Hit 2013 by Dept of Medical Informatics

ORGANIZING COMMITTEE HIT-2013

Organizing Members From Left To Right

Standing: Prof. D.Gunasekaran, Prof.Seetharaman, Prof.Kingshuk Lahon, Mrs.A.N.Uma, Dr.Senti Toshi, Dr.Jagan Mohan, Dr.Partha Nandhi, Dr.Prasant Nayak. Sitting: Prof S.Krishnan, Prof.N.Ananthakrishnan, Prof.K.R.Sethuraman, Prof.K.A.Narayan

WHAT IS DIGITAL HEALTH? Digital healthcare (also known as digital health) is an upcoming discipline

that involves the use of information and communication technologies to help address the health problems and challenges faced by patients. These technologies include both hardware and software solutions and services.[1] Generally, digital healthcare is concerned about the development of interconnected health systems so as to improve the use of computational technologies, smart devices, computational analysis techniques and communication media to aid healthcare professionals and patients manage illnesses and health risks, as well as promote health and wellbeing.[2] Digital healthcare is a multi-disciplinary domain which involves many stakeholders, including clinicians, researchers and scientists with a wide range of expertise in healthcare, engineering, social sciences, public health, health economics and management.[2][3] Digital health is the intersection of technology and healthcare. The category has been created by the convergence of ubiquitous technologies (the Internet, mobile, scalable computing power/infrastructure, and social networks) with healthcare, including health information systems, wireless biometric sensors and â&#x20AC;&#x2DC;omics (genomics, transcriptomics, metabolomics and proteomics).

WHY ATTEND?

Digital technologies and methodologies are considered by healthcare providers worldwide as key to meeting the significant challenges in delivering healthcare in todayâ&#x20AC;&#x2122;s society. This has created a pressing need for a educated and aware workforce capable of using, evaluating and designing these technologies, with a thorough understanding of the clinical, engineering, ethical and social constraints surrounding them. Digital healthcare concerns the development of interconnected health systems to promote the use and advancement of smart devices, new technologies, analysis techniques and communication media to help professionals and patients manage illness, enhance the performance of patient monitoring devices, improve clinical education, manage healthcare risks and promote wellbeing. Attending this brief one day CME, along with continued study of the core issues discussed at HIT 2013 will enable attendees to authoritatively review all relevant healthcare issues and enable students to synthesise them into a comprehensive, coherent and career-advancing experience.

WHO SHOULD ATTEND? 1. Graduates with a technical/numerate background (eg. engineering, physics, computing or informatics) who wish to launch their career in the growing digital healthcare sector by developing biomedical and healthcare system engineering skills working with healthcare technology 2. Biomedical or clinical engineers and medical physicists who wish to develop innovative career pathways for themselves will find the mix of topics covered highly relevant for their career development. 3. Clinicians (e.g. doctors, nurses, pharmacists, allied health professionals or healthcare technologists) wishing to explore the potential and impact of digital healthcare and use it to develop innovative care pathways or models of care. 4. Those exploring or pursuing a PhD or research career in digital healthcare, eHealth, health or medical informatics, to advance their understanding of the principles underlying these important new technologies and how to study them.

LONG TERM OUTCOMES Clear understanding of the potential of digital healthcare to improve quality and safety of healthcare and reduce costs Ability to procure effective digital healthcare technologies and design appropriate implementation strategies including training, workflow redesign and evaluation design, use and procurement of digital healthcare systems and services. Strategic understanding of the impact of these technologies and approaches on the future nature of health professional work, health service design, public and global health

Prof. K. R. Sethuraman

PROFILE Dr K.R. Sethuraman, joined as the Vice Chancellor Sri Balaji Vidyapeeth University on 05.04.2013. He has completed his undergraduate (196672) and postgraduate (1973-76) Medical Education in Internal Medicine at JIPMER, Pondicherry. Later, he underwent training in Cardiology at SCTIMST at Thiruvananthapuram for three years, from 1978 to â&#x20AC;&#x2DC;81. He joined JIPMER as a Lecturer in Medicine and served there for 25 years (1981-2006). He was promoted as a Professor of Medicine in 1991, as the head of department of Medical Education in 2000 and as the Director-Professor and Head of Medicine in 2003. He took voluntary retirement in 2006 and moved over to Malaysia as the Dean of Medicine at AIMST University (www.aimst.edu.my) for 7 years. During this period, he was also the Deputy Vice-Chancellor of Academic and International Affairs from 2008. The medical programme at AIMST was consolidated during his tenure and more than 80% of the graduates were found to be fully competent. His interests are varied and wide. He is an eminent educationist and has over four decades of experience in medical education. Prof. K.R.Sethuraman is a meticulous and a prolific writer, and has published books/monographs on Rational Therapy, Medical Education, Doctor-Patient Communication, Clinical Echography, Objective Structured Clinical Examination

