Health 2.0 Health In f In o f rmat rma ics t in the ED Katrina Hurley

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Gervais Bell
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1 Health Health Informatics in the ED Katrina Hurley

2 Disclosures Cannot identify any potential conflicts of interest with any commercial organization

4 Objectives Describe how health informatics impacts emergency medicine Define Health 2.0 Understand dpatients information i seeking behaviours Leverage informatics to bring health information to patients

5 Information is the lifeblood of modern medicine. Health information technology is destined to be its circulatory system. David Blumenthal NEJM 2010; 362(5):382 5.

6 Lalonde Report 1974 There is a lack of a uniform and integrated system for maintaining health records of individuals... Essential data are scattered in many locations...

7 Romanow Report 2002 Paper records are increasingly becoming obsolete and inadequate. They limit the flow of information, insufficiently document patient care, impede the integration of health care delivery, create barriers to research, and limit the information available for administration and decision making.

They limit the flow of information, insufficiently document patient care,

8 Unable to decipher the doctor s writing, the nurse had to tell the family member that the patient was either released or deceased. 8

12 Health Information Technology Improve service delivery Manage care Monitor and evaluate performance

13 What is informatics? Health informatics is a discipline that aims to promote health and improve the delivery of patient centered health care through the innovative application of information systems to collect, manage, transform and share health information.

and improve the delivery of patient centered health care through

14 Information Systems A combination of information, technology, people p and processes that interact together to collect, process and store information to support the business of the organization. Our business is health!

together to collect, process and store information to

16 Invisible... Technology is woven throughout daily life Seamlessly integrated Accepted and depended upon Few clinicians with academic interest Behind the scenes infrastructure

17 Provides quality care to women, children, youth and families in the Maritime provinces and beyond 28,000 emergency department visits 15,000 inpatient visits 4500 surgical daycare visits

18 350,000 patient charts in the IWK 20, new charts per year Release 1500 charts/day No charts destroyed to date

19 3000 unique forms 75 health records employees Can file 1 cm of paper per hour per person 12 f ll ti d 12 full time coders >220 data fields

22 Dr. John Ross Information technology is a well established tool in most industries to track every process to ensure efficiency and effectiveness, it is rarely used that way in health care

23 Information systems expense as a % of total expense ( ) NL NS NB ON MB SK AB BC YT NWT

25 Canada Health Infoway Costs $10,000,000,000 $350 per person

26 Belize 78 th UN Human Development Index World leading Health Information System $1 per person

27 Belize Outcomes Hospitalizations Age > 65: 79% decrease Strokes due to hypertension 3 rd leading cause of death to 12 th Vertical transmission of HIV Decreased 40% to 3.8%

29 Academia Lagging Industry has filled a void Protect their own interests Products promoted based on unsubstantiated claims Evidence weak in quantity/quality/consistency

30 Health 2.0

31 Romanow Report 2002 Paper records limit Canadians ability to access their personal health records and use their personal health information for making decisions about their own health and health care.

32 Definition Health Use of Web tools in health care Using principles of open source and generation of content by users Ui Using the power of networks Purpose: to personalize health care, collaborate, and promote health education J Med Internet Res Aug 6;10(3):e23.

33 Pew Internet and American Life Project February 2011

34 Factors: Decreased Access African Americans and Latinos Disability Older adults High school education $30, annual income

35 Pew Internet and American Life Project February 2011

36 How do patients use the internet? Model of trust 1. Rapid heuristic processing 2. Interrogation of well designed sites 3. Integration with off line lineadvice Personalized stories from like minded i dothers improved trust perceptions Soc SciMed May;64(9): Epub 2007 Feb 27.

37 Chronic Illness Significantly less likely to have internet access (62% vs. 81%) More likely to access user generated content More likely l to generate content Pew Internet and American Life Project March 2010

38 104, Members

39 What kind of information is sought? Specific disease or medical problem Medical treatment or procedure Symptoms Info about doctors or facilities Environmental health hazards Pew Internet and American Life Project February 2011 J Med Internet Res Oct 10;5(4):e24.

40 Perceptions of Research Lack of trust in research and researchers Difficulty applying research results to themselves as individuals Explore use of personal stories to illustrate research outcomes BMC Health Serv Res Mar 15;6:34.

41 Communicating Data RCT comparing direct to consumer ads with a simplified Drug Facts Box Consumers made better sense of the simplified data For example: statin 9% vs. 72% correctly quantified the benefit of the statin Most consumer ad participants overestimated the benefit Ann Intern Med Apr 21;150(8): Epub 2009 Feb 16.

43 Patient safety Patient empowerment Public health Distributed health care Knowledge exchange & research Accountability

44 Main Messages Technology is not the main barrier to change Evolution of health informatics is likely to be patient driven Need dfor academics to engage in studying di health 2.0 Facilitate communication Promote healthy living

OTTAWA 1800-160 Elgin St. Tel: (613) 230-2200 Ottawa, Ontario, Canada Fax: (613) 230-3793 K2P 2P7

OTTAWA 1800-160 Elgin St. Tel: (613) 230-2200 Ottawa, Ontario, Canada Fax: (613) 230-3793 K2P 2P7 What Canadians Say: The Way Forward Survey Report December 2013 Proprietary Warning The information contained herein is proprietary to the Canadian Hospice Palliative Care Association (CHPCA) and may not