Andrew Stranieri Centre for Informatics and Applied Optimisation University of Ballarat Victoria Tony Sahama Queensland University of Technology Queensland Health informatics research Health informatics research ID: 918822
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Resolving the health care crisis; health informatics for holistic medicine.
Andrew StranieriCentre for Informatics and Applied Optimisation, University of Ballarat, Victoria
Tony Sahama
Queensland University of Technology, Queensland
Slide2Health informatics research
Slide3Health informatics research
Holistic Medicine informatics (with
Uni Colombo, QUT, ICHM 2012)Data mining Cardiovascular disease, TCM (with CSU)
Online Dispute Resolution in Health (with Deakin)Decision Support for cancer patients, multi-disciplinary groupsSmart Information Portal (with Monash)
Slide4University of Ballarat and QUT for ICHM 2012
4Health informatics: transforming health care
Technologies
Telemedicine
Decision support systems
Data mining
Standards for interoperability
Information systems
Simulation
Electronic Health Record
Slide5University of Ballarat and QUT for ICHM 2012
5Backdrop: Health care is in crisis
Australia spends 9% of GDP on health
More chronic illnesses, diabetes, CVD. No cure ;Increasing costs of medical advances;Problems with health workforce supply and distribution – HCP flock to major cities of developed countries ;Persistent concerns about the quality and safety of health services;
Achieving equity in health
1 billion people never see a doctor
Information Communication Technologies are transforming Health
Slide6University of Ballarat QUT ICHM 2012
6Backdrop: Diverse medical systems are prevalent Body-person.
Physical (WM, TCM, N, H, AM)
Psychological (WM, H, TCM, AM, N), Spiritual (AM, H)Energetic (TCM, AM)Illness. Caused by external agent (WM, AM, TCM)
Caused by internal imbalance (TCM, AM)
Practitioner-patient relationship
Passive
.............................
Active
Slide7University of Ballarat 2011
7CAM are prevalant in the West (Dawn and Upchurch 2005, Hastings and Torada 2009, Lim et al 2005)Western Medicine growing in prevalence outside West (Hesketh and Zhu 1997; Chua and Furnham 2008)
Diverse medical systems are popular
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Backdrop: Co-existence of diverse medical systemsTCM and Ayervedic prevalence enhanced by emerging economies of China and IndiaHomeopathy already quite popular in many Western countries
CAM (in West) arguably provides good models of patient empowerment
Allopathic is very expensive. Few countries can afford 10%GDP on healthChronic (lifestyle) conditions resistant to AllopathicMany colleges of CAM around the worldAll systems co-exist as diverse but equally regarded practices
Slide9University of Ballarat, QUT ICHM 2012
9How/When will patients select a medical system ?Which practitioner
Treatment effectiveness
Empathy (Dose of doctor)Empowerment (Patient centred care)Practicalities (Availability, Cost)
Open research question: How to support patients to make a decision about which system?