and Medical Ethics & Professionalism. The last one, translated in Tamil (titled “Post Mortem”) has sold more than 10,000 copies. He has produced videos for teaching purposes on medical promotion, oral communication skills and on “how to face an oral examination”. Since 2005, he is a member of the International Advisory Panel for three editions of Davidson’s Textbook of Medicine, and has contributed chapters for the companion volumes - Davidson’s Clinical Cases & Davidson’s 100 Clinical Cases. He is all set for the next edition of “Davidson’s Principles and Practice of Medicine” expected to be released in late 2014. He is a strong believer of scientific research and harnesses curiosity in the minds of young medical students, creating a wave of scientific temper in them. He has to his credit over 40 indexed publications He has visited South Africa, Sri Lanka, Thailand and New Delhi as short term advisor to WHO. Prof. K.R.Sethuraman began using computers in Education and Health in 1986 at JIPMER and quickly realized its future potential, He started “Doctors’ Computer Club” in 1988 to train medical professionals on basic awareness of computers and their potential in Medicine. Based on his presentation to WHO in 1989, a basic 4-terminal patient information system was set up by the WHO at JIPMER. In 1990, with the generous help from the Alumni abroad, he set up the first CD-ROM array based Medline service in South India. During 1993-5, this was expanded to a 64 terminal network with the help of National Informatics Centre, Hyderabad. In 1999, a regional conference on telemedicine and tele-education was organised by him. Following which, ISRO granted a full fledged telemedicine unit with satellite connectivity at JIPMER to cover Andaman & Nicobar health services, in case of need. During 2000 to 2004, several e-symposia and tele-education programmes were organized in collaboration with TNMGR Varsity. Prof KA Narayan, Vice Principal and Professor & Head of Community Medicine, MGMCRI, Puducherry had been his active partner since 1988 in all the activities listed above.

Health Information Technology (HIT) and Quality Health Care - Dr K.R. Sethuraman. VC – SBV. krs@sbvu.ac.in “When a thing is new, people say: “It is not true”. Later, when its truth becomes obvious, they say: “It’s not important.” Finally, when its importance cannot be denied, they say “Anyway, it’s not new.” (William James - 1842 - 1910) Six elements of Quality Healthcare: Safety, Effectiveness, Efficiency, Timeliness, Patient centeredness and Equitability (Scottish Health Authority) Public engage in e-Health in four ways: 1. health information on the Internet;

2. custom-made online health information; 3. online support (active engagement in social computing is the most visible) 4. tele-health Five factors that act as barriers or facilitators for use: 1. characteristics of the users; 2. technological issues; 3. characteristics of eHealth services; 4. social aspects of use; 5. eHealth services in operation. Capacity Building in HIT involves five stages 1. Knowledge building 2. Professional development 3. Organisational strengthening 4. Directive reforms 5. Facilitative reforms Knowledge building For Knowledge building, Informatics Competency is needed. Its components are the following: Informatics Knowledge: Aware of the importance of healthcare data for improving practice Informatics Knowledge - Privacy/Security: Aware of the secure ways of handling confidential patient data. Aware of patientsâ&#x20AC;&#x2122; rights in computerized information management Computer Skills: Documentation/Data capture: Uses an application to document/ capture patient care data. Uses an application to plan care for patients. Computer skills: Decision Support: Uses decision support systems, expert systems, and aids for clinical decision making or differential diagnosis Informatics: Evidence-based Practice: Use optimal search strategies to locate clinically sound and useful studies from information sources. Identify, evaluate, and apply the most relevant information. Critically analyze data, information, and knowledge for use in site-specific evidence-based practice Hierarchy of Information-communication technology (ICT) simplified: i. Office Automation - (data entry, data capture) ii. Transaction Processing - (data processing) iii. Management Information â&#x20AC;&#x201C; Analyze data to be usable information iv. Decision Support - Health/Healthcare

