Theera-Ampornpunt N. Information and technology: emergency medical informatics. Presented at: The International Conference in Emergency Medicine: Challenges in Emergency Medicine: It’s Time for Change!; 2012 Feb 1; Bangkok, Thailand. Invited speaker.

1. Informatics in Emergency Medicine:
A Brief Introduction
Nawanan Theera-Ampornpunt, MD, PhD
Faculty of Medicine Ramathibodi Hospital
http://www.slideshare.net/nawanan Feb 1, 2012

2. Outline
• Introduction about Biomedical & Health Informatics
• Emergency Medicine & Implications for Informatics
• Informatics Applications in Emergency Medicine
– EHRs & HIE
– PHRs
– mHealth
– Biosurveillance
• Conclusion
2

3. Biomedical & Health 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)
3

4. DIKW Pyramid
Wisdom
Knowledge
Information
Data
4

5. Informatics As A Field
5 Shortliffe (2002)

6. Because Information is Everywhere...
6

7. Emergency Departments (ED)
• Prone to errors because of
– Urgent nature
– Limited & at times unreliable patient history
– Time & resource constraints
• Scale & unpredictability of mass casualties &
disasters make it worse
• 32% of ED visits had information gaps which can
lead to prolonged ED stay (Stiell et al., 2003)
7

8. Informatics Roles in Emergency Medicine
• Provide patient information critical to care
• Information improves quality & efficiency of care
in ED, at least for some conditions
(e.g., Theera-Ampornpunt et al., 2009; Overhage et al., 2002;
Connelly et al., 2012)
• Role of health information exchange (HIE)
highlighted
• IT as transformational tools that improve care
processes
8

9. Why Adopting Health IT?
“To Go paperless” “To Computerize”
“To Get a HIS”
“Digital Hospital”
“To Have EMRs”
“To Modernize”
9 “To Share data”

10. Dimensions of Quality Healthcare
• Safety
• Timeliness
• Effectiveness
• Efficiency
• Equity
• Patient-centeredness
10 IOM (2001)

11. Better Information Delivery Improves
• Safety (prevent allergies)
• Timeliness (have access to information early)
• Effectiveness (information for decision-making)
• Efficiency (prevent unnecessary/redundant lab)
• Equity
• Patient-centeredness
11

12. IT as Tools for Process Redesign
• Safety (no handwriting!!, allergies/DI alerts)
• Timeliness (faster internal processes)
• Effectiveness (CDSS alerts & reminders)
• Efficiency (faster care, better patient flow, better
bed management)
12

13. Because... “To Err Is Human”
13

14. To Err Is Human
• Lack of Attention
14 Image Source: aafp.org

15. To Err Is Human
• Cognitive Errors - Example: Decoy Pricing
# of
The Economist Purchase Options People
• Economist.com subscription $59 16
• Print subscription $125 0
• Print & web subscription $125 84
# of
The Economist Purchase Options People
• Economist.com subscription $59 68
15 • Print & web subscription $125 32 Ariely (2008)

16. What If This Happens in Healthcare?
• It already happens....
(Mamede et al., 2010; Croskerry, 2003; Klein, 2005)
• What if health IT can help?
16

17. Clinical Decision Support Systems (CDSSs)
PATIENT
Perception
CLINICIAN
Attention
Long Term Memory External Memory
Working
Memory
Knowledge Data Knowledge Data
Inference
17 DECISION From a teaching slide by Don Connelly, 2006

18. Clinical Decision Support Systems (CDSSs)
PATIENT
Perception
CLINICIAN
Abnormal lab
Attention highlights
Long Term Memory External Memory
Working
Memory
Knowledge Data Knowledge Data
Inference
18
DECISION

19. Clinical Decision Support Systems (CDSSs)
PATIENT
Perception
CLINICIAN
Drug-Allergy
Attention Checks
Long Term Memory External Memory
Working
Memory
Knowledge Data Knowledge Data
Inference
19
DECISION

20. Clinical Decision Support Systems (CDSSs)
PATIENT
Drug-Drug
Perception Interaction
CLINICIAN
Checks
Attention
Long Term Memory External Memory
Working
Memory
Knowledge Data Knowledge Data
Inference
20
DECISION

21. Clinical Decision Support Systems (CDSSs)
• 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”
21 Friedman (2009)

22. Electronic Health Records (EHRs)
• Electronic documentation of patient care by
providers
• Sometimes defined as longitudinal records of a
patient’s health care
22

23. Electronic Health Record (EHR) Systems
• Are they just electronic documentation?
History Diag- Treat-
...
& PE nosis ments
• Or do they have some other values?
23

