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How Can Information
Technology Improve ICU
Service Provision Kenny CHAN King-chung
Evolution of Intensive Care
Big Data in an Individual
• Natural result from Velocity &Variety
• Artifacts in readings are common
• Physiology • Machine • Lab / Radiology
• Continuous data stream
• Frequent investigations
Velocity Variety
Volume Veracity
Safe & Effective Care in ICU
Early Detection
Appropriate Decision
Effective Intervention
Change in
Condition
Timely & Logical Presentation of Data
Clinical Decision Support
Computerized Order Entry
Work List System
ICU Informatics in HK
• 1996 - First neonatal ICU • 1997 - First adult ICU • Very limited connectivity
• BP/P/HR/SpO2 • Effort of individual ICU
Next Generation - 2007
• Increasing connectivity • Mechanical Ventilators • Laboratory Information System • Access to PACS and electronic
health record
• 2017 - Installed in all adult ICUs • 3 brands and 6 versions
• 2018 - A unified system for 5 ICUs
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ICU Medication Incidents
OPIP
Unified ICU Workstation
• Information gathering • Physiology data from monitors • Laboratory results • Radiology image & results • Physiological tests (ECG/EEG/etc) • Pathology results • Medication administration
record • Setting of life-support equipment • Past medical notes • Reference materials
• Documentation / Ordering • Clinical notes / Consultation
notes • Checklists / Structured forms • Prescription & Administration
(close loop) • Life support machine setting • Fluid / Blood products / Nutrition • Medication / Medication infusion • Nursing prescription • Ordering for investigations • Booking for endoscopy /
operative procedure • Admission / Discharge / Transfer
Level of Intelligence
Level Data Processing
Domain Knowledge Analytics Capability
Clerk + - - Collect comprehensive data
Secretary ++ + - Summarize data in a logical manner
Assistant +++ ++ + Remind clinicians on patient care
Partner ++++ +++ ++ Relied on for particular task
Teacher +++++ ++++ +++ Broaden medical knowledge
Types of Big Data Analytics
• Descriptive Analytics • Use data aggregation and data mining to provide insight into the past • “What has happened?”
• Predictive Analytics • Use statistical models and forecasts techniques to understand the future • “What could happen?”
• Prescriptive Analytics • Use optimization and simulation algorithms to advice on changing outcomes • “What should we do?”
Historical Data Present Data
Outcome Predictive Algorithm
Prescriptive Algorithm
Intervention Intervention
Intervention Intervention
Descriptive Analytics
Information System as Clerk or Secretary
• Descriptive Analytics • Administrative data • Process of Care • Outcome of Care
• Available form ICU’s system and Hospital’s system
• Relatively mature
Severity of Patient Admitted to ICU
ICU Readmission Rate
Use of Big-Gun Antibiotics in ICU
0
1
10
100
Day
s be
twee
n C
ases
Date of MRSA
g-Chart for ICU Acquired MRSA Run Length = 20
Cluster Analysis of MRSA Infection
Ventilator Associated Pneumonia
• Major morbidity for ICU patients • Incidence data difficult to obtain
• Ventilator Associated Events • Proposed by CDC • Stable for 2 days (baseline)
• Same or decreasing daily min FiO2 or PEEP • Worsening (above baseline)
• Rise of daily min FiO2 > 0.2 or • Rise of daily min PEEP > 3cmH2O
• Automatic capture
Information Overload (or Filter Failure)
• Automated Journalism • Create case summary • Handover between
clinicians • Communication with
patient and family
• Chatbot • Provide standardised
information • Update patient’s progress
(Smart Health Artificial Intelligence Lab Activity)
Predictive Analytics
• Available since 1980s for Hospital Mortality prediction • Different approach and versions available
• Mainly for quality assurance • Risk-adjustment
• Predict the expected outcome • Compare with the actual outcome • Observed / Expected (or the O/E ratio)
will provide information on quality of care
Hospital Mortality for ICU Patients
ICU Length-of-Stay Ratio
Prescriptive Analytics
• “Expert System” in use for many years
• Rule-based reminder • Blood transfusion • Nutritional intake
• Model-based therapeutics • Target-controlled infusion • “Smart ventilator modes”
• ?? Data-analytic based system
Over Reliance on Analytics
• Association ≠ Causation
• Black box algorithm
• Self fulling prophecy
• Discrimination in treatment
Our Way Forward • Unified ICU data and system • Enhance data analytic capability
• Platform for Doctors & Data Scientists