Paradigm Shifts in Health Informatics Luca Dan Serbanati and Serban Radu Politehnica University, Bucharest, Romania
HEALTHINF 2013 - 6th International Conference on Health Informatics 11-14 February 2013
Agenda What is a paradigm?
1 1. ◦
2. 3.
◦ ◦ 4.
◦ ◦ 5.
◦ ◦ 6 6.
◦ ◦ ◦ 7.
“Canon of proportions” => “Vitruvian Man”
How can we use a paradigm? p g New paradigms in healthcare “Pay for performance“, “Personalized medicine”, etc. “Patient-Centered Care”
Shift of paradigms from business to healthcare “Business Business Meta-Model Meta-Model” “HL7 RIM Meta-Model”
Paradigm g shifts of from information engineering g g to ehealth “Interconnecting Health” “Integrating health”
New paradigms in health informatics Multi-agent system “R2V2R - Real-to-Virtual-to-Real” “Ecosystem”
Conclusions
Example of Paradigm Shift y
Vitruvius described the human figure as being the principal source of proportion among the classical orders of architecture. Architecture
y
P di Paradigm:
Canon of Proportions: Human body proportions are the golden proportions
Paradigm shift
of architectural styles y Cosmography of the microcosm, i A Art, SScience i y
Leonardo da Vinci believed the workings ki off th the hhuman bbody d tto be b an analogy for the workings of the universe.
Homo Vitruvianus
What is a pparadigm? g Definition: A reference f model d l off fundamental f d t l value l widely id l accepted in a particular field because it is an expression of a comprehensive belief system or f world view in that field. ◦ Usually a paradigm emphasizes relationships between some fundamental concepts that shape the thinking. ◦ A paradigm is derived from a specific way of g, communicatingg and viewingg the thinking, world.
Agenda 1 1. 2. 3. 4. 5 5. 6 6. 7.
What is a paradigm? How can we use a paradigm? Paradigms in healthcare Shift of p paradigms g from business to healthcare Shift of paradigms from information engineering to ehealth New paradigms in health informatics Conclusions
How to use a paradigm? y
y y
A paradigm influences how an individual perceives i an area off the h reall world ld or reacts to this perception. A paradigm di guides id researchh and d practice ti in i the th field of interest. It can be used as: ◦ a structuring schema in both teaching and model-driven design processes; ◦ a benchmark to assess methods or conceptual tools that are related to the paradigm goal or idea, and g ◦ as this research claims,, we can use pparadigms for transferring knowledge across domains.
Model--based design process Model 1. Choose a simple schema to be the first model of the future system 2.Validate the model against the design target
[The model is not y] satisfactory]
[Th model d l is i [The satisfactory]
3. Refine the model
4 Describe the model in 4. a design specification language 5. Use the model to implement the system
Agenda 1 1. 2. 3. 4. 5 5. 6 6. 7.
What is a paradigm? How can we use a paradigm? Paradigms in healthcare Shift of p paradigms g from business to healthcare Shift of paradigms from information engineering to ehealth New paradigms in health informatics Conclusions
New paradigms in healthcare y
New paradigms are arising in healthcare to mark epochal changes in the domain: ◦ "pay for performance“ focuses on cost control p medicine" and "evidence-based ◦ "personalized medicine“ focus on the quality of services ◦ "patient-centered patient centered care” care and "patient patient empowerment" focus on the citizens’ perception concerning the quality and efficiency of healthcare.
“Patient--Centered Care” Paradigm “Patient g "Nothing about me without me“ Or:
The right care in the right way at the right time. Method y Four new communication behaviors: ◦ Understanding and validating the patients’ perspective ◦ Extension of understanding the patient to his / her global psychosocial context ◦ Shared understanding with the patient of his / her health problem and its treatment ◦ Partnership with “empowered” empowered patients in decision making, power and responsibility.
Agenda 1 1. 2. 3. 4. 5 5. 6 6. 7.
What is a paradigm? How can a paradigm be used? Paradigms in healthcare Shift of p paradigms g from business to health Shift of paradigms from information engineering to ehealth New paradigms in health informatics Conclusions
A business
) * meta-model meta
Objective
intends/ is concerned to
decides/controls/ performs
Agent extends plays
aids to carry out
role
Activity
BusinessRules (constraints) (co st a ts)
uses as a means
Tool
achieves
creates/ uses/ modifies
is applied to
Object
plays
>
Entity
plays
*) L. D. Serbanati, Integrating Tools for Software Development,Yourdon Computing Series, Prentice Hall, 1992.
