EAS202.2013.Lecture10.March22.HealthInfo.ublearns

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  • 2nd Mentor Meeting: (5% final grade)

    Questions: career, coursework, dept. opportunities for research, clubs, etc. Establish familiarity: go-to person for future

    If you have not yet

    submitted

    Profile #2:

    This is required

    Profile # 3:

    Solar is Required

    Semester Home Stretch: Profile Assignments

  • Semester Home Stretch: Impact Paper

    Final Paper Submission, and Solar Presentation now located here

  • Content,

    format

    April 5 Assignment: Impact Paper Status Update

    as many as needed

    as many as needed

    Submission

    Soft copy upload by 12:00 pm April 5 (1 per team)

    Hard copy due at class

    One author: 1 hard copy to group Leader

    Two authors, same group: 1 hard copy to that group Leader

    Two authors, different groups: 1 hard copy to each group Leader

  • Slide Will be Used In Class Next Week (will count as grade equivalent of in-class worksheet)

    Format

    Student(s) present to Leader and Group (1.5 min)

    Audience questions, comments, clarifications

    Purpose

    EAS 202 Feedback on your Impact Paper

    Opportunity to observe a range of other versions

    Professional Skill Ability to articulate work succinctly, cogently (elevator version)

    Ability to make self understood to general audience

  • Grand Challenges in

    Engineering: Advance

    Health Informatics Ann Bisantz and Li Lin

    Industrial and Systems Engineering

  • What is Health Informatics?

    Acquisition, management, and use of information in health

    Medical records for individual patients

    Sharing data about disease outbreaks on the local to global level

    Why? Greatly enhance quality and efficiency of medical care and the response to widespread public health emergencies

    Much remains to make these systems MAXIMALLY USEFUL

    NAE Grand Challenges web site

  • What is Health Informatics?

  • Future Health

    Informatics?

    Personal devices transmitting

    information to physicians, health

    records

  • What are the Current Challenges?

  • What are the challenges?

    Current efforts aimed at the nationwide deployment of health care IT will not be sufficient to achieve the

    vision of 21st century health care, and may even set

    back the cause if these effort continue wholly without

    change from their present course. Specifically, success

    in this regard will require greater emphasis on providing

    cognitive support for health care providers and for

    patients and family caregivers

    National Academy of Sciences, 2009

  • In summary:

    IT applications appear designed largely to automate tasks or business processes. They are often design in ways that simply mimic existing paper-based forms and provide little support for the cognitive tasks of clinicians of the workflow of the people who must actually use the system[and] they did not take advantage of human-computer interaction principles, leading to poor design that increase the chance of error, add to rather than reduce work, and .introduce new forms of error that are difficult to detect

    National Academy of Sciences, 2009

  • Solution: Design Health IT so

    Different systems can talk WITHOUT requiring a person to translate

    Retype, or Cut & Paste from one system to another

    Print from one system, scan into another

    Safety is enhanced rather than reduced Human centered design of systems: Meaningful,

    correct information at the right times

    People, not systems, are in control

    Systems improve productivity rather than taking more time and $

    Design IT so that it fits the way people work!

  • What can Engineers do to Help?

    One example:

    Simulation modeling of healthcare processes and use of IT in hospitals

    Compare staffing levels, facility layouts

    Simulation model of Hospital Operating Rooms

    http://www.eng.buffalo.edu/Media/HealthcareResearch/simulation/index.html

  • More examples of Health Systems

    Research

    Cognitive and physical workload of nurses

    Medical errors and patient safety

    Financial analysis of profit-and-loss for hospital operations

    Agent-based simulation of disease models

    Intervention strategies (e.g., vaccines) for H1N1 influenza

    Optimization of payment system

    Healthcare supply chain management

    Hospital surge capacity planning for disaster management

    Clinical pathway analysis (finding the most efficient way of medical treatment)

  • Challenges for other Engineers

    Seamlessly integrating and sharing information across many levels of computer systems while still preserving privacy and security

    Developing sensors to automatically collect & transmit key health data about people (e.g., wearable blood pressure monitors); alert caregivers

    Representing, storing, and reasoning about health information automatically to support alerting and decision making about patient conditions

    Mathematically modeling the spread of new diseases to detect & monitor global pandemics in real time

  • Case Study: Better IT for

    Emergency Rooms

  • Tracking Patients in the

    Emergency Department

    Whiteboards developed by doctors and nurses to help them track what is going on with patients

    Manual whiteboards being replaced with electronic tracking systems throughout hospitals, nationwide

    What were the effects in a hospital ED when this happened?

