This document provides an introduction to health information technology (IT) applications in hospitals from Dr. Nawanan Theera-Ampornpunt. It discusses her background and credentials in health informatics. The presentation covers why healthcare differs from other industries in needing IT, examples of common health IT tools, and the value of health IT in improving quality, safety and efficiency. It summarizes landmark reports calling for healthcare reform and modernization through increased IT adoption. The concept of "meaningful use" of electronic health records is introduced as a strategy to promote effective health IT implementation in the US.

1. IT for MDs (Part 1)
Nawanan Theera‐Ampornpunt, MD, PhD
Feb. 13, 2013
Faculty of Medicine Ramathibodi Hospital
SlideShare.net/Nawanan

2. A Few Words About Me...
2003 M.D. (1st-Class Honors) Ramathibodi (Rama 33)
2009 M.S. (Health Informatics) University of Minnesota
2011 Ph.D. (Health Informatics) University of Minnesota
Currently
• Acting for Deputy Chief, Health Informatics Division, Ramathibodi
Contacts
nawanan.the@mahidol.ac.th
SlideShare.net/Nawanan
www.tc.umn.edu/~theer002
groups.google.com/group/ThaiHealthIT
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3. IT Competencies
Internet & E‐mail
Literature searches & EBM
Preparing presentation slides
Bibliographic tools
 Manuscript preparation
 Statistical analysis
 Health IT and Informatics
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4. Today’s Contents
Healthcare & Health IT
Health IT Applications in Hospitals
4

5. Health care &
Health IT
5

6. Manufacturing
6 Image Source: Guardian.co.uk

7. Banking
7 Image Source: Scbcareers.scb.co.th

8. Health care
8 ER ‐ Image Source: nj.com

9. Why Health care Isn’t Like Any Others?
 Life‐or‐Death
 Many & varied stakeholders
 Strong professional values
 Evolving standards of care
 Fragmented, poorly‐coordinated systems
 Large, ever‐growing & changing body of
knowledge
 High volume, low resources, little time
9

10. Why Health care Isn’t Like Any Others?
 Large variations & contextual dependence
Input Process Output
Patient Decision‐ Biological
Presentation Making Responses
10

11. But...Are We That Different?
Banking
Input Process Output
Transfer
Location A Location B
Value‐Add
‐ Security
‐ Convenience
‐ Customer Service
11

12. But...Are We That Different?
Manufacturing
Input Process Output
Raw Assembling Finished
Materials Goods
Value‐Add
‐ Innovation
‐ Design
‐ QC
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13. But...Are We That Different?
Health care
Input Process Output
Sick Patient Patient Care Well Patient
Value‐Add
‐ Technology & medications
‐ Clinical knowledge & skills
‐ Quality of care; process improvement
‐ Information
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14. Information is Everywhere in Health Care
14

15. Various Forms of Health IT
Hospital Information System (HIS) Computerized Provider Order Entry (CPOE)
Electronic
Health
Records Picture Archiving and
(EHRs) Communication System
(PACS)
15

16. Still Many Other Forms of Health IT
Health Information
Exchange (HIE)
m‐Health
Biosurveillance
Personal Health Records
(PHRs)
Telemedicine &
Information Retrieval Telehealth
16 Images from Apple Inc., Geekzone.co.nz, Google, PubMed.gov, and American Telecare, Inc.

17. Why Adopting Health IT?
“To Go paperless” “To Computerize”
“To Get a HIS”
“Digital Hospital”
“To Have EMRs”
“To Modernize”
“To Share data”
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18. Some Quotes
 “Don’t implement technology just for
technology’s sake.”
 “Don’t make use of excellent technology.
Make excellent use of technology.”
(Tangwongsan, Supachai. Personal communication, 2005.)
 “Health care IT is not a panacea for all that ails
medicine.” (Hersh, 2004)
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19. Health IT: What’s In A Word?
Health Goal
Information Value‐Add
Technology Tools
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20. Dimensions of Quality Healthcare
Safety
Timeliness
Effectiveness
Efficiency
Equity
Patient‐centeredness
20 (IOM, 2001)

21. Value of Health IT
Guideline adherence
 Better documentation
 Practitioner decision making or
process of care
 Medication safety
 Patient surveillance &
monitoring
 Patient education/reminder
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22. Fundamental Theorem of Informatics
22
(Friedman, 2009)
(Friedman, 2009)

23. Is There A Role for Health IT?
23 (IOM, 2000)

24. Landmark IOM Reports
(IOM, 2000) (IOM, 2001)
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25. Landmark IOM Reports: Summary
 Humans are not perfect and are bound to make
errors
 Highlight problems in the U.S. health care system
that systematically contributes to medical errors and
poor quality
 Recommends reform that would change how health
care works and how technology innovations can
help improve quality/safety
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26. Why We Need Health IT
 Health care is very complex (and inefficient)
 Health care is information‐rich
 Quality of care depends on timely availability &
quality of information
 Clinical knowledge body is too large
 Short time during a visit
 Practice guidelines are put “on‐the‐shelf”
 “To err is human”
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27. To Err Is Human
 Perception errors
27 Image Source: interaction‐dynamics.com

