Health Informatics for Hospital Executives
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Transcript of Health Informatics for Hospital Executives
Health Informatics for Hospital Executives
N Th A t MD MSNawanan Theera-Ampornpunt, MD, MS
Feb 14, 2011Ramathibodi Hospital Administration School
SlideShare.net/Nawanan
A Few Words About MeA Few Words About Me...
2003 D f M di i (1 Cl H )2003 Doctor of Medicine (1st-Class Honors) Ramathibodi
2009 M.S. (Health Informatics) University of Minnesota
Currently• Ph.D. Candidate (Health Informatics) University of Minnesota( ) y
• Medical Systems Analyst, Health Informatics Division, Ramathibodi
Contacts@Nawanan @ThaiHealthIT@ @[email protected]/Nawanan
2
www.tc.umn.edu/~theer002groups.google.com/group/ThaiHealthIT
Outline
• Healthcare & Health IT• Health IT Applications
H lth I f ti A A Fi ld• Health Informatics As A Field• IT Management
3
H l h &Healthcare & Health ITHealth IT
4
Manufacturinga u actu g
5 Image Source: Guardian.co.uk
Bankinga g
6 Image Source: Cablephet.com
Healthcareea t ca e
7 ER - Image Source: nj.com
Why Healthcare Isn’t Like Any Others?y y
• Life-or-Death• Many & varied stakeholders• Strong professional values• Strong professional values• Evolving standards of care• Fragmented, poorly-coordinated
systemssystems• Large, ever-growing & changing
body of knowledge• High volume low resources
8
High volume, low resources, little time
Why Healthcare Isn’t Like Any Others?y y
• Large variations & contextual dependenceLarge variations & contextual dependence
Input Process OutputInput Process Output
Patient Decision BiologicalPatient Presentation
Decision-Making
Biological Responses
9
But...Are We That Different?
Banking
Input Process Output
Transfer
Location A Location BValue-Add
- SecurityConvenience
Location A Location B
10
- Convenience- Customer Service
But...Are We That Different?
Manufacturing
Input Process Output
AssemblingRaw FinishedAssemblingRaw Materials
Finished Goods
Value-Add- Innovation
11
- Design- QC
But...Are We That Different?
Healthcare
Input Process Output
Patient CareSick Patient Well Patient
Value-Add- Technology & medications- Clinical knowledge & skills
12
- Quality of care; process improvement- Information
Information is Everywhereo at o s e y e e
13
Various Forms of Health IT
Hospital Information System (HIS) Computerized Provider Order Entry (CPOE)
Electronic Health
Records Picture Archiving and
14
Records (EHRs)
gCommunication System
(PACS)
Still Many Other Forms of Health IT
Health Information Exchange (HIE)
m Health
g ( )
m-Health
Biosurveillance
Personal Health Records (PHRs)
Telemedicine &
15
Information Retrieval Telehealth
Images from Apple Inc., Geekzone.co.nz, Google, PubMed.gov, and American Telecare, I
Why Adopting Health IT?
“To Computerize”“To Go paperless” To ComputerizeTo Go paperless
“Digital Hospital”“To Get a HIS”
Digital Hospital
“T H EMR ”“To Modernize”
“To Have EMRs”
“To Share data”
16
To Share data
Some QuotesQ
• “Don’t implement technology just for• Don t implement technology just for technology’s sake.”
• “Don’t make use of excellent technology. Make excellent use of technology ”Make excellent use of technology.(Tangwongsan, Supachai. Personal communication, 2005.)
• “Health care IT is not a panacea for all• Health care IT is not a panacea for all that ails medicine.” (Hersh, 2004)
17
Health IT: What’s In A Word?
Health Goal
Information Value-AddInformationT h l
Value-Add
Technology Tools
18
Dimensions of Quality Healthcarey
Safety• Safety• TimelinessTimeliness• Effectiveness• Efficiency
E it• Equity• Patient-centerednessPatient centeredness
19 (IOM, 2001)
Value of Health ITa ue o ea t
Guideline adherence• Guideline adherence• Better documentation• Practitioner decision making
for process of care• Medication safetyMedication safety• Patient surveillance &
monitoring• Patient education/reminder
20
• Patient education/reminder
Fundamental Theorem of Informatics
21(Friedman, 2009)(Friedman, 2009)
Is There A Role for Health IT?