  • What did we find?

    Things looked the same on the surface (similar form)

    Functionality differed in small but important ways

    Doctors could no longer track their work with a patient

    Comments were limited in number, length, and form

    Clinical staff couldnt use the new system to safely track patient care made up a new system instead

    System was more useful for support staff (clerical, diet, transportation)

  • Whats next? Design, Simulation, and Validation Study

    Study & Model ED System Develop

    New Displays Evaluate

    and Improve

    Validate in

    Realistic Simulation

  • Case Study: Modeling Work and IT

    in Medical Practices

    New York State is funding the implementation of electronic health records and health information exchanges through the

    state

    Is this saving $ and improving care?

  • What are the components of a

    visit to the doctor?

    Who are all the people involved?

    What are the stages or steps they each accomplish?

    How do they interact?

    Computer Simulation Modeling

    Build a runnable model of the different stages of a patient visit

    Use times, frequencies, and probability distributions from data collected at the practices

  • Administration: Check-Out Prototype - Primary & Specialty Care - EHR & Paper

    Review Physician entered Encounter Codes (Diagnostic

    & Billing) for Action Items (follow-up, labs, referrals, Rx)

    Necessary paper forms/

    documents copied

    Necessary electronic forms/

    documents located, printed

    and retrieved

    Action Items

    Fill out necessary order forms (labs

    x-ray etc.)

    Collect Co-Pay If Paper Encounter Form exists, destroyed after X time (e.g.

    3 months)

    Give Paper Encounter form

    to Biller

    Is the Admin the Biller?

    No

    Yes

    Manual input of Encounter Codes

    Paper Encounter

    Form?

    No

    Yes

    Update system denoting patient

    has paid

    Paper Encounter

    Form?

    No

    Yes

    Update form denoting patient

    has paid

    Answer final patient

    questions (look up in EHR)

    Was prescription

    E-Prescribed?

    Prescription Printed?

    Retrieve Prescription from printer

    Verify Rx in System

    Open Scheduling Software

    Schedule next patient

    appointment in system

    Fill out handwritten appointment

    card

    Print out next appointment information

    OR

    NoNo

    YesYes

    Check if patient received any prescriptions

    Fill out handwritten referral form

    Call referral practice and

    schedule appointment

    Schedule referral

    appointment for patient?

    No

    YesCheck if Patient needs a referral

    Receive verbal request from

    Physician regarding lab

    tests, x-rays etc.

    Review Paper Encounter Form

    (Diagnostic & Billing) for Action Items (follow-up, labs, referrals, Rx)

    *p *e

    *e

    OR

    *e

    *p

    *p

    *e

    *p *e

    *e*e*e

    *e

    *e *e

    *p *e

    Receive verbal communication from Physician

    regarding patient scheduling needs

    *p *e

    Schedule next patient

    appointment (handwritten

    book)*p

    *e

    *p *e*e

    *e

    *p *e

    *e

    *p *e

    Generate billing receipt & Print

    *e

    *p *e

    Update Encounter Form denoting patient

    has paid

    Create handwritten

    receipt

    *e

    *e

    *e

    *e *e

    *e

    *e *e

    *p *e

    *p *p

    *p denotes paper practice task*e denotes EHR practice task

    Patient arrives for Check-Out

    Collect Paperwork from Patient OR

    Physician

    Give ALL documents, forms, prescriptions, referrals, lab orders,

    receipts etc. to Patient

    End of Check-Out

  • Medication

    Prescription

    Electronic systems resulted in shorter times to

    prescribe medications

    29

    120

    80

    0

    20

    40

    60

    80

    100

    120

    140

    L0 L5

    Tim

    e (

    Second)

    Interoperability Levels

  • Effects on Physician Activities

    30

    Time physicians spent requesting Lab Orders was longer

    0.75

    0.8

    0.85

    0.9

    0.95

    1

    1.05

    L0 L2 L4

    Tim

    e U

    sage

    Interoperability Level

    L0

    L2

    L4

  • Patient Waiting Time and LOS

    No Effects on wait time or length of stay based on electronic system or not

    31

    0.00

    0.20

    0.40

    0.60

    0.80

    1.00

    1.20

    1.40

    1.60

    1.80

    2.00

    1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

    Tim

    e (

    Hours

    )

    Configurations

    Patient Times

    Patient.Total Time

    Patient.Wait Time