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History and Evolution of
Medical Informatics
EUGENIO iORENO MENDOZA
Topic Outline
1. MEDICAL INFORMATICS—DEFINITIONS
AND CONCEPTS
2. THE POSITION OF MEDICAL INFORMATICS IN

THE MEDICINE
3. FIVE GENERATIONS IN DEVELOPMENT OF

MEDICAL INFORMATICS
4. PERSPECTIVES OF THE DEVELOPMENT OF

MEDICAL INFORMATICS
01
MEDICAL INFORMATICS—DEFINITIONS
AND CONCEPTS
EUGENIO
Medical Informatics
● SCIENTIFIC DISCIPLINE
● CONNECTED WITH THE BEGINNING OF COMPUTER
USAGE IN MEDICINE
Medical Informatics
“MEDICAL INFORMATICS IS THE

APPLICATION OF COMPUTER TECHNOLOGY
TO ALL FIELDS OF MEDICINE-MEDICAL
CARE, MEDICAL TEACHING AND MEDICAL
RESEARCH”
Medical Informatics
“MEDICAL INFORMATICS ATTEMPTS TO

PROVIDE THE THEORETICAL AND SCIENTIFIC
BASIS FOR THE APPLICATION OF COMPUTER
AND AUTOMATED INFORMATION SYSTEMS TO
BIOMEDICINE AND HEALTH AFFAIRS...
MEDICAL INFORMATICS STUDIES BIOMEDICAL
INFORMATION, DATA AND KNOWLEDGE—THEIR
STORAGE, RETRIEVAL, AND OPTIMAL USE FOR
PROBLEM-SOLVING AND DECISION-MAKING”
Medical Informatics
“THE MEDICAL INFORMATICS IS THE

COLLECTION OF KNOWLEDGE AND METHODS FOR
ORGANIZATION AND GOVERNMENT OF THE
INFORMATION, WHICH SUPPORTS MEDICAL
RESEARCHES, EDUCATION AND PATIENTS
CARE”
02
THE POSITION OF MEDICAL INFORMATICS
IN THE MEDICINE
EUGENIO
Medical Informatics
● FOUNDATION FOR UNDERSTANDING AND PRACTICE

OF THE UP-TO-DAY MEDICINE
● NUCLEUS OF THEORETICAL AND PRACTICAL
DISCIPLINES
Medical Informatics
● INFORMATION THEORY, ● CLASSIFICATION THEORY,

● SYSTEM THEORY, ● SEMIOTICS,
● DECISION THEORY, ● ORGANIZATIONAL SCIENCES,
● COMMUNICATION THEORY, ● BIOSTATISTICS,
● STRUCTURING AND ● EPIDEMIOLOGY,
INFORMATION ● HEALTH POLITICS,
ORGANIZATION, ● MEDICAL ETHICS
● FORMING OF DATABASES,
● INFORMATIONAL
DOCUMENTATION SYSTEMS,
03
FIVE GENERATIONS IN
DEVELOPMENT OF
MEDICAL INFORMATICS
iORENO
FIRST GENERATION
1955-1965
➔ Pioneers: Joshua Lederberg and William S. Yamamoto, showed interest
in automatic calculation
➔ Robert S Ledley, as the first medical professional working with
the first computer of the pretransistor era leading to his famous
work with Lee B Lusted in automatic medical decision making.
➔ Wilfrid J. Dixon and collaborators - Development of BMDP
software (biomedical programs) for the use of computers in
biostatistics
➔ Arthur E Rickli, Cesar A Caceres and Hubert V Pipberger –
first project in computerized diagnostics developed a
method for automatic analysis of electrocardiograms.
FIRST GENERATION
1955-1965
➔ Introduction of – early forerunner of
internet; important step for development of computerized
medical applications.
➔ In 1960, the National Institute for Health Care in USA

(NIH) founded advisory committee for the computer
application in the researchers (ACCR) for the
development in the field of automatization of the
medical health care services.
SECOND GENERATION
1965-1975
➔ European Pioneers: Peter L. Reichertz

in Germany and Francois Gremy in
France
➔ Late 60s 1st hospital information
systems were implemented in Sweden,
(Danderyd and Karolinska Hospital),
Great Britain (Kings Hospital in
London), and Germany (Medizinische
System Hannover).
SECOND GENERATION
1965-1975
➔ 1979 1st Nobel prize in physiology and
medicine was given for an achievement in
informatics, the computed tomography by
Godfrey H. Hounsfield and Allan C. Cormack.
➔ Computer-assisted medical decision making
started to develop significantly in the USA
with the consultation system help of Homer R
Warner and collaborators.
➔ In early seventies the development of
artificial intelligence methods and expert
systems was noted.
THIRD GENERATION
1975-1985
➔ The interest in education by health workers grew by being
engaged in medical informatics, including also the significant
number of doctors who began to engage in the medical
informatics professionally.
➔ Important congresses were organized:
1974 – 11 world congresses on medical informatics

organized by International Medical Informatics
Association (IMIA),
1976 - 20 European congresses organized by European

Federation of Medical Informatics (EFMI)
THIRD GENERATION
1975-1985
➔ Appearance of software packages
and PCs at the world market,
opened new possibilities – namely
connecting computers from home
ambulance directly to the
informational systems in health
care centers.
➔ Installation of terminals by
patient beds (bed side terminals)
were developed
FOURTH GENERATION
1985-1995
➔ Artificial intelligence was being introduced as separate disciplin

informatics, and began to be used by numerous expert systems in pra
➔ Hospital information systems composed of independent modules added
health care (ISPHC) and hospital information systems (HIS) into co
on regional and national level. Such approach showed significant ad
development of BIS.
➔ Clinical (department) information systems are being developed suppo
making in everyday medical work.
FIFTH GENERATION
1995 to present
➔ The appearance of electronic computers with network of terminals s

influenced integration of informatics methods into medical segments
work sites,
➔ Investment in huge material means of payment and adequate human pot
significant improvements of hardware and software technologies
➔ Expansion of the use of microprocessor technology leading the so c
revolution” resulting in application of Medical Informatics in surg
instrumentation and prostheses.
EVOiUTION ON THE SOFTWARE USED IN MEDICAi
INFORMATICS
MENDOZA
1960s
● In the mid 1960’s the gíoup The Ameíican Society foí Testing and Mateíials (ASTM)
íecognized a need foí set standaíds with seveíal aíeas of health caíe.
○ laboíatoíy message exchange, data content, health infoímation system secuíity,
and píopeíties íelating to electíonic health íecoíd
● This is the beginning of what we now call Health Infoímation Management
● By 1965 the College of Ameíican Pathologists developed a nomenclatuíe (deteímined

numbeí sequence foí disease coding) foí pathology which is inteínationally íecognized
and cuííently used.
1970s
● In 1974 a unifoím dischaíge data set called ‘Unifoím Hospital Dischaíge Data Set
(UHDDS) was appíoved by Health and Human Seívices (HHS) and íecommended by the
National Centeí foí Vital Health Statics (NCVHS).
○ a set of items that aíe based on standaíd definitions to incíease consistent data
collection acíoss multiple useís which decíeases dispaíities in health caíe by the
collection of consistent and íeliable infoímation
1980s
● 1983
○ concept of open souíce softwaíe initiated by Richaíd Stallman
○ development of the GNU Píoject oí fíee softwaíe shaíing, which has become vital
in the success of implementing health infoímation systems
● 1984
● The Ameíican College of Radiology and National Electíical Manufactuíeís Associations
collaboíated and íecognized a need foí a standaíd digital image foímat which is cuííently
known as a DICOM image
○ makes shaíing electíonic images possible without facing incompatibility issues
1980s
● 1987
○ fiíst íelease of what we all know is Health ievel7 (Hi7)
○ included a vaíiety of message foímat standaíds foí
■ patient oídeís
■ íegistíation and
■ obseívations íepoíting
○ by 1991 the Accíedited Standaíds Committee (ASC) staíted developing
inteíactive communication standaíds foí the tíansmission of
■ health claims
■ financial applications, and
■ administíative tíansactions
● developments bíought us into an eía of health infoímation exchange

2014
● 2014
○ latest health caíe initiative staíting Januaíy 2014 is
called blue button
○ an inteíactive secuíe application that allows patients
to view, download, and update theií health caíe
infoímation
04
PERSPECTIVES OF THE DEVELOPMENT IN
MEDICAL INFORMATICS
MENDOZA
MEDICAL INFORMATICS
● application of teíminal and PC with moíe simple manneís of opeíation will enable
íoutine use of computeí technology by all health píofessionals.
● development of natuíe languages foí communication with the computeís and the
identification of input voice will make the woík simpleí
● use of netwoík systems and a gíeat numbeí of ‘bed side teíminals’

○ easieí the communications among the health caíe peísonnel and
○ optimize the diagnostics, caíe and tíeatment of patients.
MEDICAL INFORMATICS
● telemedicine and telecaíing will be fuítheí impíoved
○ health caíe infoímational systems will be stíengthened with the synthesis of

database about the patient and the basis of medical knowledge with expeít
systems
○ a functional integíation will be built in the dictionaíy of medical teíms oí ‘data
dictionaíy’
● in the field of data píotection new solutions aíe also expected

MEDICAL INFORMATICS
● woíking on unique standaíds cíeation, classifications, nomenclatuíes and coding
● integíation of national health caíe infoímational systems and tíanspoítability of

softwaíe and technology
MEDICAL INFORMATION
CURRENT PROBiEMS
● Standaíds of coding of alphanumeíic data and text

● Standaíds of coding of pictuíes and bio signals
● Integíation of medical instíumentaíium and equipment
● Multimedical woíking stations, communication netwoíks
● Regulation of íules and íecommendations (medical, legal píoceedings, ethical,
economic and social)
● High cooídination of actions is necessaíy foí all health píofessional peísons, medical
infoímaticians, infoímatics píofessional, and politicians who aíe íesponsible foí health
caíe píotections with the insuíance of constant souíces of financing
REFERENCES
Ameíican Health Infoímation Management Association; AHIMA calls foí impíoved health
infoímation goveínance to unify standaíds foí EHR use. (2012). Infoímation Technology
Newsweekly, , 443. Retíieved fíom
http://seaích.píoquest.com/docview/1095551688?accountid=32521
Masic, I. (2013). The Histoíy and New Tíends of Medical Infoímatics. Donald School Jouínal of
Ultíasound in Obstetíics and Gynecology, 7(3), 301-312. doi:10.5005/jp-jouínals-10009-1298
Rendon, F. (n.d.). The iong Road to Digitization: A Histoíy of Healthcaíe Infoímatics. Retíieved
fíom
https://www.healthwoíkscollective.com/long-íoad-digitization-histoíy-healthcaíe-infoímatics/
EVIDENCE BASED
HEALTHCARE
JUSTINE I. BALMADRID
BUCM YEAR III
Review
□ Evidence based medicine (EBM) - the conscientious, explicit, judicious and

reasonable use of modern, best evidence in making decisions about the
care of individual patients.
- integrates clinical experience and patient values with the best available
research information.
□ "Evidence-based health care - the conscientious use of current

best evidence in making decisions about the care of individual patients or
the delivery of health services.
□ Evidence-based practice - conscientious, problem-solving approach to

clinical practice that incorporates the best evidence from well-designed
studies, patient values a n d preferences, and a clinician's expertise in
making decisions about a patient's care.
To make clinical decisions:
Hierarchy of evidence
□ Evidence available in any clinical
decision-making c a n b e arranged in
order of strength based on its
likelihood of freedom from error.
□ Example: for treatment decisions
>meta-analyses of well conducted
large randomized trails may b e the
strongest evidence,
> followed by large multi-centric
randomized trails,
>meta-analysis of well conducted
small randomized trails,
>single centered randomized trails,
observational studies,
> clinical experience or basic
science research
The practice of evidence based
medicine.
□ Systematic Reviews - synthesize the results of multiple primary investigations
by using strategies that limit bias and random error.
□ Meta-analysis - statistical technique used to combine and summaries the
results of several independent studies relating to a specific hypotheses.
- aim is to integrate the findings, pool the d a t a and identify the overall
trend of results
□ The Cochrane Collaboration - an international and independent non-profit
organization established in 1993 aimed at producing up-to-date, accurate
information about the effects of healthcare available worldwide.
- produces and disseminates systematic reviews of healthcare interventions
and promotes the search for evidence in the form of clinical trials and other
intervention studies
medicine.
□ The Cochrane Library - collection of evidence based healthcare
databases.
□ Databases within the Cochrane Library
The Cochrane Database of Systematic Reviews (CDSR).
The Cochrane Database of Abstracts of Reviews of Effectiveness (DARE).
The Cochrane Central Register of Controlled Trials (CCTR). This contains
references to thousands of controlled trials identified by the Cochrane
Collaboration.
Cochrane database of methodology reviews (CDMR). This contains
protocols a n d reviews of Cochrane methodological studies.
medicine.
□ Grey Literature - that which is produced on all levels of government,
academics, business a n d industry in print and electronic formats, but which
is not controlled by commercial publishers
-broadly defined to include everything except peer-reviewed books and
journals accepted by Medline.
□ Types of grey literature - wide range of material including,
government publications,
reports, statistical publications,
newsletters, fact sheets,
working papers,
technical reports,
conference proceedings,
policy documents and protocols and bibliographies.
Skills required by an
Evidence Based Practitioner
□ The growing need for
evidence based
healthcare is because of
the following factors:
□ Information overload
□ Rising patient
expectations
□ Introduction of new
technologies
□ Ageing populations
Scope of Evidence Based Healthcare
□ Producing evidence (research)

-research workers are responsible for producing evidence.
-then on making evidence available.
□ Evidence base clinical practice
-such as PPPP( Physician-Patient- Partnership Program) – patient centered
care (partners in problem solving)
□ Evidence based policy making, purchasing, and management of health
services
-decision makers/managers in allocating funds, purchase or manage
resources.
The top 10 most useful sites for
obtaining evidence
Back to modules 3 – 5
Continuation….
APPRAISE
□ Critical Appraisal Process

- aims to identify methodological flaws in research
-provide consumers of research with the opportunity to make informed
decisions about the quality of research evidence.
- systematic process of analyzing research to assess methods, validity and
usefulness.
□ Key questions:
Why was the study done?
What type of study was done?
What are the study characteristics?
What are the study characteristics?
□ What was done to address bias?

□ What are the results and are the results valid?
□ What conclusions can you make?
APPLY
□ If you have found evidence that is valid, significant and generalizable from
the study population to your patient,
□ You must decide whether and how to apply the findings to your patient's
care.
□ Applying the best evidence is arguably the Evidenced-Based Practice (EBP)
step that requires the most skill.
□ It is at this step that you synthesize the best scientific knowledge with your
clinical expertise and the patient's unique values and circumstances to
reach a clinical decision:
APPLY
□ Before applying evidence from
research to your patient, ask
yourself:
□ Were the study patients similar to
my population of interest - d o the
results apply to my patient?
□ Were all clinically important
outcomes considered and are
the results clinically important?
□ Are the likely treatment benefits
worth the potential harm and
costs?
□ Can this practice b e
implemented in this healthcare
setting?
□ What are my patients’ values and
preferences?
□ How c a n I help my patient make
a decision?
AUDIT
□ The Audit step in Evidence-Based Practice (EBP) is one of self-evaluation.

□ Self-evaluation of performance in EBPis essentially the process of answering
questions such as the following:
□ Am I asking well‐formulated answerable questions?
□ Am I becoming more efficient in my searching for the best evidence?
□ Am I critically appraising evidence for its validity and usefulness?
□ Am I integrating critical appraisals into my practice?
□ Is what I have learned been translated into better clinical practice?
AUDIT
□ The following checklist offers more detailed questions to consider when
completing the Audit step.
THANK YOU FOR LISTENING ☺
References:
□ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3789163/
□ https://canberra.libguides.com/evidence?fbclid=IwAR36FUrZ_urTH3uejYOQ
63dzM5_J_TgfXXxA7aKEvRPVkYjEvPEesynKlu4
□ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3074860/?fbclid=IwAR36FU
rZ_urTH3uejYOQ63dzM5_J_TgfXXxA7aKEvRPVkYjEvPEesynKlu4
□ https://www.aoa.org/practice/clinical-guidelines/evidence-based-optome
try-process
□ https://www.nurse.com/evidence-based-practice
□ https://www.healthknowledge.org.uk/e-learning/epidemiology/specialists/
evidence-medicine-healthcare
EVIDENCE
BASED
HEALTHCARE
Kryzta Alaine S. Cabaccang
III MD BUCM
EBM/EBP vs EBHC
■ Evidence Based Medicine is a conceptual approach of
the physician in making decisions related to the
individual patient.
■ Evidence Based Health Care
– broader concept that includes advanced approach
to understanding the patients, families and doctors
beliefs, values and attitudes.
– relies on evidence, but primarily those on
population level
Evidence Based Health Care
■ Need & demand:

– information overload, rising patient expectations, the
introduction of new technologies and ageing populations
■ Scope:
1. Producing evidence (research)
2. Evidence-based clinical practice
3. Evidence-based policy making, purchasing, and
management for health services
Evidence-Based Practice (EBP) in
Health
■ “the conscientious, explicit and judicious use of
current best evidence in making decisions
about the care of the individual patient. It means
integrating individual clinical expertise with the
best available external clinical evidence from
systematic research” – David Sackett
Evidence-Based Medicine
Evidence-Based Medicine
■ “conscious and reasonable use of current, best scientific evidences in making
decisions in treatment of each individual patient”
■ systematic approach to clinical problem solving which allows the integration of
the best available research evidence with clinical expertise and patient values
■ The practice of EBM
– lifelong, self-directed, problem-based learning
– need for clinically important information about diagnosis, prognosis, therapy
and other clinical and health care issues
■ “converts the abstract exercise of reading and appraising the literature into the
pragmatic process of using the literature to benefit individual patients while
simultaneously expanding the clinician’s knowledge base.”
Pre-EBP
■ relied on the advice of more experienced colleagues,

often taken at face value, their intuition, and on what
they were taught as students
■ Experience is subject to flaws of bias and what we
learn as students can quickly become outdated
■ Relying on older, more knowledgeable colleagues as a
sole information source can provide dated, biased and
incorrect information
Evidence-Based Practice (EBP)
■ Aims
– provide the most effective care that is available while
improving patient outcomes
■ promotes an attitude of inquiry in health professionals and
starts us thinking about:
– Why am Idoing this in this way?
– Is there evidence that can guide me to do this in a more
effective way?
■ ensures that finite health resources are used wisely and that
relevant evidence is considered when decisions are made about
funding health services
Evidence-Based Practice
■ The three major aspects of evidence that you need to

critically appraise are:
1. Validity - can you trust it?
2. Impact - are the results clinically important?
3. Applicability - can you apply it to your patient?
A SK
Asking Structured and Focused
Clinical Questions
■ identification of uncertainty, or the need for information, and the translation
of this uncertainty into answerable clinical questions
■ key tasks for clinicians
– Develop the ability to formulate precise, structured, and answerable
clinical questions
■ The question needs to be:
1. Directly relevant to the identified problem, and
2. Constructed in a way that facilitates searching for a precise answer.
Asking Structured and Focused
Clinical Questions
■ E B P experts recommend the following steps in
formulating a clinical question:
1. Analyse the question into components using the P IC
O framework;
2. Rephrase your question using the concepts from
your P IC O analysis;
3. Identify the type or domain of the question
Types of Clinical Question
■ Establishing the question type allows you to:

