2. Class Exercise: Part 1
Thinking About IT Problems
in Your Organization
ลองยกตัวอย่างปัญหาด้าน IT ภายในคณะฯ/
หน่วยงานของท่าน และยกตัวอย่างว่าผู้บริหาร
สารสนเทศควรจะแก้ไขปัญหาดังกล่าวอย่างไร
3. Part 1
Realizing Values of Digital Technology
- IT as Value Add
- Strategic Management
- Managing People in IT Projects
4. What ideas come to mind?
Digital Health
Transformation
When you think of
8. “Big data is like teenage sex:
everyone talks about it,
nobody really knows how to do it,
everyone thinks everyone else is doing it,
so everyone claims they are doing it...”
-- Dan Ariely @danariely (2013)
Substitute “Big data” with “AI”, “Blockchain”, “IoT”
of your choice.
-- Nawanan Theera-Ampornpunt (2018)
9. 9
A B C D
Artificial
Intelligence
Blockchain Cloud Big Data
10. Hype vs. Hope
Jeremy Kemp via http://en.wikipedia.org/wiki/Hype_cycle
http://www.gartner.com/technology/research/methodologies/hype-cycle.jsp
14. 14
Input Process Output
Patient Care
Health care
Sick Patient Well Patient
Value-Add
- Technology & medications
- Clinical knowledge & skilled providers
- Quality of care; process improvement
- Customer service
- Information
Toward Systems Thinking
21. 21
• Life-or-Death
• Difficult to automate human decisions
– Nature of business
– Many & varied stakeholders
– Evolving standards of care
• Fragmented, poorly-coordinated systems
• Large, ever-growing & changing body of
knowledge
• High volume, low resources, little time
Why Healthcare Isn’t (Yet) “Smart”?
23. 23
• “Don’t implement technology just for
technology’s sake.”
• “Don’t make use of excellent technology.
Make excellent use of technology.”
(Tangwongsan, Supachai. Personal communication, 2005.)
• “Health care IT is not a panacea for all that ails
medicine.” (Hersh, 2004)
Some “Smart” Quotes
28. 28
• Humans are not perfect and are bound to
make errors
• Highlight problems in U.S. health care
system that systematically contributes to
medical errors and poor quality
• Recommends reform
• Health IT plays a role in improving patient
safety
Summary of These Reports
29. 29
• Safe
• Timely
• Effective
• Patient-Centered
• Efficient
• Equitable
Institute of Medicine, Committee on Quality of Health Care in America. Crossing the quality
chasm: a new health system for the 21st century. Washington, DC: National Academy
Press; 2001. 337 p.
High Quality Care
35. 35
• Safe
• Timely
• Effective
• Patient-Centered
• Efficient
• Equitable
Institute of Medicine, Committee on Quality of Health Care in America. Crossing the quality
chasm: a new health system for the 21st century. Washington, DC: National Academy
Press; 2001. 337 p.
Value Add: High Quality Care
37. 37
Hospital Information System (HIS) Computerized Physician Order Entry (CPOE)
Electronic
Health
Records
(EHRs)
Picture Archiving and
Communication System
(PACS)
Various Forms of Health IT
39. 39
Ordering Transcription Dispensing Administration
Computerized
Physician
Order Entry
(CPOE)
Automatic
Medication
Dispensing
Electronic
Medication
Administration
Records
(e-MAR)
Barcoded
Medication
Administration
Barcoded
Medication
Dispensing
Health IT for Medication Safety
40. 40
• Safe
–Drug allergies
–Medication Reconciliation
• Timely
–Complete information at point of
care
• Effective
–Better clinical decision-making
Being Smart in Healthcare
41. 41
• Efficient
–Faster care
–Time & cost savings
–Reducing unnecessary tests
• Equitable
–Access to providers & knowledge
• Patient-Centered
–Empowerment & better self-care
Being Smart in Healthcare
42. 42
Image Source: (Left) http://docwhisperer.wordpress.com/2007/05/31/sleepy-heads/
(Right) http://graphics8.nytimes.com/images/2008/12/05/health/chen_600.jpg
To Err Is Human: Attention
43. 43
Image Source: Suthan Srisangkaew, Department of Pathology, Facutly of Medicine Ramathibodi Hospital, Mahidol University
To Err Is Human 3: Memory
44. 44
Cognitive Errors - Example: Decoy Pricing
The Economist Purchase Options
A. Economist.com subscription $59
B. Print subscription $125
C. Print & web subscription $125
Ariely (2008)
16
0
84
The Economist Purchase Options
A. Economist.com subscription $59
B. Print subscription $125
C. Print & web subscription $125
68
32
# of
People
# of
People
To Err Is Human 4: Cognition
45. 45
External Memory
Knowledge Data
Long Term Memory
Knowledge Data
Inference
DECISION
PATIENT
Perception
Attention
Working
Memory
CLINICIAN
Elson, Faughnan & Connelly (1997)
Clinical Decision Making
46. 46
External Memory
Knowledge Data
Long Term Memory
Knowledge Data
Inference
DECISION
PATIENT
Perception
Attention
Working
Memory
CLINICIAN
Elson, Faughnan & Connelly (1997)
Possible Human Errors
Possibility of
Human Errors
47. ภาพรวมของงานด้าน Health IT
Intra-Hospital IT
• Electronic Health Records &
Health IT for Quality & Safety
• Digital Transformation
• AI, Data Analytics
• Hospital IT Quality
Improvement (HA-IT)
Inter-Hospital IT
• Health Information
Exchange (HIE)
Extra-Hospital IT
• Patients: Personal
Health Records (PHRs)
• Public Health: Disease
Surveillance & Analytics
Patient
at Home
48. 48
Hospital A Hospital B
Clinic D
Policymakers
Patient at
Home
Hospital C
HIE Platform
Health Information Exchange (HIE)
49. 49
Some Risks of Clinical Decision Support Systems
• Alert Fatigue
Unintended Consequences of Health IT
52. 52
Context
The sailboat image source: Uwe Kils via http://en.wikipedia.org/wiki/Sailing
The destination
The boat
The sailor(s) &
people on board
The tailwind The headwind
The direction
The speed
The past journey
The sea
The sail
The current location
59. 59
A Good “Vision”
Marchewka (2006)
“Our goal is to land a man on the
moon and return him safely
to the earth by the end of the decade.”
