ARENA” by jizhen1947


									    Healthcare informatics towards 2020

                        Øystein Nytrø
          IDI and Program for healthcare informatics

          Paper with contributions from Arild Faxvaag

    Nerd alert:
    Health with an IT perspective!
    • I don’t know anything…

    What am I talking about?
    Health is:
    • Subjective
    • Individual
    • Basic for living

    Medicine is:
    • 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.

    Healthcare is:
    • Knowledge intensive: About diseases, phenomena, treatments etc.
    • Information intensive: About patients, individual history, population,
       epidemiology etc.
    • 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
    •   Aging
    •   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:
         – Accounting
         – 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
     • Bioinformatikk
        – Norges konkurransefortrinn knyttet til
            • Bofasthet
        – 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
          –   Flerfaglighet
          –   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
          –   Disiplinorientert
          –   Prosjektbasert, enkel organisering av prosjekter
     •   Overordnete visjoner:
          –   Ting vi skal gjøre!
          –   Dra til Mars. eMelhus.
     •   IKT with a mission
     •   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?

           Drama workshops

Analysis & Scenario building
                                    Requirements analysis Requirements    Design and

                 Scenarios & personas
                                        Video, mock-ups              Paper prototype/ Evaluation
Images, Video, Interviews                  and notes                running prototype

               By developer
          In the field or in a lab

 Field studies                                                      Usability testing
                                    Drama workshops
     New technology

     •   Mobile wireless computing
         (PDAs, Tablets, WLAN, GPRS og
         3G terminals, Bluetooth, ID

      DHL vs. a hospital
                        DHL                             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
                        predictable                     predictable

     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
     Background                                                  activities.

     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-handed input.

     Drama workshop

     •   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.

     Future work

     •   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.


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