Department of Social Informatics Graduate School of Informatics Kyoto University, Japan July 8, 2004...
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Transcript of Department of Social Informatics Graduate School of Informatics Kyoto University, Japan July 8, 2004...
Department of Social InformaticsDepartment of Social InformaticsGraduate School of InformaticsGraduate School of Informatics
Kyoto University, Japan July 8, 2004Kyoto University, Japan July 8, 2004
The Social Informaticsof Healthcare Infrastructure
Bruce R. SchatzSchool of Library & Information Science
School of Biomedical & Health Information SciencesUniversity of Illinois at Urbana-Champaign, USA
[email protected] , www.canis.uiuc.edu
The Solution to The Problem The Solution to The Problem Social Informatics
Information technology solution to important social problem
(Distributed System for Data Analysis)
Healthcare InfrastructureManaging the Health of Populations(Health System for All People)
Healthcare InfrastructureHealthcare Infrastructure
Infrastructure is the Whole SystemHospital, Clinic, HomeDoctors, Nurses, Brochures, Internet
NO Viable Model for Health SystemToo much Cost! Too Much Volume!
Health SystemsHealth Systems
Healthcare is THE Economic IssueBIGGEST item in modern societiesFast growing due to aging population
Healthcare will BREAK Every NationNations go bankrupt and People die!
The Fundamental Cause 1The Fundamental Cause 1
Medicine versus HealthCure Sick in BIG HospitalMaintain Wellness in small Clinic
Recent Rise of Chronic IllnessNo cure with drugs & surgery only manage with diet & exercise
The Fundamental Cause 2The Fundamental Cause 2
Health Systems now for Acute IllnessHospitals are Profitable Business butClinics are supported by Government
Systems cannot handle Chronic IllnessChronic Illness now dominates Costs
and Systems cannot handle Volume
The Viable Solution 1The Viable Solution 1 Independent Clinics are Doomed
1990s America -- small Clinics failedwhen Government support reduced.
Health Systems start HMOsHealth Maintenance Organizations2000s America – HMOs all failing.2000s Japan – small Clinics will failwhen Government support reduced.
The Viable Solution 2The Viable Solution 2 Need Complete Provider Pyramids
High Level for High Quality at High CostLow Level for Low Quality at Low CostHandle Volume by Pushing Cases DownBottom Levels handle MOST CASES
Viable Healthcare InfrastructureHospitals with Doctors for Surgery, Clinics
with Nurse for Drugs, Homes with Patients for nearly all Health Interactions!
Social InformaticsSocial Informatics Need New Viable Infrastructure
Health Information TechnologyProvides Support for Patients in HomesCreates Bottom of Pyramid to Offload
Informatics can Solve this ProblemPatients themselves create population
health database via social informatics that automatically routes healthcare
Informatics TechnologiesInformatics Technologies Measure Population Health
Adaptive Question Asking of Quality of Life Questionnaires
Answers for Individuals creates Database for the Population
Manage Population HealthStructured Health Vectors from
normalized patient recordsStatistical Information Retrieval cluster
patients into care cohorts
Measure Population Health 1 Measure Population Health 1 Quality of Life Questionnaires
Self-Assessment directly by PatientsGeneral Status questions, e.g. SF-36Specific Disease questions, e.g. Arthritis: Can you walk without pain? Heart Disease: Do your ankles swell?
QoL correctly does coarse predictionVA Heart Study: SF-12 better than
surgeon about patient survival
Measure Population Health 2Measure Population Health 2 Electronic Records for fine prediction
Paper supports 10s of questionsElectronic supports 100s or 1000s
Adaptive Question AskingChoose questions by weighted treewalkEach session asks 10s of questions
customized to particular condition Generate Population Database
Daily individual records from all homes
Manage Population HealthManage Population Health Structured Health Vectors
Patient answers Questions dailyAverage scores generate Health VectorElements of Vector are Meaningful
Cluster Patient CohortsNormalize Vectors for Similar ClustersWeight Question Groups MedicallyRoute Care into Pyramid using
Clusters to Determine Cohorts
Theory ExperimentTheory Experiment Questionnaire from Merged QoL
120 questions from 20 questionnairesGeneral plus some Specific questions
Simple Clusters do coarse predictionStudents simulate sick or well patientsK-means with random seeds does
correct clustering from actual health monitor sessions with 100 answers
Practice ExperimentPractice Experiment Practical Risk Assessment Possible?
Need 4 Cohort Clusters correctly predicted: hospital, clinic, telephone, home
Is 120 questions (10*more) enough? What Clusters can do fine prediction?
Use Historical Database of Real Patients answering Paper QoL Questionnaires
Agglomerative with complete link always consistent but always correct? May need appropriate structured vector weighting
Clinical ExperimentClinical Experiment Real Patients in Real Settings
1000 senior patients with heart diseaseUse in Medicare Coordinated CareTelephone Interface via voice responseDetermine Care Levels automatically
Demonstrate Feasible TechnologiesAdaptive Question Asking with
Faceted Category ClassificationStatistical Cohort Clustering with
Structured Vector Weighting
Current Prototype StatusCurrent Prototype Status Theory Experiment
Completed in LIS 450MIH and LIS 429Health Informatics & Information Retrieval
Practice ExperimentOn-going collaboration with Carle HospitalAdaptive Faceted being DevelopedHistorical Databases being Analyzed
Clinical ExperimentMulti-Year Trial Proposal to US AHRQ
Agency for Healthcare Research &Quality
Clinical RationaleClinical RationaleClinical RationaleClinical Rationale
Population Monitoringof
Average Health
Healthcare InfrastructureHealthcare Infrastructure
Provider PyramidsScale to Volumes for Chronic Illness
Risk AssessmentAutomatically Determine Level of Care
The Future of Health SystemsThe Future of Health Systems
Effective PreventionInfrastructure supports Routine CareHealthcare biggest use of Internet
Historical NexusTelephone: Everyone is an OperatorHealthcare: Everyone is a Doctor
Further InformationFurther Information Papers
See articles on Internet Health Monitors and on Monitoring Population Health by R. Berlin, MD, and B. Schatz, PhD, at www.canis.uiuc.edu under Publications under Papers.
DemosTry prototypes and view analysis at
www.canis.uiuc.edu under MedSpace at bottom of web page.