ehealth Challenges
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Iris Thiele Isip Tan MD, MSc, FPCP, FPSEMChief, UP College of Medicine Medical Informatics UnitAssociate Professor 4, UP College of MedicineSection of Endocrinology, Diabetes & Metabolism, Philippine General Hospital
“Unitron Sky Walker” by pasukaru76, http://www.flickr.com/photos/pasukaru76/6271854325/
eHealth Challenges
7 Dec 2012
Saturday, December 8, 12
http://www.engineeringchallenges.org/cms/8996/9221.aspxSaturday, December 8, 12
http://www.engineeringchallenges.org/cms/8996/9221.aspxSaturday, December 8, 12
“jigsaw puzzle” by spekulator, http://www.sxc.hu/photo/944284
Make solar energy
economical
Provide energy from fusion Develop carbon
sequestration methods
Manage the nitrogen cycle
Provide access to
clean water
Advance health
informatics
Engineer better
medicines
Restore & improve urban infrastructure
Reverse-engineer the brain
Prevent nuclear terror
Secure cyberspaceEnhance
virtual reality
Advance personalized
learning
Engineer the tools of scientific discovery
Saturday, December 8, 12
Kulikowski et al. AMIA Board white paper: definition of biomedical informatics and specification of core
competencies for graduate education in the discipline. J Am Med Inform Assoc 2012;19:931-8.
Saturday, December 8, 12
Kulikowski et al. AMIA Board white paper: definition of biomedical informatics and specification of core
competencies for graduate education in the discipline. J Am Med Inform Assoc 2012;19:931-8.
Saturday, December 8, 12
eHealth Challenges
Image from katerha, http://www.flickr.com/photos/katerha/5021019816/
Center for Development of Advanced Computing (India)
Electronic Medical Record
Systems for improved patient education
and compliance
Data mining for medical knowledge
Saturday, December 8, 12
eHealth Challenges
Image from katerha, http://www.flickr.com/photos/katerha/5021019816/
Center for Development of Advanced Computing (India)
Electronic Medical Record
Saturday, December 8, 12
http://www2.fraserhealth.ca/media/how%20hazardous%20is%20healthcare%202.jpg
Saturday, December 8, 12
Adverse events
2.9%Colorado
& Utah
3.7%New York
Medical Errors
50%Ooops 44,000 -
98,000 deaths/year
To Err is Human: Building a Safer Health System
Institute of Medicine 1999
6.6-13.6% mortality
Saturday, December 8, 12
http://www.youtube.com/watch?v=7Ks3hezVSIM
Saturday, December 8, 12
Electronic Medical Record (EMR)
Core application for patient-specific information
Saturday, December 8, 12
EMR: Challenges
Structured data entry vs free text
Y N Visual disturbancesY N Eye itchingY N Eye pain
Saturday, December 8, 12
EMR: Challenges
Universally agreed-on medical vocabulary or standard terminology
Saturday, December 8, 12
EMR: Challenges• Protection of
patient privacy and confidentiality–Health Insurance
Portability and Accountability Act (1996)
Saturday, December 8, 12
Good information is the best medicine. Michael E. DeBakey, MD
Saturday, December 8, 12
http://youtu.be/2ikjOSmqpyo
Saturday, December 8, 12
EMR: Challenges
UsabilityIntegrate EMR into busy clinical workflow
Saturday, December 8, 12
“NextGen is unusable” by juhansonin,
http://www.flickr.com/photos/juhansonin/3857845956/
Saturday, December 8, 12
EMR: ChallengesOptimal computing device for the clinical setting?
Saturday, December 8, 12
Incident record
Patient record
Health record
Data generated when individual interacts with HCP
A series of incident records generated by specific HCP
All patient records generated over an individual’s lifetime by all HCPs who provide services
http://www.hc-sc.gc.ca/ohih-bsi/Saturday, December 8, 12
http://youtu.be/Lo_3qOejQzI
Saturday, December 8, 12
EMR: Challenges• Standards: to facilitate integration of
data, especially across systems from different vendors
–Digital Imaging & Communications in Medicine (DICOM)
–Health Level 7 (HL7)
Saturday, December 8, 12
http://www.emrindustry.com/index.php/will-next-generation-emrs-be-platform-stack-of-apps/
Saturday, December 8, 12
http://www.carepractice.com/emr-needs-a-kick-in-the-app-hole/
“The utopic future of medicine will seamlessly combine data from your daily apps and personalize a health treatment plan based on the life you actually live.”
