Informatics in Emergency Medicine: A Brief Introduction (Presentation)

Informatics in Emergency Medicine:A Brief Introduction

Nawanan Theera-Ampornpunt, MD, PhDFaculty of Medicine Ramathibodi Hospital

http://www.slideshare.net/nawanan Feb 1, 2012

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Outline

• Introduction about Biomedical & Health Informatics• Emergency Medicine & Implications for Informatics• Informatics Applications in Emergency Medicine

– EHRs & HIE– PHRs– mHealth– Biosurveillance

• Conclusion

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Biomedical & Health Informatics

• “[T]he field that is concerned with the optimal use of information, often aided by the use of technology, to improve individual health, health care, public health, and biomedical research” (Hersh, 2009)

• “[T]he application of the science of informationas data plus meaning to problems of biomedical interest” (Bernstam et al, 2010)

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Wisdom

Knowledge

Information

Data

DIKW Pyramid

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Informatics As A Field

Shortliffe (2002)

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Because Information is Everywhere...

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Emergency Departments (ED)

• Prone to errors because of– Urgent nature– Limited & at times unreliable patient history– Time & resource constraints

• Scale & unpredictability of mass casualties & disasters make it worse

• 32% of ED visits had information gaps which can lead to prolonged ED stay (Stiell et al., 2003)

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Informatics Roles in Emergency Medicine

• Provide patient information critical to care• Information improves quality & efficiency of care

in ED, at least for some conditions(e.g., Theera-Ampornpunt et al., 2009; Overhage et al., 2002; Connelly et al., 2012)

• Role of health information exchange (HIE) highlighted

• IT as transformational tools that improve care processes

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Why Adopting Health IT?

“To Computerize”“To Go paperless”

“Digital Hospital”

“To Modernize”

“To Get a HIS”

“To Have EMRs”

“To Share data”

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Dimensions of Quality Healthcare

• Safety• Timeliness• Effectiveness• Efficiency• Equity• Patient-centeredness

IOM (2001)

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Better Information Delivery Improves

• Safety (prevent allergies)

• Timeliness (have access to information early)

• Effectiveness (information for decision-making)

• Efficiency (prevent unnecessary/redundant lab)

• Equity• Patient-centeredness

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IT as Tools for Process Redesign

• Safety (no handwriting!!, allergies/DI alerts)

• Timeliness (faster internal processes)

• Effectiveness (CDSS alerts & reminders)

• Efficiency (faster care, better patient flow, better bed management)

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Because... “To Err Is Human”

14 Image Source: aafp.org

To Err Is Human

• Lack of Attention

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• Cognitive Errors - Example: Decoy Pricing

The Economist Purchase Options

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Ariely (2008)

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6832

# of People

# of People

To Err Is Human

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What If This Happens in Healthcare?

• It already happens....(Mamede et al., 2010; Croskerry, 2003; Klein, 2005)

• What if health IT can help?

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Clinical Decision Support Systems (CDSSs)

External Memory

Knowledge Data

Long Term Memory

Knowledge Data

Inference

DECISION

PATIENT

Perception

Attention

WorkingMemory

CLINICIAN

From a teaching slide by Don Connelly, 2006

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External Memory

Knowledge Data

Long Term Memory

Knowledge Data

Inference

DECISION

PATIENT

Perception

Attention

WorkingMemory

CLINICIANAbnormal lab

highlights

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External Memory

Knowledge Data

Long Term Memory

Knowledge Data

Inference

DECISION

PATIENT

Perception

Attention

WorkingMemory

CLINICIANDrug-Allergy

Checks

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External Memory

Knowledge Data

Long Term Memory

Knowledge Data

Inference

DECISION

PATIENT

Perception

Attention

WorkingMemory

CLINICIAN

Drug-Drug Interaction

Checks

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• 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”

Friedman (2009)

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• Electronic documentation of patient care by providers

• Sometimes defined as longitudinal records of a patient’s health care

Electronic Health Records (EHRs)

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• Are they just electronic documentation?

• Or do they have some other values?

Diag-nosis

History & PE

Treat-ments ...

