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

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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

Contactsnawanan.the@mahidol.ac.th

SlideShare.net/Nawanan

www.tc.umn.edu/~theer002

groups.google.com/group/ThaiHealthIT

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Your Introduction

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My Personal Journey on 

Health Informatics

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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

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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

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Q & A...

Download Slides

SlideShare.net/Nawanan

Contacts

nawanan.the@mahidol.ac.th

www.tc.umn.edu/~theer002

groups.google.com/group/ThaiHealthIT

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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