Saturday, December 8, 12
Saturday, December 8, 12
http://vimeo.com/38063992
Saturday, December 8, 12
“As opposed to the doctor-centric, curative model of the past, the future is going to be
patient-centric and proactive.”Elias A. Zerhouni MD, NIH Director
Dec 2007
Image by JD Hancockhttp://www.flickr.com/photos/jdhancock/4100030094/
Saturday, December 8, 12
Participatory Medicine
Image by Liz Gracehttp://www.flickr.com/photos/liz-grace/5078868809/
“Movement in which networked patients shift from being mere passengers to responsible drivers of their health ...
providers encourage and value them as full partners”
Society for Participatory Medicine
Saturday, December 8, 12
Personal Health Record
• Provider-owned and provider-maintained digital summary– Read-only for patient– Access to lab results
through a password-protected Web site
– Commercial EHRs offer digital summaries through patient portals
• Patient-owned software program
– Patient can enter, organize, retrieve own health information
– Web-based i.e. Google Health, Microsoft HealthVault
Endsley et al. An Introduction to Personal Health Records http://www.afp.org/fpm
Saturday, December 8, 12
Personal Health Record• Portable, interoperable digital file
–Selected, clinically relevant health data can be managed, secured and transferred
–Platforms: Smart cards, PDAs, cellphones, USB-compatible devices
Endsley et al. An Introduction to Personal Health Records http://www.afp.org/fpm
Saturday, December 8, 12
Saturday, December 8, 12
No longer fill out formsAuthentication
Protection from fraud if lostRapid access to previously unavailable information
Paperwork for health record transfers are eliminatedElectronic prescriptions can be stored on the card
Saturday, December 8, 12
eHealth Challenges
Image from katerha, http://www.flickr.com/photos/katerha/5021019816/
Center for Development of Advanced Computing (India)
Systems for improved patient education
and compliance
Saturday, December 8, 12
http://www.chaindrugreview.com/front-page/newsbreaks/thrifty-white-introduces-smart-cap-to-spur-rx-complianceSaturday, December 8, 12
http://www.ama-assn.org/amednews/2010/05/10/bisb0510.htm
Saturday, December 8, 12
Gamificationuse of game play mechanisms
for non-game applications
http://www.imedicalapps.com/2011/08/2011-mobile-health-world-congress-gamification-health-care/Saturday, December 8, 12
http://www.informationweek.com/healthcare/mobile-wireless/10-wearable-health-tech-devices-to-watchSaturday, December 8, 12
eHealth Challenges
Image from katerha, http://www.flickr.com/photos/katerha/5021019816/
Center for Development of Advanced Computing (India)
Data mining for medical knowledge
Saturday, December 8, 12
Saturday, December 8, 12
Slide from presentation of Desikan et al, 2011 Siam International Conference on Data MiningSaturday, December 8, 12
“toes” by basheertome, http://www.flickr.com/photos/basheertome/7001981033/
We are drowning in data but starving for knowledge!
clinical decision support
healthcare resource management
Saturday, December 8, 12
Challenges in Data Mining for Healthcare
data set from various data sources
bias from heterogeneous data
missing values, noise and outliers
Pink Sherbet photography, http://www.flickr.com/photos/pinksherbet/4621820292/
protection of security, integrity and privacy
Saturday, December 8, 12
eHealth Challenges
Image from katerha, http://www.flickr.com/photos/katerha/5021019816/
Center for Development of Advanced Computing (India)
Electronic Medical Record
Systems for improved patient education
and compliance
Data mining for medical knowledge
Saturday, December 8, 12
Thank Youhttp://www.endocrine-witch.net
@endocrine_witch
Image from http://wthr.frumph.net/
Saturday, December 8, 12