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2nd Mentor Meeting: (5% final grade)
Questions: career, coursework, dept. opportunities for research, clubs, etc. Establish familiarity: go-to person for future
If you have not yet
submitted
Profile #2:
This is required
Profile # 3:
Solar is Required
Semester Home Stretch: Profile Assignments
Semester Home Stretch: Impact Paper
Final Paper Submission, and Solar Presentation now located here
Content,
format
April 5 Assignment: Impact Paper Status Update
as many as needed
as many as needed
Submission
Soft copy upload by 12:00 pm April 5 (1 per team)
Hard copy due at class
One author: 1 hard copy to group Leader
Two authors, same group: 1 hard copy to that group Leader
Two authors, different groups: 1 hard copy to each group Leader
Slide Will be Used In Class Next Week (will count as grade equivalent of in-class worksheet)
Format
Student(s) present to Leader and Group (1.5 min)
Audience questions, comments, clarifications
Purpose
EAS 202 Feedback on your Impact Paper
Opportunity to observe a range of other versions
Professional Skill Ability to articulate work succinctly, cogently (elevator version)
Ability to make self understood to general audience
Grand Challenges in
Engineering: Advance
Health Informatics Ann Bisantz and Li Lin
Industrial and Systems Engineering
What is Health Informatics?
Acquisition, management, and use of information in health
Medical records for individual patients
Sharing data about disease outbreaks on the local to global level
Why? Greatly enhance quality and efficiency of medical care and the response to widespread public health emergencies
Much remains to make these systems MAXIMALLY USEFUL
NAE Grand Challenges web site
What is Health Informatics?
Future Health
Informatics?
Personal devices transmitting
information to physicians, health
records
What are the Current Challenges?
What are the challenges?
Current efforts aimed at the nationwide deployment of health care IT will not be sufficient to achieve the
vision of 21st century health care, and may even set
back the cause if these effort continue wholly without
change from their present course. Specifically, success
in this regard will require greater emphasis on providing
cognitive support for health care providers and for
patients and family caregivers
National Academy of Sciences, 2009
In summary:
IT applications appear designed largely to automate tasks or business processes. They are often design in ways that simply mimic existing paper-based forms and provide little support for the cognitive tasks of clinicians of the workflow of the people who must actually use the system[and] they did not take advantage of human-computer interaction principles, leading to poor design that increase the chance of error, add to rather than reduce work, and .introduce new forms of error that are difficult to detect
National Academy of Sciences, 2009
Solution: Design Health IT so
Different systems can talk WITHOUT requiring a person to translate
Retype, or Cut & Paste from one system to another
Print from one system, scan into another
Safety is enhanced rather than reduced Human centered design of systems: Meaningful,
correct information at the right times
People, not systems, are in control
Systems improve productivity rather than taking more time and $
Design IT so that it fits the way people work!
What can Engineers do to Help?
One example:
Simulation modeling of healthcare processes and use of IT in hospitals
Compare staffing levels, facility layouts
Simulation model of Hospital Operating Rooms
http://www.eng.buffalo.edu/Media/HealthcareResearch/simulation/index.html
More examples of Health Systems
Research
Cognitive and physical workload of nurses
Medical errors and patient safety
Financial analysis of profit-and-loss for hospital operations
Agent-based simulation of disease models
Intervention strategies (e.g., vaccines) for H1N1 influenza
Optimization of payment system
Healthcare supply chain management
Hospital surge capacity planning for disaster management
Clinical pathway analysis (finding the most efficient way of medical treatment)
Challenges for other Engineers
Seamlessly integrating and sharing information across many levels of computer systems while still preserving privacy and security
Developing sensors to automatically collect & transmit key health data about people (e.g., wearable blood pressure monitors); alert caregivers
Representing, storing, and reasoning about health information automatically to support alerting and decision making about patient conditions
Mathematically modeling the spread of new diseases to detect & monitor global pandemics in real time
Case Study: Better IT for
Emergency Rooms
Tracking Patients in the
Emergency Department
Whiteboards developed by doctors and nurses to help them track what is going on with patients
Manual whiteboards being replaced with electronic tracking systems throughout hospitals, nationwide
What were the effects in a hospital ED when this happened?