A Business Model of Organisation: Coordinator Center (CC) Agents: CT Coordinator Statistical unit Data Safety Board
) * Clinical Trials
Management of clinical trial
starts
Organisation: Investigator centre Agents: Chief investigator CRF data collector Environment: Clinical ward A Agents: t Health care providers
Managment of statistical t ti ti l units it creates
Medical treatment of enrolled patients
Master File
Patient
Enrollment management
Directives
Startup experimentation
Investigator Patient Information
Patient Information
Compiled CRF Investigator
Patient monitoring
CT Protocol Resource
Directives
Compiled CRF Directives
Experimentation closure
Investigator
*) L. Collada Ali, P. Fazi, D. Luzi, F.L. Ricci, L.D. Serbanati, M. Vignetti, Toward a Model of Clinical Trials, ISBMDA 2004, 5th International Symposium of Biological and Medical Data Analysis, Barcelona, 2004.
The RIM HL7 V3 MetaMeta-model R l Li k RoleLink 0, * Playes 0..1 0, * 1
Entity
0..1
0, *
Act Relationship
0, *
0, *
1
1
Role
1
0, *
Participation
0, *
1
Scopes
*)
*)
Health Level Seven International, HL7 version 3, http://www.hl7.org
0, * 1
Act
HL7 Domain Analysis Model (DAM) for the th LuMiR L MiR Healthcare H lth D Domain i
Domain Message Information Model (D-MIM) of the Contact concept
HL7 generated message
Agenda 1 1. 2. 3. 4. 5. 6 6. 7.
What is a paradigm? How can a paradigm be used? Paradigms in healthcare Shift of p paradigms g from business to healthcare Shift of paradigms from information engineering to ehealth New paradigms in health informatics Conclusions
The “Interconnecting health” paradigm di y
y
Progress in IT has made possible the development of some new paradigms in health informatics. informatics Interconnecting health focuses on the ability to connect health organizations and systems, systems and the role of IT as an enabler in achieving this connectivity connectivity. ◦ The growth in importance of electronic health records in the last two decades marked a technological but also "cultural" shift. ◦ The evolution of “Interconnectingg health” was a continuous broadening of the horizon of interoperability in health.
Virtual Health Record (RHIO)
Electronic Health Records
R f Reference content Patient Schedule History & Allergies Drugs & Immunization
EMR
PHR
Patient Lab Data Diagnostic Image
Reference content Patient Schedule History & Allergies Drugs & Immunization
EMR
Patient Lab Data Diagnostic Image
Reference content
PHR
Patient Schedule History & Allergies
PHR
Drugs & Immunization
EMR
Patient Lab Data Diagnostic Image
PHR
KB Community Reference content Patient Schedule History & Allergies Drugs & Immunization
EMR
Reference content Patient Schedule History & Allergies Drugs & Immunization
Reference content
EMR
Patient Schedule
Patient Lab Data Diagnostic Image
Reference content Patient Schedule
History & Allergies Drugs & Immunization D I i i Patient Lab Data
EMR
Diagnostic Image
Electronic Medical Record
History & Allergies Drugs & Immunization
EMR
Hospitalization
Personal Health Record
Patient Lab Data Diagnostic Image
Patient Lab Data Diagnostic Image
Outpatient specialist care
EHR
Drug prescriptions Residential care Reference content
Emergency g y services Home care
Electronic Health Record
Patient Schedule History & Allergies Drugs & Immunization
EMR
Patient Lab Data Diagnostic Image
Reg gional H Health IInforma ation O Organiza ation (R RHIO)
Virtual Health
) * Record
Clinical documents Patient Notification /Alarm
Drug and lab test prescriptions
Past medical history
Current health status Emergency Summary
Lab test results
Clinical Event Notification
CAT analysis Emergency GP Encounter
Observations
Health conditions
Contacts Home Recovery Home Recovery Hospitalization
Therapy
Patient summaries
Clinical Event Notification
Medication
Clinical Trial Evaluation Report
Knowledge Base • Ontology • Clinical guidelines • Process Templates
• Service & Metadata Registry • Clinical Document Repository Medical image and report
Security & Privacy y y Repositories • Care consumers • Care providers • Care organizations Clinical Pathways • Role profiles
Clinical Event Notification Discharge Summary
* Ongoing treatments Proces s Instan ce
Clinical E Event t Notification
Trends in Episodes of Care
Sickness Prevalence Demographics
Workflow Engine Vital Sign Progress Report
Care Plan
*) L.D.Serbanati, F.Ricci, G.Mercurio, A.Vasilateanu, Steps
towards a digital health ecosystem, J Biomed Inform, Elsevier, 2011
Agenda 1 1. 2. 3. 4. 5 5. 6 6. 7.