Electronic Health Record (EHR) Systems

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• Literature suggests improvement in health care through– Guideline adherence (Shiffman et al, 1999;Chaudhry et al, 2006)

– Better documentation (Shiffman et al, 1999)

– Practitioner decision making or process of care (Balas et al, 1996;Kaushal et al, 2003;Garg et al, 2005)

– Medication safety (Kaushal et al, 2003;Chaudhry et al, 2006;vanRosse et al, 2009)

– Patient surveillance & monitoring (Chaudhry et al, 2006)

– Patient education/reminder (Balas et al, 1996)

– Cost savings and better financial performance (Parente & Dunbar, 2001;Chaudhry et al, 2006;Amarasingham et al, 2009;Borzekowski, 2009)

Benefits of Health IT

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• Computerized Medication Order Entry• Computerized Laboratory Order Entry• Computerized Laboratory Results• Physician Notes• Patient Demographics• Problem Lists• Medication Lists• Discharge Summaries• Diagnostic Test Results• Radiologic Reports

Functions that Should be Part of EHR Systems

IOM (2003), Blumenthal et al (2006)

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Health Information Exchange (HIE)

Hospital A Hospital B

Clinic C

Government

Lab Patient at Home

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Personal Health Records (PHRs)• “An electronic application through which individuals can

access, manage and share their health information, and that of others for whom they are authorized, in a private, secure, and confidential environment.” (MarkleFoundation, 2003)

• “A PHR includes health information managed by the individual... This can be contrasted with the clinician’s record of patient encounter–related information [a paperchart or EHR], which is managed by the clinician and/or health care institution.” (Tang et al., 2006)

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Types of PHRs

• Patient portal from a provider’s EHRs (“tethered” PHRs)

• Online PHRs– Stand-alone– Can be integrated with EHRs from multiple providers

(unidirectional/bidirectional data sharing)

• Stand-alone PHRs– PC-based applications– USB Drive– CD-ROM or other data storage devices– Paper

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Use Cases of PHRs

• Data entry/update by patients• Data retrieval by providers

– With patient’s consent

– “Break-the-glass” emergency access

• Data update from EHRs• Privacy settings• Personalized patient education & reminders• Communications with providers

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Mobile Health (mHealth)

• Exponential increase in mobile devices• Technology penetration in rural, underserved

settings• Democratization of information access• Roles of social media

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mHealth & Social Media in Disaster Management

• Communication, coordination & collaboration tools for relief workers, disaster managers, victims

• Used heavily in– Haiti’s 2010 earthquake– Japan’s 2011 earthquake & tsunami– Thailand’s 2011 record flooding

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What Happened in Thailand in 2011?

• Unusually heavy rainfalls• Flooding began in the north, continued

downstream to Gulf of Thailand• Dams insufficient capacity to handle the

amount of water• Severe flooding in ~ 1/3 of Thailand• Record flooding in 50 years

Wikipedia

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Impact

Thaiflood.com (10/28/2011)

• 800+ deaths• Many millions affected• Residences, businesses,

factories & industrial complexes, hospitals, etc. all affected

• Historic sites damaged• Economic impact: (est.) $46

billion (World Bank)

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mHealth & Social Media in Thailand’s Flooding• Situation monitoring tools (central government)

http://www.kromchol.com/

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mHealth & Social Media in Thailand’s Flooding

• Situation monitoring tools (local BKK government)

http://dds.bangkok.go.th/Canal/

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• Non-governmental information dissemination

http://www.thaiflood.com

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• Preparedness, Educational & Advocacy Tools

http://www.youtube.com/user/roosuflood

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• Healthcare provider & MoPH coordination

https://www.facebook.com/groups/mophwarroomcoordination/

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• Simply to tell the world how we are doing...

© Suthasinee Senasu, MD (2011)Ayutthaya Hospital, late October

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• Simply to tell the world how we are doing...

© Suthasinee Senasu, MD (2011)Ayutthaya Hospital, late October

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Biosurveillance

42 Source: Google.org/FluTrends

Google Flu Trends (Biosurveillance)

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Conclusion• Health IT and informatics

– Provide information for high quality emergency care– Have potential to transform care processes (not just

computerizing patient care)– Come in various forms (EHRs, CDSS, HIE, PHRs,

mHealth, biosurveillance)

• Increasing roles of health IT and informatics for tomorrow’s emergency and disaster management

• New innovations & new uses of IT discovered through every emergency situation

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Questions?

Health & Medicine

Informatics in Emergency Medicine: A Brief Introduction (Presentation)