The Future of Health Informatics

1. The Future of Health Informatics  Three Case Studies

2. 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

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

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

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

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7. Quackwatch • 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. • Its primary focus is on quackery-related information that is difficult or impossible to get elsewhere.

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

9. Lesson 2: Clarity of Purpose • 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.

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

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

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

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

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

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

16. Cause of Critical Incident Type of error % % Human Factors Error 65.9 Failure to check 43.9 Fixation Error 20.5 Inexperience 41.0 Unknown Cause 10.6 Inattention 32.7 Equipment Failure 3.0 Fixation 20.5 Haste 25.8 Distraction 14.0 Fatigue 10.8 Not following procedure 6.1 Case Study 3: Human Error

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

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

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

20. 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