1. Identify the research methodology that provides the best evidence to
answer the question. Note that the hierarchy of evidence will differ
according to question type.
2. Select the best EBP Tools to search for the evidence.
■ Ex: Cochrane Database of Systematic Reviews only addresses treatment
and prevention questions. Other databases address questions of treatment
and prevention, diagnosis, prognosis, etiology, quality improvement, and
health economics, among others.
3. Select evidence filters in PubMed / CINAHL and other databases that
will help narrow your search to papers using appropriate research
methods.
Background & Foreground
Questions
■ Background questions
– These types of questions typically ask who, what, where,
when, how & why about things like a disorder, test, or
treatment, or other aspect of healthcare. For example:
1. What are the clinical manifestations of menopause?
2. What causes migraines?
3. How can we prevent falls in the elderly?
Background & Foreground
Questions
■ Foreground questions
– These questions typically concern a specific patient or
particular population. They tend to be more specific and
complex than background questions. Quite often,
foreground questions investigate comparisons, such as two
drugs, or two treatments. For example:
1. Is Crixivan effective in slowing the rate of functional impairment in a
45 year old male patient with Lou Gehrig's Disease?
2. In patients with osteoarthritis of the hip, is water therapy more
effective than land-based exercise in restoring range-of-motion?
3. Does the use of cell phones increase the incidence of brain cancer?
The Evidence Hierarchy: What is the
"Best Evidence"
NHMR
C
?
■ to take a top-down
approach to locating
the best evidence
whereby you first
search for a recent
well-conducted
systematic review
and if that is not
available, then move
down to the next
level of evidence to
answer your
question
What is the "Best Evidence"?
NHMRC
■ Higher hierarchy
– More rigorous method
– Minimize the effect of bias on
the results
Systematic Reviews vs
Primary Studies:
What's Best?
Systematic Reviews and Meta
Analyses
■ considered to provide the best evidence for all question types
– based on the findings of multiple studies that were identified in
comprehensive, systematic literature searches
■ position of systematic reviews at the top of the evidence hierarchy is not an
absolute. Example:
1. The process of a rigorous systematic review can take years to complete
and findings can therefore be superseded by more recent evidence.
2. The methodological rigor and strength of findings must be appraised by
the reader before being applied to patients.
3. A large, well conducted Randomised Controlled Trial (RCT) may provide
more convincing evidence than a systematic review of smaller RCTs.
Primary Studies
REMEMBER: the best available

evidence may not come from the
optimal study type
■ NOTE: Clinical Queries filter available in some databases such as PubMed and
CINAHL matches the question type to studies with appropriate research designs.
Systematic Reviews vs
Narrative Reviews
Systematic Reviews
■ synthesises the results from all available studies in a particular

area, and provides a thorough analysis of the results, strengths
and weaknesses of the collated studies
■ Qualities:
1. It addresses a focused, clearly formulated question.
2. It uses systematic and explicit methods:
a. to identify, select and critically appraise relevant research
b. to collect and analyze data from the studies that are included in the
review
■ may or may not include a meta-analysis used to summarise and
analyse the statistical results
Narrative Reviews
■ opinion with selective illustrations from the literature

■ not qualified as adequate evidence to answer clinical questions
■ provide an overview of the research landscape on a given topic
and so maybe useful for background information
■ usually lack systematic search protocols or explicit criteria for
selecting and appraising evidence
■ very prone to bias
Filtered vs Unfiltered
Information
Filtered Information
■ appraises the quality of a study and recommend its application in practice

■ Time saver 🡪 critical appraisal of the individual articles has already
been done
– appropriate to use for clinical decision-making at the point-of-care
■ provide a more definitive answer than individual research reports
■ Examples:
1. Cochrane Database of Systematic Reviews
2. BMJ Clincial Evidence
3. ACP Journal Club
Cochrane Library
■ Contains systematic reviews and index to journal articles in the
evidence-based health care area
■ also a source of information on the methodology of systematic reviews
■ a database from the Cochrane Collaboration that allows simultaneous
searching of six E B P databases
■ Cochrane collaboration - international voluntary organization that prepares,
maintains and promotes the accessibility of systematic reviews of the
effects of healthcare
■ Cochrane Database of Systematic Reviews
– widely recognised as the gold standard in systematic reviews due to the
rigorous methodology used
Cochrane Library
■ Abstracts of completed Cochrane Reviews are freely available through PubMed
and M eta-Search engines such as TRIP database.
■ It should be used when looking for information on the effectiveness of an
intervention, for example:
1. What is the effectiveness of treatment y?
2. What is the effectiveness of treatment x in condition z?
3. Is treatment y better than treatment x?
4. Are there any systematic reviews of stroke rehabilitation effectiveness?
■ The Cochrane Library should not be used for the following:
1. General healthcare information
2. Guidelines for clinical practice or audit procedures
3. Primary research (other than systematic reviews and randomised controlled
trials)
4. Questions relating to the cause, prognosis, epidemiology or risk factors for an
illness or disease
Unfiltered information
■ original research studies that have not yet been synthesized or

aggregated
■ more difficult to read, interpret, and apply to practice
■ Examples
1. CINAHL
2. EMBASE
3. Medline
4. PubMed
AQUIRE
Selecting a Resource
Medline vs PubMed
■ MEDLINE
– is the largest component of PubMed
– records are indexed with NLM's controlled vocabulary, the Medical
Subject Headings (MeSH)
■ P UBME D
– freely accessible online database of journal citations and
abstracts created by the U.S. National Library of Medicine (NLM).
– Approximately 5,400 journals published in the United States and
more than 80 other countries have been selected and are
currently indexed for MEDLINE.
– relatively small number of citations are available
EVP TOOLKIT
■ bring together all Evidence-Based online resources into a single entry point
■ Resources are listed according to the hierarchy of evidence
NHMRC
Filtered Resources: M eta-Search
Engines
■ TRIP (Turning Research Into Practice) Pro Database
– systematic reviews, practice guidelines, and critically-appraised topics
and articles
– Also searches PubMed Clinical Queries and various other sources.
– Use the PICO search option and then filter the results according to study
type
■ PEDro Physiotherapy Evidence Database
– Randomized Trials, Systematic Reviews and Clinical Practice Guidelines
in physiotherapy
– Critically appraises Randomised Trials and awards a PEDro Score
Filtered Resources: M eta-Search
Engines
■ PDQ (pretty-darn-quick) -Evidence
– Access to systematic reviews of health systems evidence
– Links together systematic reviews, overviews of reviews and
primary studies
Filtered Resources: Systematic
Reviews / M eta Analyses
■ Cochrane Library
– CDSR: "Gold Standard" for high-quality systematic reviews
– includes Database of Abstracts of Reviews of Effectiveness (DARE)
■ contains abstracts of systematic reviews that have been quality-assessed
■ Each abstract includes a summary of the review together with a critical
commentary about the overall quality.
■ complements the CDSR by quality-assessing and summarizing reviews that
have not yet been carried out by The Cochrane Collaboration
■ N L M PubMed Clinical Queries
– Use the Clinical Queries entry point in PubMed to find systematic
reviews and other evidence-based studies
Filtered Resources: Critically-Appraised
Topics [Evidence Syntheses and
Guidelines]
■ UpToDate
– evidence-based, physician-authored clinical decision support resource
which clinicians trust to make the right point-of-care decisions.
– It is continuously updated and includes a collection of medical and
patient information, access to drug monographs and drug-to-drug,
drug-to-herb and herb-to-herb interactions information, and a number
of medical calculators.
■ National Guideline Clearinghouse
– A comprehensive database of evidence-based clinical practice
guidelines produced by the Agency for Health Care Research and
Quality (USA), in partnership with the American Medical Association and
the American Association of Health Plans.
– NOTE: Guideline evidence varies from expert opinion to high levels of
evidence
Guidelines]
■ Joana Briggs Institute E B P database (JBI)
– is one of the world’s leading providers of evidence–based information
and tools for providing the best possible patient care.
– covers a wide range of medical, nursing, and allied health specialties
– You can search simultaneously a wide range of summarized and
appraised evidence to inform practice.
– Includes over 3,000 records across seven publication types: Evidence
Based Recommended Practices, Evidence Summaries, Best Practice
Information Sheets, Systematic Reviews, Consumer Information Sheets,
Systematic Review Protocols, and Technical Reports
Guidelines]
■ Australian Clinical Practice Guidelines Portal
– provides access to clinical practice guidelines produced for
Australian practice that have been assessed against criteria
modified from the United States National Guidelines
Clearinghouse, and adapted to the Australian context.
■ National Institute of Health and Care Excellence (NICE)
– UK-produced guidelines, advice, quality standards and
information services for health, public health and social care.
– Also contains resources to help maximize use of evidence
and guidance.
Guidelines]
■ Royal Australian College of General Practitioners Clinical
Guidelines (RACGP)
– produces clinical guidelines on a wide range of topics to
assist GPs in their work.
– Also included are links to externally produced guidelines
that are endorsed by the RACGP.
■ Natural Medicines
– evidence-based information on natural medicines.
Filtered Resources:
Critically-Appraised Individual
Articles [Article Synopses]
■ Bandolier: Evidence based thinking about healthcare
– an independent journal about evidence-based healthcare
published in the UK.
– It includes information about evidence of effectiveness and
puts the results forward as simple bullet points of those
things that worked and those that did not Information is
sourced from systematic reviews, meta-analyses,
randomized trials, and from high quality observational
studies.
Unfiltered Resources: RCTs, Case
Cohorts, Control Studies
■ PubMed
– Click on "Clinical Queries"
– Four study categories--Therapy, Diagnosis, Etiology,
Prognosis--are provided; select the category that matches
your question type.
– Indicate whether you wish your search to be more Sensitive
(i.e., include most relevant articles but probably including
some less relevant ones) or more Specific (i.e., including
mostly relevant articles but probably omit a few).
■ MEDLINE (EBSCOhost)
– subset of PubMed
■ CINAHL plus with Full Text (EBSCO)
– To limit your CINAHL search to the best evidence-producing studies: Click on
the ‘Limits’ icon to use ‘Clinical Queries’ or limit to ‘Research’ or other
‘publication’ types (i.e.,systematic review)
■ psychINFO (EBSCO)
– Professional and academic literature in psychology, medicine, psychiatry,
nursing, sociology, education, pharmacology, physiology, linguistics, and other
areas.
– Use the Methodology limiter to choose desired evidence-based methodology
type(s).
■ Scopus (Elsevier’s abstract and citation database)
– largest abstract and citation database of research literature and quality web
sources.
– NOTE: Scopus also includes EMBASE citations but does not allow searching
via EMTREE subject headings.
■ Web of Science Core Collection
– Includes:
Science Citation Index Expanded (1974+)
Social Sciences Citation Index (1974+)
Arts and Humanities Citation Index (1975+)
Conference Proceedings Citation Index- Science (1990+)
Conference Proceedings Citation Index- Social Science & Humanities (1990+)
Current Chemical Reactions (1985+)
Index Chemicus (1993+)
THANK YOU!
References
■ https://canberra.libguides.com/c.php?g=599346&p=4149725 s-lg-box-128
88101
■ Bhargava, K., & Bhargava, D. (2007, August). Evidence Based Health Care: A
scientific approach to health care. Retrieved September 17, 2020, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3074860/
■ Masic, I., Miokovic, M., & Muhamedagic, B. (2008). Evidence based medicine -
new approaches and challenges. Retrieved September 17, 2020, from
■ Epsom and St Helier University Hospital (NHS Trust) (n.d.). Searching the
Cochrane Library. Retrieved September 17, 2020, from
www.Epsom-sthelier.nhs.uk/lis
■ PICO Questions: A Tutorial: Home. (n.d.). Retrieved September 17, 2020, from
https://uwyo.libguides.com/c.php?g=97822
SOCIO-TECHNICAL
THEORY IN TELEHEALTH
NAPOLIS | PUBLICO | UTOD

TELEHEALTH
“healing at a distance”
TELEHEALTH
Delivery of health care services, where patients and providers are

separated by distance.
The use of ICT for the exchange of information for the diagnosis and
treatment of diseases and injuries, research and evaluation, and for
the continuing education of health professionals.
World Health Organization, 2016

TELEHEALTH
Can contribute to achieve universal health coverage by improving

access for patients to quality, cost-effective, health services wherever
they may be. It is particularly valuable for those in remote areas,
vulnerable groups and ageing populations.
World Health Organization, 2016

Goals of Telehealth:
● Make health care accessible to people who live in rural or isolated

communities.
● Make services more readily available or convenient for people with

limited mobility, time or transportation options.
● Provide access to medical specialists.
● Improve communication and coordination of care among members of a

health care team and a patient.
● Provide support for self-management of health care.

Telehealth Modalities
Synchronous:
-Real-time telephone or live audio-video interaction typically with a patient using a

smartphone, tablet, or compute
Asynchronous:
-“store and forward” technology where messages, images, or data are collected at
one point in time and interpreted or responded to later.
Remote patient monitoring:

-allows direct transmission of a patient’s clinical measurements from a distance
(may or may not be in real time) to their healthcare provider
Examples of Telehealth Services
1. Patient Portal
-More secure online tool
-Alternative to email
2. Virtual Appointment
- consultation via online video

conferencing
- drawback: lacks an
in-person evaluation, which
may hamper accurate
diagnosis.
2. Remote monitoring
- Web-based or mobile apps

- Wearable devices that
automatically record and
transmit information
Benefits of Telehealth
1.Beneficial to patients in isolated communities and remote regions, who can

receive care from doctors or specialists far away without the patient having to
travel to visit them.
2.Allow healthcare professionals in multiple locations to share information and

discuss patient issues as if they were in the same place.
3.Remote patient monitoring through mobile technology can reduce the need
for outpatient visits and enable remote prescription verification and drug
administration oversight.
Benefits of Telehealth
4. Preferable for patients with limited mobility
5.Facilitate medical education by allowing workers to observe experts

in their fields and share best practices more easily.
6.Eliminate the possible transmission of infectious diseases or

parasites between patients and medical staff.
Limitations of Telehealth
1. Limited access to technological devices (e.g., smartphone, tablet,

computer) needed for a telehealth visit or connectivity issues.
2. Situations in which in-person visits are more appropriate due to urgency,

underlying health conditions, or inability to perform an adequate physical
exam
3. The need to address sensitive topics, especially if there is patient

discomfort or concern for privacy
4. Level of comfort with technology for HCP and patients
5. Cultural acceptance of conducting virtual visits in lieu of in-person visits by

HCP and patients
SOCIO-TECHNICAL THEORY
● Theory regarding the social aspects of people and

society and technical aspects of organizational structure
and processes.
● interrelatedness of social and technical aspects of an

organization or the society as a whole.
SOCIO-TECHNICAL SYSTEM
● Interaction of technical and human needs in effective

design, combining the needs of people with the
organization’s need for technical efficiency (Daft, 2016)
● Broken down into:
○ Social system
○ Technical system
○ Joint optimization
Social System Components Technical System Components

● Individual and Team Behaviors ● Type of production technology
● Organizational/Team Culture ● Level of interdependence
● Management PRactices ● Physical work setting
● Leadership Style ● Complexity of production process
● Degree of Communication ● Nature of raw materials
Openness ● TIme pressure
● Individual Needs and Desires
● Joint optimization is the combination of both social and

technical system that results in an optimized production
environment, utilizing the best of both resources
available to the company’
○ Always focused on the goal, not how that goal is
achieved
○ Lets individuals take responsibility for outcomes and
can make decisions autonomously
○ Adaptable to changing technologies
Complex Socio-technical Systems for Telehealth
Layer 5: Healthcare Ecosystem in Society
● Where the legal, regulatory and cultural framework that affect the
operation of the health organizations that provide the health services
to the citizens are established
● Groups involved: ● Resources from Layer 4:
○ Legislative bodies ○ Info on epidemiological data
○ Administration ○ Statistics on events
○ Regulatory agencies ○ Economic data
○ Stakeholders
○ International health organizations
○ Standardization bodies
Layer 4: Healthcare Organization
● Action of the organizations providing health care and social services

that have the capacity and skills to provide services based on
Telehealth
● Involves: ● Resources from Layer 3:
○ Operating rules and regulations ○ Data on operation performance
for the Telehealth Systems
○ Events and changes in Telehealth
○ Quality management Systems that might affect patient
○ Cost/efficiency evaluation safety
Layer 3: Telehealth Systems
● Group made up of people, technologies and procedures that support

the provision of Telehealth services within the functional and economic
framework established by the Healthcare Organization for whom it
operates situated at the immediate upper layer
● Involves: ● Resources from Layer 2:
○ Design of general architecture ○ Best practice guidelines
○ Articulation of flows of knowledge and ○ Technical and functional
communication among the actors requirements for design and
implementation
Layer 2: Entities Subsystems
● Interact among themselves exchanging information within a healthcare

flow process fixed in the Telehealth System
● Constrictions to Level 1:
○ Professional skills requirements
○ Patient information
○ Equipment requirements
○ Certification of equipment and software
○ Quality of telecommunication services
○ Accessibility
○ Codification of data
○ Home premises
○ Environmental specifications
Layer 1: Components
Barriers in Telehealth Service
Implementation
Barriers in Telemedicine Implementation
❏ Technical Barriers
❏ Behavioral Barriers
❏ Economical Barriers
❏ Organizational Barriers
❏ Legal Barriers
TECHNICAL BARRIER
- Technology itself is becoming a barrier in the development of
telemedicine
- Due to high cost of replacing the older technology.
❏ Rapid Upgrade to ICT - rapid advancement of telemedicine

technology
❏ Inadequate ICT Infrastructure - lack of ICT in remote areas
❏ Initial start – up cost of ICT infrastructure - high cost and
budgetary constraints
❏ Low Internet Connectivity - unreliable and low wideband internet
Behavioural Barrier
- Social and culture milieu of the community and society of a particular country
creates lots of barriers in adapting, utilizing, and sustaining telemedicine
services.
❏ Resistance to Change - lack of support to newer ICT tools

❏ ICT Literacy - poor awareness to modern technologies and their use in
delivering healthcare
❏ Lack of Confidence
Economical Barrier
-Two major concerns are to reimburse healthcare workers for

telehealth consultations and to open up new patient markets.
❏ Reimbursement and Insurance Barriers

- Providers are unable to bear all the cost of telemedicine
- Insurance companies do not reimburse the teleconsultation
bills and payments
Organizational Barrier
● The lack of formal organizational structure to deliver telemedicine
services is the biggest barrier for the development of telemedicine
services in any country
❏ Lack of Accreditation and Regulatory Bodies

- Lack of accreditation of telemedicine facilities creates fear among
the users of telehealth.
- In the absence of definite regulatory policy and guidelines,
physician has apprehension and fear to practice telemedicine.
Legal Barriers
- Telemedicine practices have raised many legal and ethical issues, which are
normally not encountered during traditional healthcare delivery.
❏ Online Prescription - no legal framework for e-prescription

❏ Malpractice Liability - lack of SOPs for telemedicine practice
❏ Licensing of telemedicine/telehealth service providers
❏ Informed consent before teleconsultation - need for a prior
written or verbal informed consent for any telemedicine
consultation and treatment misrepresents telemedicine as a
different form of service
References:
https://www.who.int/goe/publications/goe_telemedicine_2010.pdf
https://www.ortelehealth.org/content/telemedicine-or-telehealth-definitions
https://www.cdc.gov/coronavirus/2019-ncov/hcp/telehealth.html
MEDICAL INFORMATICS IN
THE PHILIPPINES
CHESTER HANZ T. CARBONILLA
• eHealth is often interchangeably used with medical, health or
biomedical informatics
HISTORY
• Rudiments
• 1960s when clinical residency training programs were formalized and resident
physicians began using the telephone incrementally to consult more senior
clinicians on the management of hospitalized patients
• two decades after, beepers became ubiquitous to alert and inform
clinicians on patient status
HISTORY
• Loosely practiced in the Philippines as early as the nineteen eighties
• 1985
• First documented eLearning and telehealth activity in the country
• SatelLife-Healthnet project which linked medical centers in the United States
and the Philippines
• System provided e-mail communications and other services via the LEO
Healthsat satellites
• Residents in tertiary care facilities who had access to IBM compatible
machines were already using word processors to store patient
information
HISTORY
• 1991
• Makati Medical Center initiated a series of videoconferences with Stanford
University Hospital
• Department of Health who took the Field Epidemiology Training
Program (DOHFETP)used Epi-Info
• Philippine Association for Medical Informatics (PAMI)
• Dr. Benjamin Marte
• membership mostly composed of Department of Health staff
• representative for the country in APAMI for the years 1994 to 1995
HISTORY
• Incorporation of a non-governmental organization called the
Philippine Medical Informatics Society, Inc
• First Symposium on Medical Informatics and Seminars on Telepathology (Dr.
Paul Fontelo, Armed Forces Institute of Pathology)
• Medical Records Management (Dr. Michael Yang, OACIS)
• Integrating Technology into Medical Education (Dr. Emmanuel Besa, Medical
College of Pennsylvania)
• Late nineties
• More structured approach to ‘medical informatics’
• through the establishment of the Medical Informatics Unit University of the
Philippines Manila
SURVEYS
• 2007
Philippine Health Information Network, led by the Department of Health, with the support of
the WHO and the Health Metrics Network embarked on an evaluation of the Philippine
Health Information System using the Health Metrics Network.
• Key finding are as follows:
• (1) HIS institutions, human resources and financing are inadequate
• (2) IT and database support to HIS staff is adequate only at national level, but not at the
subnational level. Telephone access and internet connection are still problematic.
• (3) Electronic processing of the field health survey information system (FHSIS) is
leadership-dependent, and in-depth analysis is lacking.
• (4) Lack of funding and non-priority have been citedas reasons for not providing
capacitybuilding activities for HIS.
• In 2009, the WHO conducted the second global survey on eHealth
• 114 participating countries, including that of the Philippines.
• The survey revealed that there exists ICT training both formal and non-degree courses for
students and health professionals alike
WHY MED INFORMATICS
• As early as 1994, Jayasuriya (1995) had already cited challenges with
the country’s health information systems.
“The existence of major gaps in information the inappropriateness of
the available information for the needs and most evidently that
information is not utilized for management at most levels.“
• At that point, capability building programs for health information

systems had just begun to be developed like the Field Epidemiology
Training Program of the Department of Health
Starting Points: National
Studies on eHealth Capacities
• By 1998, faculty members from the UP College of Medicine began
taking formal courses in medical informatics in different institutions
around the world
• University of Washington
• National Library of Medicine in Bethesda, Maryland
• University of Warwick in Coventry, England
• These faculty members served as the core group of what will be the
Medical Informatics Unit at UP Manila.
Research
• Upon return, the faculty core group started working on health information
systems projects and applied many of the principles they learned from their
training.
• Medical Informatics Unit of the UP College of Medicine
• World Health Organization and the
• Department of Health.
• refine their techniques and protocols to address the growing informatics
needs of the country
• Community Health Information Tracking System, a Linux, Apache, MySQL,
PHP-based system released under the general public license (GPL)
• CHITS
• finalist at the Stockholm Challenge 2006
• one of top three e-government projects in the Philippines by the Asia Pacific
Economic Cooperation Digital Opportunity Center
Research
• United States Agency for International Development and
Development Research of Canada
• the experience for the faculty and staff of the MIU to handle increasingly
complex projects in medical informatics
• Master of Science in Health Informatics (MSHI) was finally approved
in 2004 and implemented in academic year 2005-2006
• A key component of the MSHI was service as well as research
Opportunities
• Philippine National Health Information Infrastructure (PNHII)
• form the framework for the automation of many health transactions and may
eventually pave the way for the justification of IT investments in health
• Department of Health,
• Department of Science and Technology,
• University of the Philippines Manila,
• Philippine Health Insurance
• BuddyWorks Telehealth project of the National Telehealth Center,
• offers the possibility of managing electronic patient records needs of the
government health bureaucracy.
Issues
• Nation still suffers from several issues that impede progress.
• Lack of health human resource interested in the field.
• Most of the initial enthusiasts were clinician specialists who were engaged in
health informatics more as a novelty rather than as a profession.
• Network infrastructure (which also involves IT human resource)
• availability of affordable IT human resource and their retention in the age of
globalization remains an issue
• Benefits of information technology have not yet dawned to many
decision-makers in the health sector.
• The huge capital outlay for a health information system remains a stumbling
block to the integration of IT in health operations.
Medic a l Informatic s
A Presentation by SGD 2
Outline
I. Tools and technology in Health Informatics