22 (IOM, 2000)
Landmark IOM Reportsp
23
(IOM, 2001)(IOM, 2000)
Landmark IOM Reports: Summaryp y
• Humans are not perfect and areHumans are not perfect and are bound to make errors
Hi hli ht bl i th U S• Highlight problems in the U.S. health care system that
t ti ll t ib t tsystematically contributes to medical errors and poor quality
• Recommends reform that would change how health care works and ghow technology innovations can help improve quality/safety
24
p p q y y
Why We Need Health ITWhy We Need Health IT• Health care is very complexHealth care is very complex
(and inefficient)• Health care is information rich• Health care is information-rich• Quality of care depends on timely
il bilit & litavailability & quality of information
• Clinical knowledge body is too large• Short time during a visitg• Practice guidelines are put
“on-the-shelf”
25
on the shelf• “To err is human”
To Err Is HumanTo Err Is Human• Perception errors
26 Image Source: interaction-dynamics.com
To Err Is HumanTo Err Is HumanL k f Att ti• Lack of Attention
27 Image Source: aafp.org
To Err Is Human• Cognitive Errors - Example: Decoy Pricing
To Err Is Human• Cognitive Errors - Example: Decoy Pricing
# ofThe Economist Purchase Options
• Economist.com subscription $59 16
# of People
Economist.com subscription $59• Print subscription $125• Print & web subscription $125
084
The Economist Purchase Options# of
PeopleThe Economist Purchase Options
• Economist.com subscription $59• Print & web subscription $125
6832
People
28
(Ariely, 2008)p $ 32
What If This Happens in Healthcare?
It l d h• It already happens....(Mamede et al., 2010; Croskerry, 2003; Klein, 2005)
• What if health IT can help?
29
Adoption of Health IT: Assumptions
Adoption Use Outcomes
30
30
U.S.’s Efforts on Health IT Adoption
??
“ We will make wider use of electronic records...We will make wider use of electronic recordsand other health information technology, to help
control costs and reduce dangerouscontrol costs and reduce dangerous medical errors.”
President George W Bush
31 Source: Wikisource.org Image Source: Wikipedia.org
President George W. BushSixth State of the Union Address, January 31, 2006
Public Policy in Informatics: A US’s Case
1991: IOM’s CPR Report published1991: IOM s CPR Report published
1996: HIPAA enacted
2000-2001: IOM’s To Err Is Human & Crossing the Quality Chasm published
2004: George W. Bush’s Executive Order establishing ONCHIT (ONC)g ( )
2009-2010: ARRA/HITECH Act & “Meaningful use” regulations
32
Meaningful use regulations
U.S. Adoption of Health ITpAmbulatory (Hsiao et al, 2009) Hospitals (Jha et al, 2009)
Basic EHRs w/ notes 7.6%Comprehensive EHRs 1.5%pCPOE 17%
• U.S. lags behind other Western countries (Schoen et al, 2006;Jha et al, 2008)
• Money and misalignment of benefits is the biggest reason
33
gg
We Need “Change”We Need “Change”
“...we need to upgrade our medical records by switching from a paper to y g p pan electronic system of record keeping...”
P id t B k Ob
34
President Barack ObamaJune 15, 2009
The Birth of “Meaningful Use”
“...Our recovery plan will invest in y pelectronic health records and new technology
that will reduce errors, bring down costs, ensure privacy and save lives ”ensure privacy, and save lives.
President Barack ObamaAddress to Joint Session of Congress
35
Address to Joint Session of CongressFebruary 24, 2009
Source: WhiteHouse.gov
American Recovery & Reinvestment ActAmerican Recovery & Reinvestment Act
• Contains HITECH Act(Health Information Technology for Economic and Clinical Health Act)
• ~ 20 billion dollars for Health IT investments
• Incentives & penalties for providers
36
National LeadershipNational LeadershipOffice of the National Coordinator for Health InformationOffice of the National Coordinator for Health Information Technology (ONC -- formerly ONCHIT)
David Blumenthal, MD, MPPNational Coordinator for Health Information TechnologyHealth Information Technology (2009 - Feb 2011) [Just
37 Photo courtesy of U.S. Department of Health & Human Services
What is in the HITECH Act?
