Wednesday, July 29, 2015

Experiences in Health information systems with students from Taiwan

We are currently working with 4 very young and enthusiastic students from Taiwan who as a part of their first learning module in HIS have been assigned the task of exploring upstream events in health information systems, namely data capturing.

They have been previously exposed to paperless hospitals only and seeing our paper based files and records along with huge paper registers in our CT-MRI rooms along with the latest generation CT and MRI scanners was a contrast that they needed to document and couldn't resist clicking pictures of those.:-)

They are very well versed in handling their devices (some of them have been using emails since the age of 8) and can instantly look up anything on the net if they feel the need, something that would be rare to see (in my personal experience) with Indian medical students. They finished 6 GB of 3G wifi internet time in 2 days (i have to make do with 4 GB in a month, one reason i can't click on any videos). :-)

They have patiently and courageously  worked with our medical students to record patient histories in Chinese (translated from Hindi and English) and other patient data and i asked them today if they were able to input the data directly into their computers and subsequently their blogs and patient-EHRs or they actually wrote it in their diary and later typed it to their computers. They said they had handwritten it first and then subsequently uploaded it. I asked them if they would be able to think of a better way to interface with the system and avoid paper altogether in this crucial first step to data entry in the HIS. Let us see if they can think of something interesting as a solution to this in the coming months.

目前,我们正在与4非常年轻,热情的台湾留学生谁是他们的第一个学习模块的一部分,在HIS已分配探索卫生信息系统,即数据采集上游事件的任务。他们此前已暴露于只和我们看到基于纸质档案和记录以及在我们的CT-MRI室巨大的纸寄存器以及最新一代的CT和MRI扫描仪是一种反差,他们需要的文件,无法抗拒无纸化医院点击这些图片。:-)他们十分精通处理自己的设备(其中一些已经使用电子邮件,因为8岁),并可以即时查找任何东西在网络上,如果他们觉得有必要,这将是对难得看到(以我个人经验)与印度医学生。他们完成了2天6 3G GB的wifi上网时间(我得凑合着4 GB的一个月,其中一个原因我无法点击任何视频)。 :-)

他们耐心和勇气,曾与我们医学生在中国(从印地文和英文翻译)和其他病人数据记录患者病历,我问他们,如果今天他们能够直接输入数据到自己的电脑,随后他们的博客和耐心-EHRs或者他们实际上写在他​​们的日记,后来它输入到他们的计算机。他们说,他们首先必须手写,然后上传随后它。我问他们,如果他们能想到更好的办法在这关键的第一步完全的接口与系统,并避免纸张在他的数据录入。让我们看看他们能想到的一些有趣的事情作为一个解决这个在未来几个月。

Mùqián, wǒmen zhèngzài yǔ 4 fēicháng niánqīng, rèqíng de táiwān liúxuéshēng shuí shì tāmen de dì yīgè xuéxí mókuài de yībùfèn, zài HIS yǐ fēnpèi tànsuǒ wèishēng xìnxī xìtǒng, jí shùjù cǎijí shàngyóu shìjiàn de rènwù. Tāmen cǐqián yǐ bàolù yú zhǐ hé wǒmen kàn dào jīyú zhǐ zhì dǎng'àn hé jìlù yǐjí zài wǒmen de CT-MRI shì jùdà de zhǐ jìcúnqì yǐjí zuìxīn yīdài de CT hé MRI sǎomiáo yí shì yī zhǒng fǎnchā, tāmen xūyào de wénjiàn, wúfǎ kàngjù wú zhǐ huà yīyuàn diǎnjī zhèxiē túpiàn.:-) Tāmen shífēn jīngtōng chǔlǐ zìjǐ de shèbèi (qízhōng yīxiē yǐjīng shǐyòng diànzǐ yóujiàn, yīnwèi 8 suì), bìng kěyǐ jíshí cházhǎo rènhé dōngxī zài wǎngluò shàng, rúguǒ tāmen juédé yǒu bìyào, zhè jiāng shì duì nándé kàn dào (yǐ wǒ gèrén jīngyàn) yǔ yìndù yīxué shēng. Tāmen wánchéngle 2 tiān 6 3G GB de wifi shàngwǎng shíjiān (wǒ dé còuhézhù 4 GB de yīgè yuè, qízhōng yīgè yuányīn wǒ wúfǎ diǎn jí rènhé shìpín). :-)

