Bigger on the Inside: A TARDIS view of Health Informatics

A TARDIS or Time And Relative Dimension In Space is a fictional timemachine and spacecraft that appears in the British science fiction television program Doctor Who (1). As a Whovian (Doctor Who fans), I found it interesting to use this reference in starting my blog for my introductory subject for Health Informatics in MS Health Informatics in UP Manila. Thus, this blog TardisTechSupport was born.

The most peculiar feature of the TARDIS is that it is bigger on the inside than the outside. The outside of the TARDIS is a plain old school color blue Police Box from the United Kingdom. But when one steps inside the TARDIS, one can be awed as to how big and spacious it can be, with the big control room at the center of the room. For Whovian, I subscribe to the thinking in the image found below — “I think Inside the Box. Because it’s bigger on the inside.”

tardis

image from: https://www.pinterest.com/pin/7459155605496922/

Tardis Exterior

tardis-exterior-2010image from: http://www.thedoctorwhosite.co.uk/tardis/

Tardis Interior

tardis-interiorimage from: http://www.thedoctorwhosite.co.uk/tardis/

I think that Health Informatics can be said to be similar to the TARDIS, wherein one may think that it is just a small subject to tackle (like a simple unassuming police box), but once you get inside, there are a lot of space and information that one can explore just to understand the subject more.

I started this subject just a few months back and I can say that I still have a lot to explore on this subject matter.

The first blog I started on with this subject was “The ever changing world of Informatics, Global Health and eHealth.” Informatics, Global Health and eHealth were defined in the blog, but the relevance of each one can be seen in the Concept Map shown below. We started with the concepts of public health and international health to give us Global Health. Global health combined with Informatics will give us eHealth. Lastly, moving forward from eHealth along with new technologies will bring us to the future of eHealth.

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image from: https://tardistechsupport.wordpress.com/2016/08/15/the-ever-changing-world-of-informatics-global-health-and-ehealth/

We then moved on to the Future of eHealth, but more specifically the “Future of Health Informatics in the Philippines”. In this entry, I discussed the 3 major issues that impede the progress of health informatics and gave proposals to promote widespread use and accessibility, awareness, ease and comfort of use, and beneficial use and efficiency. (2) This can be clearly seen on the infographic below.

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image from: https://tardistechsupport.wordpress.com/2016/08/25/future-of-health-informatics-in-the-philippines/

Along the way, we also discussed the status of health information systems in developing countries as well as the governance and management in health informatics. We identified some steps to achieve the advancement of health informatics in the Philippines, namely:

  • The eHealth be part of the official curriculum of medical students
  • Formal training to be given to medical staff
  • Identification and adoption of best practices
  • Tailor-fitting health informatics to the Philippine situation

Another interesting topic that was discussed was the establishment of the Philippine Health Information Exchange thru the partnership between the Department of Science and Technology (DOST), Philippine Health Insurance Corporation (PHIC) and Department of Health (DOH). The Philippine Health Information Exhange (PHIE) is a health informatics system that will allow the operation and accurate use of data from various institutions and health facilities around the country. Below is the flowchart on how the PHIE will handle the shared health information among and between different health providers.

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image from: ehealth.gov.ph

Enterprise architecture in healthcare is one of the lengthier and harder topics to discuss in Health Informatics. In the enterprise architecture entry, I summarized the type of enterprise architecture frameworks available and chose which one would be the best applicable to the health sector. Some of the enterprise architecture compared are Zachman Framework, The Open Group Architecture Framework (TOGAF), the Extended Enterprise Architecture Framework (E2AF) and the Generalised Enterprise Reference Architecture and Methodology (GERAM). Among these 4 types, The Open Group Architecture Framework (TOGAF) is the best suited for the Philippine Health Information System.

The idea of Electronic Health Records was the first thing that came into my mind when I applied for the Masters in Health Informatics. It showed how limited my knowledge of health informatics before entering this course. As soon as I opened the doors, it became clear that I am barely scratching the surface on this field. Under this topic, I’ve learned other names for “Electronic Health Records”, namely, Automated Health Records, Electronic Medical Records and Computer-based Patient Record. Regardless of how the system is called, it is important to recognize that the records must be organized primarily to support continuing, efficient and quality health care. Each system must also continue to meet legal, confidentiality and retention requirements of the patient, the attending health professional and the healthcare institution. The World Health Organization listed some issues and challenges in using Electronic Health Records: (3)

  • Unique patient identifier must be addressed before moving forward to automation
  • Clinical data entry issues and lack of standard of terminology
  • Resistance to computer technology and lack of computer literacy
  • Strong resistance to change by many health care providers
  • High cost of computers and computer systems and funding limitations
  • Concern by providers as to whether information will be available on request
  • Concerns raised by the healthcare professionals, patients and the general community about privacy, confidentiality and the quality and accuracy of electronically generated information
  • Quality of electronic healthcare information and accuracy of data entries
  • Lack of staff with adequate knowledge of disease classification systems
  • Manpower issues – lack of staff with adequate skills
  • Environmental issues – electrical wiring and supply of electricity, amount and quality of space needed for computers, etc.
  • Involvement of clinicians and hospital administrators

After the Electronic Health Record topic, we moved to Personal Health Records. We focused on an electronic application used by patients to maintain and manage their health information in a private, secure, and confidential environment. For this topic, we tested out different Personal Health Records mobile applications. Being an iPhone user, I searched the AppStore and narrowed it down to 5 applications, namely, onpatient PHR, Healthspek, FollowMyHealth, Health Tracker and Manager for iPhone and Teledoc Member. Among these 5, I chose FollowMyHealth as my top Personal Health Records app. All applications have their advantages and disadvantages, but FollowMyHealth outweighs the advantages over its disadvantages. The image below is the sample format of the FollowMyHealth mobile application.

