Predavanja o eZdravju za zdravnike staziste (javno zdravje)

1. INFORMATIZACIJA V
ZDRAVSTVU
doc. dr. Matic Meglič, dr. med., MBA
Predstojnik Centra za Informatiko v Zdravstvu
NIJZ

2. ZA ZAČETEK: KOLIKO E- SMO?
Pametni mobilniki?
Tablični računalniki?
Aplikacije za klinično delo (elektronski zdravstveni karton)?
App-i za diagnostiko, izračun tveganj, kazalnikov?
Wiki, klinično znanje? Medscape, MD Consult
Twitter? LinkedIn? (Facebook)

3. Vpliv tehnološkega razvoja
na zdravje in zdravstveni sistem:
•
•
•
•
•
•
•
Dostopne tehnologije
24/7
‚The quantified self‘
Opolnomočeni pacient
Paradigma eJavnoZdravje
Personalizirana medicina
Big Data, Big Analytics
Meglič, NCCR2013

4. Kje lahko eZdravje pomaga?
x
x
• Pri vseh ključnih načinih ukrepanja
– Preventiva (primarna, sekundarna, terciarna)
– Zdravljenje
Meglič, Brodnik, IGI2009
x

5. x
x
blog.urbansedlar.com/

6. x
forbes.com
mladez.rs
ohgizmo.com
telecareconsulting.com
informaitonweek.com

7. x
Azmo the dragon

8. SLOVENSKE IZKUŠNJE
Aplikativna projekta eDepresija in eOskrba

9. Koordinacija
zdravljenja depresije
• Intervencija:
– Spletno/mobilno
okolje
– Koordinator oskrbe
– Klinična pravila
– Samoocenjevanje
– Opomniki

11. eOskrba: KOPB, diabetes, hujšanje…
4
Enaki principi
• -koordinacija
oskrbe
• -kl. smernice
• -vključevanje pac.

12. ALI STVARI DELUJEJO?

13. Izboljšanje simptomov
35
30
25
Število BDI na začetku SD
Kontrole 10
28,70
8.34
15
Primeri
12
29,50
8.15
10
t = 0.23; P = .82
5 t; P
20
BDI na koncu
17,80
7,97
t = 2.33; P = .03
SD
Kontrole
7.91
Primeri
8.05
0
BDI na začetku
BDI na koncu
Razpoložljivi
primeri
Skupina
primerov
Skupina
kontrol
Zdravi na začetku
0/21 (0%)
0/25 (0%)
Zdravi na koncu
9/12 (75%) 1/10 (10%)
Meglic et al., JMIR 2010

14. INFORMATIKA IN
ZDRAVSTVENO VARSTVO

15. Meglič, Brodnik, IGI2009

16. Poročanje
-MZ
-ZZZS
-IVZ/ZZV
eRecept
eNapotnica
eOdpustno pismo
eIzvid
ePoročilo/Obrazec
Povezovanje
do
pacienta, izva
jalcev
Orodja za
proces dela
Ekspertni
sistemi:
Meglič, Brodnik, IGI2009
Izmenjava
dokumentov, podat
kov
HIS, EZK
Triaža, ocen
a tveganja
Procesna
orodja
Telemedicina,
Koordinacija
Opolnomočenje
pacienta
LIS, PACS
Podporna orodja (€,
logistika, nabava,
poročanje
Interakcije, KI
zdravil
Diagnostična
orodja ipd.
Dostop do
znanja

17. INFORMATIKA V JAVNEM
ZDRAVJU
Za kaj gre?

18. Nova paradigma: eJavnoZdravje
• Personalizacija
• Infomediacija in opolnomočenje
• Infodemiologija

19. PRILOŢNOSTI
Skupine s
tveganim
vedenjem
Ciljane
kampanje
Vključevanje
uporabnikov
®hackingalert

20. NOVO ZNANJE
• Frost et al. JMIR 2011
• taking certain drugs “offlabel“ with higher perceived
efficacy
• side effect of amitriptyline
(dry mouth) as the purpose
for taking the drug (e.g. to
treat excessive saliva).

