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Emerging Trends in Health Informatics and HIT

The author makes general comments about the emerging trends in Health Informatics as well as trends in common technologies such as EHRs, mobile technology, telemedicine and bioinformatics.
by

Robert Hoyt MD

on 7 March 2014

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Transcript of Emerging Trends in Health Informatics and HIT

Electronic Health Records
Health Information Exchange
Personal Health Records
Telemedicine
Mobile Technology
Robert Hoyt MD
Director, Medical Informatics
University of West Florida
Pensacola, Florida
www.informaticseducation.org


Health Informatics:
Practical Guide
Sixth Edition now available

www.informaticseducation.org
We have not become paperless in spite of technology
Disclaimers
I have no conflicts of interest to report

My views do not necessarily reflect those of the University of West Florida
Learning Objectives:
Participants should be able to discuss:

1. General emerging trends in the field of Health
Informatics
2. Emerging trends in health information
technology ( HIT): electronic health
records, mobile technology, telemedicine and
bioinformatics

The field suffers from too many names
XX Informatics
Predicting the future is not easy
"Everything that could be invented has been invented" Charles H. Duell, US Patents and Brands Office 1899

“There is no reason anyone would want a computer in
their home.” — Ken Olson, Digital Equipment Corp. 1977

"640K ought to be enough for anybody." Bill Gates 1981
A few healthcare systems will reap the benefits of big data and HIT

Kaiser Permanente (KPNC) was able to increase the percent of controlled hypertensive patients from 43 to 80% (2001-2009) by using their EHR, system wide CPGs, HTN registry, Polypills for medication compliance and medical assistants for followup. National average increased from 55-64% in this same time period

JAMA. August 2013. 310(7): 699-705
General Comments
HIT will continue to evolve unabated but we
may struggle to afford it, apply it and study it
New reimbursement models will pay for quality
and improved patient outcomes.
HIT will be needed to monitor + report progress
HIT may not save money or lives

Electronic Health Records
While Meaningful Use is the road map, be prepared for issues:
Will we see improved patient outcomes or just better record keeping?
Will we see a detailed analysis of stage 1 before stage 2 or 3 becomes mandatory?
What will be the impact of EHRs on malpractice?
How will overcoding be regulated?
Gartner Hype Cycle
2013
Mobile Technology +
Wearable HIT
Current Architecture
Cloud
Sensor
Phone
Bluetooth
RFID
Ant
Electronic Health
Records
EHRs Need to be Interoperable!
EHRs Need To Be Integrated With
:
Health Information Organizations
Medical Devices: smartpumps, EKGs, spirometry, etc.
Hospital, pharmacy & radiology information systems
Closed loop medication systems: barcoding, eMARs
New delivery models: ACOs and PCMH models
Clinical research
Data analytics and data mining
OSUWMC Medical Device Integration
How many FTEs are saved by automatic data input into EHR?
3G/4G
Bioinformatics
More Sensors
MC-10 Biostamp skin sensor for temperature heart rate and hydration www.mc10inc.com
Uses near field communication (NFC) (RFID) to connect to smartphone
Data, Data, Data
"Big data is the term for a collection of data sets so large and complex that it becomes difficult to process using on-hand database management tools or traditional data processing applications" (Wikipedia)
Successful healthcare organizations will data mine their data warehouses using descriptive, predictive and prescriptive analytics
One of the goals will be for almost real time analysis of inpatient care to look for patient safety issues such as potential drug interactions, deteriorating patients and poor use of resources. EHRs make this possible
Breathometer
One of many smartphone attachments that can monitor health or disease
They plan to monitor other metabolic states using the same phone jack
For iOS or Android phones
Shark Tank success story
$49
Google Glass
Glasses attachment that facilitates access to the Internet
Mega-help or mega-distraction?
Being tested in healthcare: Phillips and Accenture
Smartphone Microscope
Developed by UCLA for remote viewing of
nanoscale objects e.g. malaria parasites
Scope attachment created with a 3-D printer
Uses laser diode
Able to visualize viral particles
Accuracy confirmed with electron microscopy

