The Future of Health Informatics Three Case Studies

The Future The best way to predict the future is to invent it. Alan Kay The future is here. It's just not widely distributed yet. William Gibson

Health Informatics involves “an understanding of computer technology, medical knowledge and organisational processes to develop new systems for healthcare delivery”. Health Informatics

The Interface Image Processing Terminology Sensor Design HCI Signal Processing Data Exchange Communications Standards The Organisation Document Management Staff to Staff Communication Violations Human Factors Display & Alarm Design Patient Records Data Bases HL7 Imaging Artificial Intelligence Security Patient Doctor The Hospital Computer Systems Access Control Encryption Telemedicine Audit Image Understanding Support for Patient Groups Validation Verification Web Portals Evaluation Clinical Trials Authentication Reproduction Ethics Dicom The Health Informatics Environment

What Developments Support for Patient Groups Support for Patient Groups  Quackwatch – Content First Telemedicine Telemedicine  Outreach Monitoring – Lifeshirt and others Human Factors Design Human Factors Design  Alarms and Displays – Preventing Medical Error

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Quackwatch Quackwatch, a member of Consumer Federation of America. Quackwatch, a member of Consumer Federation of America. It is a nonprofit corporation whose purpose is to combat health-related frauds, myths, fads, and fallacies. It is a nonprofit corporation whose purpose is to combat health-related frauds, myths, fads, and fallacies. Its primary focus is on quackery-related information that is difficult or impossible to get elsewhere. Its primary focus is on quackery-related information that is difficult or impossible to get elsewhere.

Lesson 1: Proven Need Founded by Dr. Stephen Barrett in 1969 as the Lehigh Valley Committee Against Health Fraud Founded by Dr. Stephen Barrett in 1969 as the Lehigh Valley Committee Against Health Fraud The Quackwatch Web site was launched December 1996 The Quackwatch Web site was launched December 1996 Donation financed and sustainable Donation financed and sustainable International list of expert advisors International list of expert advisors

Lesson 2: Clarity of Purpose Quackwatch defines quackery as:- Quackwatch defines quackery as:-  Anything involving over promotion in the field of health  Includes questionable ideas, products and services  Regardless of the sincerity of their promoters.  The word "fraud" is reserved only for deliberate deception.

Quackwatch Activities Investigating questionable claims Investigating questionable claims Answering inquiries Answering inquiries Distributing reliable publications Distributing reliable publications Reporting illegal marketing Reporting illegal marketing Generating consumer-protection lawsuits Generating consumer-protection lawsuits Improving the quality of health information on the Internet Improving the quality of health information on the Internet Attacking misleading advertising on the Internet Attacking misleading advertising on the Internet

Why is this the future? Partnership of experts and patients Partnership of experts and patients Its organisation centred Its organisation centred  Technology follows content and need The site is not too slick The site is not too slick  Looks as if its made by real people

Case Study 2: Outreach Monitoring Ambulatory Monitoring Ambulatory Monitoring  Holter Monitoring  Automatic Defibrillators ICU Monitoring ICU Monitoring  Need to take monitoring nearer to patients  Foresight Health 2020  In Hospital and further Demographic Time Bomb Demographic Time Bomb  Ageing Population  Australia and Japan  Keeping older people in their homes  Activity Monitoring

Telemedicine Synergistic on new non-medical technologies Synergistic on new non-medical technologies  Land-based telephone technology  Mobile telephone technology  Blue Tooth Takes different forms Takes different forms  Remote ECG analysis  Remote consultation

More Radical Approach Lifeshirt Lifeshirt  Set of sensors in a jacket  Recorded on a PDA  Analysed by software remotely or at home  Remote monitoring possible  GPS

Lifeshirt requires Online/automatic data interpretation Online/automatic data interpretation  Data-mining and machine learning Easy to use sensors Easy to use sensors Social framework of response Social framework of response

Case Study 3: Human Error Cause of Critical Incident % Human Factors Error65.9 Fixation Error20.5 Unknown Cause10.6 Equipment Failure 3.0 Type of error% Failure to check43.9 Inexperience41.0 Inattention32.7 Fixation20.5 Haste25.8 Distraction14.0 Fatigue10.8 Not following procedure 6.1

OK? Goal State No Yes Error State? Rule-based Level Error types: Rule-based mistakes Best self detection method: DEH & Error Suspicion (ES) Skill-based Level Error types: Slips and Lapses Best self detection method: Direct Error Hypothesis (DEH) Error State ? Consider local state information Familiar Pattern? Apply Rule Yes Problem Solved? Yes No Knowledge-based Level Error types: Rule-based mistakes Best self detection method: Standard Check Find higher analogy Revert to higher mental functions Infer diagnosis, strategy, action, etc. None found Found

Lessons to be drawn Informatics solutions that are not ecological will create more error Informatics solutions that are not ecological will create more error Solutions that create more error will destroy clinical confidence in informatics Solutions that create more error will destroy clinical confidence in informatics Solutions that destroy confidence in informatics will not be used Solutions that destroy confidence in informatics will not be used

Conclusions Health Informatics will be very important in the future Health Informatics will be very important in the future  Very varied  Depend on Social underpinning  Has to be appropriate not flash

Conclusions Our imagination is the only limit to what we can hope to have in the future. Charles F. Kettering I have seen the future and it doesn't work. Robert Fulford