Health Informatics its role, importance and a historical perspective (why should I care?) David Parry, School of Computing, AUT

Transcription

1 Health Informatics its role, importance and a historical perspective (why should I care?) David Parry, School of Computing, AUT

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3 Agenda Where did Health informatics come from? What does it do? Why should I care?

4 Why you can t keep up Number of clinical trials published in PUBMED per year

5 Informatics is Information-centred not computer centred Based on getting clinical value from information (Very) important in primary care A support for administration and workflow as well as clinical activity A New Zealand Success story

6 History Informatics deals with handling information Recorded Observations Hippocrates( BC) Index Medicus John Shaw Billings 1879

7 The broad street pump John Snow August 1854,

8 Computers arrive...

9 Moore s law

10 People and computers Computing Complexity Human Complexity 1 million years BC

11 History Internet started in 1960s to protect networks in the case of nuclear warfare. World Wide Web suggested in paper published in Browsers early 1990 s 19.2 Billion webpages in 2005 Most users now access WWW via mobile devices.

12 Per 100 inhabitants Global ICT developments, Mobile cellular telephone subscriptions Internet users Fixed telephone lines Active mobile broadband subscriptions 60 Fixed (wired) broadband subscriptions Source: ITU World Telecommunication /ICT Indicators database

13 What does Health Informatics do? Successful areas of Health informatics include: Reminder systems Electronic health records Data repositories Coding, Ontologies and vocabularies Data sharing M/Uhealth

14 Essentially... Storing Presenting Collecting Information Analysing Sharing

15 Medicine needs records

16 Problems with paper

17 Problems with paper

18 Electronic Health Records Present in effectively all GP surgeries, and most DHB s

19 Five uses of clinical data (MOH) Data collected should be available for: Supporting clinical intervention Clinical Governance Administration (in all parts of Health) Strategy and policy development Research

20 The sixth use? Patient (consumer) self-management and self care.

21 Decision support Use data from Electronic record, combine with rules Reminders eg high blood pressure, protocols Decision Analysis need utility values

22 Recall and health management Cervical Screening, Contraceptive Pill Blood pressure, diabetes Paediatric checks Moving into.. Community care Telehealth

23 The Central Paradox of CaseMIX Every patient is different BUT we want to compare them.. So we code them

24 Why use a vocabulary? example Pre-eclampsia Gestational Proteinuric Hypertension Toxaemia GPH PET PE All the same all map to.. pre-eclampsia code

25 SNOMED CT

26 Why is coding difficult? Experts don t agree even when a loose standard of agreement is required (Chiang 2006) SNOMED CT is very large and changes by 5-10% each release Data is used in ways that might be unfamiliar to the originator Reliability of SNOMED-CT Coding by Three Physicians using Two Terminology Browsers Michael F. Chiang, John C. Hwang, Alexander C. Yu, Daniel S. Casper, James J. Cimino, and Justin Starren AMIA Annu Symp Proc. 2006; 2006:

27 Presenting Information -Access (distance) to health care Population (by territorial authority) more than 30 minutes from a GP; using LCPA (least cost path algorithm)

28 Sharing : Messaging :HL 7 Health level 7 Initial version going back to 1987 Extensive use around the world, and since 1994 in New Zealand

29 Why messages? No communication electronically at all life is difficult Shared universal record so far impossible c.f. connecting for health UK Messaging send standard, relevant pieces of information between electronic systems.

30 Messages and the n(n-1) Problem Pharmacy GP Labs Hospital

31 Recall and health management Cervical Screening, Contraceptive Pill Blood pressure, diabetes Paediatric checks Moving into.. Community care Telehealth

32 Mobile and ubiquitous health

33 Pill dispensing Counts pills dispensed Wireless device

34 Why should I care? Informatics needs clinical input and clinical problems to work on. Good solutions come from clinical involvement If clinicians don t get involved...

35 What not to do...

36 Keep Hardware Secure

37 Keep data secure

38 Questions?

39 Useful information sources HINZ IMIA - Health IT cluster : National Health IT board: HISA (Australia)- RACGP ehealth site: