1. Overview of Health Informatics
& Disease Surveillance System
Nawanan Theera-Ampornpunt, M.D., Ph.D.
Aug. 22, 2013 SlideShare.net/Nawanan

2. A VISION FOR
HEALTH CARE

3. eHealth
Health Information Exchange (HIE)
Hospital A Hospital B
Clinic C
Government
Lab Patient at Home

4. CHALLENGES IN
COMPUTERIZING
HEALTH CARE

5. Manufacturing
Image Source: Guardian.co.uk

6. Banking
Image Source: Cablephet.com

7. Health care
ER - Image Source: nj.com

8. 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. Engineer’s View
Input Process Output
Transfer
Banking
Value-Add
- Security
- Convenience
- Customer Service
Location A Location B

10. Input Process Output
Assembling
Manufacturing
Raw
Materials
Finished
Goods
Value-Add
- Innovation
- Design
- QC
Engineer’s View

11. Engineer’s View
Input Process Output
Patient Care
Health care
Sick Patient Well Patient
Value-Add
- Technology & medications
- Clinical knowledge & skills
- Quality of care; process improvement
- Information

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

13. Information is Everywhere in Medicine
Shortliffe EH. Biomedical informatics in the education of
physicians. JAMA. 2010 Sep 15;304(11):1227-8.

14. The Anatomy of Health IT
Health
Information
Technology
Goal
Value‐Add
Means

15. HEALTH IT:
AN OVERVIEW

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

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

18. 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

19. Is There A Role for Health IT?
(IOM, 2001)(IOM, 2000)

20. Landmark IOM Reports: Summary
• Humans are not perfect and are bound to
make errors
• High‐light 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

21. 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 to be in
any clinician’s brain, and the short time
during a visit makes it worse
• Practice guidelines are put “on‐the‐shelf”
• “To err is human”

22. Image Source: aafp.org
To Err Is Human
• Lack of Attention

23. 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

24. The Anatomy of Health IT Revisited
Health
Information
Technology
Goal
Value‐Add
Means

25. Ultimate Goals of Health IT
•Individual’s Health
•Population’s Health
•Organization’s Health

26. Dimensions of Quality Health Care
• Safety
• Timeliness
• Effectiveness
• Efficiency
• Equity
• Patient‐centeredness
(IOM, 2001)

27. Documented Benefits of Health IT
• Literature suggests improvement through
– Guideline adherence
– Better documentation
– Practitioner decision making or process of care
– Medication safety
– Patient surveillance & monitoring
– Patient education/reminder
– Cost savings and better financial performance

28. Fundamental Theorem of Informatics
(Friedman, 2009)

29. HEALTH
INFORMATICS

30. Wisdom
Knowledge
Information
Data
Data-Information-Knowledge-Wisdom
Contextualization/
Interpretation
Processing/
Synthesis/
Organization
Judgment

31. Definitions of Health Informatics
• Biomedical & Health Informatics (Formerly
known as Medical 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
information as data plus meaning to
problems of biomedical interest”
(Bernstam et al, 2010)

32. Summary About M/B/H Informatics
• Focuses more on information, not technology
• Task-oriented view:
Collection Processing
Storage
Utilization
Communication
/Dissemination/
Presentation

33. M/B/H Informatics As A Field
(Shortliffe, 2002)

34. M/B/H Informatics As A Field
(Hersh, 2009)

35. M/B/H Informatics and Other Fields
Biomedical/
Health
Informatics
Computer &
Information
Science
Engineering
Cognitive
&
Decision
Science
Social
Sciences
(Psycholog
y,
Sociology,
Linguistics,
Law &
Ethics)
Statistics
&
Research
Methods Medical
Sciences &
Public
Health
Management
Library
Science,
Information
Retrieval,
KM
And More!

36. The Intersection
Clinical
Informatics
Public
Health
Informatics
Consumer
Health
Informatics
Patients &
Consumers
Providers &
Patients
Policy-Makers,
Payers, Public
(Also providers)

37. HEALTH INFORMATION
EXCHANGE & DISEASE
SURVEILLANCE

38. eHealth
Health Information Exchange (HIE)
Hospital A Hospital B
Clinic C
Government
Lab Patient at Home

39. Standards: Why?
• The Large N Problem
N = 2, Interface = 1
# Interfaces = N(N-1)/2
N = 3, Interface = 3
N = 5, Interface = 10
N = 100, Interface = 4,950

40. Functional
Semantic
Syntactic
How Standards Support Interoperability
Technical Standards
(TCP/IP, encryption,
security)
Exchange Standards (HL7 v.2,
HL7 v.3 Messaging, HL7 CDA,
DICOM)
Vocabularies, Terminologies,
Coding Systems (ICD-10, ICD-9,
CPT, SNOMED CT, LOINC)
Information Models (HL7 v.3 RIM,
ASTM CCR, HL7 CCD)
Standard Data Sets
Functional Standards (HL7 EHR
Functional Specifications)
Some may be hybrid: e.g. HL7 v.3, HL7 CCD
Unique ID

41. U.S. Health Information Exchange
• Regional Health Information
Organizations (RHIOs)
• State e-Health initiatives
• Nationwide Health Information Network
(NHIN)
• Still ongoing efforts, but with significant
progress

42. Other Public Health Informatics
Applications
• e-Health & m-Health
– m-Health in disaster management: #ThaiFlood
• Data reporting to government agencies
– Claims & reimbursements
– Diseases
– Utilization statistics
– Quality measures
– etc.
• Biosurveillance (case reporting vs.
predictive)
• Epidemiologic & health services research

43. Thailand’s Biosurveillance
Source: www.biophics.org

44. Google Flu Trends
Source: Google.org/FluTrends

45. Summary
• Health informatics as a discipline
• Health IT comes in various forms &
useful in various settings
• HIE is “vision” toward HEALTH for many
informaticians
• Disease surveillance systems one form
of Health IT
• May or may not rely on HIE