Resolving the health care crisis
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Transcript Resolving the health care crisis
Resolving the health care crisis;
health informatics for holistic
medicine.
Andrew Stranieri
Centre for Informatics
and Applied
Optimisation,
University of Ballarat,
Victoria
Tony Sahama
Queensland University
of Technology,
Queensland
Health informatics research
Health informatics research
• Holistic Medicine informatics (with Uni Colombo,
QUT, ICHM 2012)
• Data mining Cardiovascular disease, TCM (with
CSU)
• Online Dispute Resolution in Health (with Deakin)
• Decision Support for cancer patients, multidisciplinary groups
• Smart Information Portal (with Monash)
Health informatics: transforming
health care
Technologies
Telemedicine
Decision support systems
Data mining
Standards for interoperability
Information systems
Simulation
Electronic Health Record
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Backdrop: Health care is in crisis
Australia spends 9% of GDP on health
More chronic illnesses, diabetes, CVD. No cure ;
Increasing costs of medical advances;
Problems with health workforce supply and distribution –
HCP flock to major cities of developed countries ;
Persistent concerns about the quality and safety of
health services;
Achieving equity in health
1 billion people never see a doctor
Information Communication Technologies are
transforming Health
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Backdrop: Diverse medical
systems are prevalent
Body-person.
Physical (WM, TCM, N, H, AM)
Psychological (WM, H, TCM, AM, N),
Spiritual (AM, H)
Energetic (TCM, AM)
Illness.
Caused by external agent (WM, AM, TCM)
Caused by internal imbalance (TCM, AM)
Practitioner-patient relationship
•
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Passive.............................Active
ICHM 2012
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Diverse medical systems are
popular
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CAM are prevalant in the
West (Dawn and Upchurch
2005, Hastings and Torada
2009, Lim et al 2005)
Western Medicine growing in
prevalence outside West
(Hesketh and Zhu 1997;
Chua and Furnham 2008)
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Backdrop: Co-existence of diverse
medical systems
All systems co-exist as diverse but equally regarded
practices
TCM and Ayervedic prevalence enhanced by emerging
economies of China and India
Homeopathy already quite popular in many Western
countries
CAM (in West) arguably provides good models of patient
empowerment
Allopathic is very expensive. Few countries can afford
10%GDP on health
Chronic (lifestyle) conditions resistant to Allopathic
Many colleges of CAM around the world
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How/When will patients select a
medical system ?
Which practitioner
»Treatment effectiveness
»Empathy (Dose of doctor)
»Empowerment (Patient centred care)
»Practicalities (Availability, Cost)
Open research question: How to support patients
to make a decision about which system?
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Health informatics: transforming
health care
Technologies
Telemedicine
Decision support systems
Data mining
Standards for interoperability
Information systems
Simulation
Electronic Health Record
University of Ballarat and QUT for ICHM 2012
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Health informatics: transforming
health care
Trends
Toward more preventative health care
Toward more participatory health care
Toward co-existence of medical systems
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Empowering patients
Telemedicine
Access HCP remotely by video conference
https://gp2u.com.au/
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Tele-dentistry
UB Consortium Pilot. Nursing home to Dentist for
Cost effective treatment plans
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HD3D Pilot project
Tele-oncology
Tele-psychiatry
Oncologist and patient with nurse. Record consultation
onto DVD
HD3D Specialist psychiatrist for fine motor movements
Tele-wound management
Nurse in home uploads a 3D image of a wound for a
wound specialist to assess
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HD3D Pilot project
Tele-wound. Automated depth assessment
Open Research question:
Identify image processing applications within
holistic medicines
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Remote surgery
Japan/Korea Arata et al 2007
World Congress on Medical Physics and Biomedical Engineering 2006
IFMBE Proceedings Volume 14, 2007, pp 3065-3068. A remote surgery experiment
between Japan-Korea using the minimally invasive surgical system
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Telemedicine for holistic medicine
Acupuncture at sea. Information Technology in Alternative
Medicine. 2010. Bernard Fong, A. C. M. Fong, C. K. Li
Mindfulness by telehealth. Measuring mindfulness: which
aspects of mindfulness change following a brief telehealth
intervention for PTSD? B Niles1*, A Seligowski1 and A
Silberbogen2 BMC Complementary and Alternative Medicine
2012, 12(Suppl 1):P191 doi:10.1186/1472-6882-12-S1-P191
Open Research question:
Identify which practices within holistic medicines can
appropriately be performed by Tele-health
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Decision support systems
Systems that encode knowledge, use an inference
and reach a conclusion. Examples:
•
•
•
•
Intensive Care Unit Ballarat Hospital. Knowledge from
experienced nurses in a DSS for training
DSS for inferring supportive care (relationship, spiritual,
financial, transport, etc) needs of cancer patients
DSS for inferring pathology lab test diagnosis
•
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Supportive care needs DSS
• Typically with Quality of Life instruments but;
• Difficult to fit QOL instruments into busy HCP
workflows
• Difficult to engage patients. Non interactive,
always the same questions.
• Not customised for local settings. Questions
validated over large populations cannot be
modified
• Our approach: DSS;
• DSS infers needs, and infers appropriate
referrals. Report adds value to HCP
• Interactive. Patients/carers online, at home,
dynamic questions.
• Can be customised for local settings. Eg no
referrals to psychologists if none around.
