Healthcare informatics towards 2020
IDI and Program for healthcare informatics
Paper with contributions from Arild Faxvaag
Health with an IT perspective!
• I don’t know anything…
What am I talking about?
• Basic for living
• Multidisciplinary, based on the natural sciences in studying diseases,
engineering in developing tools and therapy, and based on
understanding and treating individuals with a wide range of
physiological, social and psychological problems.
• Knowledge intensive: About diseases, phenomena, treatments etc.
• Information intensive: About patients, individual history, population,
• About: Diagnosing, Intervening and Nursing
Healthcare informatics (CEN251)
A scientific discipline that concerns itself
with the cognitive, information processing
and communication tasks of health care
practice, education and research, including
the information science and technology to
support these tasks.
Challenges of healthcare
• Increased cost of healthcare spending
– US: 15% of GDP in 2003
– OECD average: 9%
– Expected to rise with 3-4 %points next 5 years
• Increased cost of treatment
– Focus on development of high-cost procedures, tools and medicine
– Dubious cost-effectiveness both nationally and globally
• The 90% rule:
– 10% of the population uses 90% of the resources
• Global discrepancy – 8 physicians/Mpers in Angola, 530/Mpers in Cuba
• Consumerism - healthcare as status
• Technology – always more knowledge and more diseases and tools
World health variables, 2000
source: UN Population Division
Population growth rate
Life expectancy at birth
Mortality under age 5 (per
60 1000 births
Least developed Les developed More developed
(668 Mpers) (4,2Mpers) (1,2Mpers)
Why be application specific?
• Having a common goal
• Shaping the future by interacting with reality
• Cross-disciplinary work
• Good ideas come from hard problems
• Technology does only exist in a context!
• It is used by humans, in a society, for a purpose.
• Better remember that!
Challenges for informatics - applied
• A host of unconnected legacy systems:
– Planning and logistics
– Connected to tools (X-ray, laboratory…)
• Little information flow between services:
– A patient wanders from one organization to the next, from one physician to
another one, with different problems and diseases.
– Do they communicate efficiently?
• Relevant clinical information is not available to the right person at the
right time in the right place
• Relevant clinical knowledge is not integrated in the information systems
• Information quality: Inconsistencies and errors
• The patient is left out of the loop
Some methodological questions:
• For what purpose and whom is a system designed?
• Does the system work as intended, - and designed?
• Is the system used as anticipated?
• What is the cost/effect?
• Does the system produce the desired results?
• How does systems impact the organization of
• Does increased complexity of technology help or
Ways to go:
• Patient-centered recording and use of medical data for cooperative
• Process-integrated decision support through current medical knowledge
• Comprehensive use of patient data for research and health care
• Combining bio-information and health-information
• Structured and knowledge-rich patient records
• Architectures that support cooperative care across organizations and
care layers: Distribution, roles, access, safety and security.
• Patient-directed information and knowledge
• Pathways of care and care processes
IME, NTNU, you and me and health
• Let’s do something worthwhile before the North-Atlantic freezes
• Let’s start with doing technologically advanced, conceptually
simple and cheap things of global value.
• We’ve potentially got the worlds most unique laboratory: The
norwegian healthcare system
Arbeid med å ”oppdatere arkiv”
• Tre muligheter
– Hare i hue: Trenger ikke å dokumentere
– Se behovet: Informasjon som vitalt i prosessen, ikke bare for
journalen og framtiden
– Informasjon har verdi
• NTNU framsyngruppe i bioinformatikk
– Norges konkurransefortrinn knyttet til
– Helsevesenets enkelhet, homogenitet og tilgjengelighet
– Ett spørsmål som stadig dukker opp: Hvordan bringe resultatene
tilbake i klinikken:
– Moralsk forpliktelse: Gjør noe som er relevant for dem som betaler
• Det kreves enorme løft internasjonalt for å oppgradere basis
• Behov for globalisering av Norge
• Behov for relevans av IME/NTNU
• Rekrutterende og appellerende
• Vi kan ikke drive mer ”ikt-industri” enn det er flinke kandidater
• Tiltrekk de flinkeste studentene
– Ved synlig og relevant forskning
– Ved høy kvalitet
– Forskningsbasert undervisning
• Norge er forskningsfiendtlig
– Fordi vi har lav profil
– Fordi vi ikke synliggjør kopling mellom samfunn-teknologi-forskning
– Fordi vi har teite politikere
– Fordi vi ikke synliggjør forskningen i undervisningen
• Forskningen må organiseres
– Prosjektbasert, enkel organisering av prosjekter
• Overordnete visjoner:
– Ting vi skal gjøre!
– Dra til Mars. eMelhus.
• IKT with a mission
• JEG MÅ FORSKE PÅ NOE!
• Jeg forsker både med hode og hjerte
• Hva som skjer underveis, ikke hvor vi kommer
– Som en metode, ikke som en måloppfyllelse
User-centered methods: Challenges
• Field studies:
– How to make use of observation data and interviews for the design?
• Drama workshops and lo-fi prototyping:
– How to involve the users as active participants in the design process?
• Prototyping and prototyping tools:
– How much needs to be prototyped? (”Just-enough prototyping”)
• Usability testing:
– How do we evaluate the usability of mobile systems for health workers?
Analysis & Scenario building
Requirements analysis Requirements Design and
Scenarios & personas
Video, mock-ups Paper prototype/ Evaluation
Images, Video, Interviews and notes running prototype
In the field or in a lab
Field studies Usability testing
• Mobile wireless computing
(PDAs, Tablets, WLAN, GPRS og
3G terminals, Bluetooth, ID
DHL vs. a hospital
Work The work is procedure driven The work is problem driven
Workers The workers follow procedures The workers solve problems
Control The system is in control The workers are in control
Information flow The computer system needs The workers need information from
information from the workers the computer system
Work processes The process is simple and The process is complex and less
Knowledge The knowledge can easily be The knowledge and competence is
externalized “in the world”. to a large extent tacit.
Mobile computing: some issues
Desktop computers Mobile and wireless
Foreground/ Computer use is the main activity. The computer is integrated with other
Hardware and The PC fits many purposes Hardware matters (size, weight,
ergonomics shape, battery,,)
Mind/Body Symbol manipulation (mind) Physical and mental (body-mind)
Environment data Physical position is irrelevant (cyber Location and data from environment
space) can be used
Screen size Large screens Small screens, sunlight
Input Keyboard and mouse Stylus and buttons, but often need for
• One day workshop in a full-scale model
• 6-8 health workers in two teams
• 1-2 facilitators (drama instructors)
• Lo-fi mockups (foam models, Post-its,,)
• Recording to video (1-2 persons)
• 2-3 developers as observers.
”Current practice” scenario
Imagining the future: Prototyping
• Drama and improvised prototyping works well with health
• Drama workshops give developers deep understanding of
• Health workers are creative and clear given the right setting,
methods and prototyping materials.
• Health workers, like the rest of us, have a good implicit
knowledge of technology.
• Construction of a usability lab for mobile health ICT, supported by
Norwegian Research Council (NFR).
• Integration with new Electronic Patient Record center at NTNU. (EPJ).
• Further research on methods and tools.
• Cooperation with developers and IT researchers.
• Integration of UCD with existing Software Engineering methods (e.g.