Tāmen nàixīn hé yǒngqì, céng yǔ wǒmen yīxué shēng zài zhōngguó (cóng yìn dì wén hé yīngwén fānyì) hé qítā bìngrén shùjù jìlù huànzhě bìnglì, wǒ wèn tāmen, rúguǒ jīntiān tāmen nénggòu zhíjiē shūrù shùjù dào zìjǐ de diànnǎo, suíhòu tāmen de bókè hé nàixīn-EHRs huòzhě tāmen shíjì shang xiě zài tā​​men de rìjì, hòulái tā shūrù dào tāmen de jìsuànjī. Tāmen shuō, tāmen shǒuxiān bìxū shǒuxiě, ránhòu shàngchuán suíhòu tā. Wǒ wèn tāmen, rúguǒ tāmen néng xiǎngdào gèng hǎo de bànfǎ zài zhè guānjiàn de dì yī bù wánquán de jiēkǒu yǔ xìtǒng, bìng bìmiǎn zhǐzhāng zài tā de shùjù lùrù. Ràng wǒmen kàn kàn tāmen néng xiǎngdào de yīxiē yǒuqù de shìqíng zuòwéi yī gè jiějué zhège zài wèilái jǐ gè yuè.

Thursday, July 2, 2015

UDHC expanding Case-based-medical-informatics

Our EHR platform tries to expand the field of Case-Based-Medical-Informatics toward further development of 'Personalized Medicine.' 

Please see these links on the same: http://www.biomedcentral.com/1472-6947/4/19http://www.pitt.edu/~super1/lecture/lec53081/009.htm. The first link is a primer on case-based-medical-informatics but is unfortunately written in a manner that is difficult to digest and the second link is from a presentation that illustrates it in a different and hopefully simpler manner. Here is some more reading on Personalized Medicine:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3269464/ and Patient centered medicine:http://www.biomedcentral.com/1472-6947/13/6

We regularly use an interface that allows us to integrate our largely paper based workflow into our
open online EHRs. See these web-linked samples from some of our current EHRs below:

For Inpatients in our Medical College in Bhopal, India please find
linked below these 3 EHRs that also contains the Conversational
clinical decision support workflow):

http://www.udhc.co.in/INPUT/displayIssueGraphically.jsp?topic_id=1745,

http://www.udhc.co.in/INPUT/displayIssueGraphically.jsp?topic_id=1668,

http://www.udhc.co.in/INPUT/displayIssueGraphically.jsp?topic_id=1739

Our Telemedicine patients (again with the Conversational clinical
decision support workflow-scroll to bottom):

One sample EHR uploaded by the patient's caregiver in USA:
http://www.udhc.co.in/INPUT/displayIssueGraphically.jsp?topic_id=1751

One sample EHR from a patient in
Delhi:http://www.udhc.co.in/INPUT/displayIssueGraphically.jsp?topic_id=1617

One sample EHR from a patient in Mathabhanga, rural
India:http://www.udhc.co.in/INPUT/displayIssueGraphically.jsp?topic_id=1597

To take care of current globally felt problems of discordance between the doctor-patient
interface and doctor-computer interface, much of the interfacing with the computer is done by our trained PICMs
(Patient information communication managers) and here's a business model (http://userdrivenhealthcare.blogspot.in/2015/06/global-learning-toward-local-caring.htmlon how both the EHR and PICM can be effective toward addressing the very problems in India (ensuring access to medical services by the
poor, current congestion in most healthcare facilities) that some analysts feel make EHRs premature for India.

Most of our patients (many of them from rural India) are not able to understand the processing of their data by our participatory global health network and so the learning conversations/discussions are openly archived for viewing and further learning and mining by anyone who is interested in the data provided it is attributed under a creative commons license.
Some urban patients such as the one here:http://www.udhc.co.in/INPUT/displayIssueGraphically.jsp?topic_id=1751 from USA may be able to follow large part of the conversations and even put in a word (scroll down to the bottom of the history to see the conversations) through their primary care-givers in the forum (as the patient is otherwise de-identified per HIPAA in the EHR as well as the discussion forum).
For most of our rural patients (who may not be able to filter the chatter from hundreds of responses) the global physician moderator and PICM sends an output to the local PICM (community health-worker) through our online platform (see this early sample here:http://www.udhc.co.in/SOLUTION/viewSolution.jsp?solution_id=6&topic_id=166, also in the local language (Bengali) here:http://www.udhc.co.in/SOLUTION/viewSolution.jsp?solution_id=7&topic_id=166)

Currently i am doing this job of the global physician moderator along with my student Dr Kaustav Bera (you will find both of us mentioned in the above output link) and we have a few community-health-worker PICMs in Central and North Eastern India. We need more and more physicians and community-health-worker PICMs to scale our model and one of the ways we plan to train them is through our currently active Medical Elective program detailed here:http://promotions.bmj.com/jnl/bmj-case-reports-student-electives/. This is a global health case-report elective that incorporates most of the strategies and approaches our PICMs would employ.