Transcript AVL در پزشکی (دکتر کشتگری)

‫کاربرد های فناوری اطالعات در پزشکی و‬
‫مراقبت از سالمت‬
‫منیژه کشتگری‬
‫دانشگاه صنعتی شیراز‬
‫‪[email protected]‬‬
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‫تعريف فناوري اطالعات و ارتباطات‬
‫• فناوري اطالعات عبارت است از گردآوري‪ ،‬سازماندهي‪ ،‬ذخیره و نشر اطالعات اعم از‬
‫صوت‪ ،‬تصوير‪ ،‬متن يا عدد كه با استفاده از ابزار رايانهاي و مخابرات صورت پذيرد‪.‬‬
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‫ابزار ‪IT‬‬
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‫زبانهای برنامه نویس ی‬
‫برنامه های کامپیوتری و کاربردی‬
‫بانکهای اطالعاتی‬
‫سخت افزار‬
‫شبکه های کامپیوتری‬
‫روشهای طراحی و آنالیز‬
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‫مزایای استفاده از ‪IT‬‬
‫‪ ‬حمایت از پنج هدف سازمان‬
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‫ارتقاء بهره وری‬
‫کم کردن هزینه ها‬
‫بهبود در تصمیم گیری‬
‫بهبود در ارتباط با مشتری‬
‫‪ ‬توسعه و ایجاد سیستمهای کاربردی جدید‬
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‫‪Health IT‬‬
‫‪ ‬استفاده از کامپیوتر و برنامه های کامپیوتری جهت ذخیره‪ ،‬حفاظت‪ ،‬بازیابی و ارسال اطالعات‬
‫‪ administrative ،clinical‬و ‪ financial‬به صورت الکترونیکی در سیستم مراقبت‬
‫سالمت‬
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HIT Technology
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Internet
Handheld (PDA)
Notebooks
Wireless
24/7
Work Anywhere/Anytime
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HIT Standards
 Privacy
 Security
 National Health Information Network (NHIN)
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Health IT can include
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electronic health records
personal health records
e-mail communication
clinical alerts and reminders
computerized decision support systems
hand-held devices
other technologies that store, protect, retrieve
and transfer clinical, administrative, and
financial information electronically within
health care settings.
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Personal Health Record (PHR)
 An electronic application through which
individuals can maintain and manage their health
information (and that of others for whom they are
authorized) in a private, secure, and confidential
environment.
 examples of an agent acting for an individual
include parents acting for children, or, in the later
stages of life, children acting for parents.
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Electronic Medical Record
 An application environment composed of the clinical
data, repository, clinical decision support, controlled medical
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vocabulary, order entry, computerized provider order entry,
pharmacy, and clinical documentation applications.
This environment supports the patient’s electronic medical record
across inpatient and outpatient environments, and
is used by healthcare practitioners to document, monitor, and
manage health care delivery within a care delivery organization
(CDO).
The data in the EMR is the legal record of what happened to the
patient during their encounter at the CDO and is owned by the CDO.
Electronic Health Record: A subset of each care delivery
organization s EMR
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PHR, EHR,EMR
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Disadvantages
of EHR
1. The possible incompatibility of computer systems among
various health care providers can lead to difficulty in sharing
the data.
2. Privacy and security can be an issue. If someone hacks into
a computer system, thousands of patients' records can be
compromised. Also, some critics say the federal government
wants to use electronic records systems to ration health care
services.
3. Computer crashes make records inaccessible.
4. The cost of implementing an electronic records system can
be expensive.
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EHR case study
Survey Result
• Use of Electronic Health Records in U.S.
Hospitals
• A Review of Jha et al. (2009)
• The new England journal o f medicine
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Purpose
• To provide more precise estimates of EHR
adoption among U.S. hospitals
• With a clear definition of a hospital EHR system
(“basic EHRs”)
• Also a definition of “comprehensive EHRs”
• To evaluate hypotheses that larger, teaching,
and private hospitals are more likely to adopt
EHRs
• To identify barriers to adoption to guide
policymakers
• Study commissioned by Office of the National
Coordinator for Health Information Technology 14
Past studies
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Methods
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Design
Cross-sectional mail survey
Sample
All acute care general medical and surgical hospitals that
are member of the American Hospital Association (N =
4814)
• Survey Administration (Mar - Sep 2008)
• Survey sent to hospital’s CEO
• CIOs are typically assigned to complete survey
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Methods
• Survey Content
• Presence/absence of 32 clinical functionalities of
an EHR system
• Whether their hospital had fully implemented
these functions
– in all major clinical units
– in one or more (but not all) major clinical units
– in none of the units
• Whether certain factors were major or minor
barriers or were not barriers to EHR adoption
• 2952 hospitals in the sample
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Basic and Comprehensive EHR
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Basic and Comprehensive EHR