II. Concepts of Human-Computer Interaction
III. Diagnostics in Telehealth
IV. Improving Health Care Through Medical Informatics
01
 Tools and Technology in

Informatics
Health Information Technology
Refers to electronic systems health professionals

and patients use to store, process and analyze
health data.
Can be divided into two main categories:
- Medical Practice Management - focuses on
practitioner and administrators
- Electronic Health Records - focuses on
patients
Medic a l
P r a c tic e
Management
- Manages the administrative
and clinical aspect of a
physician’s practice
- Geared more for clerical work
- Users would be the clinicians,
front desk workers and
administrative personnel
- E-orders, E-prescribing, and
Clinical decision support tool.
E lec tronic H ealth R ec o rds
(EHR)
- EHR focuses on documentation and storage of patient’s
medical information
- Later EHRs can be shared to other health facilities which
enable different physicians to treat properly their
patients due to access to this kind of information.
E lec tronic H ealth R ec o rds
(EHR)
- Gives alert for preventive
procedures/ screenings
- A basis for comparison from
previous health data to
current ones
- Reduces risk of loss of
records and saves space
once occupied by paper
documents
Features of Health Information Technolog
1. Patient Portal
○ Includes the patient’s history,
treatments, and medications
○ Patients themselves can
access their medical history,
schedule appointments,
message their doctors, view
bills, and make payments all
online.
○ Use of personal devices - such
as mobile phones or tablets
Features of Health Information Technology
2. Patient Scheduling - choose what specific data and time they want
3.Medical Billing Softwares

● handle the entire billing
workflow process
● Included here are the
insurance claims, insurance
verification, payment
processing, and patient
tracking.
4. ePrescribing
● Speeds up the entire
prescription process
● Prescriptions can be
tracked and controlled
substance prescriptions can
be monitored more
accurately
5.Remote Patient Monitoring
● Medical Sensors
● Reduce the costs that come
with chronic care and
hospital readmission; can
also be used in
post-discharge care, senior
care, workmen’s
compensation cases,
behavioral health and
substance abuse treatment
6.Master Patient Index
● Connects a patient’s
record with more than one
database
● Allows different
departments to share all
data simultaneously
● Goal: provide more
accurate data and better
security of patient’s
information
A d v a ntage s of E lec tronic
Health R e c o r d s
○ Providing accurate, up-to-date, and complete information
about patients at the point of care
○ Enabling quick access to patient records for more coordinated,
efficient care
○ Securely sharing electronic information with patients and other
clinicians
○ Helping providers more effectively diagnose patients, reduce
medical errors, and provide safer care
○ Improving patient and provider interaction and communication,
as well as health care convenience
A d v a ntage s of E lec tronic
Health R e c o r d s
○ Enabling safer, more reliable prescribing
○ Helping promote legible, complete documentation and
accurate, streamlined coding and billing
○ Enhancing privacy and security of patient data
○ Helping providers improve productivity and work-life
balance
○ Enabling providers to improve efficiency and meet their
business goals
○ Reducing costs through decreased paperwork, improved
safety, reduced duplication of testing, and improved health.
Benefits of Electronic Health R e c o r d s
○ Better health care by improving all aspects of patient care, including
safety, effectiveness, patient-centeredness, communication, education,
timeliness, efficiency, and equity.
○ Better health by encouraging healthier lifestyles in the entire
population, including increased physical activity, better nutrition,
avoidance of behavioral risks, and wider use of preventative care.
○ Improved efficiencies and lower health care costs by promoting
preventive medicine and improved coordination of health care
services, as well as by reducing waste and redundant tests.
○ Better clinical decision making by integrating patient information
from multiple sources.
Disadvantages of Electronic
Health Record
● Potential Privacy and Security Issues
● Inaccurate Information
● Frightening Patients Needlessly
● Malpractice Liability Concerns
02
Concepts of
Human-Computer Interaction
Human Computer Interac tion
(HCI)
● Multifaceted discipline devoted to the study and practice of design and
usability (Carroll, 2003).
● HCI has emerged as a central area of both computer science,
development and applied social science research.
● Usability methods have been used to evaluate wide range of medical
information technologies including
○ infusion pumps
○ ventilator management systems
○ physician order entry
○ pulmonary graph displays
○ information retrieval systems
○ research web environments for clinicians
(HCI)
● Usability include 5 attributes:
1) learnability: system should be relatively easy to learn
2) efficiency: an experienced user can attain a high level of
productivity
3) memorability: features supported by the system should be easy
to retain once learned,
4) errors: system should be designed to minimize errors and
support error detection and recovery
5) satisfaction:the user experience should be subjectively
satisfying.
(HCI)
● Even with growth of usability research, there remain formidable
challenges to designing and developing usable systems.
● HCI Researcher have been devoted to the development of
innovative designs concepts such as:
○ Virtual Reality
○ Ubiquitous computing
○ Multimodal interfaces
○ Collaborative Work spaces
○ Immersive Environments
(HCI)
● HCI research has also been focally concerned with the
cognitive, social, and cultural dimensions of the computing
experience.
● It is concerned with developing analytic frameworks for
characterizing how technologies can be used more
productively across a range of tasks, settings, and user
populations.
● Models of cognitive engineering are typically predicated on a
cyclical pattern of interaction with a system. This pattern is
embodied in Norman’s ( 1986 ) seven stage model of action .
Norman’s 7 stage
model of action
Human
In 1983, Card, Moran and Newell described the Model Human
Processor: a simplified view of the human processing involved in
interacting with computer systems.
MHP comprises 3 subsystems:
1. perceptual system
2. motor system
3. cognitive system
Input-output channels
● In interaction with a computer, the human input is the data
output by the computer vice versa.
● Vision, hearing and touch are the most important senses

in HCI.
● The fingers, voice, eyes, head and body position are the
primary effectors.
Input-output channels
● Visual perception can be divided in 2 stages: the physical
reception of the stimulus from the outside world, and the
processing and interpretation of that stimulus
● Hearing: The ear receives vibrations on the air and transmits them
through various stages to the auditory nerves.
● Touch stimuli are received through the skin, which contains

various types of sensory receptors
● Mechanoreceptors are responding to immediate pressure as
the skin is intended.
● Some areas of the body have greater sensitivity/acuity than

others.
● This can be measured using the two-point threshold test

Human Memory
● 3 types of memory: sensory buffers, short-term memory (or working
memory) and long-term memory.
1. Sensory memory
-The sensory memories act as buffers for stimuli received through each of the
senses: iconic memory for vision, echoic memory for sounds and haptic
memory for touch.
1. Short-term memory
- STM is used to store information which is only required fleetingly. STM
can be accessed rapidly, however, also decays rapidly. It has a limited
capacity.
- Miller stated the 7+/-2 rule, which means that humans can store 5-9
chunks of information.
Human Memory
3. Long-term memory
- LTM differs from STM in various ways.
- It has an unlimited capacity, a slow access time and forgetting occurs

more slowly or not at all.
- Information is stored here from the STM through rehearsal.
There are 2 types of LTM:

- Episodic memory
- Semantic memory.
Human Memory
There are 3 main activities related to LTM: storage of information,
forgetting and information retrieval.
- Storage: If the total learning time is increased, information is

remembered better (total time hypothesis).
- Forgetting: There are 2 main theories of forgetting: decay and
interference.
- Retrieval: There are 2 types of information retrieval: recall and
recognition.
THINKING: REASONING AND
PROBLEM SOLVING
● Reasoning is the process by which we use the knowledge we have to
draw conclusions or infer something new about the domain of
interest.
There are different types of reasoning:

Deductive, Inductive and Abductive
● Problem solving is the process of finding a solution to an unfamiliar

taste, using (adapting) the knowledge we have.
There are different views on problem solving:
Gestalt theory
Problem space theory
Use of analogy
Emotion
● Emotion involves both physical and cognitive events.
● Our body responds biologically to an external stimulus and we

interpret that in some way as a particular emotion.
● That biological response (affect) changes the way we deal with

different situations and this has an impact on the way we interact with
computer systems
Computer
● Interaction (with or without computer) is a
process of information transfer.
● The diversity of devices reflects the fact
that there are many different types of data
that may be entered into and obtained
from a system, as there are many different
users.
● Nowadays, computers respond within in
milliseconds and computer systems are
integrated in many different devices.
Computer
● The most sophisticated machines
are worthless unless they can be
used properly by men.
● Elements
○ Input and Output Devices
○ Memory
○ Processing
○ Paper
○ Virtual Reality
○ Physical Interaction
Computer
Text Entry Devices
● The alpha numeric
keyboards
● Chord keyboards
● Phone Pad and T9 entry
● Handwriting Recognition
● Speech Recognition
● Numeric Pads
Computer
Positioning, Pointing and Drawing
● Mouse
● Touchpad
● Trackball and thumbwheel
● Joysticks
● Touch-sensitive screens
● Stylus and light pen
● Tablets
● Eyegaze
● Cursors Keys and discrete positioning
Computer
Display Devices Devices for virtual reality
● Bitmap displays, and 3D Interaction
resolution and color ● Positioning 3D
● Technologies ● 3D Displays
● Large Displays and
Situated Displars
● Digital paper
Computer
Physical Control, Sensors Paper: Printing and
and Special Devices Scanning
● Special Displays ● Printing
● Sound Ouput ● Fonts and Description
● Touch, Feel and Smell Languages
● Physical Controls ● Screen and Page
● Environment and ● Scanners and Optical
Biosensing Character Recognition
Computer
Processing and Networks
Memory ● Effects of finite processor
● RAM and Short term
speed
memory (STM) ● Limitations on
Interactive performance
● Disk and Long term ● Network computing
memory (LTM)
● Understanding speed and
capacity
● Compression
● Storage format and
standards
● Methods of Access
INTERACTION
- Process of information transfer

- Communication between the use and
the system
IMPORTANT:
- HCI studies how people design,
implement and use computer
interfaces.
- It attempts to ensure that the user
and the computer both get on with
each other and interact successfully
INTERACTION
● HCI is a design that should produce a fit between the user, the
machine, and the required services in order to achieve a certain
performance, both in quality and optimality
● Goals of HCI
○ To produce usable and safe systems, as well as functional
systems
○ To achieve good usability of computers, a developer must:
■ Understand the factors that determine how people
use technology
■ Develop tools and techniques to enable building
suitable systems
■ Achieve efficient, effective, and safe interaction
■ Put user first
INTERACTION
HCI Technologies:
● Design should consider many aspects of human behaviors and needs to be useful
● The existing interface differ in the degree of complexity both because of degree of
functionality/usability and the financial and economical aspect of the machine in the
market
3 levels of user activity
Physical - Determines the mechanics of interaction between human and computer

- Rely on 3 human senses: vision, audition, and touch
Cognitive - Deals with the ways that users can understand the system and interact
with it
Affective - aspect that makes the user continue to use the machine by changing
attitudes and emotions toward the user
INTERACTION
RECOMMENDATIONS FOR FUTURE

ADVANCEMENT:
● Explore new ways of understanding
Users
● Explore new ways of designing and
building new devices
03
Diagnostics in Telehealth
The Fo rgotten Electronic
Telephone Messaging
Bridging Distance with
Informatics:
Real-world Systems
Remote Remote
Monitoring Interpretation
Video-bas ed Telepresenc e
Telehealth
Categories of Telehealth R e s o u r c e s
Separation
Participants, bandwidth, information
transmitted, medical specialty,health
care condition, & financial
reimbursement
Synchronous Asynchronous
(Real-Time) (Store & Forward)
Video Conferencing,
Telephony, Chat Groups, Teleradiology, websites,
Major challenge: and Telepresence email, and text-messaging
SCHEDULING
Categories based on bandwidth and overall
complexity:
The F o rgotten T elephone
● Until recently, the telephone was a forgotten component in teleheath.
● Focus: Video
● Up to 25% of all primary care encounters occur via the telephone:
○ Triage
○ Case management
○ Results review
○ Consultation
○ Medication adjustment
○ Logistical issues: scheduling
● Telephone consultations are not reimbursed by most insurance
carriers
The F o rgotten T elephone
● Telephone follow-up for chronic conditons
● Large care companies: large telephone triage centers
● With some insurance providers reimbursing for e-mails and
text messaging, providers are asking why not reimburse for
telephone calls also.
E lec tronic Messaging
● E-mails
○ Disadvantages
■ Delivery is not guaranteed;
■ Security
■ Unstructured Messaging
● Personal clinical electronic communications
○ Messages never leave the website
○ Patient portals: web-based messaging
■ EHRs (Electronic Health Records)
Remote M onitoring
● Remote monitoring is a subset of telehealth focusing on the
capture of clinically relevant data in the patients’ homes or
other locations outside of conventional hospitals, clinics or
health care provider offices, and the subsequent
transmission of the data to central locations for review.
● Conceptual model: clinically significant changes in patient
condition occur between regularly scheduled visits and that
these changes can be detected by measuring physiologic
parameters.
Remote M onitoring
● Care Model: presumes that, if these changes are detected
and treated sooner, the overall condition of the patient will
be improved.
● Remote monitoring focuses on management, rather than on
diagnosis.
● Patients: chronic disease or condition
● Used to track parameters that guide management.
● Any measurable parameter is a candidate for remote
monitoring.
Log in to site Manually enter data.
Connect device to Transfer readings electronically.
PC
Connect directly or transmit data via bluetooth
Mobile phone Mobile phone transmits data to provider for review.
MOBILE HEALTH
Any condition that is evaluated by
measuring a physiologic parameter is a
candidate for remote monitoring.
B lood Gluc o s e Asthma Hypertension

- Parameter most - Peak flow or - Automated blood
measured in remote full-loop pressure cuffs
setting spirometers
P a c emaker Home
CHF
function c o agulation
- Measuring daily meters
weight to detect
fluid gain - Chronic
anticoagulation
therapy
F a c tor s that limit the widespread us e
of remote monitoring:
1. The question of efficacy

2. Who will review the data?
3. Money
Remote interpretation
Is a category of store- and- forward telehealth that involves the capture of images, or other
data, at one site and their transmission to another site for interpretation
Includes:
● radiographs (teleradiology)
● photographs (teledermatology, teleophthalmology, telepathology)
● wave forms such as ECGs (e.g. telecardiology)
● text-based medical data
Remote interpretation
The store-and-forward telehealth modalities - have benefited most from the development of
the commodity Internet and the increasing availability of affordable high bandwidth
connections that it provides.
Advantages:
● makes it much better suited for the transfer of text-based data and image files, rather
than for streaming data or video connections
● From a logistical perspective, multiple remote interpretations may be batched and
performed together, thereby providing important workflow and convenience advantages
over traditional medical examinations or realtime video telehealth paradigms
Teleradiology
Definition:
The ability to send radiographic images, x rays from one location to another.
→ is the largest category of remote interpretation and the largest category of telehealth.
→ represents the most mature clinical domain in telehealth
3 essential components: - an image sending station, transmission network, and a receiving

image review station
(PACS) PICTURE ARCHIVING AND COMMUNICATIONS SYSTEMS
● capture, store, transmit and displays digital radiology images

Teleradiology
Factors Contributing to More Rapid Adaption Of Telehealth (Pathology and Radiology)
1. The relationship between these specialists and their patients
1. It is reimbursable by insurance payer
1. Numerous evaluation studies have demonstrated that digital image interpretation

has comparable, or potentially even better, accuracy and efficiency compared to
traditional film-based radiological examination.
Teleophthalmology
Example 1.For retinal disease Screening (Diabetic Retinopathy)
Systems have been developed that allow nurses or technicians in primary care offices to obtain
high quality digital retinal photographs
- These images are sent to regional centers for interpretation.

- If diabetic retinopathy is identified or suspected, the patient is referred for full
ophthalmologic examination.
Remote interpretation of retinal images by certified reading centers, when taken after dilation of
the eyes using standard photographic protocols originally developed for clinical research trials,
has been demonstrated to classify diabetic retinopathy more accurately than traditional dilated
eye examination.
Teleophthalmology
Example 2: Retinopathy of prematurity (ROP)
● is a leading cause of blindness in premature

infants, and hospitalized infants are examined
regularly to identify treatment-requiring disease
● As a result, systems have been developed in which

trained nurses capture retinal photographs and
transmit them to experts for remote interpretation
(Richter et al. 2009 ).
Video -bas ed T elehealth
● Early studies:
○ Goal was to provide access to specialists in remote or rural areas.
○ utilized a hub-and-spoke topology where one hub, (usually an academic medical center) was
connected to many spokes (usually rural clinics)
○ Early teleheath consults involved the patient and the primary care provider at one site conferring
with a specialist at another site.
● First legislation in Medicare reimbursement of telehealth consults which required a “PRESENTER” at the
remote site
○ Scheduling problem, combined with the advent of more user-friendly equipment ultimately led
Medicare to drop the presenter requirement
○ Second obstacle: availability of relevant clinical information
Video -bas ed Telehealth
● Synchronous video telehealth has been used
PLAIN OLD TELEPHONE SERVICE (POTS) in almost every conceivable situation.
- conventional phone lines that provide 64 bits-
per- second (64 kbs) transmission speed,
diagnostic quality video typically requires at least 1. In addition to traditional consultations, the
128 Kbs -384 Kbs systems have been used to transmit grand
rounds and other educational presentations.
Integrated Service Digital Network (ISDN) connections
or leased lines
1. Video cameras have been placed in
operating rooms at hub sites to transmit
images of surgeries for educational
purposes.
3.Video cameras have been placed in emergency departments and operating rooms at spoke
sites to allow experts to “telementor” less experienced physicians in the remote location.
4. Video cameras have also been placed in ambulances to provide remote triage.
Mobile Devices
- promising because mobile networks are low-cost and widely-available for consumers, and
are increasingly accessible even in developing countries.
-Health Insurance Portability and AccountabilityAct (HIPAA)

Categories of synchronous video telehealth that have developed sustainable models:
1. Telepsychiatry
2. Correctional telehealth
3. Home telehealth
4. Emergency telehealth
5. Remote intensive care
Telepsychiatry
● Psychiatry is the ideal clinical domain for synchronous video consultation
● Diagnosis is based primarily on observing and talking to the patient.
1. Physical examination is relatively unimportant so the lack of physical contact is not limiting
2.There are very few diagnostic studies or procedures, so interfacing to other clinical
systems is less important
3.State offices of mental health deliver a significant fraction of psychiatric services,

minimizing reimbursement issue
Correc tional
Problems (Prison telehealth
Population) Telehealth
1.Growing population in the facilities •Both synchronous and asynchronous telehealth

2.Prisoners have higher rates of medical problems allow a provider to evaluate and/or diagnose
than the general population. and provide access to care for primary and
•high blood pressure, asthma and arthritis specialty care services to prisoners.
•tuberculosis (TB), hepatitis B or C and other
sexually transmitted diseases. •By providing these services via telehealth,
•suffers from mental illness and substance correctional facilities can decrease costs
abuse associated with access to care, including
3.Location of the correctional facility is another transportation, security and healthcare costs, and
costly expense improve healthcare outcomes by providing
specialty services
Home Telehealth To Presence
Home telehealth can be divided into two major categories:
1. TELEHOME CARE
● Is the telehealth equivalent of home nursing care.
● It involves frequent video visits between nurses and, often homebound, patients.
● Several studies have shown that telehome care can be especially valuable in the
management of patients recently discharged from the hospital and can
significantly reduce readmission rates.
Home Telehealth To Presence
2. Management of chronic diseases
● Involves a longer duration of care and less frequent interactions.

