ehealth Challenges

Iris Thiele Isip Tan MD, MSc, FPCP, FPSEMChief, UP College of Medicine Medical Informatics UnitAssociate Professor 4, UP College of MedicineSection of Endocrinology, Diabetes & Metabolism, Philippine General Hospital

“Unitron Sky Walker” by pasukaru76, http://www.flickr.com/photos/pasukaru76/6271854325/

eHealth Challenges

7 Dec 2012

Saturday, December 8, 12

http://www.flickr.com/photos/pasukaru76/6271854325/

http://www.flickr.com/photos/pasukaru76/6271854325/

http://www.engineeringchallenges.org/cms/8996/9221.aspxSaturday, December 8, 12

http://www.engineeringchallenges.org/cms/8996/9221.aspx

http://www.engineeringchallenges.org/cms/8996/9221.aspx

“jigsaw puzzle” by spekulator, http://www.sxc.hu/photo/944284

Make solar energy

economical

Provide energy from fusion Develop carbon

sequestration methods

Manage the nitrogen cycle

Provide access to

clean water

Advance health

informatics

Engineer better

medicines

Restore & improve urban infrastructure

Reverse-engineer the brain

Prevent nuclear terror

Secure cyberspaceEnhance

virtual reality

Advance personalized

learning

Engineer the tools of scientific discovery


http://www.sxc.hu/photo/944284

http://www.sxc.hu/photo/944284

Kulikowski et al. AMIA Board white paper: definition of biomedical informatics and specification of core

competencies for graduate education in the discipline. J Am Med Inform Assoc 2012;19:931-8.


eHealth Challenges

Image from katerha, http://www.flickr.com/photos/katerha/5021019816/

Center for Development of Advanced Computing (India)

Electronic Medical Record

Systems for improved patient education

and compliance

Data mining for medical knowledge


http://www.flickr.com/photos/katerha/5021019816/


eHealth Challenges







http://www2.fraserhealth.ca/media/how%20hazardous%20is%20healthcare%202.jpg




Adverse events

2.9%Colorado

& Utah

3.7%New York

Medical Errors

50%Ooops 44,000 -

98,000 deaths/year

To Err is Human: Building a Safer Health System

Institute of Medicine 1999

6.6-13.6% mortality


http://www.youtube.com/watch?v=7Ks3hezVSIM




Electronic Medical Record (EMR)

Core application for patient-specific information


EMR: Challenges

Structured data entry vs free text

Y N Visual disturbancesY N Eye itchingY N Eye pain


EMR: Challenges

Universally agreed-on medical vocabulary or standard terminology


EMR: Challenges• Protection of

patient privacy and confidentiality–Health Insurance

Portability and Accountability Act (1996)


Good information is the best medicine. Michael E. DeBakey, MD


http://youtu.be/2ikjOSmqpyo




EMR: Challenges

UsabilityIntegrate EMR into busy clinical workflow


“NextGen is unusable” by juhansonin,

http://www.flickr.com/photos/juhansonin/3857845956/






EMR: ChallengesOptimal computing device for the clinical setting?


Incident record

Patient record

Health record

Data generated when individual interacts with HCP

A series of incident records generated by specific HCP

All patient records generated over an individual’s lifetime by all HCPs who provide services

http://www.hc-sc.gc.ca/ohih-bsi/Saturday, December 8, 12

http://www.hc-

http://www.hc-

http://youtu.be/Lo_3qOejQzI




EMR: Challenges• Standards: to facilitate integration of

data, especially across systems from different vendors

–Digital Imaging & Communications in Medicine (DICOM)

–Health Level 7 (HL7)


http://www.emrindustry.com/index.php/will-next-generation-emrs-be-platform-stack-of-apps/




http://www.carepractice.com/emr-needs-a-kick-in-the-app-hole/

“The utopic future of medicine will seamlessly combine data from your daily apps and personalize a health treatment plan based on the life you actually live.”




