Digital Infrastructure for the Learning Health System The Foundation for Continuous Improvement in Health and Health Care: Workshop Series Summary (2011) / Chapter Skim
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8 Fostering the Global Dimension of the Health Data Trust
8 Fostering the Global Dimension of the Health Data Trust
Pages 197-222
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From page 197... ...
He also describes several techniques being employed to address these challenges, including clinical research information models, servicebased approaches to semantic interoperability and data standards, detailed clinical data element representations built on archetypes, and an effort to prioritize electronic health record (EHR) and workflow integration in the development of clinical decision support systems that are designed to capture and present fine-grained clinical diagnostic cues.
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From page 198... ...
David Buckeridge and John Brownstein from McGill University describe how HIT is enabling dramatic changes in domestic and international infectious disease surveillance. Detailing how the digital infrastructure can enhance existing systems through the use of automation and decision support, the authors also address novel approaches to surveillance enabled by recent informatics innovations.
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From page 199... ...
However, simply providing a mechanism for the high-level interoperability of data will not provide sufficient functionality for a learning health system. System integration and shared detailed clinical data representations are also required.
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From page 200... ...
In addition, even in countries where general practitioners do not fulfill a "gatekeeper" function -- controlling access to specialist services -- the quality of initial diagnosis at the primary care level determines much of the future course for an individual patient. In order to support patient safety in both clinical and research settings, significant ICT challenges need to be overcome in the areas of interoperability, common standards for data integration, data presentation, recording, scalability, and security (Ohmann and Kuchinke, 2009)
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brings together a highly multidisciplinary consortium where three carefully chosen clinical "use cases" will drive, evaluate, and validate the approach to the ICT challenges. The project will build on existing international work in clinical trial information models (BRIDG and the Primary Care Research Object Model)
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. If the Internet is an apparently inexhaustible information medium, the grid would also add rapid computation, large-scale data storage, and flexible collaboration by harnessing the power of large numbers of computers.
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The advantage to a business that outsources its information systems to a cloud provider is that it need not own the infrastructure of servers and communications nor concern itself with maintaining the applications. The current convergence of utility computing with social networking applications has led to several serious proposals to use clouds for patient-, or more accurately, carer-managed electronic health records (EHRs)
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From page 204... ...
The road map had to encompass issues regarding networks; infrastructure deployment; "middleware"; services to end users; standards; security; ethical, legal, and regulatory developments; social adjustments; and economic investments. A draft road map was filtered through a number of "use cases" including drug discovery, large-scale public health emergency, imaging-based screening, and management of chronic conditions.
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From page 205... ...
Developments in healthcare systems -- including the halting progress of the English National Health Service National Programme for IT -- have led governments to consider the role of cloud computing for the management of electronic patient records. This is regarded as a positive development that should help close the gap between healthgrids (for science and knowledge management)
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Thus, we propose a twin-track approach: on one hand, the system may offer advice and decision support; on the other, it can ensure enforcement of privacy obligations at the process level (Figure 8-2)
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use the so-called Semantic Web Rule Language (SWRL) to reason with the ontology.
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The condition on the user(s) , the data, and the purpose of any proposed sharing of the data are given in the Web Ontology Language (World Wide Web Consortium, 2009)
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Key structural elements in an XACML implementation are the Policy Decision Point and the Policy Enforcement Point. In our case, the Policy Information Point here has been implemented as our Semantic Web Knowledge Base and the Context Handler.
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In some circumstances it may not be able to reach an unambiguous decision, referring the user to authority. Hopefully, this model points to a solution not only to the problem of automating compliance checks and speeding up the process of sharing medical data, but also to the issue of provenance management -- that is, maintaining a metarecord with the data that provides details of where it came from, how it was constructed, what processes it has undergone since, and so on.
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World Alliance for Patient Safety Working Group was charged with identifying global priorities for patient safety research. The group undertook two major initiatives: a report on the state of evidence on patient safety and calculating the global burden of unsafe care
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The 23 patient safety topics were then categorized TABLE 8-1 World Alliance for Patient Safety List of Common Adverse Events in Health Care No. Domain Patient Safety Topic 1 Structure Organizational determinants and latent failures 2 Structure Use of accreditation and regulation to advance patient safety 3 Structure Safety culture 4 Structure Inadequate training and education, manpower issues 5 Structure Stress and fatigue 6 Structure Production pressures 7 Structure Lack of appropriate knowledge, availability of knowledge, transfer of knowledge 8 Structure Having measures of patient safety 9 Structure Devices, procedures without human factors engineering 10 Process Errors in care through misdiagnosis 11 Process Errors in care through poor test follow-up 12 Process Errors in care: counterfeit/substandard drugs 13 Process Errors in care: unsafe injection practices 14 Process Bringing patients' voices into patient safety 15 Outcomes Adverse events and injuries due to medical devices 16 Outcomes Adverse events due to medications 17 Outcomes Adverse events due to surgical errors 18 Outcomes Adverse events due to healthcare-associated infections 19 Outcomes Adverse events due to unsafe blood products 20 Outcomes Patient safety among pregnant women and newborns 21 Outcomes Patient safety concerns among older adults 22 Outcomes Adverse events due to falls in the hospital 23 Outcomes Injury due to pressure sores and decubitus ulcers SOURCE: Jha (2008)
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From page 213... ...
The Global Burden of Disease Building on the work of the report, the World Alliance for Patient Safety focused on quantifying the global burden of unsafe care. The global burden of disease is the metric used by WHO, policy makers, and funders to allocate global health resources.
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From page 214... ...
Initial estimates suggest that over 34 million adverse events in hospitals occur among the conditions examined (over 60 percent from developing and transitional countries) , and that the global burden of unsafe care from these conditions may account for as many as 20 million DALYs lost per year (approximately 60 percent of which are from developing and transitional countries)
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From page 215... ...
Implementing comprehensive electronic health records and health information exchange infrastructure in the developing world is not a realistic strategy at the present date. Thus, WHO has convened an expert consensus group to identify the major causative structural factors (i.e., lack of protocols or systematic monitoring)
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From page 216... ...
The reporting of a laboratory-confirmed case of infection to a public health department is usually a manual process, which can take a week or longer to occur. Moreover, subsequent reporting between public health jurisdictions tends to follow a hierarchical pattern: a local health department informing a regional public health authority which then informs the national public health authority, a process that often takes 2 to 3 weeks (Birkhead et al., 1991; Jajosky and Groseclose, 2004; Jansson et al., 2004; Yoo et al., 2009)
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From page 217... ...
Using Information Technology to Disrupt the Traditional Approach In addition to enhancing existing surveillance systems, advances in information technology are also disrupting the traditional public health surveillance model by enabling new approaches to data sharing. Data are increasingly available from sources other than laboratories and these novel types of surveillance data are often shared outside of traditional public health channels.
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From page 218... ...
. A Renewed Science of Surveillance on the Road to Effective Disease Control Applications of information technology are enhancing existing systems and disrupting current surveillance models to make more information about infectious diseases available with less delay.
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Instead, public health surveillance as a discipline must extend its theoretical and practical foundations to embrace the opportunities presented by information technology. In other words, a renewed science of disease surveillance is needed; one that starts from public health principles and embraces information technology enhancements as well as disruptive changes on the road to improved disease control (Thacker et al., 1989)
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2005. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: A systematic review.
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2010. Public health surveillance for infectious diseases.
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2001. Adverse events in British hospitals: Preliminary retrospective record review.
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