ezdravje / informatizacija v zdravstvu - predavanja za staziste

INFORMATIZACIJA V

ZDRAVSTVU

doc. dr. Matic Meglič, dr. med., MBA

Predstojnik Centra za Informatiko v Zdravstvu

NIJZ

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)

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

Kje lahko eZdravje pomaga?

• Pri vseh ključnih načinih ukrepanja– Preventiva (primarna, sekundarna, terciarna)

– Zdravljenje

xx x

Meglič, Brodnik, IGI2009

xx

blog.urbansedlar.com/

x

forbes.com

mladez.rs

ohgizmo.com

telecareconsulting.com

informaitonweek.com

x

Azmo the dragon

SLOVENSKE IZKUŠNJE

Aplikativna projekta eDepresija in eOskrba

Koordinacija

zdravljenja depresije

• Intervencija:

– Spletno/mobilno

okolje

– Koordinator oskrbe

– Klinična pravila

– Samoocenjevanje

– Opomniki

4

Enaki principi

• -koordinacija

oskrbe

• -kl. smernice

• -vključevanje pac.

eOskrba: KOPB, diabetes, hujšanje…

ALI STVARI DELUJEJO?

Izboljšanje simptomov

Število BDI na začetku SD BDI na koncu SDKontrole 10 28,70 8.34 17,80 7.91Primeri 12 29,50 8.15 7,97 8.05

t; P t = 0.23; P = .82 t = 2.33; P = .03

0

5

10

15

20

25

30

35

BDI na začetku BDI na koncu

Kontrole

Primeri

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

INFORMATIKA IN

ZDRAVSTVENO VARSTVO

Meglič, Brodnik, IGI2009

Meglič, Brodnik, IGI2009

Ekspertni sistemi:

Triaža, ocena tveganja

Interakcije, KI zdravil

Diagnostična orodja ipd.

HIS, EZK LIS, PACS

Telemedicina,Koordinacija

Opolnomočenjepacienta

Podporna orodja (€, logistika, nabava,

poročanje

Dostop do znanja

Orodja za proces dela

Povezovanje do

pacienta, izvajalcev

Procesna orodja

Izmenjava dokumentov, podat

kov

eRecept

eNapotnica

eOdpustno pismo

eIzvid

ePoročilo/Obrazec

Poročanje -MZ-ZZZS-IVZ/ZZV

INFORMATIKA V JAVNEM

ZDRAVJU

Za kaj gre?

Nova paradigma: eJavnoZdravje

• Personalizacija

• Infomediacija in opolnomočenje

• Infodemiologija

PRILOŢNOSTI

®hackingalert

Skupine s

tveganim

vedenjem

Ciljane

kampanje

Vključevanje

uporabnikov

NOVO ZNANJE

• Frost et al. JMIR 2011

• taking certain drugs “off-

label“ with higher perceived

efficacy

• side effect of amitriptyline

(dry mouth) as the purpose

for taking the drug (e.g. to

treat excessive saliva).

Epidemiologija, nadzor

• Infodemiology, Infoveillance: new concepts in health / PH research

• web (search enginedata), patient social networks and microblogging platforms as source of knowledge andlive data

• integration and mining of data from various onlinesources to discover new clinical and population patterns i.e. diseaseoutbreaks and syndromicsurveillance

• Eysenbach 2009Eysenbach Infovigil, later Google Flu Trends

Twitter za nadzor izbruhov bolezni

• Signorini 2011, Kim 2012, both PLoS ONE: Influenza-like-illness

• ‚Twitter traffic can be used … to estimate disease activity in real time, i.e., 1–2 weeks faster than current practice allows‘

PREVENTIVA IN

PRESEJANJE:

Boljše razumevanje ciljne populacije

Who are our users?

User behaviour

What content is relevant for ourusers?

PRIMER AKTIVNEGA

VKLJUČEVANJA

I‘M A FAN OF LIFEIzziv: 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‘

The rise of Gamification - when humans beatcomputers ‚back‘

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.

Jeopardy

Rezultati

• App na voljo 3 mesece

• Splet: 166 16.800 like-ov

• App: 5.200 uporabnikov

Vpliv oglaševanja

0

500

1000

1500

2000

2500

Weekly Active Users Weekly 1-day, 7-day,and 30-day counts of users who haveengaged with your app or viewed your app(Unique Users)Daily Added App Daily New users of yourapp or connections to your Connect site.Follows acceptance of your Terms ofService. (Total count)Daily Removed App Daily Users removedpremissions for your app or connections toyour Connect site. (Total count)

App Start FB Adverts start

FB Adverts stop

FB Adverts start

FB Adverts stop

FB Adverts stop

FB Adverts start

User engagement

E-ZDRAVJE IN

RAZISKOVALNO DELO

IT services and tools to make a health careresearcher‘s life easier

• Knowledge discovery (onlinepublishing was the keyenabler for Open Access Model)– Smart filtering (i.e. PubMed)

and push notifications (usingemail, RSS, apps, twitter)

– Shared knowledge discovery(shared feeds, sharedreferences i.e. Mendeley)

• Collaboration– ResearchGate (connect)– FoldIT– http://nhshackday.com/

arstechnica.com

blog.library.si.edu/

IT services and tools to make a healthcare researcher‘s life easier (2)

• Access to new data sources online: – microblogging data, ‚live‘ trend analysis,

– Personal Health Data (the quantified self, onlineexcercise 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

Trial search tool for patients

Novi buzzword: Open Data

• Publicly available largedatasets

• Coupled with genericAPIs they are super easyto use and drill-down.

• http://www.openprescribing.org/• http://www.openhealthcare.org.uk/

• Efforts to open up pharma data.. Tough butthere are improvements.

eZdravje kot čarobna paličica?• Using the Internet for health purposes was

associated with slightly increased depression (due to increased rumination, unnecessary alarm, or over-attention to health problems) Bessière etal 2010 JMIR

• Suicide: phone (telemedicine) follow-upwas effective in reducing suicidal ideation but not effective in reducing actual self-harm

• The QALY gain by patients using telehealthin 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.

Ko se ni izšlo…

Problem poslovnega modela:• Spletno arhiviranje (za

reference) – WebCitewww.webcitation.org

• Kolaborativno znanje (rak): caBIG(https://cabig.nci.nih.gov)

Problem dodane vrednosti:• Skoraj vsi PHRji:

GoogleHealth, MedGle, RevolutionHealth, NHS PHR, (HealthVault)

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.

ZA KONECNeizogibnost

Hitrost

Previdnost ni odveč – klinična

preizkušenost

Financiranje storitev?

Vabljeni k sodelovanju!

matic.meglic@nijz.si

ehealth.si

matic_meglic

Matic Meglic