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image from: https://tardistechsupport.wordpress.com/2016/10/03/personal-health-records/

Standards and Interoperability as a subject matter is concerned with the concept of healthcare institutions in adopting standards to ensure its interoperability due to the rising cost of healthcare. Aside from lowering costs, “Interoperability will bind together a wide network of real-time, life-critical data that not only transform but become health care.”(4) ICD-10 or International Classification of Disease Version 10 is another subject that I am looking forward to taking next semester. ICD-10 is a set of codes that hold critical information about epidemiology, managing health and treating conditions.

Another topic discussed within the course is the Clinical Decision Support and an example is CHITS-EMR or Community Health Information Tracking System-Electronic Medical Records. This is an open source electronic medical record system designed to run in public health centers and rural health units. CHITS-EMR has built-in modules for general patient consultations scheduling, maternal care services, child care, family planning and reporting features for the Department of Health (DOH) Field Health Service Information System. CHITS-EMR runs over a local area network (LAN) installed inside the health center and accessible to computers installed within the health center.

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image from:  https://telehealth.ph/wp-content/uploads/2011/07/CHITS-TM

Under the Knowledge Management and Information Retrieval topic, we discussed a sample local public health problem that can be solved by the proper and targeted information education and dissemination to individuals to achieve the intended results of the healthcare program. In this entry, we discussed how knowledge management can benefit the vaccination system and scheduling of parents and children.

Legal and ethical issues also exist in Health Informatics. We discussed how on “privacy, confidentiality, security and trust”in relation to the policies that need to be put in place to protect the Filipino patient’s privacy and confidentiality of health information. A question arose as to whether the Data Privacy Act of 2012 was adequate to protect confidential health information. These 2 blogs were combined as a single blog answering both driving questions. The Data Privacy Act of 2012 is a policy promulgated by the lawmakers to protect the privacy and confidentiality of health information of the patient. In my view, the law is adequate to protect the confidential health information of the patient. Images posted by the facebook page DataPrivacyPH shows Section 16 of the Data Privacy Act of 2012. The following images are owned by DataPrivacyPH.

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images from:  https://www.facebook.com/pg/dataprivacyph/photos/?tab=album&album_id=1180862868641655

For the topic on Telehealth, we focused on the 2 pending bills involving telehealth, the Telehealth Act of 2012 and Telehealth Act of 2014. I  chose 2 sections and suggested revisions on the said sections. I chose the sections on databases and privacy as these two parts are intertwined with one another. Databases will contain vital and confidential information of the patients, thus the privacy of said information is of utmost importance. Some suggestions revolved  the need to properly secure the databases of the patients as well as ensuring that the privacy thereof will not be compromised. The penalties for the breach of said databases and privacy will be a great deterrent for breach and will ensure that the providers and personnel will handle the medical records of each patient with importance and security.

The last topic for Health Informatics is mHealth or Mobile Health. For this. we were tasked to plan our own mobile health application and discuss how the contents and features of our own mobile application will benefit the patients or individuals targeted for the said mobile application. As for my mobile health application, I decided to make one designed specifically for elders and senior citizen use. From my personal experience, I saw firsthand the likelihood that our elders would sometimes forget the medical documentations and instructions for their care. This application will ensure that the information will not only be transferred from the medical provider to the elderly patient, but to the relatives as well. The relatives must be authorized by the elderly to be able to have access to his/her medical information, otherwise this can be seen as a breach of doctor and patient confidentiality. The main reason that I decided to focus on this application is to minimize the mistakes that elders and seniors are prone to committing when they are visiting their doctors alone or with an assistant who might also be not familiar with handling the instructions of the doctor. The image below shows how I want the mobile application to look after development.

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image from:https://tardistechsupport.wordpress.com/2016/11/14/mhealth/

And this is where I will end this blog series. Health Informatics is indeed bigger on the inside than the outside, once you enter through its doors. I plan to continue updating this blog whenever I encounter anything interesting or novel that is relevant to Health Informatics. There are new paths to cross in this field in the same way that some areas inside the TARDIS are still unexplored.

#MSHI #HI201

Allons-y!

svg_autocad_tardis_by_lablayers-d6xu93g

References:

  1. https://en.wikipedia.org/wiki/TARDIS
  2. Marcelo A. Health Informatics in the Philippines. APAMI/MIST 2006 yearbook.
  3. Electronic Health Records: A Manual for Developing Countries. World Health Organization, 2006.
  4. Brailer DJ. Interoperability: The Key to the Future Health Care System. Health Affairs; 2013 [Online]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15659454. Accessed on: 29 January 2013
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