38 (Blumenthal, 2010)
“Meaningful Use”g
“M i f l U ”“Meaningful Use” of a PumpkinPumpkin
39 Image Source & Idea Courtesy of Pat Wise at HIMSS, Oct. 2009
“Meaningful Use” of Health ITg
Stage 1Stage 1- Electronic capture of health information- Information sharing
D t ti Stage 3
Better Health
- Data reporting
Stage 2
Stage 3
Use of EHRs to
Use of EHRs to improve processes of
EHRs to improve outcomes
processes of care
40 (Blumenthal, 2010)
H l h ITHealth IT ApplicationsApplications
41
Enterprise wide Hospital ITEnterprise-wide Hospital IT
• Master Patient Index (MPI)• Admit-Discharge-Transfer (ADT)• Electronic Health Records (EHRs)• Computerized Physician Order EntryComputerized Physician Order Entry
(CPOE)• Clinical Decision Support SystemsClinical Decision Support Systems
(CDSSs)• Picture Archiving and CommunicationPicture Archiving and Communication
System (PACS)• Nursing applications
42
Nursing applications• Enterprise Resource Planning (ERP)
Departmental ITDepartmental IT
• Pharmacy applications• Laboratory Information System (LIS)y y ( )• Specialized applications (ER, OR,
LR Anesthesia Critical CareLR, Anesthesia, Critical Care, Dietary Services, Blood Bank)
• Incident management & reporting system
43
EHRs & HISEHRs & HISThe Challenge - Knowing What It MeansThe Challenge Knowing What It Means
Electronic Health
El t i M di l
Records (EHRs)Hospital
Information S t (HIS)Electronic Medical
Records (EMRs)System (HIS)
Electronic Patient Records (EPRs)
Clinical
Computer-Based Patient Records
Personal Health Records (PHRs)
Information System (CIS)
44
(CPRs)
EHR SystemsEHR SystemsJ t l t i d t ti ?Just electronic documentation?
Diag-nosis
History & PE
Treat-ments ...
Or do they have other values?
nosis& PE ments
Or do they have other values?
45
Functions that Should Be Part of EHR Systems
• Computerized Medication Order Entry• Computerized Laboratory Order Entry• Computerized Laboratory Results• Physician Notes• Patient Demographics• Problem Lists• Medication ListsMedication Lists• Discharge Summaries• Diagnostic Test Results• Diagnostic Test Results• Radiologic Reports
46 (IOM, 2003; Blumenthal et al, 2006)
Computerized Physician Order Entry (CPOE)
47
Computerized Physician Order Entry (CPOE)
ValuesValues
• No handwriting!!!No handwriting!!!• Structured data entry: Completeness, clarity,
fewer mistakes (?)fewer mistakes (?)• No transcription errors!• Entry point for CDSSs• Streamlines workflow, increases efficiency, y
48
Clinical Decision Support Systems (CDSSs)Clinical Decision Support Systems (CDSSs)• The real place where most of the
l f h lth IT b hi dvalues of health IT can be achieved
• Expert systems• Based on artificial intelligenceBased on artificial intelligence,
machine learning, rules, or statisticsstatistics
• Examples: differential diagnoses treatment optionsdiagnoses, treatment options
49
(Shortliffe, 1976)
Clinical Decision Support Systems (CDSSs)Clinical Decision Support Systems (CDSSs)• Alerts & reminders
• Based on specified logical conditions• Examples:p
• Drug-allergy checks• Drug drug interaction checks• Drug-drug interaction checks• Drug-disease checks• Drug-lab checks• Drug-formulary checksg y• Reminders for preventive services or
certain actions (e g smoking cessation)
50
certain actions (e.g. smoking cessation)• Clinical practice guideline integration
Clinical Decision Support Systems (CDSSs)Clinical Decision Support Systems (CDSSs)
• Evidence-based knowledge sources e g drugEvidence based knowledge sources e.g. drug database, literature
• Simple UI designed to help clinical decision• Simple UI designed to help clinical decision making
51
A Basic Architecture of A CDSSA Basic Architecture of A CDSS
U U I t fUser User Interface
Inference Engine
Patient Data
Knowledge BaseOther Data
• Rules• Statistical data
• System states• Epidemiological/
52
• Statistical data• Literature• Etc.
