10. หลากหลายรูปแบบของ Health IT
Hospital Information System (HIS) Computerized Provider Order Entry (CPOE)
Electronic
Health
Records
(EHRs)
Picture Archiving and
Communication System
(PACS)
11. อีกหลายรูปแบบของ Health IT
m-Health
Health Information
Exchange (HIE)
Biosurveillance
Information Retrieval
Telemedicine &
Telehealth
Images from Apple Inc., Geekzone.co.nz, Google, PubMed.gov, and American Telecare, I
Personal Health Records
(PHRs)
13. Front Office
• ระบบงานบริการผู้ป่วย (Front Office)
– ระบบเวชระเบียนอิเล็กทรอนิกส์ (Electronic Medical Records
หรือ Electronic Health Records)
– ระบบสารสนเทศโรงพยาบาล (Hospital Information System)
หรือระบบสารสนเทศทางคลินิก (Clinical Information System)
– ระบบงานย่อยๆ ของหน่วยบริการภายในโรงพยาบาล
14. Back Office
• ระบบงานบริหารจัดการ ที่ไม่เกี่ยวกับงานบริการ (Back Office)
– ระบบสารสนเทศเพื่อการบริหาร (Management Information Systems
หรือ MIS)
– ระบบบริหารจัดการทรัพยากรองค์กร (Enterprise Resource Planning
หรือ ERP)
– ระบบสารสนเทศการวิจัยและการศึกษา
– เว็บไซต์ และอินทราเน็ตภายในองค์กร
– ระบบงานสารบรรณ (การเวียนเอกสาร)
36. • Clinical Decision Support (CDS) “is a process for enhancing
health-related decisions and actions with pertinent, organized
clinical knowledge and patient information to improve health and
healthcare delivery” (Including both computer-based & non-computer-
based CDS)
(Osheroff et al., 2012)
What Is A CDS?
37. What Is A CDS?
• Computer-based clinical decision support (CDS): “Use of the
computer [ICT] to bring relevant knowledge to bear on the health
care and well being of a patient.”
(Greenes, 2007)
38. Clinical Decision Support
Systems (CDS)
• The real place where most of the values
of health IT can be achieved
• There are a variety of forms and nature
of CDS
39. • Expert systems
–Based on artificial
intelligence, machine
learning, rules, or
statistics
– Examples: differential
diagnoses, treatment
options
CDS Examples
Shortliffe (1976)
40. CDS Examples
• Alerts & reminders
–Based on specified logical conditions
• Drug-allergy checks
• Drug-drug interaction checks
• Drug-lab interaction checks
• Drug-formulary checks
• Reminders for preventive services or certain actions (e.g.
smoking cessation)
• Clinical practice guideline integration (e.g. best practices
for chronic disease patients)
44. Order Sets
Image Source: http://www.hospitalmedicine.org/ResourceRoomRedesign/CSSSIS/html/06Reliable/SSI/Order.cfm
45. CDS Examples
• Simple UI designed to help clinical
decision making
–Abnormal lab highlights
–Graphs/visualizations for lab results
–Filters & sorting functions
47. External Memory
Knowledge Data
Long Term Memory
Knowledge Data
PATIENT
Perception
Attention
Working
Memory
Inference
DECISION
CLINICIAN
Elson, Faughnan & Connelly (1997)
How CDS Supports Decision
Making
Abnormal lab
highlights
48. External Memory
Knowledge Data
Long Term Memory
Knowledge Data
PATIENT
Perception
Attention
Working
Memory
Inference
DECISION
CLINICIAN
Elson, Faughnan & Connelly (1997)
How CDS Supports Decision
Making
Order Sets
49. External Memory
Knowledge Data
Long Term Memory
Knowledge Data
PATIENT
Perception
Attention
Working
Memory
Inference
DECISION
CLINICIAN
Elson, Faughnan & Connelly (1997)
How CDS Supports Decision
Making
Drug-Allergy
Checks
50. External Memory
Knowledge Data
Long Term Memory
Knowledge Data
PATIENT
Perception
Attention
Working
Memory
Inference
DECISION
CLINICIAN
Elson, Faughnan & Connelly (1997)
How CDS Supports Decision
Making
Clinical Practice
Guideline
Alerts/Reminders
51. External Memory
Knowledge Data
Long Term Memory
Knowledge Data
PATIENT
Perception
Attention
Working
Memory
Inference
DECISION
CLINICIAN
Elson, Faughnan & Connelly (1997)
How CDS Supports Decision
Making
Integration of
Evidence-Based
Resources (e.g.
drug databases,
literature)
52. External Memory
Knowledge Data
Long Term Memory
Knowledge Data
PATIENT
Perception
Attention
Working
Memory
Inference
DECISION
CLINICIAN
Elson, Faughnan & Connelly (1997)
How CDS Supports Decision
Making
Diagnostic/Treatment
Expert Systems
55. Human Factor Issues of CDS
Issues
• CDSS as a supplement or replacement of clinicians?
– The demise of the “Greek Oracle” model (Miller & Masarie, 1990)
The “Greek Oracle” Model
Wrong Assumption
The “Fundamental Theorem”
Correct Assumption
Friedman (2009)
56. Human Factor Issues of CDS
• Features with improved clinical practice
(Kawamoto et al., 2005)
– Automatic provision of decision support as part of
clinician workflow
– Provision of recommendations rather than just
assessments
– Provision of decision support at the time and location of
decision making
– Computer based decision support
• Usability & impact on productivity
59. Unintended Consequences of
• “Unanticipated and unwanted effect of health IT
implementation” (www.ucguide.org)
• Resources
– www.ucguide.org
– Ash et al. (2004)
– Campbell et al. (2006)
– Koppel et al. (2005)
CDS & Health IT
60. Ash et al. (2004)
Unintended Consequences of
CDS & Health IT
61. • Errors in the process of entering and retrieving information
– A human-computer interface that is not suitable for a highly
interruptive use context
– Causing cognitive overload by overemphasizing structured
and “complete” information entry or retrieval
• Structure
• Fragmentation
• Overcompleteness
Ash et al. (2004)
Unintended Consequences of
CDS & Health IT
62. • Errors in communication & coordination
– Misrepresenting collective, interactive work as a linear,
clearcut, and predictable workflow
• Inflexibility
• Urgency
• Workarounds
• Transfers of patients
– Misrepresenting communication as information transfer
• Loss of communication
• Loss of feedback
• Decision support overload
• Catching errors
Ash et al. (2004)
Unintended Consequences of
CDS & Health IT
63. The Bigger Picture:
Health Information Exchange (HIE)
Hospital A Hospital B
Clinic C
Government
Lab Patient at Home