28. To Err Is Human
 Lack of Attention
Image Source: aafp.org
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29. To Err Is Human
 Cognitive Errors - Example: Decoy Pricing
# of
The Economist Purchase Options People
• Economist.com subscription $59 16
• Print subscription $125 0
• Print & web subscription $125 84
# of
The Economist Purchase Options People
• Economist.com subscription $59 68
32 Ariely (2008)
• Print & web subscription $125
29

30. What If This Happens in Healthcare?
It already happens....
(Mamede et al., 2010; Croskerry, 2003; Klein, 2005)
What if health IT can help?
30

31. Adoption of Health IT: Assumptions
Adoption Use Outcomes
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32. U.S.’s Efforts on Health IT Adoption
?
“...We will make wider use of electronic records and
other health information technology, to help control
costs and reduce dangerous
medical errors.”
President George W. Bush
Sixth State of the Union Address, January 31, 2006
32 Source: Wikisource.org Image Source: Wikipedia.org

33. U.S. Adoption of Health IT
Ambulatory (Hsiao et al, 2009) Hospitals (Jha et al, 2010)
Basic EHRs w/ notes 9.2%
Comprehensive EHRs 2.7%
CPOE for medications 34%
• U.S. lags behind other Western countries
(Schoen et al, 2006;Jha et al, 2008)
• Money and misalignment of benefits is the biggest
reason
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34. We Need “Change”
“...we need to upgrade our medical
records by switching from a paper to
an electronic system of record
keeping...”
President Barack Obama
June 15, 2009
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35. The Birth of “Meaningful Use”
“...Our recovery plan will invest in
electronic health records and new technology
that will reduce errors, bring down costs,
ensure privacy, and save lives.”
President Barack Obama
Address to Joint Session of Congress
February 24, 2009
35 Source: WhiteHouse.gov

36. American Recovery & Reinvestment Act
 Contains HITECH Act
(Health Information Technology for Economic and
Clinical Health Act)
 ~ 20 billion dollars for Health IT investments
 Incentives & penalties for providers
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37. What is in the HITECH Act?
37 (Blumenthal, 2010)

38. “Meaningful Use”
“Meaningful Use”
Pumpkin
of a Pumpkin
38 Image Source & Idea Courtesy of Pat Wise at HIMSS, Oct. 2009

39. “Meaningful Use” of Health IT
Better
Stage 1
Stage 3
Health
‐ Electronic capture of
health information
‐ Information sharing Stage 2
Use of
‐ Data reporting EHRs to
Use of EHRs improve
to improve outcomes
processes of
care
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(Blumenthal, 2010)

40. Adoption Studies: Descriptive Aspect
2004
Pongpirul et al.
(2004)
2011
Theera‐
Ampornpunt
(unpublished)
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41. Q & A...
Download Slides
SlideShare.net/Nawanan
Contacts
nawanan.the@mahidol.ac.th
www.tc.umn.edu/~theer002
groups.google.com/group/ThaiHealthIT
41

42. References
 Ariely D. Predictably irrational: the hidden forces that shape our decisions. New York City
(NY):HarperCollins; 2008. 304 p.
 Blumenthal D. Launching HITECH. N Engl J Med. 2010 Feb 4;362(5):382‐5.
 Croskerry P. The importance of cognitive errors in diagnosis and strategies to minimize them.
Acad Med. 2003 Aug;78(8):775‐80. 81 p.
 Friedman CP. A "fundamental theorem" of biomedical informatics. J Am Med Inform Assoc.
2009 Apr;16(2):169‐70.
 Hersh W. Health care information technology: progress and barriers. JAMA. 2004 Nov
10:292(18):2273‐4.
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43. References
 Institute of Medicine, Board on Health Care Services, Committee on Data Standards for
Patient Safety. Key Capabilities of an electronic health record system: letter report [Internet].
Washington, DC: National Academy of Sciences;2003.
31 p. Available from: http://www.nap.edu/catalog/10781.html
 Institute of Medicine, Committee on Quality of Health Care in America. To err is human:
building a safer health system. Kohn LT, Corrigan JM, Donaldson MS, editors. Washington, DC:
National Academy Press;2000. 287 p.
 Institute of Medicine, Committee on Quality of Health Care in America. Crossing the quality
chasm: a new health system for the 21st century. Washington, DC: National Academy Press;
2001. 337 p.
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44. References
 Klein JG. Five pitfalls in decisions about diagnosis and prescribing. BMJ. 2005 Apr
2;330(7494):781‐3.
 Mamede S, van Gog T, van den Berge K, Rikers RM, van Saase JL, van Guldener C, Schmidt HG.
Effect of availability bias and reflective reasoning on diagnostic accuracy among internal
medicine residents. JAMA. 2010 Sep 15:304(11):1198‐203.
 Miller RA, Masarie FE. The demise of the "Greek Oracle" model for medical diagnostic
systems. Methods Inf Med. 1990 Jan;29(1):1‐2.
 Pongpirul K, Sriratana S. Computerized information system in hospitals in Thailand: a national
survey. J Health Sci. 2005 Sep‐Oct;14(5):830‐9. Thai.
 Schoen C, Osborn R, Huynh PT, Doty M, Puegh J, Zapert K. On the front lines of care: primary
care doctors’ office systems, experiences, and views in seven countries. Health Aff (Millwood).
2006;25(6):w555‐71.
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