• Epidemiological/surveillance data• Etc.
Clinical Decision Support Systems (CDSSs)
PATIENT
PerceptionCLINICIAN
Attention
External MemoryLong Term Memory WorkingMemory
Knowledge DataKnowledge DataMemory
Inference
53
DECISIONFrom a teaching slide by Don Connelly, 2006
Clinical Decision Support Systems (CDSSs)
PATIENT
PerceptionCLINICIAN
AttentionAbnormal lab
highlights
External MemoryLong Term Memory WorkingMemory
Knowledge DataKnowledge DataMemory
Inference
54
DECISION
Clinical Decision Support Systems (CDSSs)
PATIENT
PerceptionCLINICIAN
AttentionAbnormal lab
highlights
External MemoryLong Term Memory WorkingMemory
Knowledge DataKnowledge DataMemory
Inference
55
DECISION
Clinical Decision Support Systems (CDSSs)
PATIENT
PerceptionCLINICIAN
AttentionDrug-Allergy
Checks
External MemoryLong Term Memory WorkingMemory
Knowledge DataKnowledge DataMemory
Inference
56
DECISION
Clinical Decision Support Systems (CDSSs)
PATIENT
PerceptionCLINICIAN
Drug-Drug Interaction
ChecksAttention
Checks
External MemoryLong Term Memory WorkingMemory
Knowledge DataKnowledge DataMemory
Inference
57
DECISION
Clinical Decision Support Systems (CDSSs)
PATIENT
PerceptionCLINICIAN
Clinical Practice
Attention Guideline Reminders
External MemoryLong Term Memory WorkingMemory
Knowledge DataKnowledge DataMemory
Inference
58
DECISION
Clinical Decision Support Systems (CDSSs)
PATIENT
PerceptionCLINICIAN
Attention
External MemoryLong Term Memory WorkingMemory
Knowledge DataKnowledge DataMemory
Inference Diagnostic/Treatment Expert Systems
59
DECISION
Clinical Decision Support Systems (CDSSs)
• CDSS as a replacement or supplement of clinicians?• The demise of the “Greek Oracle” model (Miller & Masarie, 1990)
The “Greek Oracle” Model
The “Fundamental Theorem”
60 (Friedman, 2009)
Clinical Decision Support Systems (CDSSs)
Some risks• Alert fatigue
61
Workarounds
62
Health IT for Medication Safety
Ordering Transcription Dispensing Administrationg g
C OAutomatic Electronic
CPOEAutomatic Medication Dispensing
Electronic Medication
Administration Records (e-MAR)
BarcodedBarcodedMedication Di i
63
Medication Administration
Dispensing
Health Information Exchange (HIE)g ( )
Government
Hospital A Hospital B
Government
Clinic CL b P ti t t H
64
Lab Patient at Home
4 Quadrants of Hospital ITStrategic
p
HIEBusiness
Intelligence
CDSS
gPHRs
Social
ClinicalAdministrativeCPOE
EHRsVMI
Social Media
LIS
EHRsERP
VMI
ADT
MPIWord
Processor
65Operational
(Theera-Ampornpunt [unpublished], 2010-2011)
H l h I f iHealth Informatics As A FieldAs A Field
66
Biomedical/Health InformaticsBiomedical/Health Informatics• “[T]he field that is concerned with the optimal
use of information, often aided by the use of technology, to improve individual health, health care, public health, and biomedical research” (Hersh, 2009)
• “[T]he application of the science of informationas data plus meaning to problems of biomedical interest” (Bernstam et al, 2010)
67
DIKW Pyramid
Wisdom
Knowledge
InformationInformation
D tData
68
Task-Oriented View
Collection Processing UtilizationCollection Processing Utilization
StorageCommunication/Dissemination/
Presentation
69
M/B/H Informatics As A Field
70 (Shortliffe, 2002)
M/B/H Informatics and Other FieldsSocial
Sciences Statistics &
Cognitive & Decision
Sc e ces(Psychology,
Sociology, Linguistics,
Law & Ethics)
Statistics & Research Methods
Medical Sciences &Decision
ScienceSciences &
Public Health
Engineering Management
Biomedical/Computer & Library S iBiomedical/
Health Informatics
Computer & Information
ScienceScience,
Information Retrieval, KM
71
And More!