What is a paradigm? How can a paradigm be used? Paradigms in healthcare Shift of p paradigms g from business to healthcare Shift of paradigms from information engineering to ehealth New paradigms in health informatics Conclusions
Multi--Agent Multi g System y ((MAS)) y
y
The MAS paradigm could be used to model, design and implement software platforms that integrate software applications in healthcare systems. MASs are a more natural way to represent many situations that often occur in medical settings, settings such as:
◦ absence of a comprehensive control system, ◦ limited or insufficient resources for a care provider to solve a given i problem, bl and d ◦ geographical distribution of the needed information and knowledge.
y
On the other hand, in health systems we can identify many recurrent features common to MASs: ◦ ◦ ◦ ◦ ◦
delegation of responsibility, responsibility re-allocation of tasks, need to consider a large variety of user concerns and problems, planning the collaborative work , think and work in open spaces, etc.
R2V2R
Due to sensors and actuators, information flows from Real to Digital and from Digital to Real (R2V2R): Sensors
y
Caregiver’s avatar
Caregiver Actuators
Sensors
Patient’s y avatar
Patient
Real world People, ad-hoc-created teams, organisations, material and information resources, activities
Actuators
Virtual world
Avatars, virtual entities, digital resources, applications
In the case of “agentification” of a regional health information organization (RHIO), all stakeholders (care providers, professionals, patients i and d their h i relatives) l i ) from the real should be represented p as avatars: highly g y proactive agents acting with own initiatives on behalf of an individual. Other virtual entities in the system may represent real organizations i i bbut also l virtual, i l temporary, ad-hoc created organizations g as teams of professionals involved in the patient’s care process.
Ecosystem y y
y
y
A natural ecosystem is a biological community of interactingg organisms g plus p their physical p y environment. Correspondingly, a health ecosystem can be defined as a network consisting of a multitude of health service suppliers and consumers consumers, and healthcare organizations, organizations all of them supported by IT. Digital g business ecosystem y is a self-organising g g digital g infrastructure aimed at creating a digital environment for networked organisations that supports the cooperation, the knowledge sharing, the development of open and adaptive technologies and evolutionary business models. Di ital health ecos Digital ecosystem stem (DHE) is an IT infrastructure infrastr ct re designed to work in synergy with the health ecosystem by mainly supporting health activities in the real world.
The health ecosystem and its digital ) * ecosystem Healthcare Ecosystem Shared Resources
Digital Healthcare Ecosystem
Regional Health Organization
Mandate-based Organization
Virtual Health Record
Supervisor Measurement device
PHR
Hospital H it l
VHR's Virtual Entity
Patient's Avatar Organization Business’s Rules
HIS
Hospital EMR
GP Office
Hospital's Virtual Entity Virtual Team Care O Organization i i
GP
e E
POS
GP's Virtual Avatar
GP’s EMR *) L.D.Serbanati, F.Ricci, G.Mercurio, A.Vasilateanu, Steps
e E
Patient
EHR Infrastructure
Organizational Structure
Organization’s Roles
Reports Gov. Agency's Virtual Entity
Clinical Guidelines Medical Ontology
Government
Governmental Agency
Research Laboratory Organizational g Mediator
An ad-hoc Organization
Researcher's Avatar
Researcher eCRFs
e E
Home
towards a digital health ecosystem, J Biomed Inform, Elsevier, 2011
Agenda 1 1. 2. 3. 4. 5 5. 6 6. 7.
What is a paradigm? How can a paradigm be used? Paradigms in healthcare Shift of p paradigms g from business to healthcare Shift of paradigms from information engineering to ehealth New paradigms in health informatics Conclusions
Conclusions This paper aims to open a discussion on the role of paradigms in our reasoning and proposes the use of innovative paradigmparadigm based solutions in one or another field of activity. activity y A paradigm better captures the nature of the diff bbetween diff h to differences different approaches solve a problem. y Paradigm shifts in health informatics are good ggo-betweens in transferringg knowledge g to and from healthcare. y
THANK YOU!
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This work was supported pp byy the project p j ERRIC No. 264207,, FP7-REGPOT-2010-1.