24. Benefits of Health IT
• Literature suggests improvement in health care
through
– Guideline adherence (Shiffman et al, 1999;Chaudhry et al, 2006)
– Better documentation (Shiffman et al, 1999)
– Practitioner decision making or process of care
(Balas et al, 1996;Kaushal et al, 2003;Garg et al, 2005)
– Medication safety (Kaushal et al, 2003;Chaudhry et al, 2006;van
Rosse et al, 2009)
– Patient surveillance & monitoring (Chaudhry et al, 2006)
– Patient education/reminder (Balas et al, 1996)
– Cost savings and better financial performance
(Parente & Dunbar, 2001;Chaudhry et al, 2006;Amarasingham et al,
2009;Borzekowski, 2009)
24

25. Functions that Should be Part of EHR Systems
• Computerized Medication Order Entry
• Computerized Laboratory Order Entry
• Computerized Laboratory Results
• Physician Notes
• Patient Demographics
• Problem Lists
• Medication Lists
• Discharge Summaries
• Diagnostic Test Results
• Radiologic Reports
25
IOM (2003), Blumenthal et al (2006)

26. Health Information Exchange (HIE)
Government
Hospital A Hospital B
Clinic C
Lab Patient at Home
26

27. Personal Health Records (PHRs)
• “An electronic application through which individuals can
access, manage and share their health information,
and that of others for whom they are authorized, in a
private, secure, and confidential environment.” (Markle
Foundation, 2003)
• “A PHR includes health information managed by the
individual... This can be contrasted with the clinician’s
record of patient encounter–related information [a
paperchart or EHR], which is managed by the clinician
and/or health care institution.” (Tang et al., 2006)
27

28. Types of PHRs
• Patient portal from a provider’s EHRs (“tethered” PHRs)
• Online PHRs
– Stand-alone
– Can be integrated with EHRs from multiple providers
(unidirectional/bidirectional data sharing)
• Stand-alone PHRs
– PC-based applications
– USB Drive
– CD-ROM or other data storage devices
– Paper
28

29. Use Cases of PHRs
• Data entry/update by patients
• Data retrieval by providers
– With patient’s consent
– “Break-the-glass” emergency access
• Data update from EHRs
• Privacy settings
• Personalized patient education & reminders
• Communications with providers
29

30. Mobile Health (mHealth)
• Exponential increase in mobile devices
• Technology penetration in rural, underserved
settings
• Democratization of information access
• Roles of social media
30

31. mHealth & Social Media in Disaster Management
• Communication, coordination & collaboration
tools for relief workers, disaster managers,
victims
• Used heavily in
– Haiti’s 2010 earthquake
– Japan’s 2011 earthquake & tsunami
– Thailand’s 2011 record flooding
31

32. What Happened in Thailand in 2011?
• Unusually heavy rainfalls
• Flooding began in the north, continued
downstream to Gulf of Thailand
• Dams insufficient capacity to handle the
amount of water
• Severe flooding in ~ 1/3 of Thailand
• Record flooding in 50 years
Wikipedia
32

33. Impact
• 800+ deaths
• Many millions affected
• Residences, businesses,
factories & industrial complexes,
hospitals, etc. all affected
• Historic sites damaged
• Economic impact: (est.) $46
billion (World Bank)
33 Thaiflood.com (10/28/2011)

34. mHealth & Social Media in Thailand’s Flooding
• Situation monitoring tools (central government)
34 http://www.kromchol.com/

35. mHealth & Social Media in Thailand’s Flooding
• Situation monitoring tools (local BKK government)
35 http://dds.bangkok.go.th/Canal/

36. mHealth & Social Media in Thailand’s Flooding
• Non-governmental information dissemination
36 http://www.thaiflood.com

37. mHealth & Social Media in Thailand’s Flooding
• Preparedness, Educational & Advocacy Tools
37 http://www.youtube.com/user/roosuflood

38. mHealth & Social Media in Thailand’s Flooding
• Healthcare provider & MoPH coordination
38 https://www.facebook.com/groups/mophwarroomcoordination/

39. mHealth & Social Media in Thailand’s Flooding
• Simply to tell the world how we are doing...
39 Ayutthaya Hospital, late October © Suthasinee Senasu, MD (2011)

40. mHealth & Social Media in Thailand’s Flooding
• Simply to tell the world how we are doing...
40 Ayutthaya Hospital, late October © Suthasinee Senasu, MD (2011)

41. Biosurveillance
41

42. Google Flu Trends (Biosurveillance)
42 Source: Google.org/FluTrends

43. Conclusion
• Health IT and informatics
– Provide information for high quality emergency care
– Have potential to transform care processes (not just
computerizing patient care)
– Come in various forms (EHRs, CDSS, HIE, PHRs,
mHealth, biosurveillance)
• Increasing roles of health IT and informatics for
tomorrow’s emergency and disaster management
• New innovations & new uses of IT discovered
43
through every emergency situation

44. Questions?
44