Question content and nuances evolves locally
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Decision support systems in
holistic medicine
•
•
•
•
CAMEO (2012) helps cancer patients identify useful
CAM evidenced based
Zhou et al (2012) TCM DSS for Syndrome
differentiation and diagnosis
Wang et al (2008) Self learning system for TCM
diagnosis
Vithoulkas Compass DSS for helping homeopathy
practitioners select remedies
http://www.vithoulkas.com/en/booksstudy/vithoulkas-compass.html
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Decision support systems in
holistic medicine: open questions
•
•
•
How best to represent knowledge for DSS given high
level of tacit knowledge in many holistic medicine
systems?
How to support patients to choose between medical
systems
Ripple down rules? :
•
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Data mining
Data mining = Statistics + Computer
Science + Maths
Discovering patterns from data
Adverse drug reaction
Cystic Fibrosis Predictors. Quinn,
Stranieri, Yearwood, Gauditz 2010
Cardiovascular autonomic
neuropathy - replacement tests
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Data mining to discover
interactions
Quinn Weighted sum discovery
Clinical Data warehouse – de Silva
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Data mining open questions
•
How to identify tasks in holistic medicine
suitable for data mining?
How to collect and pre-process data in
standard ways to facilitate data mining?
How to integrate clinical knowledge into
data mining exercise?
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Simulation systems
•
Quality of Care
–
•
–
Games for health
–
WII, UQ Distraction for burns victims
Simulation for education
–
–
•
Virtual hospital SecondLife Imperial College
London
Knee surgery
http://www.edheads.org/activities/knee/
Virtual patient UB Miller et al SecondLife
Nursing (2009-10)
Simulation for empowerment
–
Interactive DVD for people who stutter
Meredith (2010)
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Ubiquitous health information
Patients Like Me
http://www.patientslikeme.com/
Cochrane Collaboration
http://www.cochrane.org/
Breast Cancer Online
Health InSite Portal
http://www.healthinsite.gov.au/
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Standards
System Standards
Required for interoperability, integration
performance and availability
Vocabulary Standards
Required for information management and
meaningful collection, exchange, storage
and reuse of clinical data
Messaging Standards
Required to establish the format and
sequence of data during transmission
Security Standards
Required to identify the practices
necessary to maintain confidentiality,
integrity and appropriate availability of
health information
IT system and network operations eg OSI
Device interoperability
Systems interoperability
Telecommunications
Data- description of data, structure
Classification eg ICDN
Vocabulary eg SNOMED
Terminologies- Interface and Reference
Standards used for the interchange of
data eg HL7
IT system and network operations
Data Storage- structure and content for
an electronic health record
Privacy, authentication, access control
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Terminology standards SNOMED
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Terminology standards SNOMED
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OpenEHR arhetypes
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Open questions SNOMED
•
New work proposal for TCM in SNOMED
•
Open question about SNOMED and
•
•
Ayurveda
•
Homeopathy
•
Other holistic medicines
OpenEHR archetypes for holistic medicine
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Health informatics is based on
allopathic medicine
•
•
•
Telemedicine, Decision support, Data
mining, Electronic health record,
Simulation
Co-existance of complementary
medicine with allopathic medicine can
also help alleviate the crisis
However, requires a concerted effort by
health informaticians to ensure
developments are applicable to Holistic
medicine
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HL7 for CAM?
1777.1220 : HL7 Segment : DG1
: Diagnosis Information
1777.1801
: HL7 Event : A01 : Admit Patient
1777.1225 : HL7 Segment : EVN : Event Information
1777.1802 : HL7 Event : A02 : Transfer Patient
1777.1250 : HL7 Segment : MSH : Message Header
1777.1803 : HL7 Event : A03 : Discharge Patient
1777.1255 : HL7 Segment : NK1 : Next of Kin Information
1777.1804 : HL7 Event : A04 : Register Patient
1777.1260 : HL7 Segment : NTE : Notes and Comments
1777.1805 : HL7 Event : A05 : Preadmit Patient
1777.1265 : HL7 Segment : OBR : Order Information
1777.1806 : HL7 Event : A06 : Transfer ?Outpatient to
Inpatient
1777.1270 : HL7 Segment : OBX : Observation Information
1777.1275 : HL7 Segment : ORC : Order Common Information
1777.1807 : HL7 Event : A07 : Transfer ?Inpatient to
Outpatient
1777.1808 : HL7 Event : A08 : Update Patient
1777.1280 : HL7 Segment : PD1 : Patient Demographic Information
1777.1295 : HL7 Segment : PID : Patient Information
1777.1300 : HL7 Segment : PR1 : Procedure Information
1777.1305 : HL7 Segment : PV1 : Patient Visit Information
University
of Ballarat
1777.1800 : HL7
Event Summar
y
2011
1777.1811 : HL7 Event : A11 : Cancel Admit
1777.1812 : HL7 Event : A12 : Cancel Transfer
1777.1813 : HL7 Event : A13 : Cancel Discharge
1777.1817 : HL7 Event : A17
: Bed Swap
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1777.1818 : HL7 Event : A18 : Merge Patient
Electronic health record
In Australian NEHTA. PCEHR
Microsoft Health Vault
Denmark
http://www.healthvault.com/
Bernstein 1995
US
Obama E H R by 2014
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Electronic health record
A virtual electronic
record of every health
event from before birth
to after death
Integrated so that every
authorised health care
professional can add to
or access the record
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Electronic health record: More
complaints
Patient empowerment
means more queries,
complaints, disputes
Online Dispute
Resolution – argument
structure based
organisation of the
dispute to help its
resolution
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Electronic Health Record
Open question:
Should CAM events be entered in an electronic
health record? If so, how?
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Electronic Health Record
Open question:
Should CAM events be entered in an electronic
health record? If so, how?
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Conclusion
Technologies
Telemedicine
Decision support systems
Data mining
Standards for interoperability
Information systems
Simulation
Electronic Health Record
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