John F. Kennedy (1961)
61. 61
4 Quadrants of Hospital IT
Strategic
Operational
Clinical
Administrative
62. 62
Strategic
Operational
Clinical
Administrative
Computerized Physician Order Entry (CPOE)
Admission-Discharge-Transfer (ADT)
Laboratory Information System (LIS)
Electronic Health Records (EHRs)
Clinical Decision Support Systems (CDSS)
Health Information Exchange (HIE)
Enterprise
Resource
Planning (ERP)
Business
Intelligence (BI)
Vendor Managed Inventory (VMI)
Personal Health Records (PHRs)
Master Patient Index (MPI)
Word
Processor
Social
Media
Picture Archiving &
Communication System (PACS)
Customer Relationship
Management (CRM)
4 Quadrants of Hospital IT
63. Class Exercise: Part 3
Knowing Your IT Environment
Group discussion: วิจารณ์ว่า IT environment ของ
รพ. ต่อไปนี้ อยู่ใน Quadrant ใด
74. 74
Ash et al. (2003)
• Administrative
Leadership Level
–CEO
•Provides top level
support and vision
•Holds steadfast
•Connects with the
staff
•Listens
•Champions
– CIO
• Selects champions
• Gains support
• Possesses vision
• Maintains a thick skin
– CMIO
• Interprets
• Possesses vision
• Maintains a thick skin
• Influences peers
• Supports the clinical support
staff
• Champions
The Special People
75. 75
Ash et al. (2003)
• Clinical Leadership
Level
– Champions
• Necessary
• Hold steadfast
• Influence peers
• Understand other
physicians
– Opinion leaders
• Provide a balanced
view
• Influence peers
– Curmudgeons
• “Skeptic who is
usually quite vocal in
his or her disdain of
the system”
• Provide feedback
• Furnish leadership
– Clinical advisory
committees
• Solve problems
• Connect units
The Special People
76. 76
Ash et al. (2003)
• Bridger/Support level
–Trainers & support
team
•Necessary
•Provide help at the
elbow
•Make changes
•Provide training
•Test the systems
–Skills
•Possess clinical
backgrounds
•Gain skills on the
job
•Show patience,
tenacity, and
assertiveness
The Special People
78. 78
Context
The sailboat image source: Uwe Kils via Wikimedia Commons
The destination
The boat
The sailor(s) &
people on board
The tailwind The headwind
The direction
The speed
The past journey
The sea
The sail
The current location
79. 79
“The Boat”
• Size
• Resources
• Structures
• Work Processes
• Facilities/Geography
• Etc.
80. 80
“The Sea”
• Target customers
• Local competitiveness
• Relationship of hospital to local players
• Inter-organizational collaboration
• IT market environment
• National/international trend
• Regulations
• Standard of care
• Etc.
88. 88
IT Project Management
• A project: “a temporary endeavor undertaken to
accomplish a unique purpose”
• Project management: “the application of
knowledge, skills, tools, and techniques to
project activities in order to meet or exceed
project requirements”
Marchewka (2006)
89. 89
The Project Management
Body of Knowledge (PMBOK®)
Marchewka (2006)
1. Project Integration Management
2. Project Scope Management
3. Project Time Management
4. Project Cost Management
5. Project Quality Management
6. Project Human Resources Management
7. Project Communications Management
8. Project Risk Management
9. Project Procurement Management
92. 92
The CHAOS Report
The Standish Group (1995)
Among the IT projects studied:
• 31% were cancelled before completion
• 53% were completed but over budget, over schedule, and
did not meet original specifications.
93. 93
Top Ten Factors for IT Project Success
Marchewka (2006)
Rank Success Factor
1 Executive Support
2 User Involvement
3 Experienced Project Manager
4 Clear Business Objectives
5 Minimized Scope
6 Standard Software Infrastructure
7 Firm Basic Requirements
8 Formal Methodology
9 Reliable Estimates
10 Other
Table 1.3 Source: Extreme Chaos. The Standish Group International, Inc. 2001.
http://www.standishgroup.com/sample_research/index.php
98. Class Exercise: Part 5
Change Management
Group discussion: เสนอวิธีบริหารการเปลี่ยนแปลง
ใน user แต่ละกลุ่มใน Rogers’ Adoption Curve
99. 99
Unified Theory of Acceptance and Use
of Technology (UTAUT)
Venkatesh et al. (2003)
Performance
Expectancy
Effort
Expectancy
Use
Behavior
Social
Influence
Facilitating
Conditions
Behavioral
Intention
Gender Age Experience
Voluntariness
of Use
Usefulness
Ease of Use
Social Norm
& Opinions
IT Support