Balanced Focus of Informatics
People
Techno-logyProcess
72
IT MIT Management
73
ความเดิมตอนที่แล้ว...
H lth IT• Health IT: ของดี (อาจจะ) มปีระโยชน์(แต่ก็อาจมีโทษ)
• บริบท (local contexts) มคีวามสําคัญ• ต้องมีการบริหารจัดการที่เหมาะสมตองมการบรหารจดการทเหมาะสม
็ ิประเด็นพิจารณา
• อะไรคือบริบทที่เกีย่วขอ้ง?• จะจัดการมันอย่างไร?
74
ContextThe current
locationThe tailwind The headwind
location
The di i
The past j The destinationdirection
The speed
journey
The sailor(s) & The sail
75 The sailboat image source: Uwe Kils via http://en.wikipedia.org/wiki/Sailing
The boat( )
people on board
The sea
Direction & DestinationDirection & Destinationีรพ.มหาวิทยาลัย 900 เตียง รพ.เอกชน 200 เตียง
Vision เป็นโรงพยาบาลชั้นนําของ
ภมิภาคเอเชียที่มีความเปน็เลศิในVision เป็นโรงพยาบาล High Tech
High Touch ชั้นนําของประเทศภูมภาคเอเชยทมความเปนเลศใน
ด้านบริการ การศึกษา และวิจัยHigh Touch ชนนาของประเทศ
76
“The Sail”The Sail
77Carr (2004) Carr (2003)
4 Quadrants of Hospital ITStrategic
p
HIEBusiness
Intelligence
CDSS
gPHRs
Social
ClinicalAdministrativeCPOE
EHRsVMI
Social Media
LIS
EHRsERP
VMI
ADT
MPIWord
Processor
78Operational
(Theera-Ampornpunt [unpublished], 2010-2011)
IT As A Strategic Advantage
Sustainable
g g
I i it bl ?Yes
Yes competitiveadvantage
Rare ?
Inimitable ?
Yes
Yes
No
V l bl ?
Non-Substitutable?YesNo
Competitive
Preemptiveadvantage
Valuable ?
NoC titi
No Competitivenecessity
parity
Resources/capabilities
CompetitiveDisadvantage
79 From a teaching slide by Nelson F. Granados, 2006 at University of Minnesota Carlson School of Management
“The Sail”The Sailีรพ.มหาวิทยาลัย 900 เตียง
Vision เป็นโรงพยาบาลชั้นนําของ
รพ.เอกชน 200 เตียง
Vision เป็นโรงพยาบาล High Tech Vision เปนโรงพยาบาลชนนาของภูมิภาคเอเชียที่มีความเปน็เลศิในด้านบริการ การศึกษา และวิจัย
Vision เปนโรงพยาบาล High Tech
High Touch ชั้นนําของประเทศ
Current IT EnvironmentCurrent IT Environment
• เป็น รพ.แรกๆ ที่มี HIS ซึ่งพฒันาเอง แล ต่อยอดจาก MPI ADT ไปส่ CPOE
Current IT Environment• มี MPI, ADT, EHRs, CPOE แต่ยงัมี
CDSS จํากัดและตอยอดจาก MPI, ADT ไปสู CPOE(แต่ยงัขาด CDSS) ระบบ HIS เข้ากับ workflow ของ รพ. เป็นอย่างดี
CDSS จากด
• ยังไม่มี Customer Relationship
Management (CRM)
• ปัจจบุัน ระบบ HIS ยังใช้เทคโนโลยีเดียวกับช่วงที่พัฒนาใหม่ๆ (20 ปีก่อน) เป็นหลัก มีการนําเทคโนโลยีใหม่ๆ มา
80
เปนหลก มการนาเทคโนโลยใหมๆ มาใชอ้ย่างชา้ๆ
IT As A Strategic Advantage
Sustainable
g g
I i it bl ?Yes
Yes competitiveadvantage
Rare ?