The Paradox of Professionalism and Error in Complex Systems Professionalism & expertise are needed to prevent/mitigate errors in complex & risky work such as medicine, aviation, and military operations but there are two paradoxes: 1. They increase the risk of errors by breaking procedural rules to suit the circumstances 2. Professionals tend to ignore or hide critical information about unsafe conditions and create ‘blind spots’ within organizations. (Journal of Biomedical Informatics 44 (2011) 395–401) The paradox of HIT productivity HIT is perceived as a means to improve productivity, quality & system efficiency. However, the current study results are contradictory: Some studies do confirm HIT as a means to greater productivity and efficiency, while other studies remain inconclusive. Some studies even show that HIT can be counter-productive / hazardous. (International journal of medical informatics 80 (2011) 102–115) Is HIT Ineffective Or Is It Sub-optimally Used By Us? This is a Billion $ query at present. HIT in Chronic Care With current HIT with distributed IT systems, powerful portable computing and mobile e-communication we can design a system that is patient focused, integrated and holistic in approach, and offers objective evidence-based care based on intended outcomes incorporating proactive quality assurance & error reduction in a dynamic & turbulent home environment of chronic care. In Chronic Care, HIT can help achieve true patient-orientation and “seamless information flow for seamless care”, quality in care delivery, viz., give the right treatment to the right patient, at the right time and in the right place, regularly and reliably. We have not been able to do it till now using only traditional paper records and communication. If HIT has to achieve it, we need to ensure appropriate form and effective functioning of the technology. Patient Centered HIT ideally needs a trans-disciplinary approach to healthcare. It creates new challenges. We need – i. a common language that really integrates the various health care professions (HCPs) ii. to use terms and language as commonly understood (tackling the acronyms maze!) iii. to learn how to effectively link various professions iv. integrated record as a means of clinical communication to all HCPs

Organisational Barriers: i. Non-conducive structure of organizations ii. Tasks that are not feasible in the set up iii. People policies which retard progress and block innovation iv. Lack of proper incentives v. Defunct decision processes and lack of information We need to do more studies on organizational structure, end-users’ HIT competency, incentives, liability issues, & work process issues that facilitate or retard effective implementation of HIT to enhance quality care. Bad Health Informatics Can Kill HIT can have positive impact on health care. But there is also negative impact of HIT on efficiency and even outcome quality of patient care. Medical ‘informaticians’ should feel responsible for the effects of HIT on patients and public. We need to conduct systematic analysis of HIT errors and failures to design better quality systems. The problems can be overcome by developing & applying human-centered design, implementation, & evaluation adapted to the point-of-healthcare delivery. Such a systematic approach has been achieved in aviation, the military, nuclear power, and the consumer software industry. It can, and must, be achieved in HIT as well. National HIT: Patient Safety Initiatives i. Currently, there are significant gaps in the safety initiatives for HIT systems. ii. The safety of HIT (EHR, CPOE etc) is not being explicitly addressed in most nations iii. Standardization and monitoring of safety in system design, implementation & use of HIT is critical to ensure patient-safety. Key Components of Successful Health IT Policy (USA-Canada) I. Setting clear goals and intended outcomes of HIT without being overly prescriptive. II. Adopt an iterative-incremental management approach with strong leadership and governance model. III. Defining frameworks for guiding policy improvement in a continual and systematic manner. IV. Addressing meaningful use of the existing legacy health IT systems in use. V. Capitalizing on the value of data for use in performance and quality measures, public health and research. Summing up: Effective HIT and quality healthcare: we do need them – Our Lives May Depend on it!

Dr. K.A.Narayan Professor K. A. Narayan, Vice Principal of Mahatma Gandhi Medical College and Research Institute is also the Head of the Department of Community Medicine. A graduate of the Jawaharlal Institute of Postgraduate Medical & Research (JIPMER), Pondicherry, an institute of National Importance, also did his postgraduation in Community Medicine from the same institute. After completing his postgraduation he joined as a faculty in Community Medicine is his alma mater and continued there till 2006 by which time he also headed the department. During his tenure at JIPMER he contributed to the development of the undergraduate curriculum in community medicine and other subjects. As a faculty of the National teacher training centre (NTTC) he was a resource person or organiser for a variety of workshops ranging from pedagogical methods, management, hospital waste management and disease surveillance. Trained in Statistic for Health at the University of Reading, UK under the Commonwealth Fellowship and in Qualitative Research Methods by WHO, he has gained experience in research methods, epidemiology and training and had conducted workshops and research projects. His passion for things electronic saw him as a founder member of the JIPMER computer club which trained doctors to use computers. He played a key role in the computerization of the department of Community Medicine, the networking of JIPMER, establishment of a computer laboratory and setting up of the Telemedicine Facility. He was also a member of the high power committee for developing the plans for the expansion of JIPMER. In 2006 he chose to opt for early retirement and joined the AIMST University in Northern Malaysia. There he developed the community training programme for MBBS students the highlight of which was a much acclaimed home stay programme which brought about significant attitudinal change among medical students. Continuing his interests in computerization he introduced computerised data collection