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Basic and Comprehensive EHR
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Basic and Comprehensive EHR
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Adoption of EHRs
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Barriers to EHR Adoption
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Discussion
 Though EHR adoption is low, many functionalities
are widely implemented (e.g. lab & radiologic
reports, medication lists)
 Much of health IT benefits come from decision
support, which is not part of the “basic EHR”
requirements
 Financial issues identified as predominant barriers
to adoption
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EHR inpatient sites
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EHR Outpatient sites
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‫‪Telemedicine‬‬
‫• ارایه خدم ــات درمانی در جایی كه فاصله‪ ،‬فاكتور مهمی محسوب می‬
‫شود‪ ،‬توسط متخصصان حرفه ای با استفاده از تكنـولوژی اطالعات‬
‫و ارتباطات برای تبادل اطالعات صحیح در زمینه تشخـیص‪ ،‬درمان و‬
‫پیشـگیری بیماری ها با بهره گـیری از جدید ترین دستاوردها در زمینه‬
‫خدمات درمانی در راستای تأمین هر چه بیشتر سالمت افراد"‬
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‫تاریخچه‬
‫• پیشینه استفاده از فنآوری ارتباطات در‬
‫فرایند درمان‪ ،‬به اواسط قرن هجدهم باز‬
‫می گردد‪.‬‬
‫‪‬نخستین سازمان‪ :‬ناسا‬
‫نیاز داشتند كه وضعیت‬
‫سالمت فضانوردان‬
‫خود را در موقعیت های‬
‫مختلف كنترل نمایند‪.‬‬
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‫اهداف ‪Tele Medicine‬‬
‫‪‬بهبود مراقبت از بیمار‬
‫‪‬بهبود دسترس ی و مراقبت پزشكی برای نواحی روستایی و محروم‬
‫‪ ‬دسترس ی بهتر به پزشكان‬
‫‪‬كاهش هزینه های مراقبت های پزشكی‬
‫‪‬ایجاد خدمات مراقبت پزشكی (در سطح جغرافیایی و جمعیتی‬
‫وسیع)‬
‫‪‬كاهش نقل و انتقال بیماران به مراكز درمانی‬
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‫مشاوره ازراه دور‬
‫‪ ‬سادگی و گستردگی كاربرد‬
‫‪ ‬امکان استفاده از تمام امكانات ارتباطی ‪:‬‬
‫تلفن‪ ،‬فاكس‪ ،‬پست الكترونیكی‪ ،‬گفتگوی‬
‫اینترنتی‪ ،‬صفحه پیغام و‪...‬‬
‫‪ ‬نکته ‪:‬‬
‫قابلیت دسترس ی هم به‬
‫اطال عات مفید‬
‫وهم اطالعات غلط و نادرست ‪ ،‬پزشكان‬
‫قالبی و سایت های فاقد اعتبار پزشكی‬
‫وجود دارد‬
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‫اولین جراحی ازراه دورفرااقیانوس ی درجهان‬
‫‪ ‬در ‪ 7‬سپتامبر ‪ 2001‬کيسه ی‬
‫صفرای بیمار‪ 68‬ساله ای بستری‬
‫در بیمارسـتان ‪ CIVIL‬در ش ـ ــرق‬
‫فرانسه ‪،‬توسط تیم جراحــی در‬
‫نیـویورك برداشته شد‪.‬‬
‫‪ ‬با کمک خط فیبر نوری پرسرعت‬
‫و با اسـتفاده از سیســتم جراح ــی‬
‫روباتـیك الپاروسكوپی ‪Zeus‬‬
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‫‪Telehealth‬‬
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‫به کار بردن ارتباطات الکترونیکی و تکنولوژی ارتباطات از راه دور برای انجام‬
‫و پشتیبانی خدماتی از قبیل‪:‬‬
‫مراقبت های بالینی از راه دور‬
‫آموزش وتعلیم دادن در مورد امور تندرستی به متخصصان و بیماران‬
‫اجرا و مدیریت تندرستی‬
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telemedicine and
telehealth
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Innovation in Medical Care
Sensor Networks Applications for Medical Care
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Sensor Network Examples
(Harvard Sensor Networks Lab)
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Wearable Mote
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Mercury
Used for Parkinson's disease
There are 9 nodes on the body (2 on each
arm and leg, one on the back),
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Network Case Study
UTAH Telehealth Network
• The Utah Telehealth Network connects to the University
of Utah Hospital, National Lambda Rail (NLR) and the
Internet via two one Gigabit Ethernet connections. Most
network sites utilize dedicated T1(1.544Mbps) WAN
services that connect to the University of Utah.
• Some member or affiliated sites utilize DSL internet
services.
• Currently all WAN services support data, voice and video
communications using IP.
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UTAH Telehealth Network (UTN)
• UTN provides leased circuits to healthcare facilities
starting at speeds of 1.5 Megabits per second (Mbps).
UTN manages these circuits, including the provisioning,
monitoring, and maintenance of one firewall, router and
Ethernet switch per circuit.
• UTN has received a $9 million funding commitment from
the FCC (Federal Communications Commission) for
the Utah ARCHES project, which will upgrade
infrastructure to high speed dedicated Ethernet services
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Utah ARCHES Project will upgrade and
expand current healthcare infrastructure
• Connect and/or upgrade connections to approximately 80
rural and urban healthcare facilities
• Build a network core with regional aggregation points into
which health care facilities connect
• Begin the migration from T1 to Ethernet Technology to
increase bandwidth 1.5 mbps to 5 mbps, 10 mbps, 100
mbps, 1000 mbps (1 gigabit per second)
• Connect into Internet2, a dedicated nationwide backbone
• Maintain network security and efficiency through
coordinated management among partners
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IT threats
• developments offer significant benefits to
patients and healthcare providers, but they
give rise to ethical and legal challenges in
the protection of patient privacy and
confidentiality. The traditional and
humanistic concept of doctor-patient
relationship is also under threat
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‫با تشکر‬
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