Post on 18-Jul-2015
transcript
LEVERAGING CLINICAL IT FOR DENGUE: OPPORTUNITIES
FOR TOMORROW
Nawanan Theera-Ampornpunt, M.D., Ph.D.
SlideShare.Net/Nawanan
Outline
BackgroundClinical Management of DengueRoles of Health IT in DengueSummary
Dengue: Epidemiology
Most rapidly spreading mosquito-borne viral disease in the world
30-fold increase in incidence in the last 50 years
Epidemic dengue spread to new areasSubstantial burden on health sector &
economy
WHO Dengue Guidelines for Diagnosis, Treatment, Prevention and Control (2009)
Dengue: Prevention & Control
Dengue surveillanceCase managementOutbreak response Integrated vector managementSocial mobilization & communicationResearch
Resolution SEA/RC61/R5 of WHO Regional Committee for South-East Asia (2008)WHO Dengue Guidelines for Diagnosis, Treatment, Prevention and Control (2009)
Dengue: Clinical Management
WHO Dengue Guidelines for Diagnosis, Treatment, Prevention and Control (2009), adapted from Yip (1980)
Dengue: Clinical Decisions
Diagnosis & differential diagnosis InvestigationsPhase & severityDisposition: To send back home or to admitMonitoring of patient status Fluid management & transfusion decisionsManagement of complications
Dengue: Differential diagnosis
Febrile Phase Flu-like syndromes Illnesses with a rash Diarrheal diseases Illnesses with neurological manifestationsCritical Phase Infectious Malignancies Others (e.g. acute abdomen, metabolic conditions,
hematologic disorders)
WHO Dengue Guidelines for Diagnosis, Treatment, Prevention and Control (2009)
Dengue: Admission Criteria
WHO Dengue Guidelines for Diagnosis, Treatment, Prevention and Control (2009)
Dengue: Management Guidelines
WHO Dengue Guidelines for Diagnosis, Treatment, Prevention and Control (2009)
Fluid Management in Compensated Shock
WHO Dengue Guidelines for Diagnosis, Treatment, Prevention and Control (2009)
Fluid Management in Hypotensive Shock
WHO Dengue Guidelines for Diagnosis, Treatment, Prevention and Control (2009)
Image Source: aafp.org
Imagine This Scenario
Not enough sleep
“To Err Is Human”
Lack of attention Easily distracted Limited memory Difficulty putting relevant information together
(information overload?) Inappropriate decisions (lapses, cognitive errors) Poor decisions under pressure (emergencies) Difficulty in monitoring & triage of patients
Roles of Health IT
Assists in documentation & assessments Reminds or alerts Servers as external memory Better visualizations / information
presentations Suggests management optionsGuidelines at the point of care Patient monitoring
Example of “Alerts & Reminders”
Clinical Decision Support Systems
External Memory
Knowledge Data
Long Term Memory
Knowledge Data
Inference
DECISION
PATIENT
Perception
Attention
WorkingMemory
CLINICIAN
Roles of Health IT in Dengue Clinical Management
Online templates for complete patient assessment & documentation
Alerts & RemindersDecision support tools to offer
recommendations in case management Electronic disease reporting Information integration for early detection
of an outbreak
Clinical Decision Support Systems
External Memory
Knowledge Data
Long Term Memory
Knowledge Data
Inference
DECISION
PATIENT
Perception
Attention
WorkingMemory
CLINICIAN Alerts & Reminders, Templates
Guidelines & References
Improved information
presentations (graphs, tracking
tools, etc.)
- Differential Dx- Treatment Recommendations
Google Flu Trends
Source: Google.org/FluTrends
Disease Surveillance
Google Flu Trends uses search engine keywords (non-clinical data)Accurate for practical purposes of detection
of possible outbreaks (not confirmation)
Imagine how it would be if we use clinical data (e.g. chief complaints, diagnoses in ER/clinics). Would it help us respond faster?
Opportunities for Tomorrow
Dengue management relatively straightforward, easy to implement as logic
Improved IT infrastructure within hospitals & clinicsHospital information systems & electronic
health records common (high adoption)Can be leveraged for better dengue
management within those settings
Infrastructure: EHR Adoption in Thai Hospitals
Theera-Ampornpunt (2011)
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Adoption Estimates: THAIS 2011
Estimate (Partial or Complete Adoption) NationwideBasic EHR, combined inpatient & outpatient settings
49.8%
Comprehensive EHR, combined 5.3%order entry of medications, combined 90.2%order entry of all orders, combined 79.4%
Theera-Ampornpunt (2011)
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Current State of IT Use in Dengue
Focus more on IT use in surveillance & outbreak detection
Some uses in patient education, teleconsultations, predictive modeling, & basic research
Few studies on use of health IT to manage dengue in clinical settings
Summary (1)
Dengue is an important epidemicManagement involves various steps
& criteria, maybe complicated for non-experts
Errors inevitable for inexperienced providers
Summary (2)
Health IT can be used to provide better care, e.g. through decision support
Opportunities exist for use of IT in dengue
Call for more focus on development & evaluation of IT uses in clinical management of dengue