The document discusses information and communication technology (ICT) in healthcare. It begins with an introduction to the speaker, Nawanan Theera-Ampornpunt, which includes their background and credentials. The presentation then discusses various aspects of digitizing healthcare, including what constitutes a "smart hospital" compared to just a digital or paperless hospital. Key points are that a smart hospital focuses on using technology and information to improve quality, safety, efficiency and other aspects of patient care. The presentation also covers why healthcare needs ICT, examples of health IT tools, and the importance of standards to enable information exchange and interoperability between different healthcare providers and systems.
2. 2
2003 M.D. (First-Class Honors)
2011 Ph.D. (Health Informatics), Univ. of Minnesota
Assistant Dean for Policy and Informatics
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
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
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/
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
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
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
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
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
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
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
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
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
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
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
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
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”
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”
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
Assistant Dean for Policy and Informatics
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