Slide10University of Ballarat and QUT for ICHM 2012
10Health informatics: transforming health care
Technologies
Telemedicine
Decision support systems
Data mining
Standards for interoperability
Information systems
Simulation
Electronic Health Record
Slide11University of Ballarat and QUT for ICHM 2012
11Health informatics: transforming health care
Trends
Toward more preventative health care
Toward more participatory health care
Toward co-existence of medical systems
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Empowering patients TelemedicineAccess HCP remotely by video conferencehttps://gp2u.com.au/
University of Ballarat and QUT for ICHM 2012
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Tele-dentistryUB Consortium Pilot. Nursing home to Dentist for Cost effective treatment plans
University of Ballarat and QUT for ICHM 2012
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HD3D Pilot projectTele-oncologyOncologist and patient with nurse. Record consultation onto DVD
Tele-psychiatry
HD3D Specialist psychiatrist for fine motor movementsTele-wound managementNurse in home uploads a 3D image of a wound for a wound specialist to assess University of Ballarat and QUT for ICHM 2012
Slide15University of Ballarat 2011
15HD3D Pilot project
Tele-wound. Automated depth assessment
Open Research question: Identify image processing applications within holistic medicines
Slide16University of Ballarat 2011
16Remote surgery
Japan/Korea Arata et al 2007
World Congress on Medical Physics and Biomedical Engineering 2006 IFMBE Proceedings Volume 14, 2007, pp 3065-3068. A remote surgery experiment between Japan-Korea using the minimally invasive surgical system
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Telemedicine for holistic medicine Acupuncture at sea. Information Technology in Alternative Medicine. 2010. Bernard Fong, A. C. M. Fong, C. K. LiMindfulness by telehealth. Measuring mindfulness: which aspects of mindfulness change following a brief telehealth intervention for PTSD? B Niles1*, A Seligowski1 and A Silberbogen2 BMC Complementary and Alternative Medicine 2012, 12(Suppl 1):P191 doi:10.1186/1472-6882-12-S1-P191Open Research question: Identify which practices within holistic medicines can appropriately be performed by Tele-health
University of Ballarat and QUT for ICHM 2012
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Decision support systemsSystems that encode knowledge, use an inference and reach a conclusion. Examples: Intensive Care Unit Ballarat Hospital. Knowledge from experienced nurses in a DSS for training
DSS for inferring supportive care (relationship, spiritual, financial, transport, etc) needs of cancer patients
DSS for inferring pathology lab test diagnosis University of Ballarat and QUT for ICHM 2012
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Supportive care needs DSS Typically with Quality of Life instruments but;
Difficult to fit QOL instruments into busy HCP workflows
Difficult to engage patients. Non interactive, always the same questions. Not customised for local settings. Questions validated over large populations cannot be modified Our approach: DSS; DSS infers needs, and infers appropriate referrals. Report adds value to HCP
Interactive. Patients/carers online, at home, dynamic questions.
Can be customised for local settings. Eg no referrals to psychologists if none around. Question content and nuances evolves locally
University of Ballarat and QUT for ICHM 2012
Slide20University of Ballarat 2011
20Decision support systems in holistic medicine CAMEO (2012) helps cancer patients identify useful CAM evidenced based
Zhou et al (2012) TCM DSS for Syndrome differentiation and diagnosis
Wang et al (2008) Self learning system for TCM diagnosisVithoulkas Compass DSS for helping homeopathy practitioners select remedies http://www.vithoulkas.com/en/books-study/vithoulkas-compass.html
Slide21University of Ballarat 2011
21Decision support systems in holistic medicine: open questions How best to represent knowledge for DSS given high level of tacit knowledge in many holistic medicine systems?
How to support patients to choose between medical systems
Ripple down rules? :
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Data miningData mining = Statistics + Computer Science + MathsDiscovering patterns from dataAdverse drug reaction
Cystic Fibrosis Predictors. Quinn, Stranieri, Yearwood,
Gauditz 2010Cardiovascular autonomic neuropathy - replacement testsUniversity of Ballarat and QUT for ICHM 2012
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Data mining to discover interactionsQuinn Weighted sum discoveryClinical Data warehouse – de Silva
University of Ballarat and QUT for ICHM 2012
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Data mining open questions How to identify tasks in holistic medicine suitable for data mining?
How to collect and pre-process data in standard ways to facilitate data mining?