What did we find?
Things looked the same on the surface (similar form)
Functionality differed in small but important ways
Doctors could no longer track their work with a patient
Comments were limited in number, length, and form
Clinical staff couldnt use the new system to safely track patient care made up a new system instead
System was more useful for support staff (clerical, diet, transportation)
Whats next? Design, Simulation, and Validation Study
Study & Model ED System Develop
New Displays Evaluate
and Improve
Validate in
Realistic Simulation
Case Study: Modeling Work and IT
in Medical Practices
New York State is funding the implementation of electronic health records and health information exchanges through the
state
Is this saving $ and improving care?
What are the components of a
visit to the doctor?
Who are all the people involved?
What are the stages or steps they each accomplish?
How do they interact?
Computer Simulation Modeling
Build a runnable model of the different stages of a patient visit
Use times, frequencies, and probability distributions from data collected at the practices
Administration: Check-Out Prototype - Primary & Specialty Care - EHR & Paper
Review Physician entered Encounter Codes (Diagnostic
& Billing) for Action Items (follow-up, labs, referrals, Rx)
Necessary paper forms/
documents copied
Necessary electronic forms/
documents located, printed
and retrieved
Action Items
Fill out necessary order forms (labs
x-ray etc.)
Collect Co-Pay If Paper Encounter Form exists, destroyed after X time (e.g.
3 months)
Give Paper Encounter form
to Biller
Is the Admin the Biller?
No
Yes
Manual input of Encounter Codes
Paper Encounter
Form?
No
Yes
Update system denoting patient
has paid
Paper Encounter
Form?
No
Yes
Update form denoting patient
has paid
Answer final patient
questions (look up in EHR)
Was prescription
E-Prescribed?
Prescription Printed?
Retrieve Prescription from printer
Verify Rx in System
Open Scheduling Software
Schedule next patient
appointment in system
Fill out handwritten appointment
card
Print out next appointment information
OR
NoNo
YesYes
Check if patient received any prescriptions
Fill out handwritten referral form
Call referral practice and
schedule appointment
Schedule referral
appointment for patient?
No
YesCheck if Patient needs a referral
Receive verbal request from
Physician regarding lab
tests, x-rays etc.
Review Paper Encounter Form
(Diagnostic & Billing) for Action Items (follow-up, labs, referrals, Rx)
*p *e
*e
OR
*e
*p
*p
*e
*p *e
*e*e*e
*e
*e *e
*p *e
Receive verbal communication from Physician
regarding patient scheduling needs
*p *e
Schedule next patient
appointment (handwritten
book)*p
*e
*p *e*e
*e
*p *e
*e
*p *e
Generate billing receipt & Print
*e
*p *e
Update Encounter Form denoting patient
has paid
Create handwritten
receipt
*e
*e
*e
*e *e
*e
*e *e
*p *e
*p *p
*p denotes paper practice task*e denotes EHR practice task
Patient arrives for Check-Out
Collect Paperwork from Patient OR
Physician
Give ALL documents, forms, prescriptions, referrals, lab orders,
receipts etc. to Patient
End of Check-Out
Medication
Prescription
Electronic systems resulted in shorter times to
prescribe medications
29
120
80
0
20
40
60
80
100
120
140
L0 L5
Tim
e (
Second)
Interoperability Levels
Effects on Physician Activities
30
Time physicians spent requesting Lab Orders was longer
0.75
0.8
0.85
0.9
0.95
1
1.05
L0 L2 L4
Tim
e U
sage
Interoperability Level
L0
L2
L4
Patient Waiting Time and LOS
No Effects on wait time or length of stay based on electronic system or not
31
0.00
0.20
0.40
0.60
0.80
1.00
1.20
1.40
1.60
1.80
2.00
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Tim
e (
Hours
)
Configurations
Patient Times
Patient.Total Time
Patient.Wait Time