and analysis for medical students and online tests. He set up a learning management system (LMS) for conducting and online course on medical education and statistics. In 2013 he returned to India and joined the MGMCRI as Head of department. He was also given the additional responsibility of Vice Principal. During the seminar K.A. Narayan will speak on the new regulations for clinical establishments of the Government of India, the standards established or electronic medical records and how the Web 2.0 technology will help advance quality of health care.

WEB 2.0 FOR INTERPERSONAL CONTACT WITH PEERS & PATIENTS

K.A. Narayan The Health Care sector in India has had phenomenal growth during the last few years in quality and capacity both in the public and private sector. The country is emerging as a major destination for health care services, given the lower cost of health care of international quality. The growth in core services for health influences other sectors such as insurance and finance, hospitality and travel. India is already a leader in the information technology sector. Health care sector, therefore, is becoming the largest service sector with a significant contribution to the economy. With the health sector poised for major growth in the next decade, the sheer size of the sector in the country will necessitate extensive use of information and communication technology (ICT) infrastructure, services and databases for policy planning and implementation. The Government of India has taken a number of initiatives for standardization and health information exchange. A parallel expansion in knowledge base and the way it is disseminated and accessed has occurred with the advent of Web 2.0. It brings people together in a more interactive and dynamic space. The â&#x20AC;&#x153;social networkâ&#x20AC;?, as this new generation of internet services and devices are called, can be leveraged to enrich our web experience, create a highly connected digital network of practitioners to improve quality of care as envisaged by standards set by the Government of India. The paper highlights the growth of Web 2, the standards for electronic records and information exchange and the acts governing them in India.

How Mobile Tech Can Influence Cost-Effective Health Care. - Dr. James S. Toreson “An Ounce of Prevention is Worth a Pound of Cure” - Benjamin Franklin 1735 The Benefits of Mobile-Health Technology Mobile tech’s impact on medicine will be more profound than the pc’s impact on mainframe computing. Some of the important features are listed below: •Moving the Clinic to the Patient for Many Clinical Functions: Mental, Physical, Sociological •Access to Large Population, Family Histories, and Lots of Data •Enables “Community Level Healthcare” and Holistic Health through Local Support Systems •Enables Automation to Transition from “Crisis-Care” to “Preventive-Care •Lower Facility Expense •Higher Physician Productivity •Less Time and Cost to the Patient •Higher Frequency of Care, Exams, and Patient Communications Mobile Tech & Preventive Healthcare: •Intelligent Data Acquisition Systems •Genomic Data •Current, Accurate, Electronic Health Records: Medical Data, Family Data, Patient Behavior, Lifestyle, Environment, etc. •AI driven, Clinical Decision Support Systems •Knowledge Base THE KNOWLEDGE BASE •Continuous Improvement & Review – Peer and AI •Litigation History and Avoidance •Comprehensive: Genomics, Drugs, Treatment, Symptoms, Behaviors, Family Data, Environment., etc. •Technically Layered Search for the end-users: • Consumer; Doctor; Researcher.

System Strategy: •Translational Bioinformatics, fueled by Genomics, Patient Data, Family Histories, and Environmental Data •Automation Intensive – Physician Empowering •Artificial Intelligence Enabled •Pervasive, Advanced, Quality Control •Continuous Improvement at all Levels •Cloud Based •Ultra-Secure Cost Control Elements: •Low-Cost Systems, with “Zero Defect” Quality •Minimize Skilled Personnel •High-Quality Outcomes •Reduce Time and Cost for Patient •Timely, Efficient, and Accurate Care •Patient Involvement: Knowledge, Life Style, Behavior, & Family History •Patient Experience and Satisfaction System Development: •Disease Assessment •Set Priorities Based on “80-20 Rule”: the 20% of Diseases that Cause 80% of Cost •Disease Control that is Quick to Deploy •Other Parameters e.g., Contagious diseases, Epidemics, etc. HOLISTIC HEALTH •Integration and Optimization of Psychological, Physical & Social health. MENTAL HEALTH •Brain (Mental) and Body Physiology are Connected •“Distributed Treatment” through Patient Empowerment: Education, Communication, Meditation, Music, Social, etc.

