1. 1 کاربرد های فناوری اطلاعات در پزشکی و مراقبت از سلامت منیژه کشتگری دانشگاه صنعتی شیراز keshtgari@sutech.ac.ir

2. 2 تعريف فناوري اطلاعات و ارتباطات فناوري اطلاعات عبارت است از گردآوري، سازماندهي، ذخيره و نشر اطلاعات اعم از صوت، تصوير، متن يا عدد كه با استفاده از ابزار رايانه‌اي و مخابرات صورت پذيرد.

3. 3 ابزار IT زبانهای برنامه نویسی برنامه های کامپیوتری و کاربردی بانکهای اطلاعاتی سخت افزار شبکه های کامپیوتری روشهای طراحی و آنالیز

4. 4 مزایای استفاده از IT  حمایت از پنج هدف سازمان  ارتقاء بهره وری  کم کردن هزینه ها  بهبود در تصمیم گیری  بهبود در ارتباط با مشتری  توسعه و ایجاد سیستمهای کاربردی جدید

5. 5 Health IT  استفاده از کامپیوتر و برنامه های کامپیوتری جهت ذخیره، حفاظت، بازیابی و ارسال اطلاعات clinical، administrative و financial به صورت الکترونیکی در سیستم مراقبت سلامت

6. 6 HIT Technology  Internet  Handheld (PDA)  Notebooks  Wireless  24/7  Work Anywhere/Anytime

7. 7 HIT Standards  Privacy  Security  National Health Information Network (NHIN)

8. 8 Health IT can include electronic health records personal health records e-mail communication clinical alerts and reminders computerized decision support systems hand-held devices other technologies that store, protect, retrieve and transfer clinical, administrative, and financial information electronically within health care settings.

9. 9 Personal Health Record (PHR)  An electronic application through which individuals can maintain and manage their health information (and that of others for whom they are authorized) in a private, secure, and confidential environment.  examples of an agent acting for an individual include parents acting for children, or, in the later stages of life, children acting for parents.

10. 10 Electronic Medical Record  An application environment composed of the clinical data, repository, clinical decision support, controlled medical vocabulary, order entry, computerized provider order entry, pharmacy, and clinical documentation applications.  This environment supports the patient’s electronic medical record across inpatient and outpatient environments, and  is used by healthcare practitioners to document, monitor, and manage health care delivery within a care delivery organization (CDO).  The data in the EMR is the legal record of what happened to the patient during their encounter at the CDO and is owned by the CDO.  Electronic Health Record: A subset of each care delivery organization s EMR

11. 11 PHR, EHR,EMR

12. 12 Disadvantages of EHR 1. The possible incompatibility of computer systems among various health care providers can lead to difficulty in sharing the data. 2. Privacy and security can be an issue. If someone hacks into a computer system, thousands of patients' records can be compromised. Also, some critics say the federal government wants to use electronic records systems to ration health care services. 3. Computer crashes make records inaccessible. 4. The cost of implementing an electronic records system can be expensive.

13. 13 EHR case study Survey Result Use of Electronic Health Records in U.S. Hospitals A Review of Jha et al. (2009) The new England journal o f medicine

14. 14 Purpose To provide more precise estimates of EHR adoption among U.S. hospitals With a clear definition of a hospital EHR system (“basic EHRs”) Also a definition of “comprehensive EHRs” To evaluate hypotheses that larger, teaching, and private hospitals are more likely to adopt EHRs To identify barriers to adoption to guide policymakers Study commissioned by Office of the National Coordinator for Health Information Technology

15. 15 Past studies

16. 16 Methods Design Cross-sectional mail survey Sample All acute care general medical and surgical hospitals that are member of the American Hospital Association (N = 4814) Survey Administration (Mar - Sep 2008) Survey sent to hospital’s CEO CIOs are typically assigned to complete survey

17. 17 Methods Survey Content Presence/absence of 32 clinical functionalities of an EHR system Whether their hospital had fully implemented these functions – in all major clinical units –in one or more (but not all) major clinical units –in none of the units Whether certain factors were major or minor barriers or were not barriers to EHR adoption 2952 hospitals in the sample

18. 18 Basic and Comprehensive EHR

19. 19 Basic and Comprehensive EHR

20. 20 Basic and Comprehensive EHR

21. 21 Basic and Comprehensive EHR

22. 22 Adoption of EHRs

23. 23 Barriers to EHR Adoption

24. 24 Discussion  Though EHR adoption is low, many functionalities are widely implemented (e.g. lab & radiologic reports, medication lists)  Much of health IT benefits come from decision support, which is not part of the “basic EHR” requirements  Financial issues identified as predominant barriers to adoption

