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Development & Management of Information Systems
in Healthcare
Nawanan Theera‐Ampornpunt, M.D., Ph.D.
SlideShare.net/Nawanan
Sep. 13, 2014For Mahidol University Faculty of ICT
2
Introduction
2003 M.D. (1st-Class Honors) Ramathibodi
2009 M.S. (Health Informatics) University of Minnesota
2011 Ph.D. (Health Informatics) University of Minnesota
2012 Certified HL7 CDA Specialist
Currently• Instructor, Department of Community Medicine, Ramathibodi
• Deputy Executive Director for Informatics (CIO), Chakri Naruebodindra
Medical Institute, Faculty of Medicine Ramathibodi Hospital
SlideShare.net/Nawanan
www.tc.umn.edu/~theer002
groups.google.com/group/ThaiHealthIT
3
Your Introduction
4
My Personal Journey on
Health Informatics
5
Healthcare & Health ITHealth IT Applications in HospitalsDevelopment & Management of Information Systems in Healthcare
Outline
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Health care & Health IT
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Manufacturing
Image Source: Guardian.co.uk
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Banking
Image Source: Cablephet.com
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Health care
ER ‐ Image Source: nj.com
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Life‐or‐DeathMany & varied stakeholders Strong professional values Evolving standards of care Fragmented, poorly‐coordinated systems Large, ever‐growing & changing body of knowledge
High volume, low resources, little time
Why Health care Isn’t Like Any Others?
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Large variations & contextual dependence
Why Health care Isn’t Like Any Others?
Input Process Output
Patient Presentation
Decision‐Making
Biological Responses
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But...Are We That Different?
Input Process Output
Transfer
Banking
Value‐Add‐ Security‐ Convenience‐ Customer Service
Location A Location B
13
Input Process Output
Assembling
Manufacturing
Raw Materials
Finished Goods
Value‐Add‐ Innovation‐ Design‐ QC
But...Are We That Different?
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But...Are We That Different?
Input Process Output
Patient Care
Health care
Sick Patient Well Patient
Value‐Add‐ Technology & medications‐ Clinical knowledge & skills‐ Quality of care; process improvement‐ Information
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Why Adopting Health IT?
“To Computerize”“To Go paperless”
“Digital Hospital”
“To Modernize”
“To Get a HIS”
“To Have EMRs”
“To Share data”
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“Don’t implement technology just for technology’s sake.”
“Don’t make use of excellent technology. Make excellent use of technology.”(Tangwongsan, Supachai. Personal communication, 2005.)
“Health care IT is not a panacea for all that ails medicine.” (Hersh, 2004)
Some Quotes
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What Clinicians Want?
To treat & to care for their patients to their best abilities, given limited time & resources
Image Source: http://en.wikipedia.org/wiki/File:Newborn_Examination_1967.jpg (Nevit Dilmen)
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High Quality Care
SafeTimelyEffectiveEfficientEquitablePatient‐Centered
Institute of Medicine, Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy Press; 2001. 337 p. IOM (2001)
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Information is Everywhere in Health Care
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Class Exercise
How information systems & ICT can
contribute toward high quality care?
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Achieving Quality Care with Information
SafeDrug allergiesMedication Reconciliation
Timely Complete information at point of care
EffectiveBetter clinical decision‐making
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Achieving Quality Care with Information
Efficient Faster care Time & cost savingsReducing unnecessary tests
EquitableAccess to providers & knowledge
Patient‐Centered Empowerment & better self‐care
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That’s Where Health IT Plays A Role...
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The Anatomy of the Word “Health IT”
HealthInformationTechnology
Goal
Value‐Add
Tools
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Various Forms of Health IT
Hospital Information System (HIS) Computerized Provider Order Entry (CPOE)
Electronic Health Records (EHRs)
Picture Archiving and Communication System
(PACS)
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Still Many Other Forms of Health IT
m‐Health
Health Information Exchange (HIE)
Biosurveillance
Information RetrievalTelemedicine &
Telehealth
Images from Apple Inc., Geekzone.co.nz, Google, PubMed.gov, and American Telecare, Inc.
Personal Health Records (PHRs)
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Guideline adherenceBetter documentationPractitioner decision making or process of care
Medication safetyPatient surveillance & monitoring
Patient education/reminder
Value of Health IT (in Literature)
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Fundamental Theorem of Informatics
(Friedman, 2009)Friedman (2009)
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Is There A Role for Health IT?
IOM (2000)
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Landmark IOM Reports
IOM (2001)IOM (2000)
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Humans are not perfect and are bound to make errors
Highlight problems in the U.S. health care system that systematically contributes to medical errors and poor quality
Recommends reform that would change how health care works and how technology innovations can help improve quality/safety
Landmark IOM Reports: Summary
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Health care is very complex (and inefficient) Health care is information‐rich Quality of care depends on timely availability & quality of information
Clinical knowledge body is too large Short time during a visit Practice guidelines are put “on‐the‐shelf” “To err is human”
Summary: Why We Need Health IT
33 Image Source: aafp.org
Lack of Attention
To Err Is Human
34 Image Source: Dr. Suthan Srisangkaew
Human Brain’s Limited Memory
To Err Is Human
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Medication Errors Drug Allergies
Drug Interactions
Ineffective or inappropriate treatment
Redundant orders
Failure to follow clinical practice guidelines
Common Errors
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IT Management
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Vision (Goal)
Mission (Purpose)
Business Strategies
IT Strategies
IT & Strategic Management
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IT strategies support business strategies toward a common vision & mission of the organization
IT strategies are implemented as IT projects
“Project Management” is a best‐practice methodology to manage projects so they deliver promised results on time and on budget
IT Strategies & Projects
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What are common functions of an IT unit in
a healthcare organization?
Class Exercise
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IT
Hardware & Network
Software
Data
People, Process &
Management
Components of IT
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Software development & acquisition
Healthcare Service Delivery (Front Office)
Back Office
Infrastructure
Systems administration
Network administration
Data management, analysis & reporting
Common IT Functions in Healthcare Organizations
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In‐house Development
Outsourced
Standard Off‐the‐Shelf
Standard Package with Customizations
Personalized Solutions
What are the pros & cons?
How to determine the right approach?
Software Acquisition
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A Ramathibodi journey
In‐house or Outsource?
44 Marchewka JT (2006)
Software Development Process
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Waterfall (Traditional Software Development)
Software Development Methodology
http://en.wikipedia.org/wiki/Waterfall_model
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Waterfall (Traditional Software Development)
Agile Software Development
Scrum
Extreme Programming
etc.
Other methodologies
Software Development Methodology
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Balanced Focus of Informatics
People
Techno‐logyProcess
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Healthcare is complex
Health IT can benefit healthcare through
Information collection, presentatio & use
Process improvement (e.g. reducing errors, improving quality of care)
Management of IT is crucial to an organization’s success
Balance of “People, Process & Technology”
Strategic mindset
IT Project management
Various methods to acquire & develop information systems
Know your organization (“context”)
Summary
49
Q & A...
Download Slides
SlideShare.net/Nawanan
Contacts
www.tc.umn.edu/~theer002
groups.google.com/group/ThaiHealthIT
50
Friedman CP. A "fundamental theorem" of biomedical informatics. J Am Med Inform Assoc. 2009 Apr;16(2):169‐70.
Institute of Medicine, Committee on Quality of Health Care in America. To err is human: building a safer health system. Kohn LT, Corrigan JM, Donaldson MS, editors. Washington, DC: National Academy Press;2000. 287 p.
Institute of Medicine, Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy Press; 2001. 337 p.
References
