1. Introduction Larry Frisch
SPPH 302
SPPH 302
Introduction
Larry Frisch

2. SPPH 302 Topics in Health Informatics
Larry Frisch MD, MPH
Many guest Speakers!
A recent appraisal of where we’ve come from and where we are in Health Informatics is here

3. Canada Health Infoway
Our history of health informatics is in large part that of Infoway, a quasi-governmental public corporation
Infoway has spent billions, and many think with uncertain value
The % of MDs using Electronic Medical Records (EMR) rose from 27% to 76% (80% in BC) between 2007 and 2014
Whether Infoway actually drove this is debatable
Much provincial spending support as well
Infoway has invested heavily in telehealth
This is a topic for our course
Infoway has also been a major promoter of interoperability – the ability of computer systems to communicate with one another
This too is a major topic in our course – though it’s uncertain just how much interoperability we yet have developed

4. Globe and Mail Headline, 2012
“After all the time and money invested, will e-health ever deliver on its promise? “
Richard Alvarez: “It’s taking too long…We’re still at the back of the bus when you look at most developed nations”
Canada started with a top-down approach (Infoway) that by many standards has not been a success. Many countries (especially in Europe) have achieved more for their investment.
What we are seeing today is the emergence of many interesting e-health solutions

5. In Summary
Bringing informatics to healthcare has turned out to be slower and more expensive than initially hoped – with more limited benefit than anticipated.
There have been errors and failures along the way, some of which we will look at.
There is still real promise, along with pockets of success.
These successes are what we will focus on in SPPH 302.

6. An SPPH 302 Roadmap
General topics – databases, interoperability: HL7, Snomed; privacy and security
Informatics Applications
The Electronic clinical record, Radiology, Laboratory, Pharmacy, Telemedicine, Public Health Informatics
Three part segment loosely linked to diabetes
E-health, decision support, public health & chronic disease
Telus and BC’s Healthcare horizon
What might the future hold?
Ubiquitous computing; Personalized medicine

7. Course Generalities How to contact me Office Hours – by arrangement
– or send message from within our course Connect site
Emergencies: (not cell phone)
Text:
Office Hours – by arrangement
I live in Victoria, so probably best to meet before or after our class on Thursdays

8. Connect Our CONNECT site (connect.ubc.ca) Individual and Group Work
Course syllabus and announcements – how you’ll be graded
to connect with me
Group communication and meetingplace
Drop boxes for assignments
Group discussion site for debate summaries (graded)
Group Discussion forum for debate discussions (ungraded)
Quizzes and midterm
A Course Calendar with due dates
Individual and Group Work
Individual – your readings, “Tools” assignment
Group
Your “Social Network” assignment
Your Debate and Your Debate Summary – see Assignments Debate section on Connect for dates of your debate

9. DEBATE
Argument or Debate?

10. It’s Debate Time!
It’s Debate Time!
Debate Timer

11. The Course What you will learn Basics of healthcare informatics
Relevant knowledge of health care and informatics
Experience with a selection of real informatics tools
Something about public health
This is a course in the School of Population and Public Health
What you will do
In Class
See videos
Listen to and meet experts from UBC, clinical practice & Industry
Have lectures
Listen to and participate in debates
Ineract in discussion to the extent possible in a big class
At home
Journal articles
Videos
Our course “Connect” site
Including Quizes – approximately every 2 weeks
A Midterm Exam

12. “Scenarios” Introduction Database Essentials
Informatics of Diagnostic Imaging
Informatics of the Laboratory
Exchanging information in Healthcare
Informatics of Pharmacy practice
Chronic Disease Management
Introduction to Public Health Informatics
The Informatics of Surgical Practice
Issues of Privacy and Security
Informatics of Elder Care
Public Health Informatics – the view from BCCDC
The Future of Health Informatics
Health Literacy
I want to Make an Appointment
I need to have an X Ray
I need to get a lab test
I need to see a specialist
I need to manage my Diabetes
I need to manage my Diabetes (2)
I want to know more about Diabetes
I need to have Surgery
Are my records secure?
I want my parents to be at home
How Healthy is my Community?
A Glimpse of the future

13. What Can You Expect? Is this a hard course?
Not technical – you won’t need Computer Science Background
No programming
Not a lot of new CS vocabulary
You will need to be able to download programs and be a somewhat sophisticated computer user
We will set up online Connect site where you can post questions and other class members who have solved a problem can offer assistance
If needed, I can help too.

14. What Can You Expect? I’ve tried to minimize your reading needs
There will be a number of journal articles assigned
Some material is better covered in youtube videos
The quizzes and midterm will cover material in the assigned readings or videos, and information from our classroom sessions
Both will be multiple choice, possibly with some short answers
Specifics of grading can be found in syllabus on Connect
For those of you worried about grades, the grades in last year’s course were almost all quite high – no guarantees

15. What Can You Expect? Assignments
Descriptions are lengthy to reduce your work
I don’t think most will take you a lot of time
If I’m wrong on this, please let me know
If possible we’ll modify to reduce time required
You shouldn’t be spending more than six to eight hours a week on this class (outside of our time together here)
There are three assignments:

16. What Can You Expect? “Tools for Healthcare Informatics”
EMR, HL-7, NLP, SQL
“Social Network Analysis”
A “Debate” and a “Debate Summary”
My goal is to give real hands-on experience
So that this isn’t a course where we just talk about healthcare informatics
We will also try when possible to do healthcare informatics
Though generally the tools we use are simpler than “real life” ones

