แพทยกับเทคโนโลยีสารสนเทศสุขภาพ

บุญชัย กิจสนาโยธิน พบ., PhD. (Health Informatics) ว.ว.อายุรศาสตรทั่วไป, อ.ว.เวชศาสตรปองกัน

ศนูยพ์ฒันามาตรฐานระบบขอ้มูลสุขภาพไทย(ศมสท) สวรส.

ความรูบูรณาการทางการแพทย ราชวิทยาลัยอายุรแพทย

23 มีนาคม 2556 16:00-17:00 น. หองประชุม 230/1 อาคารแพทยพัฒน คณะแพทยศาสตรจุฬาลงกรณมหาวิทยาลัย

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A bit about me

� 1983 MD CU 33 � 1883-86 Works at community hospitals � 1989 FRCPT � 1989-2001 Internist at Srisangworn Hospital � 2004 MS. Health Informatics UMN � 2008 PhD. Health Informatics UMN � Current ศูนยพ์ฒันามาตรฐานระบบขอ้มูลสุขภาพไทย(ศมสท) สถาบนัวิจยัระบบสาธารณสุข กระทรวงสาธารณสุข (สวรส)

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From: Stanley M. Huff MD.’s presentation : Clinical Care enabled by Standards in Acute care 3

Information is everywhere

From Nawanan Theera-Ampornpunt presentation 2010 4

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Knowledge-based (Evidence-based) on PDA & Smart Phone

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From : Eric Topol: The wireless future of medicine, presentation archive at TED.com7 8

9 10

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Penetration of mobile technology

13 From: Stanley M. Huff MD.’s presentation : Clinical Care enabled by Standards in Acute care 14

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Fundamental Theorem of Biomedical Informatics

Goal & Objective of Informatics

Friedman CP. A "Fundamental Theorem" of Biomedical Informatics. JAMIA Mar2009

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Types of information needed by a clinician

Patient Data refers to one person patient, family, records, observation

Population Statistics aggregated patient data

colleagues, public health dept, EHR

Medical Knowledge generalizable to many persons

textbooks, reviews articles, MEDLINE

Logistic Information How to get things done

people (RN, HUC), policy and procedure

Social Influence How others get the job done

observe and discuss w/ colleagues

Component 2/Unit 4-1 Health IT Workforce Curriculum Version 2.0/Spring 2011

1717

� Internal Data & Information � Patient encounter

� Patient specific � Aggregated � Comparison

� General operation

� External Data & Information � Comparative � Expert and Knowledge Base

Healthcare Information Framework

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Examples of Types of Patient Encounter Data and Information

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Purpose of Patient (Medical) Records

� Patient care � Communication � Legal documentation � Billing and reimbursement

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เวชระเบียน Chart, Paper base Medical Record

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Patient Data

Administrative data Clinical data Use for reimbursement,

administration and reports Diagnosis, Procedure codes Charge/cost data

Use for clinical care Laboratory data, Pharmacy data Clinical notes

Individual Data Aggregated data Operational, Transactional Report form

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How DRGs are calculated?

DRG Grouper

Diagnosis ICD 10

Procedures ICD 9 CM

Age Sex

Discharge status

Length of Stay (LOS)

DRGs

Co-morbidities

RW Adj RW

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The Language, Behaviors, Traditions, Customs We Observe in the Healthcare System

24Health IT Workforce Curriculum Version 3.0/Spring 2012

The Culture of Healthcare An Overview of the Culture of Healthcare

Lecture a

(Gorman, n.d.) Used with Permission.

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Professional Cultures in Healthcare Settings

25Health IT Workforce Curriculum Version 3.0/Spring 2012

The Culture of Healthcare An Overview of the Culture of Healthcare

Lecture a

Management, business culture Customers

IT culture Users

Librarian Patrons

Counselors Clients

Doctors Patients

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Thailand Healthcare delivery

� Curative care: Diagnosis and Treatment � Rehabilitative care � Preventive care � Health Promotion

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Thailand Health Care Services

Tertiary/Super-tertiary care

Secondary/Tertiary care

Secondary care

Primary Care

90-10 • Regional/University

Hospitals

75-25 • Provincial/Regional

Hospitals

50-50

• District Hospital /Community Hospitals

25-75 • Health Centers

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Inpatient ED

Outpatient

Outpatient

?Inpatient

?Inpatient

?Inpatient

Spectrum of Healthcare services

?Home

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What & Why Health IT? � Health IT is the use of Information and

Communication Technology(ICT) in Health & Health(care) setting

� Why Health IT? A means of improving � quality of health care: patient safety � health of populations � efficiency of health care systems:

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From Nawanan Theera-Ampornpunt presentation 201030

From Nawanan Theera-Ampornpunt presentation 2010 31 32

What is EHR/EMR/PHR?

