27. • “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
36. 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
38. A safe, effective care that
focus on us, the patients,
and our needs
What Patients Want
39. • Safe (ปลอดภัย)
• Timely (ทันเวลา)
• Effective (มีประสิทธิผล)
• Patient-Centered
(ยึดผู้ป่วยเป็นศูนย์กลาง)
• Efficient (มีประสิทธิภาพ)
• Equitable (เป็นธรรม)
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.
Quality of Care
43. • Safe
–Drug allergies
–Medication Reconciliation
• Timely
–Complete information at point of care
• Effective
–Better clinical decision-making
Being “Smart” in Healthcare
44. • Patient-Centered
–Empowerment & better self-care
• Efficient
–Faster care
–Time & cost savings
–Reducing unnecessary tests
• Equitable
–Access to providers & knowledge
Being “Smart” in Healthcare
46. • 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
47. • 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
Summary of These Reports
48. 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
49. Image Source: Suthan Srisangkaew, Department of Pathology, Facutly of Medicine Ramathibodi Hospital
To Err is Human 2: Memory
50. • Medication Errors
–Drug Allergies
–Drug Interactions
• Ineffective or inappropriate treatment
• Redundant orders
• Failure to follow clinical practice
guidelines
Common Errors
51. External Memory
Knowledge Data
Long Term Memory
Knowledge Data
Inference
DECISION
PATIENT
Perception
Attention
Working
Memory
CLINICIAN
Elson, Faughnan & Connelly (1997)
Clinical Decision Making
52. Example of “Alerts & Reminders”
Reducing Errors through Alerts & Reminders
53. • Guideline adherence
• Better documentation
• Practitioner decision making or
process of care
• Medication safety
• Patient surveillance & monitoring
• Patient education/reminder
Documented Values of Health IT
54. Tip #3: Link IT Values to
Quality (Including Safety)
56. Hospital Information System (HIS) Computerized Physician Order Entry (CPOE)
Electronic
Health
Records
(EHRs)
Picture Archiving and
Communication System
(PACS)
Various Forms of Health IT
72. • 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?
73. 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 and Truths on Standards
74. 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 and Truths on Standards
75. Tip #4: 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. จับตาดู...
• การปฏิรูปของรัฐบาล: โครงการ PHRs, Long Term Care
• การผลักดัน eHealth Strategy ระดับชาติ
• นโยบาย Digital Economy ของรัฐบาล
• ภัยคุกคามด้าน privacy ใน healthcare ไทย
81. Calling All Dreamers...
Toward Healthcare 4.0 & Referral Center 4.0
“Dreamers need to stick together...
It's not programming, it's personal.”
-- Tomorrowland