● Video interactions tend to focus on patient education, more than on evaluation of
acute conditions.
Distinctions between TELEHOME CARE and DISEASE MANAGEMENT

In telehome care: initiated and managed by the In disease management: The HTU also needs to
nurse. Measurements, such as blood pressure, support remote monitoring, patient- initiated
are typically collected during the video visit and data uploads and, possibly, Web-based access to
uploaded as part of the video connection. educational or disease management resources.
Emergency Telemedicine
● “Just in time” consultation in the emergency

setting potentially represents one of the most
beneficial uses of telehealth
● Telemedicine can bring specialty expertise to a
remote location for emergency evaluation of the
patient directly, while transmit images and
laboratory work for immediate interpretation.
Remote Intensive Care
● This is often referred to as tele-ICU, and is defined as care provided to critically ill patients with at
least some of the managing physicians and nurses in a remote location.
● Critical care health professionals co-manage care from a Command Center led by board-certified
critical care physicians.
● Protocols and treatments reviews for patient management are incorporated into the care process
using data from the monitoring and alert systems that indicate when changes in care should take
place.
Telepresence
● Telepresence involves systems that allow
clinicians to not only view remote
situations, but also to act on them.
● The archetypal telepresence application
is telesurgery.
● The most basic surgical telepresence
systems simply permit two-way
audio-video communications, by which
remote surgeons can observe, teach, and
collaborate with local surgeons while they
operate on patients.
The Logistic Indoor Service Assistant (LISA) robot has been designed to minimize
direct contact between frontline workers and patients suffering from the
coronavirus disease.
04
 Improv ing Health Care Thr

Medical Informatics
01 04
Improving S O U R C E OF D ATA R ECOR D LINKA G E
Health Care 02 05
Through PRESENTATION D ATA PROTECTION
OF D ATA
Medical
03 06
Informatics F E E D B A C K OF
F E E D B A C K INFORMATION
PERFORMANCE
IMPROVING HEALTH CARE THROUGH MEDICAL INFORMATICS
SOURC
E OF
DATA
PRESENTATIO
N OFDATA
SOURCE OF
DATA
“the quality of clinical decisions

depends in part on the quality of
information available to the
decision-maker”
SOURCE OF DATA
79
PRESENTATION
OF DATA
Presentation encompasses the forms

in which information is delivered to the
end-user after processing.
PRESENTATION
OF DATA
Ways in presenting data

● Numeric data: presented in chart or graph form to allow the user to examin
trends, whereas the compilation of potential diagnoses generated from pat
assessment data is better presented in an alphanumeric- list.
● Criteria in visualization , expressiveness, effectiveness and appropriateness
● Interaction with databases and knowledge bases: Commercial

applications such as UpToDate™ are popular among clinicians
because they provide easy access to knowledge resources at the
point of care.
81
82
IMPROVING H E A L T H C A R E
THROUGH MEDICAL INFORMATICS
03
F E E D B A C K OF
PERFORMANCE
D ATA
04
RECORD LINKAGE
F E E D B A C K OF
PERFORMANCE DATA
Different approaches
(using internal or
external influences on
decision makers) can be
taken when using data
to improve care.
F E E D B A C K OF
PERFORMANCE DATA
F E E D B A C K OF
PERFORMANCE DATA
F E E D B A C K OF
PERFORMANCE DATA
Today,it is less necessary to
rely on individual clinicians
or teams to produce routine
reports because
computerized data entry
enables the routine
extraction of data for many
purposes.
R E C O R D LINKA G E
Deterministic or
probabilistic methods
can be used with
similar success rates
to link records.
● unique patient identifier applied to

all personal health data
○ 10 digit community health

index number ● The algorithm determines that John
● Soundex system (converts name Smyth and John Smythe is the same
to a code) child with asthma if sufficient other
characteristics (date of birth, street
○ Michael becomes M240
name)on the admission data and
community prescriptions match.
Informatics improves patient record
retrieval.
● The acknowledgement of a patient’s
medical records is extremely
important to the delivery of quality
care that treats patients based on
their individual needs.
○ If thereis difficulty accessing a patient’s

medical records, critical consequences may
result.
Data P r otec tion
•1998 Data Protection Act
•Builds on the earlier 1984 Data Protection Act.
•Implemented on March 1, 2000.
•Aims to ensure that processing of information using data is done in accordance with
the rights of the individuals.
•Processing of Information includes:
• Obtaining
• Recording
• Holding
• Doing calculations
•Extends legislation in manual as well as computerized records containing personal
information.
Data P r otec tion
•Under the 1998 Data Protection Act, data controllers (physicians) should be
responsible for ensuring that the access to patient data is under strict controlled
restrictions.
• If necessary, with the patient’s consent.
• NHS- Patient consent can be inferred

• General Medical Council & BMA- Explicit patient consent is still preferred
• Release of details of patients to diabetic and cancer registers
• Release of summaries of patient date to out of hours services.
Principles of good practice in the
1998 Data Protection Act
•Data are/should be:
• Fairly and lawfully processed

• Processed for limited purposes
• Adequate, relevant, and not excessive
• Accurate
• Not kept longer than necessary
• Processed in accordance with the rights of the subject of the data
• Secure
• Not transferred to countries without adequate protection
Approaches identified by the Nuffield Trust to deal
with the conflict (Freedom of Information Act VS
Data Protection)
•The following approaches were suggested:
•Use personal data with consent or other assent from the

subjects of the data
•Anonymize the data, then use them
•Use personal data without explicit consent, under a public
interest mandate
F e edbac k Information
•Difficulty of providing feedback that would be taken in a constructive manner.
•Certain principles make it more likely that the feedback will be considered
constructive by recipients, and changes that could improve care will probably be
implemented.
• Data must be perceived by clinicians as valid to motivate change
• It takes time to develop the credibility of data
• The source and timeliness of data are critical to perceived validity
• Benchmarking improves the meaningfulness of data feedback
• Opinion leaders can enhance the effectiveness of data feedback
•Data feedback that profiles an individual clinician’s practices can be effective
but may be perceived as punitive
• Data feedback must persist to sustain improved performance
R e sear c h
Gov ernanc e
● Confidentiality and security of data is of greater concern.
● Data collected for patient care may only be used t o produce
research evidence with adequate safeguards for the patients.
● Legislation varies between countries, but highest standards apply.
● Personally identifiable data with explicit signed, and informed
consent.
● In some, law relaxes this standard if it is impossible or difficult to
obtain consent
● In other countries, anonymization and adherence to good
epidemiological practice allow use of clinical data for research
purposes.
Referenc
e
● Regis College Online. 2020. How Using Health Informatics Can Improve
Health Care Treatment. [online] Available at:
<https://online.regiscollege.edu/blog/4-ways-informatics-improve-health
-caretreatment/#:~:text=%204%20Ways%20That%20Informatics%20Co
uld%20Improve%20Health,for%20health%20insurance%20administratio
n%0ATo%20ensure%20proper...%20More%20> [Accessed 22 September
2020].
● Sullivan, F. and Wyatt, J., 2006. ABC Of Health Informatics. Singapore: Blackwell
Publishing Ltd, pp.29-30.
● Sullivan,
F., & Wyatt, J. C. (2006). ABC of health informatics. Malden, MA:
Blackwell Publishing.
Thanks!
Arcilla, Elica Yem

Cuajao, Ahre Jean
Dimaunahan, Juan Carlos
Festin, Leonard Pericles
Guerrero, Beverly Ann
Mausisa, Remington
Raro, Renz Ian
Rojas, Jodene Rose
Samaniego, Kate
Tan, Danekka
Velasco, Irene
Villones, Frances Hazel Please keep this slide for attribution.
Year III
SGD 2
MEDICAL
INFORMATICS
SGD3
Adra;Donacao;Garing;Lagura;Luciano;Luminarias;Malaiba;
Najito;Orbita;Pableo;Villarin
ISSUES,
PROBLEMS, &
CHALLENGES IN
MEDICAL
INFORMATICS
PABLEO, LUMINARIAS,
MALAIBA
I. Security and Ethical Issues
II. Financial Issues
III. Resistance to Development of ICT Systems by Health
Professionals
IV. Data Integrity
V. Service Availability and Responsiveness
VI. Resources and Infrastructure Limitations
VII. Patient Engagement
VIII. Challenges faced by developers
I. Security and
Ethical
II. Financial Issues
Issues
MALAIBA
5 Data Security Challenges for Health Informatics
1. Information Stored in the Cloud May Be Vulnerable

a. Example - online leaks of celebrity photos proves that it’s not entirely
secure
b. Extra layers of security
i. healthcare system officials
2. Viruses and Malware Still Infect Computer Systems
a. Healthcare industry is especially vulnerable
i. Reportedly lags behind other industries to address problems that
were already known
b. Software isn’t updated properly
i. Data is open to attacks of more recent bugs that outdated
systems will not recognize
3. Passwords Should Be Protected

A. First line of defense against a security breach
B. A facility may have one password for hundreds of employees to use,
which makes the system vulnerable
C. Passwords must be changed regularly and kept safe
D. Failing to log off a computer when not in use.
4. Mobile Devices Make Traveling Information Easy Targets
A. Information in transit is vulnerable to being intercepted and re-routed
B. Health care facilities must set regulations for data encryption and
approved devices to house certain information
C. Losing electronic devices.
5. Every Online System Must Be Protected

A. Example - hackers reportedly gained access to Target customer
information through an online heating and cooling system
B. Every system linked to sensitive data must also be protected
Ethical Issues
Violations of privacy laws

1. Failing to log off a computer when not in
use.
2. Illegally accessing patient files.
3. Lending passwords or access codes.
4. Losing electronic devices.
5. Not shredding printouts with private
info.
6. Texting patient information.
Financial Issues
1. Direct high costs of health informatics

a. Acquisition of software and
hardware
b. Cost of importing patient data
c. Maintenance
2. Changes in how healthcare providers
work
a. Loss of jobs
III. Resistance to Development
of ICT Systems by Health
Professionals
IV. Data Integrity
V. Service Availability and
Responsiveness
DIANA P. PABLEO
Resistance to Development of ICT Systems by He
Professionals
● Older workforce
● Inherent complexity of
healthcare
● Behavioral change is a difficult
learning curve to overcome
● Limited professionalization in the
field
● Lack of a clear career structure
Data Integrity
● All computer systems are

vulnerable to both human
created threats (e.g. malicious
attacks & software bugs) and
natural threats (e.g. hardware
aging & calamities)
● Inherent sensitivity of health
data
● Ease of sharing
Service Availability and Responsiveness
● Service Availability: required

services are present and usable
when needed
● Responsiveness: system responds
to user input within an expected
and acceptable time period
● Dependent on electricity and
internet
● Hardware aging and computer
bugs/viruses
VI. Resources and Infrastructure
Limitations
VII. Patient Engagement
VIII.Challenges faced by the
developers
LUMINARIAS
Resource and Infrastructure Limitations
● According to National Electrification Administration,
there are over 2.3M households that still do not
have electricity as of 2019
● This poses a problem for rural areas, and creates a
even bigger digital divide
● Digital divide - economic, educational, and social
inequalities between those who have computers
and online access and those who do not.
● This imbalance creates missed opportunities in
education, communication, finance and health.
Resource and Infrastructure Limitations
1. Lack of human resource interested in the field

2. Network Infrastructure
3. Benefits of information technology has not
yet dawned to many decision makers in the
health sector
Patient Engagement
● Changing the habits of patients in regards to
their healthcare by requiring more
responsibility and involvement is a tough
hurdle
● Smartphone applications, and other online
applications allow patient to track their health
goals but product limitations may deter willing
patient participants
Challenges faced by the developers
● Design and development challenges
○ Developing proactive models, methods, and tools to
enable risk assessment
○ Developing standard user interface design features
and functions
● Monitoring, Evaluation, and Optimization challenges
○ Developing real-time methods to enable automated
surveillance and monitoring of system performance
and safety
○ Developing models and methods for
consumers/patients to improve health IT safety
● Certification of products for compliance with standards
IMPROVING
HEALTHCARE
THRU MED
INFORMATICS
ORBITA, DONACAO, LUCIANO

8 ways
1. Better and more efficient data storage
2. Improved healthcare marketing
3. Patient education and prevention
4. Promoting self-monitoring
5. Consistent monitoring of more serious
cases
6. 3D organs and limbs
7. Robotic service
8. Privacy
I. Better and more efficient data
storage
II. Improved healthcare marketing
III. Patient education and prevention
Orbita, Marian Abby

Better and more efficient data storage
● Most medical facilities used old-school methods to store patient records

● Data storage problems:
○ Accessibility
○ Increased workload
○ Lost, misplaced, or damaged
● When they’re stored on a server
○ both patients and medical professionals can reach patient files and records
in a second’s notice
○ patient files are safe from being lost, misplaced or damaged in case of a
disaster at the facility.
○ With easily accessible data, doctors can establish a diagnosis and even
consult with other professionals, if there is a need for such a thing.
Improved healthcare marketing
● Healthcare marketing revolves around education
● With informatics, private practices and hospitals have the ability to
introduce their brand
○ Ex. Informative blogs
● Service quality is now transparent
● As overall quality is at a higher level, there will be no more monopoly
from one or two practices in an area. Services will be far more
accessible and prominent.
Patient education and prevention
● As more and more medical practices post informative blogs, more people
will be educated and be able to prevent diseases that could have been
prevented.
● When we become health-conscious as a society, we will achieve our goal
of living better, longer lives.
● Informatics allows medical professionals to share their knowledge and
connect to their patients like never before
IV. Promoting self-monitoring
V. Consistent monitoring of more
serious cases
VI. 3D organs and limbs
Donacao, Gabrielle Alison
Promoting Self-monitoring
● Health informatics isn’t just an exclusive to medical professionals
○ Major companies developed a line of health apps that is essential for
monitoring your own health
● Using apps can provide informative content that directly leads to the prevention of
conditions and improving the knowledge of each patient
● This will result in doctors having more time to devote to serious cases and patients
who need their help
● The future of medicine, through health informatics, will be everyone being their own
doctor using verified knowledge, informative content and free-to-use resources
Consistent monitoring of more
serious cases
● Scientists have developed several methods that have helped us connect medical
devices to the internet for wireless monitoring
○ Instead of having to go to the doctor’s office on a weekly basis, patients can
get input, information, and advice from their doctors in real time
Consistent monitoring of more
serious cases
● Going to the doctor’s regularly may be seen as a positive thing today, but it’s
negative in the long run. This is because of two main reasons
○ Valuable time is lost
○ Medical professionals will work less efficiently
3D organs and limbs
● One of the most prominent problems in the healthcare industry is providing

organs for people that need transplants
● Health informatics is currently on the road to including 3D printing technology
and software to standard practices
● How will this work?
○ A patient will get a notification or an alert about their condition.
○ With 3D printers, we will be able to print real tissue cells and make ideal
organs for every patient
● Prosthetic limbs are already being 3D printed from titanium and other strong
material
s
3D organs and limbs
A needle prints the alginate into a hydrogel bath, which is later melted away to
leave the finished heart model. Image courtesy of Carnegie Mellon
University/Adam Feinberg
VII. Robotic Service
VIII. Privacy
LUCIANO, Angelica Joy G.
Robotic Service
● Aside from clinical advancements, medical informatics also introduces us to
technological advancements in surgery.
● It helps in minimizing margin error during surgical procedures.
○ Medical errors are the third leading cause of death in the US
● Artificial Intelligence (AI) and Machine Learning (ML) are a big part of health
informatics and we may soon see the inclusion of medical robots.
○ These medical robots will be constantly monitored by software engineers

and medical professionals.
Robotic Service
● Robotic surgeons bring the following benefits to medicine:
○ Increase work efficiency.
○ Minimize surgical errors.
○ They can be specialized.
○ Doctors can control them.
○ Can help with recovery and detecting other symptoms or conditions.

Robotic Service
Robotic Service
World's first 360 VR brain
surgery
• Produced and overseen
by Fundamental VR at the
Royal London Hospital
• This first VR surgery was
conducted during brain
aneurysm operation.
• It was used as a valuable
training tool for
neurosurgeons by
mimicking "hands on"
experience.
● Using blockchain technology, medical professionals
are already experimenting with new methods of data
Priva cy
encryption.
○ Blockchain is a system of recording information

in a way that makes it difficult or impossible to
change, hack, or cheat the system.
○ The goal of blockchain is to allow digital

information to be recorded and distributed, but
not edited.
○ It differs from a typical database in the way it

stores information; blockchains store data in
blocks that are then chained together.
Conclusion
● Instead of looking at technology as a must, medical professionals and
educators have to look at informatics as more of a cultural renaissance of
the medical world.
● To improve healthcare through medical informatics, we first have to

understand the problems that modern medicine faces:
○ There is a dire need for efficiency and better storage of patient data.
○ Improving the contact between patients and medical professionals.
○ Advancement in fields of medicine that are yet to be explored further.