How to integrate clinical knowledge into data mining exercise?University of Ballarat and QUT for ICHM 2012
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Simulation systemsQuality of Care Virtual hospital SecondLife Imperial College London
Games for health
WII, UQ Distraction for burns victimsSimulation for education Knee surgery http://www.edheads.org/activities/knee/ Virtual patient UB Miller et al SecondLife Nursing (2009-10)Simulation for empowermentInteractive DVD for people who stutter Meredith (2010)
University of Ballarat and QUT for ICHM 2012
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Ubiquitous health informationPatients Like Mehttp://www.patientslikeme.com/Cochrane Collaboration
http://www.cochrane.org/
Breast Cancer OnlineHealth InSite Portal http://www.healthinsite.gov.au/
University of Ballarat and QUT for ICHM 2012
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StandardsUniversity of Ballarat and QUT for ICHM 2012
Slide28University of Ballarat 2011
28Terminology standards SNOMED
Slide29University of Ballarat 2011
29Terminology standards SNOMED
Slide30University of Ballarat 2011
30OpenEHR arhetypes
Slide31University of Ballarat 2011
31Open questions SNOMEDNew work proposal for TCM in SNOMED
Open question about SNOMED and
AyurvedaHomeopathyOther holistic medicinesOpenEHR archetypes for holistic medicine
Slide32University of Ballarat 2011
32Health informatics is based on allopathic medicine Telemedicine, Decision support, Data mining, Electronic health record, Simulation
Co-existance of complementary medicine with allopathic medicine can also help alleviate the crisis
However, requires a concerted effort by health informaticians to ensure developments are applicable to Holistic medicine
Slide33University of Ballarat 2011
33HL7 for CAM?1777.1220 : HL7 Segment : DG1 : Diagnosis Information
1777.1225
: HL7 Segment : EVN : Event Information1777.1250 : HL7 Segment : MSH : Message Header1777.1255 : HL7 Segment : NK1 : Next of Kin Information1777.1260 : HL7 Segment : NTE : Notes and Comments1777.1265 : HL7 Segment : OBR : Order Information1777.1270 : HL7 Segment : OBX : Observation Information
1777.1275
: HL7 Segment : ORC : Order Common Information
1777.1280
: HL7 Segment : PD1 : Patient Demographic Information
1777.1295
: HL7 Segment : PID : Patient Information
1777.1300
: HL7 Segment : PR1 : Procedure Information
1777.1305
: HL7 Segment : PV1 : Patient Visit Information
1777.1800
: HL7 Event Summar
y
1777.1801
: HL7 Event : A01 : Admit Patient
1777.1802
: HL7 Event : A02 : Transfer Patient
1777.1803
: HL7 Event : A03 : Discharge Patient
1777.1804
: HL7 Event : A04 : Register Patient
1777.1805
: HL7 Event : A05 : Preadmit Patient
1777.1806
: HL7 Event : A06 : Transfer ?Outpatient to Inpatient
1777.1807
: HL7 Event : A07 : Transfer ?Inpatient to Outpatient
1777.1808
: HL7 Event : A08 : Update Patient
1777.1811
: HL7 Event : A11 : Cancel Admit
1777.1812
: HL7 Event : A12 : Cancel Transfer
1777.1813
: HL7 Event : A13 : Cancel Discharge
1777.1817
: HL7 Event : A17 : Bed Swap
1777.1818
: HL7 Event : A18 : Merge Patient
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Electronic health recordIn Australian NEHTA. PCEHRMicrosoft Health Vaulthttp://www.healthvault.com/
Denmark
Bernstein 1995US Obama E H R by 2014
Slide35University of Ballarat 2011
35Electronic health recordA virtual electronic record of every health event from before birth to after death
Integrated so that every authorised health care professional can add to or access the record
Slide36University of Ballarat 2011
36Electronic health record: More complaintsPatient empowerment means more queries, complaints, disputes
Online Dispute Resolution – argument structure based organisation of the dispute to help its resolution
Slide37University of Ballarat 2011
37Electronic Health RecordOpen question:
Should CAM events be entered in an electronic health record? If so, how?
Slide38University of Ballarat 2011
38Electronic Health RecordOpen question:
Should CAM events be entered in an electronic health record? If so, how?
Slide39University of Ballarat and QUT for ICHM 2012
39Conclusion
Technologies
Telemedicine
Decision support systems
Data mining
Standards for interoperability
Information systems
Simulation
Electronic Health Record