21. Epidemiologija, nadzor
•
•
•
•
Infodemiology, Infoveillanc
e: new concepts in health /
PH research
web (search engine
data), patient social
networks and
microblogging platforms as
source of knowledge and
live data
integration and mining of
data from various online
sources to discover new
clinical and population
patterns i.e. disease
outbreaks and syndromic
surveillance
Eysenbach 2009
Eysenbach Infovigil, later Google Flu Trends

22. Twitter za nadzor izbruhov bolezni
• Signorini 2011, Kim 2012, both PLoS ONE: Influenzalike-illness
• ‚Twitter traffic can be used … to estimate disease
activity in real time, i.e., 1–2 weeks faster than
current practice allows‘

23. PREVENTIVA IN
PRESEJANJE:
Boljše razumevanje ciljne populacije

24. Who are our users?

25. User behaviour

26. What content is relevant for our
users?

27. PRIMER AKTIVNEGA
VKLJUČEVANJA

28. I‘M A FAN OF LIFE
Izziv: osveščati splošno populacijo o tem, kako
zmanjšati tveganje za nastanek raka.
Način: Promocija JZ vsebin preko spletnih socialnih
omreţij z uporabo prijemov gamifikacije in
‚celebrity branding‘

29. The rise of Gamification - when humans beat
computers ‚back‘
Jeopardy
FOLDIT:
…scientific
advancement is
possible if even a small
fraction of the energy
that goes into playing
computer games can
be channelled into
scientific discovery.

35. Rezultati
• App na voljo 3 mesece
• Splet: 166
16.800 like-ov
• App: 5.200 uporabnikov

36. Vpliv oglaševanja
2500
FB Adverts
stop
2000
FB Adverts
stop
1500
1000
500
0
App Start
FB Adverts
stop
FB Adverts
start
FB Adverts start
Weekly Active
and 30-day cou
engaged with y
(Unique Users)
Daily Added Ap
app or connect
Follows accept
Service. (Total
Daily Removed
premissions fo
your Connect s
FB Adverts
start

37. User engagement

38. E-ZDRAVJE IN
RAZISKOVALNO DELO

39. IT services and tools to make a health care
researcher‘s life easier
• Knowledge discovery (online
publishing was the key
enabler for Open Access
Model)
– Smart filtering (i.e. PubMed)
and push notifications (using
email, RSS, apps, twitter)
– Shared knowledge discovery
(shared feeds, shared
references i.e. Mendeley)
• Collaboration
– ResearchGate (connect)
– FoldIT
– http://nhshackday.com/

40. arstechnica.com
blog.library.si.edu/

41. IT services and tools to make a health
care researcher‘s life easier (2)
• Access to new data sources online:
– microblogging data, ‚live‘ trend analysis,
– Personal Health Data (the quantified self, online
excercise mapping)
– Social Networks in Health and Health Care (PLM)
• Interaction with research subjects
– the connected human (Smartphones, tablets,
monitoring devices (wearable/ingestible/implantable)
– Ease of data acquisition: from Online Questionnaires,
portable monitoring devices, RFID infrastructure, etc.
– New ways to interact and acquire data

42. Trial search tool for patients

44. Novi buzzword: Open Data
• Publicly available large
datasets
• Coupled with generic
APIs they are super easy
to use and drill-down.
•
•
http://www.openprescribing.org/
http://www.openhealthcare.org.uk/
• Efforts to open up
pharma data.. Tough but
there are
improvements.

45. eZdravje kot čarobna paličica?
•
•
•
Using the Internet for health purposes was
associated with slightly increased
depression (due to increased
rumination, unnecessary alarm, or overattention to health problems) Bessière et
al 2010 JMIR
Suicide: phone (telemedicine) follow-up
was effective in reducing suicidal ideation
but not effective in reducing actual selfharm
The QALY gain by patients using telehealth
in addition to usual care was similar to
that by patients receiving usual care
only, and total costs associated with the
telehealth intervention were higher.
Telehealth does not seem to be a cost
effective addition to standard support and
treatment.

46. Ko se ni izšlo…
Problem poslovnega modela:
• Spletno arhiviranje (za
reference) – WebCite
www.webcitation.org
• Kolaborativno znanje (rak):
caBIG
(https://cabig.nci.nih.gov)
Problem dodane vrednosti:
• Skoraj vsi PHRji:
GoogleHealth, MedGle, Rev
olutionHealth, NHS
PHR, (HealthVault)

47. Ko se ni izšlo
Problem vgraditve
klinične vsebine:
• Diagnostika kožnih
sprememb: delujejo
samo tiste, kjer
specialist pregleda
sliko
(Zlo?)raba v tržne
namene:
• Nike+
3 of 4 smartphone applications incorrectly
classified 30% or more of melanomas as
unconcerning. Reliance on these
applications … can delay the diagnosis of
melanoma and harm users.

48. ZA KONEC
Neizogibnost
Hitrost
Previdnost ni odveč – klinična
preizkušenost
Financiranje storitev?
Vabljeni k sodelovanju!

49. matic.meglic@nijz.si
ehealth.si
matic_meglic
Matic Meglic