Conclusion
● Impact of the improvements in healthcare system:
○ Doctors will be able to track patients’ health status at any moment, with
interactive alerts for treatment.
○ Priority is given to enable medical professionals to provide better services

with less pressure and an easier workload.
○ Medical professionals can focus on diagnosis, efficient treatment and

providing premium services to patients of all walks of life.
INFORMATION
SYSTEMS IN
HEALTHCARE
LAGURA, MARY RUTH N.
● Sound and reliable information is the foundation of
decision-making across all health system building blocks, and
is essential for health system policy development and
implementation, governance and regulation, health research,
human resources development, health education and
training, service delivery and financing
● The health information system provides the underpinnings
for decision-making and has four key functions:
○ Data generation
○ Compilation
○ Analysis and synthesis
○ Communication and use
Health planners and decision-makers need different kinds of informa
● health determinants (socio-economic, environmental behavioral, genetic factors) and the

contextual environments within which the health system operates
● inputs to the health system and related processes including policy and organization, health
infrastructure, facilities and equipment, costs, human and financial resources, health
information systems
● the performance or outputs of the health system such as availability, accessibility, quality
and use of health information and services, responsiveness of the system to user needs,
and financial risk protection
● health outcomes (mortality, morbidity, disease outbreaks, health status, disability,
wellbeing)
● health inequities, in terms of determinants, coverage of use of services, and health
outcomes, and including key stratifiers such as sex, socio-economic status, ethnic group,
geographic location etc
Expectations of a country health information system
● Individual level data

● Health facility level data
● Population level data
● Public health surveillance
Sources of information about the country health inform
● Ministries of Health
● National Statistics Offices
● International agencies
Criteria for assessing country health
information system performance
INFORMATION
SYSTEMS IN
HEALTHCARE
- continued -
VILLARIN, JAIME
Methods for assessing country health informa
performance
Self-assessment approaches
● General Data Dissemination Strategy (GDDS)

○ Assist countries in assessing and documenting their statistical practices and procedures
and compiling metadata
○ Enable countries develop and implement plans for improvement in the different areas of
statistics covered by the GDDS
○ Principal goal: Improve data quality
○ Providing short-term technical assistance to countries to engage in a systematic review of
existing statistics as compared to international standards, essentially an externally
facilitated self assessment
performance
Self-assessment approaches
● HMN health information system assessment
○ Brings together country users and producers of health data to assess the strengths and
weaknesses of the national health information system.
○ Assessment tool framework; five main dimensions of data quality;
■ Integrity
■ Methodological soundness
■ Accuracy and reliability
■ Serviceability
■ Accessibility
○ Encompasses characteristics related to the institution or system behind the production of
the data as well as characteristics of the individual data product.
performance
Independent assessment approaches
● World Bank Statistical Capacity Indicator

○ Desk review by external technical experts
○ Provides an overview of the statistical capacity of developing countries
○ Framework has three dimensions:
■ Statistical practice (ability to adhere to internationally recommended standards and
methods)
■ Data collection (frequency of censuses/surveys and completeness of vital
registration)
■ Indicator availability (availability and frequency of key socioeconomic indicators).
Core indicators for country health information
performance
Indicators can be grouped into two broad types:
● Indicators related to data generation using core sources and methods
● Indicators related to country capacities for synthesis, analysis and validation of data.
performance
Health surveys
1.Country has a 10 year costed survey plan that covers all priority health topics and takes into account
other relevant data source
2. Two or more data points available for child mortality in the past 5 years
3. Two or more population-based data points for maternal mortality in the last 10 years
4. Two or more data points for coverage of key health interventions in the last 5 years
5. One or more data point on smoking and adult nutritional status in the last 5 years
Birth and death registration

6. Percentage of births registered
7.Percentage of deaths registered
8. ICD10 used in district hospitals and causes of death reported to national level
Census
9. Census completed within past 10 years
10.Population projections for districts and smaller administrative areas available in print and
electronically, well documented
performance
Health facility reporting
11.Number of institutional deliveries available, by district, and published within 12 months of
preceding year
12.HIV prevalence for relevant surveillance populations published within 12 months of preceding year
13.Country web site for health statistics with latest report and data available to the general public
14.Reporting of notifiable diseases makes use of modern communication technology and reporting of
statistics from district to national levels is web-based
15.Percentage of districts that submit timely, complete, accurate reports to national level
16.Data quality assessments carried out and published within last 3 years
17.International Health Regulations implemented according to international standards
performance
Health system resource tracking
18.At least one national health accounts completed in last 5 years
19.National database with public and private sector health facilities, and geocoding, available
and updated within last 3 years
20.National database with health workers by district and main cadres updated within last 2
years
21.Annual data on availability of tracer medicines and commodities in public and private health
facilities
performance
Capacity for analysis, synthesis and validation of health data
22.There is a designated and functioning institutional mechanisms charged with analysis of

health statistics, synthesis of data from different sources and validation of data from population
and facility sources
23.There is a national set of indicators with targets and annual reporting to inform annual health
sector reviews and other planning cycles
24. There is a national microdata archive for health surveys and census that is operational
25.Survey data are used to assess and adjust routine reports from health facility on vaccinations
with the results published within 12 months of the preceding year
performance
Capacity for analysis, synthesis and validation of health data
26.A burden of disease study has been conducted within the last 5 years by national
stakeholders
27.A study of health systems performance has been carried out within the last 5 years by
national stakeholders
28.There is national commitment to transparency in data dissemination and acknowledgement
of uncertainty
29.The official annual health statistics report has been published within 12 months of the
preceding (calendar or fiscal) year
BIOMEDICAL
INFORMATICS
GARING, ADRA, NAJITO

The Information
Revolution Comes
to Medicine
GARING
● clinical workstations have been available on hospital wards and in
outpatient offices for years, and are being gradually supplanted by mobile
devices with wireless connectivity
● enormous technological advances of the last three decades have all

combined to make the routine use of computers by all health workers and
biomedical scientists inevitable
○ Personal computers and graphical interfaces,
○ new methods for human-computer interaction,
○ innovations in mass storage of data (both locally and in the“cloud”),
○ mobile devices, personal health monitoring devices and tools,
○ the Internet,
○ Wireless communications,
○ social media
● care organizations have recognized that they need:
○ systems in place that effectively allow them to answer questions that
are crucially important for strategic planning
■ for their better understanding of how they compare with other
provider groups in their local or regional com petitive
environment
■ reporting to regulatory agencies
○ administrative and fifi nancial data were the major elements required
for such planning
○ comprehensive clinical data are now also important for institutional
self analysis and strategic planning
● principal barriers that clinicians encounter when trying to increase
efficiency in order to meet productivity goals in the practice of
medicine
○ inefficiencies and frustrations associated with the use of
paper-based medical records are now well accepted
○ inadequate access to clinical information
Integrated
Access to
Clinical
Information
● most health care institutions are seeking to develop integrated
computer-based information-management environments
○ single-entry points into a clinical world in which computational
tools assist with:
■ patient-care matters
■ administrative and financial topics
■ research
■ scholarly information
■ office automation
“In the heart of the evolving integrated environments lies
an electronic health record that is intended to be
accessible, confidential, secure, acceptable to
clinicians and patients, and integrated with other
types of useful information to assist in planning
and problem solving”- Shortliffe & Cimino, 2014
Moving
Beyond the
Paper
Record
Anticipating
the Future of
Electronic
Health
Records
Communication
s Technology
and Health
Data
Integration
● Introduction of the internet and the World Wide Web
● Integration of information from multiple clinical and administrative systems

within their organizations health planners and governments
● Appreciation of the need to develop integrated information resources that

combine clinical and health data from multiple institutions within regions,
and nationally.
A Model of
Integrated
Disease
Surveillance
● The practical need to pool and integrate clinical data from such diverse
resources and systems emphasizes the practical issues that need to be
addressed in achieving such functionality and resources.
● Barriers:
○ Encryption of data
○ Health Insurance Portability and Accountability Act (HIPAA) compliant
policies
○ Standards for data transmission and sharing
○ Standards for data definitions
○ Quality control and error checking
○ Regional and national surveillance databases
The Goal: A
Learning
Health Care
System
ADRA
Implications
of the
Internet for
Patients
- There is an increasing numbers of patients and healthy individuals that are turning to
the Internet for health information
- Health -related sites are among the most popular ones being explored by consumers
- Physicians and other care providers →must be prepared to deal with the information
the patients discover on the net
- Some of the information is timely and excellent →physicians can often learn about
innovations from patients
- Much of the information on the Web →lacks per review or purely anecdotal →
misleading
Education
and Training
VISION: LEARNING HEALTH CARE SYSTEM
Educational institutions produce a cadre of talented individuals

→comprehend computing and communications technology
→Have deep understanding of the biomedical milieu and the needs
of practitioners and other health workers
- Provide more training programs

- Expansion of those that already exist
- Provide support for junior faculty in health science schools who may
wish to pursue additional training in this area
Organizational
and
Management
Change
REPORTED PROBLEMS OF HEALTHCARE ORGANIZATIONS IN
EFFORT TO USE COMPUTER
- Underinvestment
- Failure to understand the requirements for process reengineering as
part of software implementation
- Problems with technical leadership and planning
VISION: LEARNING HEALTH CARE SYSTEM
- Cyclical creation of new knowledge will become reality only if:
→individual hospitals, academic medical centers, and national

coordinating bodies work together to provide the standards,
infrastructure, and resources that are necessary
- Learning health care notion is not only focused on clinician’s view of

integrated information access, other workers, and patients should also
be considered (patient-centered health care)
Defining Biomedical
Informatics and
Related Disciplines -
Terminology
Information theory →concerned about the physics of communication, viewed as a
branch of mathematics
Biomedical computing or biocomputation →computers are employed for some

purpose in biology or medicine
→associated with bioengineering applications
Medical informatics →(1970), has an emphasis on information →more central to the

field than computer itself
Medical information science →(1980) can be confused with library science, hence
medical informatics become the preferred term
Biomedical informatics →most widely accepted term for core discipline

→encompasses all areas of application in health, clinical practice, and biomedical
research.
Biomedical
Informatics
Definition of Biomedical Informatics
Interdisciplinary field that studies and pursues the effective uses of

biomedical data, information, and knowledge for scientific inquiry, problem
solving, and decision making, driven by efforts to improve human health
Theory and methodology

→BMI develops, studies, and applies theories, methods, and processes for
the generation, storage, retrieval, use, management, and sharing of
biomedical data, information, and knowledge.
Definition of Biomedical Informatics
Technological approach
→ BMI builds on and contributes to computer, telecommunication, and
information sciences and technologies, emphasizing their application in
biomedicine
Human and social context

→ BMI recognizes that people are the ultimate users of biomedical
information
→draws upon social and behavioral sciences to inform the design and
evaluation of technical solutions and policies
Relationship to
Biomedical Science
& Clinical Practice
NAJITO, Czarina Marie D.
Relationship to Biomedical Science
and Clinical Practice
Biomedical science Biomedical informatics
constrained by that structure. melds the study data, information,

knowledge, decision making, and
supporting technologies with
analyses of biomedical information
and knowledge
Biomedical informatics is perhaps best viewed as a basic biomedical

science, with a wide variety of potential areas of application
Relationship to Biomedical Science
and Clinical Practice
Relationship
to Biomedical
Engineering
NAJITO
Biomedical engineering
● In recent years, computing techniques have been used both
in the design and construction of medical devices and in the
medical devices themselves
○ “smart” devices
■ increasingly found in most medical specialties
are all dependent on computational
technology.
■ Intensive care monitors that generate blood
pressure records while calculating mean
values and hourly summaries
● The overlap between biomedical engineering and BMI
suggests that it would be unwise for us to draw
compulsively strict boundaries between the two fields.
○ There are ample opportunities for interaction
● There are ample opportunities for interaction
● Even where they meet, however, the fields have
differences in emphasis that can help you to understand
their different evolutionary histories.
Biomedical engineering Biomedical informatics
Older discipline, more established Younger discipline
emphasis is on medical devices emphasis is on biomedical

information and knowledge and on
their management with the use of
computers
○ computer is secondary, although both use computing technology

1st Philippine National Biomedical Engineering Conference (PNBMEC 2020) - De La Salle University (dlsu.edu.ph)
● PNBMEC was conceived to bring together various stakeholders, experts in the fields of engineering and medical
sciences, industry partners, government agency representatives and solution providers to share knowledge and
encourage discussions on the latest developments including emerging challenges faced in the
advancement of the Biomedical Engineering sector, specifically at the local setting.
The Nature of
Medical
Information
The Nature of Medical Information
● Clinical information seems to be systematically different from the
information used in physics, engineering, or even clinical chemistry
(which more closely resembles chemical applications generally than it
does medical ones).
● Aspects of biomedical information include an essence of uncertainty—
we can never know all about a physiological process—and this results in
inevitable variability among individuals.
● These differences raise special problems and some investigators
suggest that biomedical computer science differs from conventional
computer science in fundamental ways
● The use of computers in various low - level processes
(such as those of physics or chemistry) is similar and is
independent of the application
● there are other higher - level processes carried out in
more complex objects such as organisms (one type of
which is patients).
● We must be prepared to analyze most of the complex behaviors
that human beings display and to describe patients as completely
as possible.
● We must deal with the rich descriptions occurring at high levels in
the hierarchy, and we may be hard pressed to encode and process
this information using the tools of mathematics and computer
science that work so well at low levels.
● In light of these remarks, the general enterprise known as artificial
intelligence (AI) can be aptly described as the application of
computer science to high-level, real-world problems.
● In light of these remarks, the general enterprise
known as artificial intelligence (AI) can be
aptly described as the application of
computer science to high-level,
real-world problems.
● Biomedical informatics thus includes
computer applications that range from
processing of very low-level descriptions,
which are little different from their
counterparts in physics, chemistry, or
engineering, to processing of extremely
high-level ones, which are completely and
systematically different.
● It is difficult or impossible, however, to assume that all propositions have truth values when
we deal with the many high- level descriptions in medicine or, indeed, in everyday
situations.
Low-level objects High level objects
● sharp, crisp, and unambiguous ● soft, fuzzy, and inexact
● e.g., “length,” “mass” ● e.g., “unpleasant scent,” “good”

Integrating
Biomedical
Informatics &
Clinical Practice
Integrating Biomedical Informatics
& Clinical Practice
● The degree to which such changes are realized, and their rate of occurrence, will be
determined in part by external forces that influence the costs of developing and
implementing biomedical applications and the ability of scientists, clinicians, patients, and
the health care system to accrue the potential benefits.
& Clinical Practice
● We can summarize several global forces that are affecting
biomedical computing and that will determine the extent
to which computers are assimilated into clinical practice:
○ (1) new developments in computer hardware and
software;
○ (2) a gradual increase in the number of individuals
who have been trained in both medicine or another
health profession and in BMI; and
○ (3) ongoing changes in health care financing
designed to control the rate of growth of
health-related expenditures.
New developments in hardware &
software
● The new hardware technologies have made powerful
computers inexpensive
● Standardization of hardware and advances in network
technology are making it easier to share data and to integrate
related information management functions within a hospital or
other health care organization.
Gradual increase in the number of individuals trained in
medicine, health profession and/or biomedical informatics
● Computer scientists who understand

biomedicine are better able to design systems
responsive to actual needs and sensitive to
workflow and the clinical culture
● Health professionals who receive formal training
in BMI are likely to build systems using well
established techniques
○ while avoiding the past mistakes of other
developers
ongoing changes in health care financing designed to
control the rate of growth of health-related expenditures
● integration of computing technologies into

health care settings is managed care and the
increasing pressure to control medical
spending
○ The escalating tendency to apply
technology to all patient-care tasks is a
frequently cited phenomenon in modern
medical practice
○ Mere physical findings no longer are
considered adequate for making
diagnoses and planning treatments
& Clinical Practice
● Development of expensive new
technologies, and the belief that more
technology is better, helped to fuel the
rapidly escalating health care costs of the
1970s and 1980s, leading to the introduction
of managed care and capitation
Integrated computer systems potentially provide the means to

capture data for detailed cost accounting, to analyze the relationship
of costs of care to the benefits of that care, to evaluate the quality of
care provided, and to identify areas of inefficiency
& Clinical Practice
● In summary, rapid advances in computer hardware and software, coupled with an
increasing computer literacy of health care professionals and researchers, favor the
implementation of effective computer applications in clinical practice, public health, and
life sciences research.
● In the increasingly competitive health care industry, providers have a greater need for the
information management capabilities supplied by computer systems.
● The challenge is to demonstrate in persuasive and rigorous ways the financial and clinical
advantages of these systems
Thank you!
MED
INFORMATIC
S
SGD 4
CALLADA-CASTUERA-DACILLO-GALVEZ
JAMISOLA-MARCO-MENDOZA-OROZCO
PICONES-ROCHA-TAN
TOPIC OUTLINE
Public Health Informatics

Medical Informatics &
Castuera | Orozco |
Picones
01 04 Intelligent Clinical
Decision Support
Rocha | Tan
Telehealth/Telemedicine
Callada | Dacillo | Galvez E. 02
Role of Internet in
Public Health
Informatics 03
Jamisola | Marco | Mendoza
Public Health
Informatics
Public Health
Informatics
Definition: The systematic application of information, computer science and technology
in areas of public health, including surveillance, prevention, preparedness, and health
promotion.
MAIN FOCUS: Use of information science and technology for promoting population
health rather than of individuals.
Leans more to a disease prevention rather than treatment focus in order to prevent
chain of events or disease spread.
Often operates at the level of government rather than at the private sector
Applications of
PHI
The main applications of PHI are:
1. promoting the health of the whole population, which will ultimately promote
the health of individuals
2. preventing diseases and injuries by changing the conditions that
increases the risk of the population
Basically, PHI is using informatics in public health data collection,

analysis and actions.
What separates PHI from the other field
Informatics?
1. Emphasis on disease prevention in the population,
2. realizing its objectives using a large variety of interventions,
and
3. work within governmental settings
What is the scope of PHI?

Conceptualization, design, development, deployment, refinement,
maintenance, and evaluation of communication, surveillance, and
information systems relevant to public health
PHI could be considered one of the most useful systems in

addressing disease surveillance, epidemics, natural disasters
and bioterrorism.
Surveillance
System
● Surveillance in public health is the collection, analysis and interpretation
of data that are important for the prevention of injury and diseases
● Possible early detection of outbreaks can be achieved through timely
and complete receipt, review, and investigation of disease case reports.
● An inclusive surveillance effort supports timely investigation and identifies
data needs for managing public health response to an outbreak or
terrorist event
Surveillance
● System
Worldwide, governments strengthen their public health
disease surveillance systems by taking advantage of
modern information technology to build an integrated,
effective, and reliable disease reporting system.
○ Syndromic Surveillance Systems- Functions to collect symptoms and
clinical features of an undiagnosed disease or health event in near real
time that might indicate the early stages of an outbreak or bioterrorism
attack. This may be used to provide available patient data in conditions of
natural disaster when paper-based records might be destroyed or
unavailable
○ Geographic information system (GIS)- one of the latest development of
public health informatics. Uses digitized maps from satellites or aerial
photography to provide a large volume of data. This proved to be useful
tracking infectious disease, public health disasters and bioterrorism.
• Electronic surveillance systems
Surveillance
• This transformation has been facilitated by the
modern Public Health Information Network
systems
(PHIN), vidiPngAPeffiEcRie-
nBtAni SfoErDmSatUo i RnVaEccILeLssAaNnCdEex
among public health agencies at different levels.
• ImnfaoinrmlyaintiothneinfoPrHmINofispasphearerdeptohrotsusguhbtmheitnteedtwfroormkand
chaonspbiteaslst,oprehdysaicnidanrestraienvdecdlienaicssilyto,alnodcaitlhcoeaultdhbe
dtreapcakretdmbeanctks.tosources
Modern surveillance
systems
Surveillance Advantages Disadvantages
System
• Well-established, standardized system • Difficult to rapidly detect variation in the
of data collection and reporting quality of reporting between quarters and
• Relatively low technology threshold among administrative levels
required for implementation • Time-consuming manual entry, compilation,
• Can be easily implemented at all levels transfer and analysis of data
Paper-based
of health care • Restricted ‘real-time’ quality control and
• Low costs to implement and maintain validation of data for supervision
• Limited options for securing data to maintain
patient confidentiality and prevent data loss
• Time-saving (record reviews, patient • Dependent on a well-established

follow up) paper-based system
• Real-time report generation capability • Increased infrastructure needs (e.g.
(standardized; when necessary or computers, regular electricity supply)
needed) • Specialized human resource requirements
Electronic
• Allows for complex analyses • Specialized training and support
• Increased accuracy and confidentiality requirements
controls • Higher implementation and maintenance
• Safer data maintenance (i.e., patient cost
confidentiality and integrity)
APPLICATIONS OF PUBLIC
HEALTH INFORMATICS
1. Source of data
2. Essential tool in estimation of mortality and morbidity
3. Assist in estimation of health resources and manpower
4. Collection and analysis of real-time data
5. Role in response to worldwide disasters
6. Monitor and detect population at risk
7. Prevent diseases and outbreaks
PUBLIC HEALTH
INFORMATICS
● Electronic reporting systems played role in preventing spread of diseases
by reducing the financial and human impact of diseases on the society as a
whole
● Revolution of information technology and the urge to incorporate it into
different aspects of healthcare has become a required task for public
health leaders
● Patients, healthcare professionals, and public health officials can all help
in reshaping public health
TELEHEALTH
TELEMEDICINE
&
CALLADA, DACILLO,
GALVEZ, E.
MAIN REFERENCE:
Essentials of Telemedicine and
Telecare by AC Norris
TIPS FOR
ONLINE
MEETINGS
Here is where your
presentation begins
ORIGINS
and
DEVELOPMENT
Danica M. Dacillo
Contents
❑ Definitions of Telemedicine,
Telehealth and Telecare
❑ Origins and Development of
Telemedicine
❑ Drivers of Telemedicine and
Telecare
❑ The Future for Telemedicine
Telemedicine
• Medicine delivered at a distance
• The transfer of electronic medical data from one
location to another
• Telemedicine is the use of telecommunications to
provide medical information and services (1995)
• Telemedicine utilizes information and
telecommunications technology to transfer medical
information for diagnosis, therapy and education (1999)
Telehealth
• expansion beyond the confines of clinical
medicine
• use of information and communication
technologies to transfer healthcare
information for the delivery of clinical,
administrative and educational services
Telecare
• application of telemedicine to deliver medical services to
patients in their own homes or supervised institutions
• distinct from telemedicine because it is especially
important for a specific group of patients with long-term
chronic conditions
• definitions of telemedicine and telehealth could
encompass telecare
• utilizes information and communication technologies to
transfer medical information for the diagnosis and
therapy of patients in their place of domicile
Summary
• Telemedicine:use of information and communication technologies
to transfer medical information for the delivery of clinical and
educational services.
• Telehealth:the use of information and communication
technologies to transfer healthcare information for the delivery of
clinical, administrative and educational services.
• Telecare:the use of information and communication technologies
to transfer medical information for the delivery of clinical services
to patients in their place of domicile
ORIGINS AND DEVELOPMENT OF TELEMEDICINE
Development phase Approximate
timescale
Telegraphy and telephony 1840s- 1920s
Radio 1920s onwards (main

technology until 1950s)
Television/space 1950s onwards (main
technologies technology until 1980s)
Digital technologies 1990s onwards