25. 25 EHR inpatient sites

26. 26 EHR Outpatient sites

27. 27 Telemedicine ارایه خدمــــات درمانی در جایی كه فاصله، فاكتور مهمی محسوب می شود، توسط متخصصان حرفه ای با استفاده از تكنـولوژی اطلاعات و ارتباطات برای تبادل اطلاعات صحیح در زمینه تشخـیص، درمان و پیشـگیری بیماری ها با بهره گـیری از جدید ترین دستاوردها در زمینه خدمات درمانی در راستای تأمین هر چه بیشتر سلامت افراد"

28. 28 تاریخچه پیشینه استفاده از فنآوری ارتباطات در فرایند درمان، به اواسط قرن هجدهم باز می گردد. نخستین سازمان : ناسا نیاز داشتند كه وضعیت سلامت فضانوردان خود را در موقعیت های مختلف كنترل نمایند.

29. 29 اهداف Tele Medicine  بهبود مراقبت از بیمار  بهبود دسترسی و مراقبت پزشكی برای نواحی روستایی و محروم  دسترسی بهتر به پزشكان  كاهش هزینه های مراقبت های پزشكی  ایجاد خدمات مراقبت پزشكی ( در سطح جغرافیایی و جمعیتی وسیع )  كاهش نقل و انتقال بیماران به مراكز درمانی

30. 30 مشاوره از راه دور  سادگی و گستردگی كاربرد  امکان استفاده از تمام امكانات ارتباطی : تلفن، فاكس، پست الكترونیكی، گفتگوی اینترنتی، صفحه پیغام و...  نکته : قابلیت دسترسی هم به اطلا عات مفید  وهم اطلاعات غلط و نادرست ، پزشكان قلابی و سایت های فاقد اعتبار پزشكی وجود دارد

31. 31 اولین جراحی از راه دورفرااقیانوسی در جهان  در 7 سپتامبر 2001 کيسه ی صفرای بیمار68 ساله ای بستری در بیمارسـتانCIVIL در شــــــرق فرانسه ،توسط تیم جراحــی در نیـویورك برداشته شد.  با کمک خط فیبر نوری پرسرعت و با اسـتفاده از سیســتم جراحـــی روباتـیك لاپاروسكوپی Zeus

32. 32 Telehealth  به کار بردن ارتباطات الکترونیکی و تکنولوژی ارتباطات از راه دور برای انجام و پشتیبانی خدماتی از قبیل:  مراقبت های بالینی از راه دور  آموزش وتعلیم دادن در مورد امور تندرستی به متخصصان و بیماران  اجرا و مدیریت تندرستی

33. 33 telemedicine and telehealth

34. 34 Innovation in Medical Care Sensor Networks Applications for Medical Care

35. 35 Sensor Network Examples (Harvard Sensor Networks Lab)

36. 36 Wearable Mote

37. 37 Mercury Used for Parkinson's disease There are 9 nodes on the body (2 on each arm and leg, one on the back),

38. 38 Network Case Study UTAH Telehealth Network The Utah Telehealth Network connects to the University of Utah Hospital, National Lambda Rail (NLR) and the Internet via two one Gigabit Ethernet connections. Most network sites utilize dedicated T1(1.544Mbps) WAN services that connect to the University of Utah. Some member or affiliated sites utilize DSL internet services. Currently all WAN services support data, voice and video communications using IP.

39. 39 UTAH Telehealth Network (UTN) UTN provides leased circuits to healthcare facilities starting at speeds of 1.5 Megabits per second (Mbps). UTN manages these circuits, including the provisioning, monitoring, and maintenance of one firewall, router and Ethernet switch per circuit. UTN has received a $9 million funding commitment from the FCC (Federal Communications Commission) for the Utah ARCHES project, which will upgrade infrastructure to high speed dedicated Ethernet servicesUtah ARCHES

40. 40 Utah ARCHES Project will upgrade and expand current healthcare infrastructure Connect and/or upgrade connections to approximately 80 rural and urban healthcare facilities Build a network core with regional aggregation points into which health care facilities connect Begin the migration from T1 to Ethernet Technology to increase bandwidth 1.5 mbps to 5 mbps, 10 mbps, 100 mbps, 1000 mbps (1 gigabit per second) Connect into Internet2, a dedicated nationwide backbone Maintain network security and efficiency through coordinated management among partners

41. 41 IT threats developments offer significant benefits to patients and healthcare providers, but they give rise to ethical and legal challenges in the protection of patient privacy and confidentiality. The traditional and humanistic concept of doctor-patient relationship is also under threat

42. 42 با تشکر