� Electronic Medical Record (EMR) An electronic record of health-related information on an individual

that can be created, gathered, managed, and consulted by authorized clinicians and staff within one health care organization

� Electronic Health Record (EHR) An electronic record of health-related information on an individual

that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff, across more than one health care organization.

(National Allience for Health IT USA, 2006)

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What is EHR/EMR/PHR?

� Personal Health Record (PHR) An electronic record of health-related information on an individual

that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared, and controlled by the individual.

. (National Allience for Health IT USA, 2006)

� EPR (Electronic Patient Record), EHCR (Electronic Health Care Record), CPR (Computerized Patient Record) etc.

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What is EHR?

An EHR is an electronic version of a patients medical history, that is maintained by the provider over time, and may include all of the key administrative clinical data relevant to that persons care under a particular provider, including demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports The EHR automates access to information and has the potential to streamline the clinician's workflow. The EHR also has the ability to support other care-related activities directly or indirectly through various interfaces, including evidence-based decision support, quality management, and outcomes reporting.

(Healthcare Information and Management System Society HIMSS 2011)

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What is EHR?

� repository of patient data in digital form � stored and exchanged securely � accessible by multiple authorized users � contain information which primary purpose is to

support continuing, efficient and quality integrated healthcare. (ISO 20514, 2004)

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EHR EMR PHR

EHR – EMR – PHR relationship

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� Primary use – Direct patient care � Secondary Uses – Non-direct patient care

1. Support quality of patient care 2. Improve patient safety 3. Develop and apply decision support for health care providers 4. Manage personal health 5. Protect and enhance public health 6. Conduct research 7. Educate and credential healthcare providers and assess

training activities 8. Analyze and Manage Finances 9. Detect fraud and illicit activity 10.Develop security and confidentiality algorithms 11.Create and maintain terminology and representation formalisms 12. Identify markets and promote sales

Primary and Secondary uses of EHR/HIS

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HIS ?

Health Information Systems (HIS) Healthcare Information Systems (HIS)

Hospital Information Systems (HIS)

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Hospital Information Systems

Hospital information system (HIS), is a comprehensive, integrated information system designed to manage the administrative, financial and clinical aspects of a hospital.

Clinical Informatics is the application area of Health Informatics concerned with healthcare services (Clinical services)

Clinical information systems is a comprehensive, integrated information system designed to support clinical services.

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Hospital Information Systems (HISs) evolution

(Hanson, C.W., Healthcare Informatics. 2006)41

Hospital Information

Systems EMR

PHR

EHR

HIS - EHR – EMR – PHR relationship

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2 type of information used in Clinical Informatics

� Patient-specific information is generated by and used in the care of patients in the clinical setting : EHR data � Administration data: demographic, billing � Clinical data: Hx, PE, Lab, progress note

� Knowledge-based information comprises the scientific basis of health care : Information retrieving systems, Evidence-based information

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Information Retrieving System ระบบการสืบค้นความรู้

� Dealing with accessing and managing scientific basis of Health & Biomedicine

� Bibliographic databases (e.g. PubMed, CINAHL), Webs, Digital Library, eBooks

� Internet health and medical information: � Millions sources (Website) � critical to evaluate the credentials of content providers � Attempt to certify: Health on the Net Foundation www.hon.ch

� Evidence Base Information: Guidelines, Cochrane

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HIS/EHR in Thailand 2008 (2551) � สปสช. ทําการสํารวจป 2551 (72% of Hospitals in

Thailand)

� 86% respond rate (750/874)