Inimitable ?
Yes
Yes
No
V l bl ?
Non-Substitutable?YesNo
Competitive
Preemptiveadvantage
Valuable ?
NoC titi
No Competitivenecessity
parity
Resources/capabilities
CompetitiveDisadvantage
81 From a teaching slide by Nelson F. Granados, 2006 at University of Minnesota Carlson School of Management
“The Sailors”The Sailors
People
Techno-logyProcess
82
“The Sailors”The Sailorsีรพ.มหาวิทยาลัย 900 เตียง
• บคลากรมีอายเฉลี่ย 40 ปี
รพ.เอกชน 200 เตียง
• บคลากรมีอายเฉลี่ย 37 ปี บุคลากรมอายุเฉลย 40 ป (range 20-65)
• แผนก IT มีทั้งบุคลากรใหม่และทีเ่คย
บุคลากรมอายุเฉลย 37 ป
(range 20-57)
• แผนก IT เข้มแข็งพัฒนาระบบ HIS ตั้งแต่แรกเริ่ม
• แพทย์มีความเปน็ตัวของตัวเองสูง, ั ํ ้ ี
แผนก IT เขมแขง
• แพทย์ไม่ค่อยมี interaction กับ
บคลากรอื่น รายได้เป็นแรงดึงดดหลักมักทํางานเอกชนด้วย, ม ีturn-over rate สูงพยาบาลและวิชาชีพอื่นมักมองว่า
บุคลากรอน, รายไดเปนแรงดงดูดหลก
• ผู้บริหารได้รับการยอมรับจากบคุลากร
ทกวิชาชีพว่ามีวิสัยทัศน์และ• พยาบาลและวชาชพอนมกมองวาแพทย์คอือภิสิทธิ์ชน และมีเรื่องถกเถียงกันบ่อยๆ
ทกุวชาชพวามวสยทศนและ
บริหารงานได้ดี
83
ถกเถยงกนบอยๆ
ContextThe current
locationThe tailwind The headwind
location
The di i
The past j The destinationdirection
The speed
journey
The sailor(s) & The sail
84 The sailboat image source: Uwe Kils via http://en.wikipedia.org/wiki/Sailing
The boat( )
people on board
The sea
“The Boat”The Boat
• Size• ResourcesResources• Structures• Work Processes
Facilities/Geograph• Facilities/Geography• Etc.
85
“The Sea”T t t
The Sea• Target customers
• Local competitiveness• Relationship of hospital to local players• Inter-organizational collaborationg• IT market environment• National/international trend• National/international trend• Regulations• Standard of care• Etc.
86
SWOT Analysis“Th B t” “Th S ”
SWOT Analysis“The Boat” “The Sea”
Strengths Opportunities“The Tailwind” “The Tailwind”Strengths OpportunitiesThe Tailwind The Tailwind
Weaknesses Threats“The Headwind” “The Headwind”
87
IT vs BusinessIT vs Business
88
ContextThe current
locationThe tailwind The headwind
location
The di i
The past j The destinationdirection
The speed
journey
The sailor(s) & The sail
89 The sailboat image source: Uwe Kils via http://en.wikipedia.org/wiki/Sailing
The boat( )
people on board
The sea
Gartner’s Sourcing Life Cycle
Strategic Tactical
g y
Sourcing Strategyg Identificationg Criteria development
Evaluation and Selectiong Alignmentg Organization assessment
g
g Organization fitg Selection process g Partnership
g Core competenciesg Market scang Make-or-buy decisions
opportunities
ContractSourcingManagement
g Risk analysis
g Governance modelg Metrics
g Relationshipg Performance
assessment
DevelopmentManagement
g Payment modelsg Terms and conditionsg Provision
assessmentg Goals: reach business
objectives, efficiency,quality, innovation
90
for changesq y,
g Transition
From a teaching slide by Nelson F. Granados, 2006
IT Outsourcing Decision Tree
Is external delivery
Keep InternalNo
Does service offer titi d t ?
reliable and lower cost?
