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