In the Philippines
• University of the Philippines (Manila) National
Telehealth Center (UPM-NTHC): pioneered open-source
telemedicine and mHealth projects
✔ RxBox
✔ CHITS – Community Health Information
Tracking System
Philippine Research, Education and Government
Information Network (PREGINET)
• allows doctors and medical practitioners to diagnose and examine
patients in far-flung communities, geographically isolated regions, or
underserved areas via telemedicine
• addressing problems of accessibility, quality, and cost of healthcare
• high quality operation footage and consultations
• enables continuing education for doctors, caregivers, and other healthcare
practitioners
• doctors can more easily obtain continuous education as local clinicians
can easily consult or discuss with their colleagues here in he Philippines or
specialists abroad
Drivers of Telemedicine and Telecare
Technology Drivers Non-Technology Drivers

● computing and ● extension of access
information to healthcare service
technology ● healthcare provision
● network and for travellers
t elecommunicati ● military applications
ons ● home t elecare
infrastructure ● cost reduction
● t echnology-led ● market development
society ● health policy and
strategy
Technology Drivers
❖ Computing and Information Technology
o transition from analogue to digital communications
o role of computing
o development in IT expands access🡪 improves existing services
🡪 new facilities
o Falling equipment costs, increased power on the desktop and
ease-of-use, modern developments in videoconferencing.
❖ Network and Telecommunications Infrastructure
o ability to share information over local and wide area computer networks.
o development and convergence of communications technologies
o new transmission protocols
❖ Technology Led Society
o speed, convenience and quality
Non-Technological Drivers
❖ Extension of Access to Healthcare Services
o individuals and communities who have limited, negligible access to
such services
❖ Healthcare Provision for Travelers
o people who live within permanent access of first-level medical
services may who are denied such assistance on their travels
o healthcare while ‘in transit’ is assuming greater importance
❖ Military Applications
o patients prevented from normal access to first-class medical
facilities
o emergencies which are likely to be serious injuries incurred in
conflict and of a different type (e.g. gunshot or explosion injuries)
o new and better opportunities for triage and life-saving treatment
Non-Technological Drivers
❖ Home Telecare
o ageing population
o reduce costs by providing home care instead of expensive hospitalisation
o possible to replace some of the home visits by tele-visits
❖ Cost Reduction
o reduce the medical and economic risks associated with delivering
healthcare to patients in rural areas
o provide remote, low-cost speciality services where full-time staffing is
impractical
❖ Market Development
o market for telemedicine suppliers has yet to take o ff
❖ Health Policy and Strategy
o Policies which incorporates any telemedicine service as a routine tool
o Inclusion of telemedicine in thinking and planning for future services
o Malaysian government has embarked upon a Multimedia Super Corridor
Programme
The Future of Telemedicine
• Moving telemedicine into the mainstream
• Health policy and strategy
• Telecare
• role of the Internet
• Enhancing healthcare in underdeveloped countries
SCOPE
, BENEFITS
and
LIMITATIONS of
TELEMEDICINE
Contents
❑ Types of Telemedicine
❑ Benefits and Limitations of
Telemedicine
❑ Barriers to Progress
Types of Telemedicine
Tele-education
• information sources
available over the Internet Teleconsultation
• use of telemedical links to • telephone conversation be
deliver educational obtain a second opinion
material • patient and his doctor com
videoconferencing link
Telesurgery
Telemonitoring
• Tele mentoring: assistance
given by specialists to • use of a t elecommu
surgeons gather routine or re
• Telepresence: robotic patient’s condition
arms to carry out remote
surgical procedures
Tele-education
❖ Clinical education from teleconsultation
o teleconsultation takes place involving a healthcare worker and an expert
consultant where there is an opportunity for education
❖ Clinical Education via the Internet
o specialised access to some excellent web and other online resources
o specialised databases or literature searching tools such to retrieve
evidence-based information
❖ Academic Study via the Internet
o universities offering degree and other courses by distance learning
❖ Public Education via Telemedicine
o education of the community at large about matters of public health (e.g. issues
of diet, exercise and hygiene)
o information can be presented (pushed) or received (pulled)
o advertise facilities such as surgery hours, pharmacist opening times
Tele-education
Telesurgery
Telemonitoring
surgical procedures
Teleconsultation
• Most frequent example of telemedical procedures
• accounts for about 35% of the usage of telemedicine networks
• can take place between two or more carers without patient involvement/
between one or more carers and a patient
• Tachakra and Haig identify the following prerequisites of teleconsultation
process:
❑ Agree on the purpose of the teleconsultation
❑ Establish the process und content of the teleconsultation
❑ Ensure practitioners are trained in the use of equipment
❑ Formalize the delegation of clinical responsibilities'
❑ Decide on documentation
Tele-education
Telesurgery
Telemonitoring
surgical procedures
Benefits of Telemedicine
✔ better access t o healthcare

✔ access t o better healthcare
✔ improved communication between carers
✔ easier and better continuing education
✔ better access t o information
✔ better resource utilization
✔ reduced costs
Limitations of Telemedicine
● poor patient-carer relationships

● impersonal technology
● organisational disruption
● additional training needs
● difficult protocol development
● uncertain quality of health information
● low rates of utilisation
BARRIERS TO PROGRESS
▸ factors external to telemedical practice that will inhibit its development

▸ knowledge barriers have to be overcome in several areas before take-up
is possible, and classify these barriers as technical, economic,
organizational and behavioral
o telecommunications infrastructure and standards
o cost effectiveness
o national policy and strategy
o ethical and legal aspects
Telecommunications Infrastructure
and Standards
● Bandwidth of the shared link (capacity to carry

telemedical data)
□ not be possible to transfer large images such as
X-rays or even to establish usable videoconferencing
links
● Incompatibility of operating standards or protocols
□ transmitted data are either not received or are
unintelligible to the receiving station
Cost Effectiveness
● Why is the cost effectiveness of telemedicine is a major

subject of debate?
□ majority of pilot studies were/are funded by government
and academic grants, and they have been more
concerned with technical and clinical feasibility than cost
effectiveness
□ quite difficult to evaluate the cost benefits of a
telemedicine application
● uncertain cost benefits have deterred commercial companies
from entering the field
National Policy and Strategy
● Since this is considered as driver for

progress then its absence can act as
a brake
● coordinated action of the planners
will produce more rapid and
successful development than the
fragmented stance
Ethical and Legal Aspects
● confidentiality and security

● patients’ right of access
● data protection
● duty of care, standards of care
● Malpractice
● suitability and failure of equipment
● physician licensure and accreditation
● physician reimbursement
● intellectual property rights
TECHNOLOGY OF
TELEMEDICINE
SYSTEMS
GALVEZ, E.
OUTLINE
1. Types of Telemedicine Information

2. File Compression
3. Frame Rate and Bandwidth
4. Telecommunication Standards
5. Telecommunication System Components
6. Service Considerations
TYPES OF TELEMEDICINE INFORMATION
F2F CONSULTATIONS - Sight, sound, touch, smell and taste
TELEMEDICINE – Sensory data (sight & sound) -> electrical impulses -> remote physician
4 TYPES:
1. Text And Data
2. Audio
3. Still (Single) Images
4. Video (Sequential Images)
TEXT & DATA
ELECTRONIC DOCUMENTS
(reports, correspondence or
medical records) -> digital
format -> edited using word Frequently, textual
processor, database or information is needed before
spreadsheet program (seldom the teleconsultation takes
necessary or desirable) place or later, as a
consequence of the process.
PAPER DOCUMENTS ->
digitized using scanner (e.g.
fax) or a document camera
Post/email attachments
NOTE: Unless optical

character recognition (OCR) is
used, it will be in bitmapped
format and cannot be edited
m-Health (mobile health)
Cellular phone technologies Txt2medline
– SMS or Text Messaging •System for processing incoming Short Message Service
– MMS Picture Messaging (SMS) queries, retrieving medical journal citations from
MEDLINE/PubMed and sending them back to the user in the
– Chat text message format
– Voice Mail Server •Size of text in journal citations and abstracts is reduced using
– Broadcast Messages a database of medical terminology abbreviations and
acronyms (because of the 160-character per message
– Global Positioning System limit of text messages)
–Special programs like
Txt2medline
AUDIO
•Public switched telephone network (PSTN, sometimes
known as the plain old telephone system/POTS) – analogue
telephony
• Can be used to transmit sound (speech) for remote
diagnosis BUT:
• Quality (ease of understanding) ✘
• Bandwidth (capacity to carry information) ✘
• Hissing noise
•Digital signals – large distances w/o degradation, can also

be manipulated to improve system performance
Special sound cards that slot easily into a PC &
once installed, no special equipment other than a
suitable microphone is needed
• Can also receive audio output directly from medical
peripherals such as an ultrasound scanner
• Windows OS – standard WAV format
STILL (SINGLE) IMAGES
• Quality defined by the size of a pixel (picture
element) in an image and the number of grey or
colour levels
• Parameters determined by the quality of the
scanning device which uses photosensitive,
charge coupled diode (CCD) transducers to
digitize the image
• Smaller pixel size, more pixels in the picture
& higher resolution
• Each pixel allocated a fixed number of bits to
represent its grey-scale or color level
• Usually up to 8 bits (255 levels) for
grey-scale and up to 24 bits (16.77 million
levels) for colour (depth)
So why not use the maximum number of bits all the

time?
VIDEO (SEQUENTIAL
IMAGES)
• Videoconference between patient and consultant
regarded as the normal practice of telemedicine
• Important consideration for international
teleconsultations is the compatibility of the
analogue video signals, and therefore the video
equipment, in different countries.
• National Television Standards Committee
(NTSC) system in North America & Japan ->
525 lines per picture and a frame rate of 30
pictures per second
• Phase Alternating Line (PAL) system in
Western Europe & Australasia -> 625 lines per
picture and a frame rate of 25 pictures per
second
• Sequential Couleur a Memoire (SECAM)
system in France, Russia and the former
Warsaw Pact countries
FILE COMPRESSION
• Still image sizes, more so video sizes, create problems for image
storage and transmission (including cost), hence use of compression
• Lossless - compression/decompression (codec) algorithm
reversible without losing data or the full resolution of the
original image
• Portable Network Graphics (PNG)
• RAW
• Waveform Audio File Format (WAV)
• Lossy - discards data to achieve higher compression ratios and
decompression cannot recover the original image with its full
definition
• Joint Photographic Expert Group (JPEG) – image standard
• Motion Pictures Expert Group Audio Layer III (MP3)
FRAME RATE &
BANDWIDTH
• Video frame rates of 25 discrete pictures per
second and above fool the human brain into
perceiving continuous and smooth motion
• Video compression – display frame rates may
fall -> sequence of events/screen may appear
discontinuous/jerky (motion artefact)
• Ultimate solution: to increase the
bandwidth at a cost
• No-cost, sometimes acceptable
compromise: reduce the size of the
display window and hence the number of
pixels needed to output a frame
TELECOMMUNICATION STANDARDS
For telemedicine to work, the units at both ends of the teleconferencing link must use the same codec
algorithms and other transmission protocols.
□United Nations International Telecommunications Union (ITU) - a range of standards to guarantee
interoperability even if the videoconferencing equipment originates from different manufacturers.
TELECONSULTATION SYSTEM COMPONENTS
1) Videoconferencing System - frequently commercially built unit that organizes the
transmission, reception and storage of information from the teleconsultation process
❑ ROLLABOUT SYSTEMS - self-contained, mobile units comprising a monitor or

television screen atop a console containing the associated hardware
▪ Console with wheels or castors, so that it can be moved between sites, and
has sockets for local electrical connections
▪ Produce high-quality sound and video and are widely used in business
❑ SET-TOP SYSTEMS - also portable but miniaturization puts all the circuitry into a
single box that sits on top of a conventional TV
▪ moderate quality
❑ DESKTOP SYSTEMS – circuitry located on a standard PC card for insertion into a
desktop computer
▪ Quality sacrificed for convenience although utility is still high and cost low
TELECONSULTATION
SYSTEM COMPONENTS
2)Multipoint Systems - multiple transmitting/receiving stations in the
videoconferencing link-up
• Technical approach depends upon the telecommunications protocol
○ H.320 systems operating w/ the ISDN standard: point-to-point systems
that need a hardware device known as a multipoint control unit
○ H.333 systems using Internet protocols: hardware/software multipoint
conference server
2)Image Display System - critical part as the main substitute for the visual exam
carried out by the physician in a F2F consultation
• Image fidelity - closeness to the original image, be it a view of a person’s eye
or an X-ray film
○ Physical measurements such as luminance, dynamic range, resolution
• Image information content - more subjective & reflects the amount of info
needed to detect diagnostically important features
> Ultimate determinants of video quality: image resolution and effective frame rate
TELECONSULTATION SYSTEM COMPONENTS
4) Telemonitoring Devices – When further diagnostic information is needed then it
can be obtained from medical peripherals that act as telemonitoring devices.
▪ Special versions of common instruments (stethoscopes, blood pressure
monitors, microscopes, etc.) - output in the form of audio, electrical, or video
signals fed directly into the videoconferencing system and retrieved at the
remote site
SERVICE CONSIDERATIONS
• Link confined to a single site - local area network (LAN) system
• More often than not - wide area network (WAN) for extended distances
SYSTEMS INTEGRATION
• Crucial issue for clinicians, managers and information
system technologists, as well as for patients
• GPs/clinics, hospitals, hospital depts, health orgs,
patient
• Challenges: Uncoordinated planning and legacy and
proprietary systems with limited or no networking
capabilities
• Crucial - upgrading systems and services with future
provision of telemedical facilities in mind
• Building flexible, standardized systems that can be
upgraded incrementally with minimum disruption
• Adopt open systems technologies
• Interoperability - ability of hardware and
software to work together
• Portability - ability of software designed for
one computer platform to work on others
• Scalability - the ability of software to
function properly on both small and large
systems
vsaq-demo.withgoogle.com
ELECTRONIC PATIENT RECORDS (EPRs)
• Real benefits only become evident when you have the patient’s full and
current medical record available BEFORE OR AT the time of the
teleconsultation
• Important to maintain electronically so that the record can be referred to
during the consultation and updated during the teleconsultation or after it
ends
• Software can be written to automate these processes
❑ Comprehensive
❑ Accessible (even across network infrastructures & protocols)
❑ Updated
❑ Has links to scientific knowledge databases, to support clinical decision
making and the prescription of generic and cost-effective drugs
CHITS
Community Health Information Tracking ● Enables community to use data for local
System decision-making and health planning
•A computerized patient record system for quality ○ Health monitoring, morbidity and
health care and management even in remote mortality rates, prediction of outbreaks,
areas immunization
•Created in 2004 by Herman Tolentino through a ● Ensures sufficient drug supplies to health
grant from international Development Research centers
Center (IDRC) of Canada ● Telehealth services
•Managed by UP Manila National Telehealth ○ Consultations with PGH, patient
Center (UP Manila NThC) headed by Dr. Alvin monitoring, patient/care provider
Marcelo education, teleconferencing
•Installed in government health centers; ● Data consolidation among clinics and
community-based hospitals
○ Integration of services, decision
support, research
● Nationwide network potential with 1900 rural
health unts (RHUs) across the country
STORE-AND-FORWARD OPERATION
• Refers to situations in which information has been prerecorded before
transmission and reception, i.e. the information is not transferred during
the teleconsultation
• Email is currently a useful alternative
• Advantage: Link between sites does not need to be operational at all
times
• Digitized electrocardiographs (ECGs) and electroencephalograms (EEGs)
are the most common examples
REAL-TIME TELEMEDICINE
• Allows interaction & is also used when an immediate outcome is needed,
e.g. in an emergency
• Needs higher bandwidth vs store-and-forward operations
• Makes use of all of the data types that we have identified
✔ Telepsychiatry - one of the earliest and probably the most successful
application since it is difficult to do in store-and-forward mode
✔ Accident and emergency telemedicine – to avoid delays
TELEMEDICINE
SERVICE
PROVIDERS &
APPLICATIONS
GALVEZ, E.
OUTLINE
MAIN USERS AND APPLICATIONS OF TELEMEDICINE
1. Mainstream healthcare services

○ GPs and hospital clinicians
○ Community sector professionals who provide telecare services
○ Ambulance services
○ Pharmacists
2. Commercial companies, and governmental and not-for-profit agencies
○ Managed care organisations
○ Transport operators
○ Military and space agencies
○ Community alarm services
○ Non-government organizations
MAINSTREAM HEALTH SECTO
GENERAL PRACTITIONERS AND PRIMARY

CARE SERVICES
□Convenience medicine
❑ Monitoring of conditions
❑ Minor injuries and emergencies
❑ Better coordination with secondary care
MONITORING OF CONDITIONS
Once the GP has established the diagnosis and the care plan, monitoring may
be necessary.
ADVANTAGE: Avoids an inconvenient or even difficult trip to the doctor to

check blood pressure or some other straightforward measurement.
DISADVANTAGE: Concern on accuracy of patient-administered tests
Hypertension & DM: Most common conditions to be treated in this way

ACUTE HOSPITAL & SECONDARY
CARE SERVICES
•Patients are able to spend more time in their own homes
(telecare)
□ Builds confidence, self-reliance, and independence
•Acute hospitals can provide valuable support for practitioners
in remote areas such as the Antarctic
• Inter-hospital links offer improved cover and specialist advice
•Increasing patient view of hospitalization as
an unattractive option
•Domiciliary visit by community nurses or
midwives to patients confined to their
COMMUNITY homes effective but expensive
• Nursing home costs
SECTOR & □Home healthcare one of the most rapidly
TELECARE growing segments of the US healthcare
market
SERVICES □Elderly people are major users of telecare
□“Smart house” - range of simple sensors
(e.g. door opening, toilet use, cooker use
etc.) fitted to monitor patient activity
AMBULANCE •Communication between ambulance
teams/paramedics and hospital doctors and
personnel
SERVICES • Begins before ambulance is dispatched

□Telephone triage on emergency calls for
ambulances to reduce the number of
unnecessary calls, which can be as high as 50%
• Real clinical benefits arise when used to reduce
the time that the emergency room team needs
to assess the patient
□ Video camera in the ambulance allows
hospital physicians to see a patient’s
physical condition
□ Audio communication can relay information
about heart rate, blood pressure and even
blood analysis
• Stroke and heart attack victims are some of the
main beneficiaries of this new approach
• Includes both land-based and airborne
ambulances
PHARMACY SERVICES
•Internet pharmacies allow patients to buy
prescribed drugs online even at discount prices.
• Customers can easily shop around online to find
the best price
•Only medication that has been properly prescribed
by a certified physician can be purchased in this
way.
• Increasing numbers of fly-by-night companies
prepared to sell anything to anyone
• Legal companies want tighter regulation
•Many issues of ethics, security and confidentiality,
reimbursement, and funding to be sorted out BUT
the convenience factor drives solutions in the e-
health direction.
COMMERCIAL
SERVICES &
OTHER AGENCIES
•MANAGED CARE
ORGANIZATIONS
• TRANSPORT SERVICES
• SPACE & MILITARY
SERVICES
• COMMUNITY ALARM
SERVICES
• NON-GOVERNMENT
ORGANIZATIONS
MANAGED CARE ORGANIZATIONS
• Main objective - delivery of high-quality and
cost-effective healthcare
• Quality - enhanced by the availability of expert
opinion, teleconferencing between clinicians,
electronic information exchange, and continuing
medical education
• Cost effectiveness - realized by speedy billing and
other electronic transactions
•Origins in the insurance sector where the insurance
companies pay the medical bills.
•Managed care orgs - more active role in ‘managing’ their
members’ health than traditional insurance companies,
which simply acted as intermediaries in the financial
transactions
•Health maintenance organizations (HMOs) – cover all
necessary medical services for a fixed pre-paid fee
• Are organizations that both finance & deliver
healthcare
TRANSPORT SERVICES
•Concern, as with rural or disadvantaged populations,
is to improve the quality of healthcare or make it
available where none existed previously
□ Providing training to transport providers/services in
using an on-board computer and transmission
system that can transfer patients' medical data to
mainland healthcare organizations via satellite links
□ Use of technological advances in telemonitoring,
even via air travel
□ Comprehensive medical kit & trained personnel
□ Verbal support service for in-flight emergencies
□ Laptop computer device to monitor vital signs
and relay them to medical personnel on the
ground via satellite
SPACE AND MILITARY AGENCIES
•In-flight and hence (very) remote
treatment in space
•In terrestrial war zones, an injured
combatant can be evacuated for further
treatment but the priority may be to
return him or her to active duty as soon
as possible
□Demand rapid diagnosis and
treatment in far from ideal
circumstances (a necessity, not an
option)
COMMUNITY ALARM SERVICES
□Service usually offered to elderly
people in nursing homes,
warden-assisted residential homes,
and private dwellings, that allows
them to communicate with a human
operator at a remote call center via a
‘hands free’ telephone.
□Community alarm service providers
now looking to expand, not only by
taking on more clients, but by
offering more service
NON-GOVERNMENT ORGANIZATIONS
□Not only respond to disasters of both
human and natural creation throughout
the world but which do such important
work in developing countries
□Frequently charitable bodies funded by
donations and, like managed care
organizations, they need to engage in
cost-effective activities to make their funds
stretch as far as possible
□WHO already has worldwide networks for
the surveillance of the spreadof drug
resistance, pollution levels, and the
adverse effects of pharmaceutical
substances etc. International cooperation
and funding are needed to bring the
benefits of these knowledge bases to the
populations who so desperately need them
DEVELOPMENT &
DELIVERY OF
TELEMEDICINE
SERVICES
KRYZELLE ANNE GARLAN CALLADA
OUTLINE
Developing and Delivering a Telemedicine Service