17. The “Tools” Individual Assignment
This assignment has four parts
You’ll set up your own “SpringCharts” electronic medical record and enter some information we give you about imaginary patients.
You’ll download that data and submit it along with a short paper describing your experiences
You’ll decode a couple of HL7 “messages” we send PID|| ^^^2^ID 1|454721||DOE^JOHN^^^^|DOE^JOHN^^^^| |M||B|254 MYSTREET
Using an on-line browser tool you’ll do “natural language processing” on a short text we will send to you
You’ll do & report some searching of specific online databases
SQL tutorial – practice with simple SQL commands
Health Indicators database – more complex online searching

18. The “Tools” Individual Assignment
The Electronic Medical Records Installation should be easy for PC users.
We provide both instructions and needed help
How many of you are Mac users AND can’t access a PC where you can setup programs?
We need you to sign up on the “Mac” list
For most of you it will be simple to put our SpringCharts record onto a Mac, but some may need help

19. The Social Network Group Asignment
You’ve all been assigned to groups – there are currently 13, though this may change
Goal is to have 8 persons +/- in each group
Each of you will identify about 12 adults in your personal social network
You will use a software tool to describe and illustrate your network:

20. Social Network Graphs

21. Why Social Networks? Health is about interconnectedness
Many illnesses pass from person to person
Some aspects of Health are equally “contagious”
Let’s take a look at this TED talk
“What the world needs now is more connections”
Like Dr. Christakis, you will study happiness in your social network

22. Social Networks
For the first part of this assignment you will submit a “graph” showing all of your group’s social networks
For the second part, you will administer Dr. Christakis’ four question happiness survey to members of your networks
You’ll survey them twice during the course
You’ll indicate the happiness scores of each network member and see if there’s any pattern in your group’s networks and over time.
You’ll submit your results and a short write-up of the findings

23. Social Networks
The first step in this assignment is for each of you to complete a required tutorial in Protection of Human Subjects
About three hours, but without it you can’t participate in this assignment
You’ll have about 4 weeks to get this done and submitted on our Connect site
Here’s the tutorial link:

24. Summary My office hours: Connect.ubc.ca
As arranged, before or after class
Connect.ubc.ca
Three assignments, each with several parts
Tools for health informatics
Social Network Analysis
Debates (next part of this presentation)
Tutorial on Protection of Human Subjects

25. Questions? Comments?

26. Let’s take a ten minute break…
Please return in a timely manner

27. Our “Problem” for Today
Health literacy --- According to the Canadian Literacy and Learning Network 42% of Canadian adults 16 to 65 have “low literacy skills.” When it comes to health literacy (defined as the ability to process and understand basic health information that allow them to make appropriate decisions about their health and care) 55% of working age adults have “less than adequate” health literacy with those over 65 faring worse. In the US, only 12% of the population is said to have “proficient” health literacy. Computer literacy problems are also very common, but have not been as consistently measured. This means that many people who receive healthcare may or may not understand the instructions they are given, but if these instructions are presented in a written form many patients will not be able to understand them adequately. Increasingly some doctors advise their patients to go to specific internet sites to get further information on their health conditions. Other doctors will give written handouts to their patients. Knowing that patients may have illiteracy, health illiteracy, or computer illiteracy in any combination, should doctors and nurses present information to their patients and clients without formally assessing literacy using one of several accepted literacy measures?

28. A U.S. – focused film with at least one BC (UVic) contributor
Thoughts on Literacy
A U.S. – focused film with at least one BC (UVic) contributor

29. Why Address Health Literacy in This Course?
As more and more of healthcare delivery and receipt take place on or mediated by computers health literacy is crucial
We can’t use as easily the film’s “diagnostic signs
Visits may become shorter and less personal
At the same time, we have an opportunity to use computers to assess and address issues of literacy
Literacy is not just about words, but it is about numbers and tables
Computers may help patients to better interpret these

30. Another Literacy Computer literacy “The Digital Divide”
Young vs. Elderly
Poor vs. wealthy
Rich countries vs. poorer ones
Countries with open internet vs. closed
Cultures which encourage the expansion of knowledge vs. narrow focus on ideology
A clever and insightful (?) “Meme” analysis

31. What do you think?
What about this idea that older people have more digital troubles?
(The Tom C, Jim C, and Jack S story)

32. The Digital Divide Still Influences how we can implement complex new systems.
For example:

34. Electronic Health Record (EHR) Implementation
Not all of the problems are digital divide
And EHRs are about all health care providers (and patients) not just doctors
But doctors are major users, and a form of digital divide still makes implementation rocky not just in Nanaimo.

35. The Ethics of Informatics
Assuring that access to informatics is fairly distributed
Assuring education that
Allows everyone (even old people) to become effective computer users
Allows us to be aware that the internet can both encourage and proliferate divisive and sometimes false viewpoints that can be socially disruptive

36. Questions
I’ve probably gone over the mechanics of the class too quickly.
Do you have any questions about either the content we’ve discussed today or practical things (like quizzes, assignments, debates)?
Comments?

37. So We’re Launched!!! See you next week.
I strongly encourage doing the readings (and videos) before class.
That will help both you and our speakers.
Don’t forget our course discussion group if you have questions or thoughts to share.