Genomics - Predictive : •Currently Constrained to Single Gene (Monogenic or “Mendelian“) Disorders •Complex Diseases Caused by Combinations of Genetic Information (Polygenic) •Complexity of Genome Requires Massive Computing Power, Sophisticated Algorithms, and Artificial Intelligence (AI)

Translational Bioinformatics: Translational bioinformatics = informatics methods that link biological entities (genes, proteins, small molecules) to clinical entities (diseases, symptoms, drugs)--or vice versa. (Professor Russ B. Altman, MD, PhD Stanford University) An Example of AI Software: •“eXtasy” - Software Breakthrough (Oct 2013) •Advanced artificial intelligence Based •Detection of Disease-Causing Mutations •20X Improvement in Accuracy •Developed at KU Leuven in Belgium Conclusion Quantifiable Data from Mobile Tech is Critical for Advancing: •Translational Bioinformatics •Genomics •Epidemiology •Health Care to the Masses Evaluation is Vital “If You Can’t Measure It, You Can’t Improve It” - Lord Kelvin

Swaminathan T.N. Experience: • The goal of the proposed research is to investigate the statistical relationship between the trends of various medical parameters taken from patients and their impact on the healthcare of these patients. • These results will be used to determine an optimal set of medical parameters (trading off cost vs. healthcare outcomes) that would be acquired from patients and analyzed by a system comprised of computer hardware and software that would be cost-effective for broad deployment in healthcare. • I have the expertise, leadership, and motivation to be the program director to carry out this multi-disciplinary research work, including computer technology, complex hardware/software systems, and sensors. As a member of technical staff at Chrysler Corporation, I was the project manager of the research, development and commercialization of their sales & marketing model that was constructed based on their sales data for the last 15 years. • I was also instrumental in building their forecast model by applying various statistical methods on the model. As a project manager at General Motors I lead the Analytics team in building a huge Data warehouse system for analyzing their warranty systems and bringing out various reports that would give them the list of defects on vehicles and how to do the quality control of those defects at the time of production. • As the COO of Forte Systems, I led the research, development, and commercialization of a VOIP product that will integrate emails, Voice messages and Faxes in your mailbox and recognizes voice commands. • As co-founder of RoboClinics established the strategic relationships with Medical Research organizations like MGMCRI and IT companies. • Researched about the current Healthcare problem, devised a solution, translated the solution into a Technology based product and working with investors to raise money for the development of the product.

Education: University of Madras University of Madras University of Hyderabad

B.S. in Statistics June 1976 M.S. in Statistics June 1976 M.S. in Computer Science Dec 1980

Positions and Employment: 1980-1984 1985-1995 1996-2000 2000-2010 2011- 2013

Technical Staff Tata Consulting Services Project Manager CovanSys Corporation VP Technical Forte Systems VP Technical Global Systems Technologies Inc VP Technical RoboClinics

Other Experience and Professional Memberships: PMP Certificate ITIL Foundation Certificate Agile Project Management Certificate

Entrepreneurship in Health Care Technology and Economics (RoboClinic Model) - Mr Swaminathan T. RoboClinics Background • History • Problem • Solution • Challenges History of RoboClinics • Ten Years of Research • Pouring Through Research Papers • Analyzing the Business Problem • Coming up with the Solution • Leveraging the Technology Business Problem • Overworked & underpaid PCPs • Increasing HealthCare cost and Decreasing QOS • Shortage of PCPs • Inner Cities and Rural areas are underserved • Implementation of Affordable Healthcare Act • Additional 50 Million people have to be serviced Business Solution Leveraging the Technology & Patient’s Data • Patient’s Centric Services • Self managed Services • Zero error in data acquisition • Consistent & Repeatable Services • Quality & Speedy Services any where

Business Challenges • Devising a Total End-to-End Solution • Identifying the right strategic partners • Identifying the right Technology • Seeking Funds for Product Development • Putting together the Dream team for Development Business Challenges – Cont. • Developing the Product for less Cost • Getting FDA Approvals • Identifying the right Market Channels to market it • Rolling out and Supporting of the Product • Taking the Company Public through IPO Economics of RoboClincs • Cost of Hardware • Cost of Software • Cost of Delivery to Patients & Doctors • Universal Preventive Care for All masses

e-Digest - Mrs. A.N. Uma, Asst.Prof., Anatomy Dept.