OUTSOURCE!
No
Yescompetitive advantage?
Keep InternalYes
91 From a teaching slide by Nelson F. Granados, 2006
IT Outsourcing Decision Tree: Ramathibodi’s Case
External delivery unreliable• Non-Core HIS
Ramathibodi s Case
Non-Core HIS,External delivery higher cost• ERP maintenance/ongoing customization
Is external delivery
Keep InternalNo
customization
Does service offer titi d t ?
reliable and lower cost?
OUTSOURCE!
No
Yescompetitive advantage?
Keep InternalYes
ERP initial implementation,
PACS RISCore HIS, CPOE
Strategic advantages• Agility due to local workflow accommodations
PACS, RIS, Departmental
systems, IT Training
92
Agility due to local workflow accommodations• Secondary data utilization (research, QI)• Roadmap to national leader in informatics
IT Training
Gartner Hype Cycle
93Image source: Jeremy Kemp via http://en.wikipedia.org/wiki/Hype_cycle
http://www.gartner.com/technology/research/methodologies/hype-cycle.jsp
Rogers’ Diffusion of Innovations: Adoption Curve
94Rogers (2003)
Unified Theory of Acceptance and Use of Technology (UTAUT)Technology (UTAUT)
Performance ExpectancyUsefulness p y
Effort Expectancy
B h i l
Ease of UseUse
BehaviorSocial Influence
Behavioral IntentionSocial Norm
& Opinions
Facilitating ConditionsIT Support
Gender Age Experience Voluntariness of Use
95 Venkatesh et al. (2003)
Adoption Strategies: “The Tipping Point” Version
Th Th R l f E id iThe Three Rules of Epidemics
• The Law of the Few
• Connectors
• Mavens
Change AgentsOpinion Leaders
Super-Users• Salesmen
• The Stickiness Factor Ease of Use
Champions
• The Power of Context Social Norm & Opinions
Gladwell (2000)
IT Support
96
Gladwell (2000)
Hospital IT Adoption Success Factors
• Communications of project plans & progressesW kfl id i• Workflow considerations
• Management support of IT projects• Common visions• Shared commitment• Multidisciplinary user involvement• Project managementProject management• Training
Innovativeness• Innovativeness• Organizational learning
97 Theera-Ampornpunt (2009) [Unpublished]
Resources on Change Management
98
Lorenzi & Riley (2004)
Leviss (Editor) (2010)
Summary• Healthcare is complex
H lth IT b fit h lth th h• Health IT can benefit healthcare through• Information delivery• Process improvement• Empowering providers & patients
• The world is moving toward health IT• Health informatics is related to & relies on the field of IT, but
th t ththey are not the same• Management of hospital IT is crucial to success
• Know your organization (“context”)• Strategic mindset
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• Project & change management
Final Words...• Don’t forget our real aim...
Adoption Use OutcomesAdoption Use Outcomes
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Q & AQ & A...D l d SlidDownload Slides
SlideShare.net/Nawanan
Contacts
@Nawanan @ThaiHealthIT
www.tc.umn.edu/~theer002
groups.google.com/group/ThaiHealthIT
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• Hersh W. A stimulus to define informatics and health information technology. BMC Med Inform Decis Mak. 2009;9:24.
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b ff b d h d d l [ ]use by office‐based physicians: United States, 2008 and preliminary 2009 [Internet]. 2009 [cited 2010 Apr 12]; Available from: http://www.cdc.gov/nchs/data/hestat/emr_ehr/emr_ehr.pdf
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