    Stages of Medication Process

  • 29

    • The real place where most of the values of health IT can be achieved – Expert systems

    • Based on artificial intelligence, machine learning, rules, or statistics

    • Examples: differential diagnoses, treatment options (Shortliffe, 1976)

    Clinical Decision Support Systems (CDS)

  • 30

    – Alerts & reminders • Based on specified logical conditions • Examples:

    – Drug-allergy checks – Drug-drug interaction checks – Reminders for preventive services – Clinical practice guideline integration

    Clinical Decision Support Systems (CDS)

  • 31

    Example of “Reminders”

  • 32

    • Reference information or evidence- based knowledge sources – Drug reference databases – Textbooks & journals – Online literature (e.g. PubMed) – Tools that help users easily access

    references (e.g. Infobuttons)

    More CDS Examples

  • 33

    Image Source: https://webcis.nyp.org/webcisdocs/what-are-infobuttons.html

    Infobuttons

  • 34

    • Pre-defined documents – Order sets, personalized “favorites” – Templates for clinical notes – Checklists – Forms

    • Can be either computer-based or paper-based

    Other CDS Examples

  • 35

    Image Source: http://www.hospitalmedicine.org/ResourceRoomRedesign/CSSSIS/html/06Reliable/SSI/Order.cfm

    Order Sets

  • 36

    • Simple UI designed to help clinical decision mak