- Defining Service Goals
- The Assessment of Needs
- User Involvement
- The Business Case and Planning
- Business Process Reengineering
- Selecting the Technology
- Establishing Practice Guidelines
- Implementing and Managing the Service
DEFINING SERVICE GOAL
- What is the project trying to achieve and is

telemedicine the best way to deliver the objectives?
- main service goals are
- improved quality of care;
- e tended access to care;
- cost reduction:
- better collaboration and integration;
- educational opportunities.
THE ASSESSMENT OF NEEDS
- 3 types of needs:
- clinical
- economic
- technical
- Clinical needs:
- Criteria:
- Nature of specialty
- Purpose of service
- Personnel and training
- Service integration
- Economic needs
- Criteria:
- Staff
- Capital and revenue cost
- Income aid reimbursement.
- Reorganization costs.
- Patient-incurred costs.
- Technical needs
- Criteria:
- Technology audit
- Network infrastructure.
- User requirements.
USER IMPROVEMENT
- Users - both carers and patients (front-line people who will largely
determine the success or failure of the service)
- Important aspect:
- Involve remote site:
- users, both carers and patients, should be involved in the design and
operation of their site
- Manage user e pectation
- Users with little e perience of healthcare delivery let alone telemedicine are
often daunted by procedures that carers may feel are trivial, and patients can
readily be put at ease by simple e planations of what is going to happen to
them and what the outcomes and timescales are likely to be
- Build teams
- The service will be most successful if the individuals identified in the needs
assessment process see themselves as members of a team
- Recognising the validity of other people’s views and acknowledging their
efforts (publicly wherever possible) are essential to this process.
USER IMPROVEMENT
- Ensure training
- A plan for initial and ongoing training (as people leave and join) is essential for the
well-being of both staff and patients
- Locate services
- clinical needs must be balanced against economic and technical needs and it is
wisest to locate link points where user involvement and e pertise are highest
- Integrate services
- Needs assessment and team building may identify opportunities for service
integration, for e ample, using a telemedicine link to facilitate patient monitoring
in the community after a teleconsultation or a discharge from hospital
- Cross-discipline user involvement is the key to integrated service development, and
planners should be proactive in harnessing these opportunities.
- Market services:
- E ternal marketing (not over-selling) is essential to ensure the take-up and growth
of the service.
- Internal marketing and information sharing among healthcare colleagues via
seminars, workshops and evaluations is also necessary to promote the service and
avail the participants of constructive criticism
THE BUSINESS CASE AND PLANNING
- Approach:
- Define the real objective
- Define population and demand
- Show the connection with e isting services
- Summarize technical options
- Describe the benefits
- Consider alliances
- Indicate market opportunities
- Project management
BUSINESS PROCESS REENGINEERING
- implies an attempt to break down an organization’s business
practices into their component parts and reassemble them to
form a new machine
- e amples by which reengineering of conventional care through
telemedicine can bring benefits:
- reduction in travel for patients;
- closer collaboration of clinicians in primary and secondary care;
- availability of international medical e pertise in real time;
- improved clinical and administrative workflow;
- seamless integration of care services across sectors:
- use of telemedical monitoring devices in the home.
SELECTING THE TECHNOLOGY
- Main technology components of a telemedicine system (videoconferencing
stations. display systems, telemonitoring devices, telecommunication options
etc.) and relates them to the applications and clinical procedures for which they
are suitable.
- Technology issues associated w/ design & development of telemedicine systems
- the bandwidth needed to deliver the necessary service effectively:
- the network infrastructure and its installation and maintenance:
- appropriateness of hardware & software for store-and-forward/realtime operation:
- conformance of equipment with accepted standards:
- the choice of videoconferencing station, e.g. rollabout, desktop etc.:
- the display definition and colour depth of the display [264];
- the need for and use of telemonitoring devices:
- the need for fault-tolerant and back-up systems:
- the need for date and time stamping for audit purposes:
- security and confidentiality requirements;
- user acceptance of technology:
- impact on the organisation.
ESTABLISHING PRACTICE GUIDELINES
- generic criteria for validating guidelines and their purpose:
- Purpose of teleconsultation (‘e plain the purpose and process to the
patient’)
- Definition of responsibility
- Ensuring an ethical basis
- Ensuring quality of care
IMPLEMENTING AND MANAGING THE SERVICE
- Factors:
- Managing change
- Key issues:
- understanding the present;
- setting goals and objectives;
- leadership;
- people involvement and communication:
- overcoming resistance to change;
- keeping up the momentum.
- Organization of hub and remote site
- Developmental plan
IMPLEMENTING AND MANAGING THE SERVICE
- Data collection and performance indicator
- Targets:
- numbers of patients seen (including gender, age, ethnicity and social status);
- percentage of correct diagnoses via telemedical link;
- numbers of patients with successful medical outcomes compared w/
conventional care:
- travel time and costs for patients to attend teleconsultations;
- patient satisfaction with the service:
- number of patient complaints;
- operational system hours:
- length of each teleconsultation or other session;
- out-of-hours usage;
- item and total costs compared with budget allocations:
- amount of income generated.
ETHICAL & LEGAL
ASPECTS OF
TELEMEDICINE
KRYZELLE ANNE GARLAN CALLADA
OUTLINE
- Confidentiality, patient rights and consent

- Data protection and security
- Ethical and legal aspect of the internet
- Telemedicine malpractice
- Jurisdictional issues
CONFIDENTIALITY, PATIENT RIGHTS AND CONSENT
1. Confidentiality:
- guiding principle behind this legal perspective is the concept
that information is held to be confidential if its release has the
potential to injure a person either emotionally or materially
- applies whether or not a contract or other formal relationship
e ists between the confider and the confidant
- Confidence is not betrayed, however, if what is disclosed is
common knowledge or if disclosure serves a greater public
interest
- 3 guidelines for patient confidentiality:
- There e ists a basic right of patients to privacy of their medical
information and records.
- Patients’ privacy should be observed unless waived in a
meaningful way (i.e. informed, non-coercive) or in rare
instances where it counters public interest.
- Information disclosed should be limited to that information or
portion of the medical record needed to fulfil the immediate and
specific purpose
2. Patient-Doctor relationship
- Patients have a right to e pect that you will not disclose any
personal information which you learn during the course of your
professional duties unless they give permission. Without
assurances about confidentiality patients may be reluctant to
give doctors the information they need in order to provide good
care
- Note: this duty is not absolute and can be overruled if disclosure
is compelled by law or is in the greater public interest
- The secrecy requirement applies to the full range of transmitted
information-te t, data, images. video and audio-whether this
information is generated within the teleconsultation itself or
obtained from other sources such as medical records
3. Patient consent to Disclosure of Information
- When patients give consent to disclosure of information about them, you must make
sure that they understand what will be disclosed, the reasons for disclosure and the
likely circumstances:
- You must make sure that patients are informed whenever information about them is
likely to be disclosed to others involved in their health care, and that they have the
opportunity to withhold information:
- You must respect requests by patients that information should not be disclosed to
third parties. save in e ceptional circumstances (for e ample, when the health or
safety of others would otherwise be at serious risk);
- If you disclose information you should release only as much information as is
necessary for the purpose;
- You must make sure that health workers to whom you disclose information
understand that it is given to them in confidence which they must respect;
- If you decide to disclose confidential information, you must be prepared to e plain
and justify your decision
4. Access to medical records
- Current thinking regarding medical records:
- division of ownership in which the healthcare organisation ‘owns’ the physical record
and the patient ‘owns’ the information contained within
- Clinicians, by virtue of the trust placed in them by the patient. can access the
information in the record for the benefit of the patient but they cannot, e cept under
special circumstances, deny the patient access to the medical information
5. Consent to treatment
- Every competent adult has a right to refuse or consent to available medical
treatment or healthcare
- Purpose of consent:
- the cooperation of the patient is an important factor in the efficacy of treatment,
and a legal purpose protecting the carers against a criminal charge of assault or
battery, or a claim for damages for trespass to the person, or negligence
- The legal protection is necessary if carers are to treat patients without fear of reprisal
from individuals who later regretted their agreement to medical intervention
DATA PROTECTION AND SECURITY
1.Secure network access
- How sensitive are the data we wish to protect?
- What are the consequences of a breach of security?
- Who are the authorized and unauthorized users?
- How vulnerable are the data?
- What are the technical issues?
- Do we wish to eliminate. minimize or simply reduce the
threat of unauthorized access?
- How do we balance the needs of authorized users with the
constraints imposed by security?
ETHICAL AND LEGAL ASPECT OF THE INTERNET
1. Patient, Physician and the Internet
- Internet will be a major influence on the way we practice medicine and
the way in which patients assume increasing responsibility for their own
care
- Ethical and legal dilemma:
- physicians now find that they need to provide online services
- concern about the amount of time they need to spend with patients to
e plain the shear mass of data and the way in which the Internet is reducing
the asymmetry of the patient-doctor relationship
- concern with privacy and confidentiality of personal information
- Benefits:
- Services will be tailored more to individual needs and customized care
becomes the norm, the web will also be used to host treatment regimes such
as disease management programs and care protocols. and the
depersonalization of these activities could result in the loss of vital conte tual
clues and a reduction in the quality of care
2. Ethical guidelines and patient information
- Hi-Ethics consortium
- Aims to unite the most widely used consumer health Internet sites and
information providers whose goal is to earn the consumer’s trust and confidence
in Internet health services
- objectives of Hi-Ethics
- offer Internet services that reflect high quality and ethical standards;
- provide health information that is trustworthy and up to date;
- keep personal information private and secure, and employ special precautions for
any personal health information;
- empower consumers to distinguish online health services that follow these
- principles from those that do not
- intention of Hi-Ethics
- provide Internet users with the consumer protection they deserve while providing
content and web site developers with a clear set of rules that can be successfully
and accountably implemented
3. Ethics and legality of internet medical services
- Internet to deliver medical restricted to:
- advice in a patient-carer setting
- to the dispensing of prescriptions
- Issues:
- value of the online therapy to the patient is clearly dependent on the
credentials and e pertise of the carer
- need for accreditation with training and assessment guidelines
- electronic signatures as authorization
- E-sign allows state agencies to specify standards for the
accuracy, integrity and access to records but prevents them
from substantial regulation of transactions and the
reimposition of paper record requirements
TELEMEDICAL MALPRACTICE
1.Duty of care and clinical negligence
- telemedical negligence requires the plaintiff to establish that
- the defendant (e.g. the teleconsultant) owes him or her a duty of ecm
(established via the patient-doctor relationship;
- the duty has been breached, i.e. the teleconsultant was negligent;
- he or she suffered harm (compensatory injury) as a consequence of the
negligence.
- Considerations::
st
- 1 : duty of care owed to a telepatient is much the same as that owed to a
patient treated by conventional means since it depends upon the nature of
the patient-doctor relationship which is similar in most respects
- little case law for telemedicine to define clear precedents
- while the doctor’s duty of care is well established, the liability of
paramedics, nurses and other non-clinical carers is less certain
- 2nd : standard of care (courts have dual role)
- to define the appropriate standard of care in any given medical
specialism
- to determine if the teleconsultant’s actions fall short of that
standard and constitute negligence
- Most cases of negligence arise from missed diagnoses since these
grounds are easiest to identify
- 3rd: cause of damage
- It is easier to convince a court that damage has occurred than to
prove that the damage was a result of negligence
- Only if the court is convinced that damage followed directly from
the negligence of the defendant, and would not have occurred ‘but
for’ this negligence will the court find for the plaintiff: ‘but for’ test
2. Professional standard and regulation
- process of professional regulation is conducted mainly through
the issue of guidelines and the various committees that deal with
misconduct
- Types of allegations:
- criminal conviction for a non-trivial offence;
- practice that is seriously deficient (e.g. negligence);
- serious professional misconduct.
3. Law applicable to telemedical equipment
- repeated causes of adverse incidents with medical devices:
- poor quality, obsolete or worn-out devices;
- incompatibility with ancillary equipment;
- poor documentation;
- inappropriate use;
- inadequate training;
- mistakes in servicing or lack of servicing
- where does the liability for negligence due to equipment failure or
malfunction in a teleconsultation lie?
- The basic principle of product liability in English law is that a plaintiff has a cause
for action if an injury or loss occurs as a consequence of defective products.
- The liability may arise from a contractual obligation or from a duty of care.
- The defendant can be the equipment manufacturer, a service supplier using the
equipment, an assembler for poor workmanship, or a repairer not e ercising due
care
4. Operational risk due to technology
- 2 categories:
- Inadequacies due to technology
- Those due to personnel insufficiencies
- 4 main technology risk:
- quality of images;
- lack of suitable equipment;
- malfunctioning equipment;
- inadequate guidelines
5. Operational risk due to personnel
- five main risks to telemedical practice arising from deficiencies in
the care team
- poor communication;
- limited ability;
- poor training;
- improper delegation:
- unclear responsibility.
JURISDICTION ISSUES
1. State regulation of telemedicine
- disunited and uncoordinated laws in different states/areas in the country
make jurisdictional issues a major barrier to the progress of telemedicine.
- The central issue is the licensure of clinicians who can practice telemedicine
but the implications are many
2. Licensure and accreditation
- the license to practice medicine in a state, is confused by the ability of
telemedicine to facilitate healthcare across state, federal and international
boundaries
3. Clinician reimbursement
- reimbursement of clinicians for advice and treatment rendered across state
boundaries is a source of friction and concern but the issues may not be as
important as they seem
Role of Internet
in
Public Health
Informatics
● Public Health Introduction
● Public Health Surveillance
● Integrating Data Sources for Improved Decision Making
● Responding to Bioterrorist Attacks
● Technical Requirements for Public Health Applications
Public
Health
•Promote health and the quality of life by preventing and controlling
the spread of disease, injury, and disability
Roles:
1. Collection of statistics on the occurrence of the diseases
2. Dissemination of guidelines to health care practitioners and the
public
3. Funding research on ways to improve public health
4. Delivering health care to the underserved
Internet and Public
Health
● Provides sufficient security to protect sensitive medical
records
● Accessible to all public health workers and the public
● Remains operational even in times of natural or man-made
disasters
Public Health
Surveillance
•ongoing systematic collection, analysis, and interpretation of data, with the
timely dissemination of these data to those responsible for preventing and
controlling disease and injury
•benefit from Internet-based transactions to assist in collecting data about the
health of individuals, personal risk factors, medical treatments, and sources of
disease and injury in the environment
•recognize large scale trends in the occurrence disease and allocate resources
to minimize the damage to the public health
Role of Community Public Health
Office
To process information about individual patients and local outbreaks in order to
recognize and respond to the needs of the community
Public Health
Surveillance
1.Allows automatic reporting by medical laboratories of test results for
some communicable disease (ex. tuberculosis)- ProMed-Mail
2.Offers novel opportunities for planning and resource allocation,
potentially improving care and reducing costs
3.Helps form decisions on the cost-effectiveness of setting up new
regulations, their enforcement, or their propagation and dissemination
within the health enterprise
Integrating Data Sources for Improved Decision M
● Internet is used for better integration of the available data to

improve data analysis and health monitoring
● Vertically integrated data and communications systems best serve the
traditional public health functions for a given disease
● It requires public health offices and their databases be connected to
the Internet and it must provide mechanisms for protection of the
security and confidentiality of data
Integrating Data Sources for Improved Decision M
● Internet offers the opportunity for public health officials to collect data
from private sources that might be important in their surveillance efforts.
● Accessibility of such information through the Internet:
○ allow health care providers to respond rapidly to disease clusters
○ reduce the exposure of the population to disease.
● Information is available today in electronic format, and with proper
protections for proprietary and confidential information, it could be made
available to public health officials via the Internet.
Responding to Bioterrorist Attacks or
Outbreaks
● How to detect and respond to a bioterrorist attack has become a growing concern for the public health
community.
● The use of biological weapons by terrorists could inflict life-threatening illnesses on a large scale.
● In the case of bioterrorist attack, each of the phases of the public health process would depend on
a successful infrastructure:
○ recognizing a trend
○ identifying the cause of the trend
○ formulating a strategy for responding to it
○ allocating resources for the response
○ deploying the response
○ monitoring its success
● Data would need to be provided to public health teams charged with identifying the pathogen
and formulating and implementing a response.
● The ability to keep information from the public in order to avoid panic could also be important,
depending on the situation.
Outbreaks
● The CDC found in a 1998 study: most local health departments lacked
the capabilities to adequately detect and respond to a report of
bioterrorism.
● Lack of basic information and communications systems
● Lack of Internet access
● Lack of suitable computer capacity
● Lack of training in the use of electronic information technologies for
conventional health purposes
Outbreaks
● Development of National Health Alert Network
● Purpose: to provide a nationwide secure communications network capable to simultaneously transmit critical public health
information to every state, regional and local public health agency.
● This capability is of critical importance to the effective management of terrorism incidents, naturally occurring infectious disease
outbreaks and other public health emergencies
○ Facilitate the collection of information from testing laboratories, the sharing of information among public health officials, and
consultations among them
○ Desktop personal computers and laptops connected to the Internet with sufficient bandwidth:
■ to handle the transfer of laboratory reports
■ for interactive collaboration among public health officials
■ multimedia distance training.
○ Public key encryption for secure communications and authentication.
○ Network will be designed with sufficient redundancy
■ need for continuous availability
■ to provide backup operations in case of a link failure and disaster recovery plans to allow rapid restoration
of service in case of other component failures
○ Videoconferencing capabilities: allow public health officials to communicate more effectively during a crisis
Technical Requirements for Public
Health Applications
Technical advances in a number of areas would be required in using the
internet for public health surveillance:
● Ubiquity
● Security
● Availability
● Bandwidth
● Latency
Solutions to these technical problems could greatly expand the use of the
internet in support of public health
BANDWIDTH LATENCY AVAILABILITY SECURITY UBIQUITY
●Public health data ● Few of the ● Moderate ● Paramount ● It is critical that

generally requires applications of importance importance the public health
low bandwidth the Internet in ● The ● It is critical to information
●Videoconferencing public health are minute-to-minute have infrastructure
among public health sensitive to small monitoring of technologies for extend to every
officials would delays in the outbreaks of acute authenticating community, state,
require higher transmission of disease would not data and users and federal public
bandwidths data tolerate extended ● Also important is health agency
●There is also ● Less important periods of network the ability to ● Information gaps
potential for many failure protect sensitive would be a great
data objects to be ● Loss of network institutional data burden, since it
transmitted through might lead to loss and sensitive would require
the network, raising of data and failure information creating a
the bandwidth to respond in a relating to secondary
requirement timely fashion bioterrorist mechanism for
attacks data collection
and
dissemination
Medical Informatics and
Intelligent Clinical
Decision Support
MEDICA
L
INFORMATIC
Jestoni A. Rocha
SGD
4
S
MEDICAL
INFORMATICS
● application of computers, communications and information technology and
systems to all fields of medicine - medical care, medical education and medical
research
● field concerned with the management and use of information in health and
biomedicine
MEDICAL
INFORMATICS
● rapidly developing scientific field that deals with resources,
devices and formalized methods for optimizing the storage,
retrieval and management of biomedical information for
problem solving and decision making
Medical Informatics used in
HealthCare
● Communication ● Knowledge management
○ Telemedicine ○ Journals
○ Tele-radiology ○ Consumer Health information
○ Patient e-mail ○ Evidence-based medical information
○ Presentations
Medical Informatics used in
HealthCare
● Information Management
● Decision Support
○ Electronic Medical Records
○ Reminder systems
○ Billing transactions
○ Diagnostic Expert Systems
○ Ordering Systems
○ Drug Interaction
Medical Informatics
Solutions
● Databases
● Information Retrieval
● Internet
● Computer programs
Database
s
● A collection of data in machine readable format organised so that it can
be retrieved or processed automatically by computer
● A flat file database is organised like a card file, with many records
(cards) each including one or more fields (data items).
Information
Retrieval
● Field concerned with the organization and retrieval of knowledge- based information
● A variety of online resources are now available to both patients and physicians
○ MEDLINE
■ Bibliographic databases of journal literature with more than 11 million
references, 4000 journals dating from 1966
CLINICAL DECISION
SUPPORT SYSTEM
Prepared by:
JORSAL DIONNE TAN
MD-III
TOPIC
OUTLINE
● Definition
● Requirements
● Effects of Clinical Practice Guidelines
and Evidenced-Based Practice on CDSS
● Challenges and Barriers to CDSS
Clinical Decision
Support
● Computer applications that:
○Match patient-specific information to a clinical knowledge
base
○Communicate patient-specific assessments and
recommendations at suitable times
○Assist with the clinical decision-making process
CLINICAL DECISION SUPPORT
MODEL
CDSS
REQUIREMENTS
●Knowledge base
●Program for combining knowledge
with patient-specific information
●Communication mechanism
Knowledge
Base
● Automated representation of clinical knowledge
○Clinical knowledge
■ -Facts, best practices, guidelines, logical rules,
reference information, etc.
●Compiled clinical information on diagnoses,

