Healthcare informatics towards 2020 Øystein Nytrø IDI and Program for healthcare informatics Paper with contributions from Arild Faxvaag

Nerd alert: Health with an IT perspective! I don’t know anything…

What am I talking about? Health is: Subjective Individual Basic for living Medicine is: Multidisciplinary, based on the natural sciences in studying diseases, engineering in developing tools and therapy, and based on understanding and treating individuals with a wide range of physiological, social and psychological problems. Healthcare is: Knowledge intensive: About diseases, phenomena, treatments etc. Information intensive: About patients, individual history, population, epidemiology etc. About: Diagnosing, Intervening and Nursing

Healthcare informatics (CEN251) A scientific discipline that concerns itself with the cognitive, information processing and communication tasks of health care practice, education and research, including the information science and technology to support these tasks.

Challenges of healthcare Increased cost of healthcare spending US: 15% of GDP in 2003 OECD average: 9% Expected to rise with 3-4 %points next 5 years Increased cost of treatment Focus on development of high-cost procedures, tools and medicine Dubious cost-effectiveness both nationally and globally The 90% rule: 10% of the population uses 90% of the resources Global discrepancy – 8 physicians/Mpers in Angola, 530/Mpers in Cuba Aging Consumerism - healthcare as status Technology – always more knowledge and more diseases and tools

World health variables, 2000 source: UN Population Division

Why be application specific? Having a common goal Shaping the future by interacting with reality Cross-disciplinary work Good ideas come from hard problems Technology does only exist in a context! It is used by humans, in a society, for a purpose. Better remember that!

Challenges for informatics - applied A host of unconnected legacy systems: Accounting Planning and logistics Connected to tools (X-ray, laboratory…) Little information flow between services: A patient wanders from one organization to the next, from one physician to another one, with different problems and diseases. Do they communicate efficiently? Relevant clinical information is not available to the right person at the right time in the right place Relevant clinical knowledge is not integrated in the information systems Information quality: Inconsistencies and errors The patient is left out of the loop

Some methodological questions: For what purpose and whom is a system designed? Does the system work as intended, - and designed? Is the system used as anticipated? What is the cost/effect? Does the system produce the desired results? How does systems impact the organization of services? Does increased complexity of technology help or hinder?

Ways to go: Patient-centered recording and use of medical data for cooperative care Process-integrated decision support through current medical knowledge Comprehensive use of patient data for research and health care reporting Combining bio-information and health-information Structured and knowledge-rich patient records Architectures that support cooperative care across organizations and care layers: Distribution, roles, access, safety and security. Patient-directed information and knowledge Pathways of care and care processes

IME, NTNU, you and me and health Let’s do something worthwhile before the North-Atlantic freezes over. Let’s start with doing technologically advanced, conceptually simple and cheap things of global value. We’ve potentially got the worlds most unique laboratory: The norwegian healthcare system

Arbeid med å ”oppdatere arkiv” Tre muligheter Hare i hue: Trenger ikke å dokumentere Se behovet: Informasjon som vitalt i prosessen, ikke bare for journalen og framtiden Informasjon har verdi NTNU framsyngruppe i bioinformatikk Bioinformatikk Norges konkurransefortrinn knyttet til Bofasthet Helsevesenets enkelhet, homogenitet og tilgjengelighet Ett spørsmål som stadig dukker opp: Hvordan bringe resultatene tilbake i klinikken: Moralsk forpliktelse: Gjør noe som er relevant for dem som betaler

Globalisering Det kreves enorme løft internasjonalt for å oppgradere basis helsetjeneste Behov for globalisering av Norge Behov for relevans av IME/NTNU Rekrutterende og appellerende

NTNU-strategi Vi kan ikke drive mer ”ikt-industri” enn det er flinke kandidater Tiltrekk de flinkeste studentene Ved synlig og relevant forskning Ved høy kvalitet Flerfaglighet Forskningsbasert undervisning Norge er forskningsfiendtlig Fordi vi har lav profil Fordi vi ikke synliggjør kopling mellom samfunn-teknologi-forskning Fordi vi har teite politikere Fordi vi ikke synliggjør forskningen i undervisningen Forskningen må organiseres Disiplinorientert Prosjektbasert, enkel organisering av prosjekter Overordnete visjoner: Ting vi skal gjøre! Dra til Mars. eMelhus. IKT with a mission JEG MÅ FORSKE PÅ NOE! Jeg forsker både med hode og hjerte Hva som skjer underveis, ikke hvor vi kommer Som en metode, ikke som en måloppfyllelse

User-centered methods: Challenges Field studies: How to make use of observation data and interviews for the design? Drama workshops and lo-fi prototyping: How to involve the users as active participants in the design process? Prototyping and prototyping tools: How much needs to be prototyped? (”Just-enough prototyping”) Usability testing: How do we evaluate the usability of mobile systems for health workers?

Requirements analysis Drama workshops Analysis & Scenario building Requirements analysis Requirements Design and Prototyping Scenarios & personas Video, mock-ups and notes Paper prototype/ running prototype Evaluation Images, Video, Interviews By developer In the field or in a lab Field studies Usability testing Drama workshops

New technology Mobile wireless computing (PDAs, Tablets, WLAN, GPRS og 3G terminals, Bluetooth, ID Tags,,).

DHL vs. a hospital DHL Hospital Work The work is procedure driven The work is problem driven Workers The workers follow procedures The workers solve problems Control The system is in control The workers are in control Information flow The computer system needs information from the workers The workers need information from the computer system Work processes The process is simple and predictable The process is complex and less predictable Knowledge The knowledge can easily be externalized “in the world”. The knowledge and competence is to a large extent tacit.

Mobile computing: some issues Desktop computers Mobile and wireless Foreground/ Background Computer use is the main activity. The computer is integrated with other activities. Hardware and ergonomics The PC fits many purposes Hardware matters (size, weight, shape, battery,,) Mind/Body Symbol manipulation (mind) Physical and mental (body-mind) Environment data Physical position is irrelevant (cyber space) Location and data from environment can be used Screen size Large screens Small screens, sunlight Input Keyboard and mouse Stylus and buttons, but often need for one-handed input.

Drama workshop One day workshop in a full-scale model 6-8 health workers in two teams 1-2 facilitators (drama instructors) Lo-fi mockups (foam models, Post-its,,) Recording to video (1-2 persons) 2-3 developers as observers.

”Current practice” scenario

Imagining the future: Prototyping

Results Drama and improvised prototyping works well with health workers. Drama workshops give developers deep understanding of ”context-of-use”. Health workers are creative and clear given the right setting, methods and prototyping materials. Health workers, like the rest of us, have a good implicit knowledge of technology.

Future work Construction of a usability lab for mobile health ICT, supported by Norwegian Research Council (NFR). Integration with new Electronic Patient Record center at NTNU. (EPJ). Further research on methods and tools. Cooperation with developers and IT researchers. Integration of UCD with existing Software Engineering methods (e.g. RUP).