ACS Nano 2013; September 12 online
Smartwatches
The Basis Smart Watch can monitor activity, sleep, heart rate, perspiration and skin temperature $199
While Samsung has produced one of the first smartwatches, expect others shortly, e.g Apple iWatch
Will the smartwatch replace the smartphone for physiological monitoring?
Rumor we will see smart rings soon
AliveCor
FDA clearance. iOS or Android
Single channel EKG; good for rhythm analysis
Sensor connects to back of case. Touch finger
from each hand to sensors
Wirelessly connects to app on phone and
transmits to Web
Ubiquitous Computing
The Internet of Things
Many experts predict that everything will eventually have processing chips and they will all interconnect. We are starting to see this with "smart homes", "smart cards and "smart hospitals"
Complete genome sequencing will be $1000
in the near future. Interpretation of this
information is the controversial part
We are already seeing integration of the phenotype (what you see) with the genotype (genetics), plus risk factors and lab results.
This is best accomplished with comprehensive EHRs: VA, Kaiser, Biome are already doing this
Successful Healthcare Organizational Attributes
Visionary Leadership
Strong Team Work and Staff Buy-In
Enterprise Level Standardization
Intelligent Use of Healthcare Data
A Strong Financial Bottom Line
Engaged and Informed Patients
Robust Technology: EHR,
Patient Portals, HIE, etc
Bluetooth LE
Also known as Bluetooth Smart
Has a range of about 50 meters, with regular Bluetooth 4.0 range of 100 meters
Very low power requirements so battery can last six months with constant use. Popular for sensors
Personal Genomics
23andMe
Based on saliva sample. 255 tests for conditions and lineage (ancestry). $99
This includes disease risk (121), carrier states (50) and likely responses to certain drugs (24) and traits (60)
Maternal and Fraternal lineage, DNA relatives and % Neanderthal
Ordered to stop by FDA December 2013
Epigenetics
Just when we got comfortable with thinking health is determined by nature (genetics) and nurture (environment), along comes Epigenetics
This new field studies how genes get turned on and off (e.g. DNA or RNA methylation). DNA sequence doesn't change.
This helps to explain cell differentiation and evolution
Thought to be a ripe area for future cancer treatment
Telemedicine
Remote delivery of medical care
Can be simple Skype session with specialist e.g. Telemental health
Can be store-and-forward e.g. Teledermatology
Can be virtual audio-video visits: American Well, MDLiveCare, 3G Doctor, etc.
Virtual ICUs (eICUs)
Central Hub hospital covers smaller hospital's ICU
In spite of controversy regarding return on investment and decreased length of stay, this technology is being rolled out on medical wards, ERs and holding units
Telemonitoring
Zephyr Biopatch monitors heart rate, HRV, respiration, activity and EKG
We can expect more artificial intelligence and super-computers
IBM's Watson is being being tested at WellPoint, Sloan Kettering, MD Anderson and the Cleveland Clinic. One project is EMR Assistant
Watson can be hosted in the cloud and will have open APIs for developers and will fit on a single server
Disruptive Innovations
Full Speed Ahead
Definition: "innovation that helps create a new market and value network, and eventually goes on to disrupt an existing market and value network".
Examples: iPhone, iPad, digital cameras, Cloud computing, Cloud stores (Amazon), Wikipedia, Google, etc.
Expect more disruptive technologies to appear and you probably won't anticipate their arrival: e.g.
SSDs, LEDs, etc.
How about a Tricorder?
Scanadu
will be released in 2014
Will measure pulse, BP, temp, HRV, EKG and oxygen level from forehead
Health Informatics
The field is very popular
On the AMIA web site here are the stats (2013):
26 Certificate programs
40 Master's level programs
21 PhD programs
12 NLM-sponsored programs
3 Undergraduate programs
4 Doctor of Nursing Practice programs
Unknown how many non-degree courses exist.
Many Health Informatics courses as electives
Health Informatics
In 2013 the new sub-specialty certification in Clinical Informatics began for physicians
AMIA is working on a similar certification for non-physicians
Nurses already can be certified as Nurse Informaticists
Data analysts are in great demand
Technologies to Watch
CONCLUSIONS
Questions
Two Smart Community Hospitals in Ohio
Cerner EHR
Interactive TV for education. Internet
and movie access. Care team displayed.
Clinical dashboard in room for clinicians
All monitors integrated with EHR
General Comments
Consumer health IT on the rise
More sensors and mobile technology
More and better research needed
Meaningful use will continue but what it will look like
after
government subsidies is unclear, as is the overall impact of the program
Zio Patch
I won't be discussing social media in healthcare
Job Market
US HIT Implementation Strategy Based on Meaningful Use
Emerging Trends in Health Informatics and HIT

Genetic profiles will eventually become the standard of care
Data analytics is a must. Without it we won't know what to do with the tsunami of data
General Comments
Google Contact Lens
Full transcript