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Lecture : eHealth
Lecture Outline
The Future of Healthcare - The banking metaphor Existing Health on the Web eHealth - terminology Transmural Care Electronic Medical Records (EMR) Medical Records - Access Clinical Decision Support Systems Telemedicine - Case Studies eHealth Standards eHealth / eScience : Cancer Diagnosis Benefits of eHealth Medical Errors Why is eHealth Adopted Slowly? New sources of "health"
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Most transactions carried out by the customer Centralisation of specialist services Decentralisation of nonspecialist services
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eHealth
Healthcare which is supported by electronic processes Other terms: Healthcare informatics or Health Information Technology (HIT) Medical Information Systems (MIS) Biomedical informatics (also includes Bioinformatics: gene sequencing etc.)
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eHealth
Healthcare which is supported by electronic processes eHealth includes: Electronic Medical Records: easy communication of patient data between different healthcare professionals (GPs, specialists, care team, pharmacy) Telemedicine: do not require a patient and specialist in same physical location.
Transmural Care
Transmural: Care should not stop at the walls of the hospital Both intra- and extra-mural, thus transmural care. Care before, during and after the hospital stay. Cooperation and coordination among local practitioner, hospital, home care and rehabilitation centres Patient part of an agreed programme - protocols and standards.
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Access of patient data by clinical staff at any given location Accurate and complete claims processing by insurance companies Building automated checks for drug and allergy interactions Clinical notes Prescriptions Scheduling Sending and viewing labs
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Two types of record: Born digital" record : information originally entered in electronic format Digital format record : originally produced in a hardcopy form (x-ray film, photographs, etc.), scanned or imaged and converted to a digital form. Also: Personal Health Record (PHR) - stored and maintained by the patient. Issue: Home computer vulnerable to attack
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need for periodic conversion and migration to ensure the formats they were captured in remain accessible Media degrades Media becomes obsolete protection of privacy is a major concern - need privacy and security policies
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Patients have the right to check for any errors in their record and insist that amendments be made if required.
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Objectives: Diagnostic support Drug dosing Preventive care reminders Disease management (diabetes, hypertension, AIDS, asthma) Test ordering, drug prescription
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The delivery of medicine at a distance. Two basic forms: Live telemedicine - videoconference link Store-and-forward telemedicine - transmit for assessment offline Typical Telemedicine interaction: store and forward followed by live interaction. Data types text (e.g. patient's notes) image (e.g. x-ray) Telemedicine often relies on images (still or moving) Equipment general purpose (e.g. PCs) specialist (e.g. electronic stethoscope)
Telemedicine
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The delivery of medicine at a distance. Telemedicine most useful when Specialist services are in very high demand or Patients are extremely isolated (Antarctica or remote communities in Australia, Africa and Alaska) Home care is often delivered by telemedicine Automatic monitoring and pill dispensing etc. Telesurgery may also be considered as a subset of telemedicine. Patient operated on by remotely controlled robotic arms etc.
Telemedicine (contd.)
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Before: No access to specialist consultants Long wait for GP to be called in After: Linked to specialist consultant in Royal Cornwall Hospital Recorded sessions useful for training nurses and for audit Cornwall Healthcare Trust expects to save 100,000 a year http://www.bthealth.com/casestdy/cstudy/case11.htm
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Biggest telemedicine project in the world Mainly telephone service Expanding to: Web
Online diagnosis for common conditions Health encyclopaedia My NHS healthspace (personal info portal): news, reminders, knowledge
Digital TV
eHealth Standards
Not-for-profit organisations involved in the standardization process American Society for Testing and Materials (ASTM), Health Level 7 (HL7) Healthcare Information and Management Systems Society (HIMSS) CEN (European Committee for Standardisation) ISO TC215 Controlled medical vocabularies: Standardized Nomenclature of Medicine, Clinical Terms (SNOMED-CT) Logical Observation Identifiers Names and Codes (LOINC) OpenGALEN Common Reference Model 21(#total)
Benefits of eHealth
Reduced record keeping expenses More accurate data No poor handwriting problems Automated sharing among patients and provider Empower the patient to manage their own health via Internet information and decision support tools Reduced office visits to get results Avoidance of duplicating tests Automatic summarisation/graphical displays of context-relevant information to the physician
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Medical Errors
Human Errors: IOM Report, 1999 44,000 to 98,000 die in US annually from medical errors at 44,000, would rank as 8th leading cause of death
car accidents: 43,458 breast cancer: 42,297 AIDS: 16,516
Medical Errors
Does Software Help? Therac-25 Radiation therapy machine At least six known accidents between 1985 and 1987 Patients were given massive overdoses of radiation At least five patients died of the overdoses Causes: both organisational and technical 100 medical software recalls annually, 40 for software errors
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Integration of IT
2010 - WRONG!
1980
1990
2000
IT as a gadget Trojan horse: networks, Full Integration of IT into Business (Organisational, Legal) Re-engineering of the system
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Cardiac - Cancer - Mental Health Costs can be competitive Popular tourist resort for families
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Summary
The Future of Healthcare - The banking metaphor Existing Health on the Web eHealth - terminology Transmural Care Electronic Medical Records (EMR) Medical Records - Access Clinical Decision Support Systems Telemedicine - Case Studies eHealth Standards eHealth / eScience : Cancer Diagnosis Benefits of eHealth Medical Errors Why is eHealth Adopted Slowly? New sources of "health"
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