http://vimeo.com/38063992




“As opposed to the doctor-centric, curative model of the past, the future is going to be

patient-centric and proactive.”Elias A. Zerhouni MD, NIH Director

Dec 2007

Image by JD Hancockhttp://www.flickr.com/photos/jdhancock/4100030094/


http://www.flickr.com/photos/jdhancock/4100030094/

http://www.flickr.com/photos/jdhancock/4100030094/

Participatory Medicine

Image by Liz Gracehttp://www.flickr.com/photos/liz-grace/5078868809/

“Movement in which networked patients shift from being mere passengers to responsible drivers of their health ...

providers encourage and value them as full partners”

Society for Participatory Medicine


http://www.flickr.com/photos/liz-grace/5078868809/

http://www.flickr.com/photos/liz-grace/5078868809/

Personal Health Record

• Provider-owned and provider-maintained digital summary– Read-only for patient– Access to lab results

through a password-protected Web site

– Commercial EHRs offer digital summaries through patient portals

• Patient-owned software program

– Patient can enter, organize, retrieve own health information

– Web-based i.e. Google Health, Microsoft HealthVault

Endsley et al. An Introduction to Personal Health Records http://www.afp.org/fpm


Personal Health Record• Portable, interoperable digital file

–Selected, clinically relevant health data can be managed, secured and transferred

–Platforms: Smart cards, PDAs, cellphones, USB-compatible devices

Endsley et al. An Introduction to Personal Health Records http://www.afp.org/fpm


No longer fill out formsAuthentication

Protection from fraud if lostRapid access to previously unavailable information

Paperwork for health record transfers are eliminatedElectronic prescriptions can be stored on the card


eHealth Challenges




and compliance




http://www.chaindrugreview.com/front-page/newsbreaks/thrifty-white-introduces-smart-cap-to-spur-rx-complianceSaturday, December 8, 12

http://www.chaindrugreview.com/front-page/newsbreaks/thrifty-white-introduces-smart-cap-to-spur-rx-compliance

http://www.chaindrugreview.com/front-page/newsbreaks/thrifty-white-introduces-smart-cap-to-spur-rx-compliance

http://www.ama-assn.org/amednews/2010/05/10/bisb0510.htm




Gamificationuse of game play mechanisms

for non-game applications

http://www.imedicalapps.com/2011/08/2011-mobile-health-world-congress-gamification-health-care/Saturday, December 8, 12

http://www.imedicalapps.com/2011/08/2011-mobile-health-world-congress-gamification-health-care/

http://www.imedicalapps.com/2011/08/2011-mobile-health-world-congress-gamification-health-care/

http://www.informationweek.com/healthcare/mobile-wireless/10-wearable-health-tech-devices-to-watchSaturday, December 8, 12

http://www.informationweek.com/healthcare/mobile-wireless/10-wearable-health-tech-devices-to-watch

http://www.informationweek.com/healthcare/mobile-wireless/10-wearable-health-tech-devices-to-watch

eHealth Challenges







Slide from presentation of Desikan et al, 2011 Siam International Conference on Data MiningSaturday, December 8, 12

“toes” by basheertome, http://www.flickr.com/photos/basheertome/7001981033/

We are drowning in data but starving for knowledge!

clinical decision support

healthcare resource management


http://www.flickr.com/photos/basheertome/7001981033/

http://www.flickr.com/photos/basheertome/7001981033/

Challenges in Data Mining for Healthcare

data set from various data sources

bias from heterogeneous data

missing values, noise and outliers

Pink Sherbet photography, http://www.flickr.com/photos/pinksherbet/4621820292/

protection of security, integrity and privacy


http://www.flickr.com/photos/pinksherbet/4621820292/

http://www.flickr.com/photos/pinksherbet/4621820292/

eHealth Challenges





and compliance





Thank Youhttp://www.endocrine-witch.net

@endocrine_witch

Image from http://wthr.frumph.net/


http://www.endocrine-witch.net

http://www.endocrine-witch.net

http://wthr.frumph.net

http://wthr.frumph.net

ehealth Challenges

Health & Medicine

Transcript of ehealth Challenges