The Future of Health Informatics Three Case Studies

The Future of Health Informatics Three Case Studies

The Future The best way to predict the future is to invent it. Alan Kay The future is here. It's just not widely distributed yet. William Gibson

Health Informatics involves “an understanding of computer technology, medical knowledge and organisational processes to develop new systems for healthcare delivery”.

Computer Systems Patient The Interface Support for Patient Groups Dicom Web Data Exchange Portals Imaging Communications Standards Signal Processing HL 7 Image Processing Encryption Display & Alarm Design Ethics Telemedicine Authentication Security Artificial Document Image Understanding Intelligence Management Access Control Sensor Design Doctor Terminology HCI Data Bases Evaluation Clinical Trials Reproduction Staff to Staff Human Factors Patient Records Communication Violations Verification The Validation Audit Organisation The Health Informatics Environment The Hospital

What Developments n Support for Patient Groups u n Telemedicine u n Quackwatch – Content First Outreach Monitoring – Lifeshirt and others Human Factors Design u Alarms and Displays – Preventing Medical Error

Case Study 1: Quackwatch SM Your Guide to Health Fraud, Quackery, and Intelligent Decisions Operated by Stephen Barrett, M. D If you write, please mention how you found this Web site. Have you been seriously harmed by a health scam? Please write to victims@quackwatch. com. UK victims click here We accept small donations to support our work. What's New? Questions? Comments? Navigation Tips Discussion List Free Newsletter Join Advisory Board Chirobase Dental Watch Homeo. Watch MLM Watch Nutri. Watch NCAHF

Quackwatch n Quackwatch, a member of Consumer Federation of America. n It is a nonprofit corporation whose purpose is to combat health-related frauds, myths, fads, and fallacies. n Its primary focus is on quackery-related information that is difficult or impossible to get elsewhere.

Lesson 1: Proven Need n Founded by Dr. Stephen Barrett in 1969 as the Lehigh Valley Committee Against Health Fraud n The Quackwatch Web site was launched December 1996 n Donation financed and sustainable n International list of expert advisors

Lesson 2: Clarity of Purpose n Quackwatch defines quackery as: u u Anything involving over promotion in the field of health Includes questionable ideas, products and services Regardless of the sincerity of their promoters. The word "fraud" is reserved only for deliberate deception.

Quackwatch Activities n Investigating questionable claims n Answering inquiries n Distributing reliable publications n Reporting illegal marketing n Generating consumer-protection lawsuits n Improving the quality of health information on the Internet n Attacking misleading advertising on the Internet

Why is the future? n Partnership of experts and patients n Its organisation centred u n Technology follows content and need The site is not too slick u Looks as if its made by real people

Case Study 2: Outreach Monitoring n Ambulatory Monitoring u Holter Monitoring u Automatic Defibrillators n ICU Monitoring u Need to take monitoring nearer to patients u Foresight Health 2020 u In Hospital and further n Demographic Time Bomb u Ageing Population u Australia and Japan u Keeping older people in their homes u Activity Monitoring

Telemedicine n Synergistic on new non-medical technologies u u u n Land-based telephone technology Mobile telephone technology Blue Tooth Takes different forms u u Remote ECG analysis Remote consultation

More Radical Approach n Lifeshirt u Set of sensors in a jacket u Recorded on a PDA u Analysed by software remotely or at home u Remote monitoring possible u GPS

Lifeshirt requires n Online/automatic data interpretation u Data-mining and machine learning n Easy to use sensors n Social framework of response

Case Study 3: Human Error Cause of Critical Incident % Human Factors Error 65. 9 Fixation Error 20. 5 Unknown Cause 10. 6 Equipment Failure 3. 0 Type of error Failure to check Inexperience Inattention Fixation Haste Distraction Fatigue Not following procedure % 43. 9 41. 0 32. 7 20. 5 25. 8 14. 0 10. 8 6. 1

Skill-based Level Error types: Slips and Lapses Best self detection method: Direct Error Hypothesis (DEH) Error State? OK? Yes Goal State No Yes Rule-based Level Error types: Rule-based mistakes Best self detection method: DEH & Error Suspicion (ES) Problem Solved? Error State ? No Consider local state information Familiar Pattern? Yes Found Knowledge-based Level Error types: Rule-based mistakes Best self detection method: Standard Check Apply Rule Find higher analogy None found Revert to higher mental functions Infer diagnosis, strategy, action, etc.

Lessons to be drawn n Informatics solutions that are not ecological will create more error Solutions that create more error will destroy clinical confidence in informatics Solutions that destroy confidence in informatics will not be used

Conclusions n Health Informatics will be very important in the future u Very varied u Depend on Social underpinning u Has to be appropriate not flash

Conclusions Our imagination is the only limit to what we can hope to have in the future. Charles F. Kettering I have seen the future and it doesn't work. Robert Fulford