1. LEVERAGING CLINICAL IT
FOR DENGUE: OPPORTUNITIES
FOR TOMORROW
SlideShare.Net/Nawanan
Nawanan Theera-Ampornpunt, M.D., Ph.D.

2. Outline
 Background
 Clinical Management of Dengue
 Roles of Health IT in Dengue
 Summary

3. Dengue: Epidemiology
 Most rapidly spreading mosquito-borne
viral disease in the world
 30-fold increase in incidence in the last
50 years
 Epidemic dengue spread to new areas
 Substantial burden on health sector &
economy
WHO Dengue Guidelines for Diagnosis, Treatment, Prevention and Control (2009)

4. Dengue: Prevention & Control
 Dengue surveillance
 Case management
 Outbreak response
 Integrated vector management
 Social mobilization & communication
 Research
Resolution SEA/RC61/R5 of WHO Regional Committee for South-East Asia (2008)
WHO Dengue Guidelines for Diagnosis, Treatment, Prevention and Control (2009)

5. Dengue: Clinical Management
WHO Dengue Guidelines for Diagnosis, Treatment, Prevention and Control (2009),
adapted from Yip (1980)

6. Dengue: Clinical Decisions
 Diagnosis & differential diagnosis
 Investigations
 Phase & severity
 Disposition: To send back home or to admit
 Monitoring of patient status
 Fluid management & transfusion decisions
 Management of complications

7. Dengue: Differential diagnosis
Febrile Phase
 Flu-like syndromes
 Illnesses with a rash
 Diarrheal diseases
 Illnesses with neurological manifestations
Critical Phase
 Infectious
 Malignancies
 Others (e.g. acute abdomen, metabolic conditions,
hematologic disorders)
WHO Dengue Guidelines for Diagnosis, Treatment, Prevention and Control (2009)

8. Dengue: Admission Criteria
WHO Dengue Guidelines for Diagnosis, Treatment, Prevention and Control (2009)

9. Dengue: Management Guidelines
WHO Dengue Guidelines for Diagnosis, Treatment, Prevention and Control (2009)

10. Fluid Management in Compensated Shock
WHO Dengue Guidelines for Diagnosis, Treatment, Prevention and Control (2009)

11. Fluid Management in Hypotensive Shock
WHO Dengue Guidelines for Diagnosis, Treatment, Prevention and Control (2009)

12. Imagine This Scenario
 Not enough sleep
Image Source: aafp.org

13. “To Err Is Human”
 Lack of attention
 Easily distracted
 Limited memory
 Difficulty putting relevant information together
(information overload?)
 Inappropriate decisions (lapses, cognitive errors)
 Poor decisions under pressure (emergencies)
 Difficulty in monitoring & triage of patients

14. Roles of Health IT
 Assists in documentation & assessments
 Reminds or alerts
 Servers as external memory
 Better visualizations / information
presentations
 Suggests management options
 Guidelines at the point of care
 Patient monitoring

15. Example of “Alerts & Reminders”

16. Clinical Decision Support Systems
PATIENT
Perception
CLINICIAN
Attention
Long Term Memory External Memory
Working
Memory
Knowledge Data Knowledge Data
Inference
DECISION

17. Roles of Health IT in
Dengue Clinical Management
 Online templates for complete patient
assessment & documentation
 Alerts & Reminders
 Decision support tools to offer
recommendations in case management
 Electronic disease reporting
 Information integration for early detection
of an outbreak

18. Clinical Decision Support Systems
PATIENT
Improved Guidelines &
information Perception References
CLINICIAN presentations Alerts &
(graphs, tracking Attention Reminders,
tools, etc.) Templates
Long Term Memory External Memory
Working
Memory
Knowledge Data Knowledge Data
Inference - Differential Dx
- Treatment
DECISION Recommendations

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

20. Disease Surveillance
 Google Flu Trends uses search engine
keywords (non-clinical data)
 Accuratefor practical purposes of detection
of possible outbreaks (not confirmation)
 Imagine how it would be if we use clinical
data (e.g. chief complaints, diagnoses in
ER/clinics). Would it help us respond faster?

21. Opportunities for Tomorrow
 Dengue management relatively
straightforward, easy to implement as logic
 Improved IT infrastructure within hospitals &
clinics
 Hospital information systems & electronic
health records common (high adoption)
 Can be leveraged for better dengue
management within those settings

22. Infrastructure:
22
EHR Adoption in Thai Hospitals
Theera-Ampornpunt (2011)

23. Adoption Estimates: THAIS 2011
23
Estimate (Partial or Complete Adoption) Nationwide
Basic EHR, combined inpatient & outpatient 49.8%
settings
Comprehensive EHR, combined 5.3%
order entry of medications, combined 90.2%
order entry of all orders, combined 79.4%
Theera-Ampornpunt (2011)

24. Current State of IT Use in Dengue
 Focus more on IT use in surveillance &
outbreak detection
 Some uses in patient education,
teleconsultations, predictive modeling, &
basic research
 Few studies on use of health IT to manage
dengue in clinical settings

25. Summary (1)
 Dengue is an important epidemic
 Management involves various steps
& criteria, maybe complicated for
non-experts
 Errors inevitable for inexperienced
providers

26. Summary (2)
 Health IT can be used to provide
better care, e.g. through decision
support
 Opportunities exist for use of IT in
dengue
 Call for more focus on development
& evaluation of IT uses in clinical
management of dengue