� >32 different HIS applications

� HIS application

Application No %

HOSxP 235 30%

MIT NET 76 10%

STAT 48 6%

Hospital OS 39 5%

HI 37 5% 45

สถานการณ HIS/EHR 2553-54 (N=902) (นพ.นวนรรน ธีระอัมพรพันธุ 2554)

Product/Vendor Frequency (%) HOSxP 449 (50.17%) Self-developed or outsourced 142 (15.87%) Hospital OS 64 (7.15%) SSB 32 (3.58%) Mit-Net 22 (2.46%) MRecord 21 (2.35%) H.I.M. Professional 20 (2.23%) MedTrak/TrakCare 19 (2.12%) HoMC 18 (2.01%) No hospital information system used 14 (1.56%)

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Competencies of Health Professionals (Institute Of Medicine –IOM)

47From: Greiner 2003: Health Professions Education: A Bridge to Quality 47

eHealth/HIS Components (WHO-ITU Model)

� All components are essential � All components should be balanced

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Unbalance development of Thailand eHealth/HIS components

Str

ateg

y &

Inv

estm

ent

Standards & Interoperability

Infrastructure

Services, Applications Software

Leadership & governance

Legislation, policy & compliance

Workforce

Str

ateg

y &

Inv

estm

ent

Stra

tegy

& In

vest

men

t

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Thailand eHealth/HIS Shaky Foundation

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What is Interoperability?

� "the ability of two or more systems or components to exchange information and to use the information that has been exchanged". [The Institute of Electrical and Electronics Engineers (IEEE, USA)]

� "In healthcare, interoperability is the ability of different

information technology systems and software applications to communicate, to exchange data accurately, effectively, and consistently, and to use the information that has been exchanged. " [The National Alliance for Health Information Technology (NAHIT, USA) ] 51

Different kinds of communication between HIS (Systems Interoperability)

From: Stegwee , Identification of different types of standards for domain-specific interoperability. In: Proceedings of the Workshop on Standard Making: A Critical Research Frontier for Information Systems, John L. King and Kalle Lyytinen,(eds.), Seattle, WA. 2003.

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Categories of Interoperability

Hammond, Interoperability – What’s in a word?, electronic Journal of Health Informatics 5(1): 201053

Level of Interoperability

1. Interconnectivity for the ability to exchange information at a network, syntactic, and process flow

level;

2. Interchangeability for the ability to use information at a presentation, semantic, and input/output level;

3. Interoperability for the ability to use information at an application, pragmatic, and process control level.

From: Stegwee , Identification of different types of standards for domain-specific interoperability. In: Proceedings of the Workshop on Standard Making: A Critical Research Frontier for Information Systems, John L. King and Kalle Lyytinen,(eds.), Seattle, WA. 2003. 54

Interoperability and Standards

From: Tim Benson: Principle of Health Interoperability HL7 & SNOMED 55

Landscape ของมาตรฐานขอมูลสุขภาพ

From: Standards – Yesterday, Today and Tomorrow: Integrating the Standards for Healthcare presentation , Ken Lunn, 17 October 2011 56

Interoperability needs STANDARDs � Core data sets standards � Semantics standards

� Coding : ICDs, National Drug Codes � Medical Terminology: SNOMED-CT, LOINC

� Syntactic standards : HL7 messaging standards, HL7-CDA (Clinical Document Architecture)

� Security and Privacy standards

ประเภทของมาตรฐานขอมูลสุขภาพ

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Standards National

1. Core data set standards (ชุดขอ้มูล) 12 & 18 files standards 2. Semantic standards (คาํจาํกดัความ ความหมาย)

ICD 10 TM, ICD 9 CM Citizen IDs

3. Syntactic standards (รูปแบบการส่งขอ้มูล) X

4. Security and privacy standards X

มาตรฐานขอมูลสุขภาพไทย ปจจุบัน

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มาตรฐานขอมูลในแผนยุทธศาสตร ศมสท.

Standards National

1. Core data set standards (ชุดขอ้มูล) Referral, Chronic Diseases

2. Semantic standards (คาํจาํกดัความ ความหมาย)

Drug Terminology (TMT), Lab. Code (LOINC)

Providers ID

3. Syntactic standards (รูปแบบการส่งขอ้มูล) HL7-CDA

4. Security and privacy standards X

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