3. Dengue: Epidemiology
Most rapidly spreading mosquito-borne
viral disease in the world
30-fold increase in incidence in the last
50 years
Epidemic dengue spread to new areas
Substantial burden on health sector &
economy
WHO Dengue Guidelines for Diagnosis, Treatment, Prevention and Control (2009)
4. Dengue: Prevention & Control
Dengue surveillance
Case management
Outbreak response
Integrated vector management
Social mobilization & communication
Research
Resolution SEA/RC61/R5 of WHO Regional Committee for South-East Asia (2008)
WHO Dengue Guidelines for Diagnosis, Treatment, Prevention and Control (2009)
5. Dengue: Clinical Management
WHO Dengue Guidelines for Diagnosis, Treatment, Prevention and Control (2009),
adapted from Yip (1980)
6. Dengue: Clinical Decisions
Diagnosis & differential diagnosis
Investigations
Phase & severity
Disposition: To send back home or to admit
Monitoring of patient status
Fluid management & transfusion decisions
Management of complications
7. Dengue: Differential diagnosis
Febrile Phase
Flu-like syndromes
Illnesses with a rash
Diarrheal diseases
Illnesses with neurological manifestations
Critical Phase
Infectious
Malignancies
Others (e.g. acute abdomen, metabolic conditions,
hematologic disorders)
WHO Dengue Guidelines for Diagnosis, Treatment, Prevention and Control (2009)
13. “To Err Is Human”
Lack of attention
Easily distracted
Limited memory
Difficulty putting relevant information together
(information overload?)
Inappropriate decisions (lapses, cognitive errors)
Poor decisions under pressure (emergencies)
Difficulty in monitoring & triage of patients
14. Roles of Health IT
Assists in documentation & assessments
Reminds or alerts
Servers as external memory
Better visualizations / information
presentations
Suggests management options
Guidelines at the point of care
Patient monitoring
16. Clinical Decision Support Systems
PATIENT
Perception
CLINICIAN
Attention
Long Term Memory External Memory
Working
Memory
Knowledge Data Knowledge Data
Inference
DECISION
17. Roles of Health IT in
Dengue Clinical Management
Online templates for complete patient
assessment & documentation
Alerts & Reminders
Decision support tools to offer
recommendations in case management
Electronic disease reporting
Information integration for early detection
of an outbreak
18. Clinical Decision Support Systems
PATIENT
Improved Guidelines &
information Perception References
CLINICIAN presentations Alerts &
(graphs, tracking Attention Reminders,
tools, etc.) Templates
Long Term Memory External Memory
Working
Memory
Knowledge Data Knowledge Data
Inference - Differential Dx
- Treatment
DECISION Recommendations
20. Disease Surveillance
Google Flu Trends uses search engine
keywords (non-clinical data)
Accuratefor practical purposes of detection
of possible outbreaks (not confirmation)
Imagine how it would be if we use clinical
data (e.g. chief complaints, diagnoses in
ER/clinics). Would it help us respond faster?
21. Opportunities for Tomorrow
Dengue management relatively
straightforward, easy to implement as logic
Improved IT infrastructure within hospitals &
clinics
Hospital information systems & electronic
health records common (high adoption)
Can be leveraged for better dengue
management within those settings
22. Infrastructure:
22
EHR Adoption in Thai Hospitals
Theera-Ampornpunt (2011)
23. Adoption Estimates: THAIS 2011
23
Estimate (Partial or Complete Adoption) Nationwide
Basic EHR, combined inpatient & outpatient 49.8%
settings
Comprehensive EHR, combined 5.3%
order entry of medications, combined 90.2%
order entry of all orders, combined 79.4%
Theera-Ampornpunt (2011)
24. Current State of IT Use in Dengue
Focus more on IT use in surveillance &
outbreak detection
Some uses in patient education,
teleconsultations, predictive modeling, &
basic research
Few studies on use of health IT to manage
dengue in clinical settings
25. Summary (1)
Dengue is an important epidemic
Management involves various steps
& criteria, maybe complicated for
non-experts
Errors inevitable for inexperienced
providers
26. Summary (2)
Health IT can be used to provide
better care, e.g. through decision
support
Opportunities exist for use of IT in
dengue
Call for more focus on development
& evaluation of IT uses in clinical
management of dengue