drug interactions, and evidence-based
guidelines
Communication
Mechanism
● Method for:
○Entering patient data
▪Import from the electronic medical record
○Outputting to the user of the system so a decision can
be made
▪Possible diagnoses, drug allergy alerts, duplicate testing
reminder, drug interaction alerts, drug formulary guidelines,
or preventive care reminder
Knowledge and
Interventions
●Knowledge base
○ Clinical knowledge
▪Best practices, evidence-based guidelines
○ Rules and associations of compiled
data
●Interventions
Clinical Practice
Guidelines
●Systematically developed statements
●Assist practitioners in decision making about
appropriate healthcare
●Specific clinical circumstances
Clinical Practice Guidelines
Sources
● Government agencies
● Institutions
● Organizations such as professional
societies
● Expert panels
Evidence-Based Practice
Guidelines
●Integrate the best available scientific knowledge
with clinical expertise
●Base recommendations on the best
available evidence
● Reflect a consensus of experts
CHALLENGE
S
●Achieving the five rights of clinical decision
support requires communicating:
○the right information
○to the right person
○in the right format
○through the right channel
○at the right time.
Challenges in Designing or Selecting a
CDSS
● Whose decisions are being supported?
● What information is presented?
● When is the information being
presented?
● How is the information being presented?
Barriers to Using a
CDSS
●Acquisition and validation of patient data
●Modeling of medical knowledge
●Elicitation of medical knowledge
Barriers to Using a
CDSS
●Representation of and reasoning about
medical knowledge
●Validation of system performance
●Integration of decision support tools
Are Electronic Medical
Records/Electronic
Health Records equal to
CDSS?
REFERENCE
S:
● Essentials of Telemedicine and Telecare by AC Norris
● Telemedicine: Guidance for Physicians in the Philippines by faculty and
graduate students of the University of the Philippines Medical Informatics Unit
● Aziz, H. A. (2017). A review of the role of public health informatics in healthcare.
Journal of Taibah University Medical Sciences, 12(1), 78-81.
● Philippine Initiatives in Health Informatics by Christian S. Dicioco
● Networking Health: Prescriptions for the Internet by National Academy
of Sciences
● Basic Concepts in Medical Informatics by J Wyatt and J Liu
● Medical Informatics:Improving Healthcare Through Information by William R.
Hersh.
REFERENCE
S:
● Berner, E. S. (2009, June). Clinical decision support systems: State of the Art. AHRQ Publication No. 09-0069-E
Agency for Healthcare Research and Quality http://healthit.ahrq.gov/images/jun09cdsreview/09_0069_ef.html
● Das, M. & Eichner, J. (2010, March). Challenges and barriers to clinical decision support (CDS) design and imp
the agency for healthcare research and quality CDS demonstrations (Prepared for the AHRQ National Resource
Information Technology under Contract
● No. 290-04-0016.) AHRQ Publication No. 10-0064-EF. Retrieved from
https://healthit.ahrq.gov/sites/default/files/docs/page/CDS_challenges_and_barriers.pdf
● Agency for Healthcare Research and Quality. (n.d.). Types of CDS interventions. Retrieved from
http://healthit.ahrq.gov/images/mar09_cds_book_chapter/CDS_MedMgmnt_ch_1_sec_4_interventions.ht m
● Becker Medical Library. (2011). Clinical/Practice guidelines. Retrieved from
http://digitalcommons.wustl.edu/cgi/viewcontent.cgi?article=1017&context=becker_pubs
SGD 4 MEMBERS
THAN
K
CALLADA I CASTUERA I DACILLO I GALVEZ I JAMISOLA I MARCO
MENDOZA I OROZCO I PICONES I ROCHA I TAN
YOU!
Medical
Informatics
Group 5
Alfad, Banday, Bulos, Carillo, Dineros, Garcia, Gonzales, Jaranilla, Jimenez, Kuronaga, Llaneta, Madera
TOPICS
01 02
Ethical &Legal Standards Ethical,Legal Issuesand
in Health/Medical Challengesin Managing
Informatics Patient Information
03 04
Issuesof Privacy&Confidentiality Guidelines &Protocols for
Issuesin Telemedicine Telemedicine
5
5
1
Ethical &LegalStandardsin
Health/Medical Informatics
Garcia, Jaranilla, Banday

5
5
Topic Outline
❏ Terminologies ❏ Codes of ethics related to

❏ Ethics in Healthcare healthcareinformatics ❏ International Legal
Informatics ❏ IMIACodeof Ethics Standards in
❏ Ethics Resources for ❏ Fundamental Ethical Health Informatics
Principles
Healthcare Informatics
❏ General Principles of ❏ Local Legal Standardsin
Professionals Informatics Ethics HealthInformatics
❏ SevenPurposes for the ❏ Codeof EthicsTimeline
Codeof Ethics
Garcia, Kathleen O. Jaranilla, Lindsay D. Banday, Clarice
MedicalInformatics Health Informatics
Medical informatics is the study and
Health informatics is the
application of methods to improve
interprofessional field that studies
the management of patient data,
and pursues the effective uses of
clinical knowledge, population data,
biomedical data, information, and
and other information relevant to
knowledge for scientific inquiry,
patient care and community health.
problem-solving, decision making,
motivated by efforts to improve
- BMJ Journals
human health.
- NCBI 2020
Ethical, legal andsocialissuesthat areshaping the
health informatics profession today
➢ The protection of private patient information
➢ Patient safety
➢ Risk assessment
➢ Reportingdesign and data display
➢ Systemimplementation
➢ Curriculumdevelopment
➢ Research ethics
➢ Liability
➢ User involvement and accessibility
➢ Ethical dilemmas resulting from data availability and sharing
5
5
Ethics
➢ is the art of behaving.
➢ ethics here means to behave in a proper way in
accordance with your profession: to do what
you say and to say what you do.
Health informatics Informatics Ethics

➢ the scientific field dealing with “resources, ➢ deals with ethical behaviors
devices, and formalized methods for optimizing required from anyone handling
the storage, retrieval and management of data and information
biomedical information for problem solving and
decision making”
5
5
Healthcare Informatics Ethics is formed by
Healthcare Ethics andInformatics Ethics
5
5
Ethics in HealthcareInformatics
Aims to raise awareness in professionals using healthcare

informatics regarding the stakes and risks linked to information
usage and ensure the enforcement of latest legal regulations and
deontology codes.
Proper knowledge of ethics in healthcare informatics should help

professionals translate legal obligations into internal rules and
guidelines.
5
5
Ethics Resourcesfor HealthcareInformatics Professionals
Legal Regulations: International Conventions; EU Directives; national laws.
Codes of Ethics are formal documents that list ethical principles and duties of professionals in a
specific area.
Guidelines or protocols are types of procedures that help healthcare professionals respect laws,
principles and avoid misconduct.
Case studies help professionals better understand their situation by providing guidance and
possible solutions for similar cases.
Ethics committeesare consultative committees in a hospital or other institutions whose role is to

analyze ethical dilemmas and advise and educate healthcare providers, patients and families
regarding difficult ethical decisions
SevenPurposes for the Code of Ethics
● The promotion of high standards of health information management practice
● The identification of core values of the health information management
mission
● A summary of the broad ethical principles that reflect the core values
● Establishment of ethical principles used to guide decisions and actions
● Establishment of a framework for professional resolution of conflicts and
ethical uncertainties
● Providing ethical principles that allow the public to hold health information
management professionals accountable
● Providing opportunities for mentors to guide new practitioners in ethics
education
Codesof ethics related to healthcare informatics
In 2002, the International Medical Informatics Association (IMIA) adopted the

Code of Ethics for Health Information Professionals on data protection and
health information.
The IMIA code of ethics serves several purposes:

1. It provides ethical guidance for the professionals themselves;
2.It provides a set of principles against which the conduct of professionals
may be measured;
3.It provides the public with a clear statement of the ethical considerations
that should shape the behavior of the professionals themselves.
https://imia-medinfo.org/wp/wp-content/uploads/2015/07/IMIA-Code-of-Ethics-2016.pdf 12
International Medical Informatics Association (IMIA) Code of Ethics

2 sets of principles:
● Fundamental ethical principles
○ autonomy, equality and justice, beneficence, nonmaleficence,
impossibility and integrity
● General principles of informatics ethics
○ information privacy and disposition, openness, security, access,
legitimate infringement, least intrusive alternative, and
accountability
13
Fundamental Ethical Principles
1.Principle of Autonomy
All persons have a fundamental right to self-determination.
2.Principle of EqualityandJustice
All persons are equal as persons and have a right to be treated accordingly.
3.Principle of Beneficence
All persons have a duty to advance the good of others where the nature of this good is in keeping with the
fundamental and ethically defensible values of the affected party.
4. Principle of Nonmaleficence
All persons have a duty to prevent harm to other persons insofar as it lies within their power to do so
without undue harm to themselves.
5.Principle of Impossibility
All rights and duties hold subject to the condition that it is possible to meet them under the circumstances
that obtain.
6.Principle of Integrity
Whoever has an obligation has a duty to fulfill that obligation to the best of their ability
General Principles of Informatics Ethics
1. Principle of Information-PrivacyandDisposition
All persons and group of persons have a fundamental right to privacy, and hence to control over the
collection, storage, access, use, communication, manipulation, linkage and disposition of data about
themselves.
1. Principle of Openness
The collection, storage, access, use, communication, manipulation, linkage and disposition of personal data
must be disclosed in an appropriate andtimelyfashion to the subject or subjects of those data.
1. Principle of Security
Data that have been legitimately collected about persons or groups of persons should be protected by all
reasonable and appropriate measures against loss degradation, unauthorized destruction, access, use,
manipulation,linkage, modification or communication.
1. Principle of Access
The subjects of electronic health records have the right of access to those records and the right to correct
themwith respect to its accurateness, completeness and relevance
General Principles of Informatics Ethics
5.Principle of LegitimateInfringement
The fundamental right of privacy and of control over the collection, storage, access, use, manipulation, linkage,
communication and disposition of personal data is conditioned only by the legitimate, appropriate and relevant
data-needs of a free, responsible anddemocratic society, and by the equal and competing rights of others.
6.Principle of theLeast IntrusiveAlternative

Anyinfringement of the privacy rights of a person or group of persons, and of their right of control over data
about them, may only occur in the least intrusive fashion and with a minimum of interference with the rights of the
affected parties.
7.Principle of Accountability
Any infringement of the privacy rights of a person or group of persons, and of the right to control over data
about them, must be justified to the latter in good time and in an appropriate fashion.
2003- British Computer Society (BCS) adopted a Code of Ethics for

Health Informatics Professionals (HIPs)
➔ This code is similar to the IMIA Code, which may be due to the
shared contribution of one of its authors (Dr. Eike-Henner W. Kluge)
UKCHIP Code of Conduct

➔ adapted from the BCS code
➔ sets out standards of behavior required from health informatics
professionals registered with the United Kingdom Council for Health
Informatics Professions
➔ deals with all aspects of professional activity including registrants’
duties to patients, the public, employers and colleagues
TEN PRINCIPLES
2004- Canadian Code (COACH High-level
Ethical Principles ) 1. Accountability
➔ Published by Canada’s Health Informatics 2. Identifying Purposes
Association 3. Consent
➔ an abridged version containing ten 4. Limiting Collection
5. Limiting Use, Disclosure,
aspirational high-level principles that is
and Retention
available to the public 6. Accuracy
➔ The full version of the code is available for 7. Safeguards
members only. 8. Openness
9. Individual Access
10. Challenging Compliance
American Codes
➔ 2006- American Health Information

Management Association (AHIMA) Code of
Ethics
➔ 2007- American Medical Informatics
Association (AMIA) Code of Ethics
◆ references the AHIMA and IMIA codes
and focuses more on duties of health
informatics professionals expected
towards key stakeholders in healthcare
INTERNATIONAL
LEGAL
STANDARDS IN
HEALTH
INFORMATICS
LOCAL LEGAL
STANDARDS IN
HEALTH
INFORMATICS
21
Ethical and
Legal Issues
and
Challenges in
Managing
Patient
Information
A M I N A O. ALFAD,
M A S A H I RO S. KU RONAGA JR.
A M I E L VAN E. LLANETA
Y EA R III
Ethical
Issues in
Managing
Patient
Information
A M I E L VAN E. LLANETA
Y EA R III
ADVANCED
TECHNOLOGY
INCREASEDTHE USE OF
TELEMEDICINE AND
INFORMATION TECHNOLOGY
INCREASESTHE IMPORTANCE OF THE

ETHICAL ISSUES INVOLVED IN MANAGING
PATIENT INFORMATION
TELEMEDICINE
provision of online healthcare services when the distance
between aservice provider and apatient matters
ETHICAL ISSUES IN TELEMEDICINE
consideration of patient’s benefit or loss in

receiving telemedicine services and his/her right
to choose the therapy and react to
dissatisfactory services
TELECONSULTATION: MAIN ETHICAL CHALLENGE
IN TELEMEDICINE
◼ Doctors are required to be highly competent in service provision.
◼ Doctors are supposed to recognize the value of virtual
communications.
◼ Computer systems are yet unsafe even if they are supposedly privileged
with high security.
◼ Tele-consultation provides a full access for all to new information
and skills.
◼ Telemedicine is growing rapidly with new relevant standards
ETHICAL CHALLENGES
PRIVACY CONCERNS
MOBILE DEVICE THEFT
DIGITAL SECURITY
BREACHES
ACCURACY ISSUES
PRIVACY CONCERNS
MEDICAL RECORDS AND OTHER PERSONAL DATA
HEALTH INFORMATION • Health conditions
• Substance abuse issues
• Sexual history
• Psychiatric diagnsoses
decisions that determine storage procedures and control the level of access to health
information should always include confidentiality and sensitivity
considerations
While it may be more convenient to make information available to alarge pool of employees and
vendors, ethical management limits access -- regardless of how inconvenient it
may be -- to preserve the privacy and confidentiality of patients.
MOBILE DEVICE THEFT
◼ Security breaches through mobile device theft present asecurity
threat and an ethical challenge in managing health information
◼ Ethical management of health information includes such measures
as
encrypting data so unintended parties cannot decipher
it.
◼ In addition, when laptops or other mobile devices are stolen from
medical employees, implementing remote data wipes can
delete stolen information.
DIGITAL SECURITY BREACHES
◼ In addition to physical thefts, some medical security breaches are digital
and are the result of computer viruses
◼ Ethical management of health information must include defensive
measures, such as scanning for viruses and malware, to
ensure the privacy and security of health information.
ACCURACY ISSUES
◼ While health information can provide valuable data to improve patient care,
inaccurate information can potentially harm patients
◼ Most of the errors were aresult of omitting dose, frequency and
duration information.
◼ ethical health-care management canbe achieved by implementing
computer design functions, known as “forcing functions,”
that will not allow the user to skip data fields.
Legal Issues
in Managing
Patient
Information
A M I N A O. ALFAD
Y EA R III
PRIVACY AND CONFIDENTIALITY: CONCEPT
CLARIFICATION, CONCEPT MAPPING
Privacy pertains to an individual’s right to be free from unwanted
external scrutiny
Confidentiality points to the duty that rests on those to whom
private information has been entrusted, that is, that they will not
unnecessarily disclose such privileged communication
“
“All that may come to my knowledge in the exercise
of my profession or in daily commerce with men,
which ought not to be spread abroad, I will keep
secret and will never reveal.”
tradition of privacy and confidentiality within the context of patient care is attributed to:
—Hippocrates of Cos (4 th century BC)

PATIENTCONSULTATION&DOCUMENTATION
“That which is not written was not done”
Healthcare has become more complex, health

professionals possess a certain sense of compulsion to
document every detail of a patient consultation, which is
brought about by:
□ Intricacy of insurance reimbursement claims

processes
□ Rising amount of malpractice litigation being lodged
against health workers
EVOLUTIONOFHEALTHINFORMATIONLANDSCAPE
Exchange of Health
Telemedicine
Information
❑ virtual patient consultations and
❑ Paper-documented medical records specialist referrals involving parties
❑ Electronic Health/Medical Records separated by physical distance
Ethical and Legal Guidelines

Growing field of
applied in the context of H I S
contemporary research
❑ statutory and ethical guidelines
❑ Publication of case reports intended applied in the context of health
to educate other professionals information system use in patient
care
HIS: health information system

These developments contribute towards enhancing the delivery of care to all people, they
also tend to redefine the scope of privacy and confidentiality within the context of the
provider-patient relationship. The implications:
1. A broader audience for patient information

2. Aggregation of patient data into large, networked databases,
which are intended to facilitate access by, and link information
from, different co-managing health providers
3. The use of information and communications technology to
disseminate private health data for non-health and
non-educational purposes
4. Data transmitted through electronic channels
Legal and
Ethical
Framework
Legal and Ethical Framework Affecting Privacy And Confidentiality
Within The Context Of The Physician-Patient Relationship
● M a ny countries are passing legislations to address issues of data protection

and the confidentiality of medical records by adopting measures that regulate
or serve as guidelines in the utilization of technology in healthcare
● World Health Organization (WHO) – has provided guidelines particularly directed
at developing countries for the use of medical records and electronic health records
● Americ an Recovery and Reinvestment Act of 2009 (ARRA) updated the Health
Insurance Portability and Accountability Act - HIPAA) – laws are being updated
to increase patients’ health professions control over their medical information and
allow for damages in case of breach of confidentiality
● Asia-Pacific Economic Cooperation (APEC) Privacy Framework in 2005 –
provides guidelines for balancing the right to privacy of individuals and the
promotion of electronic commerce
Legal and Ethical Framework Affecting Privacy And Confidentiality
Within The Context Of The Physician-Patient Relationship
● Telemedicine, intended to bridge the gap in accessibility of healthcare, is being

advocated in the Philippines as a national agenda, and yet privacy issues still remain
a central concern.
● In telemedicine, there is emphasis on the need for patient consent a nd patient
information (nature of consultation, awareness of who will have access to
consultation, and to whom patient information will be disclosed).
● The duty of confidentiality for health providers and the rights of patients to
privacy are uncontested and universally recognized. The same principles have
been adopted and maintained by the Philippine M e d i c a l Association (PMA) and
similar associations in other countries.
● Physicians in the Philippines pledge a more modern version of the oath upon being
admitted to professional practice of by the PRC and are similarly bound to uphold the
confidentiality of patient information by the Code of Ethics of the Board of Medici n e
and the P M A .
National Legal and
Ethical Framework
affecting Privacy and
Confidentiality within
the context of the
Physician-Patient
Relationship
Right to Privacy in General
Philippine Constitution Sec 3.

The privacy of communication and correspondence shall be
Article III - a person’s right to privacy
inviolable except upon lawful order of the court, or when public
is enshrined in no less than
safety or order requires otherwise, as prescribed by law
fundamental law
It provides that every person shall respect the dignity, personality,
Civil Code (Republic Act No. 386) –
privacy and peace of mind of another. The Civil Code makes any
a person’s general right to privacy
person who abuses the rights of another liable for damages.
Its provision protecting the secrets of any person may find
application in cases of government physicians who have custody of
Revised Penal Code (Art No. 3185)
patient records and who would reveal private information about
– criminalizes “Revelation of Secrets”
patients or any other employee who may abuse their position to
obtain confidential information
A. Republic Act No. 8505 – Rape
Victim Assistance and Protection Act
of 1998 There are also specific laws guarantee the right to privacy of rape
victims and minors in conflict with the law
B. Republic Act No. 9344 – Juvenile
Justice and Welfare Act of 2006
Right to Privacy in Relation to the Healthcare System
Philippine AIDS Prevention

and Control Act of 1998, handling of information, both the identity and status, of persons with HIV
Republic Act No. 8504
confidentiality of records of those who have undergone drug rehabilitation
Comprehensive Dangerous
Drugs Act of 2002, Sec. 36. - Authorized Drug Testing
Republic Act No. 9165 Sec. 40 - Records Required for Transactions on Dangerous Drug and
Precursors and Essential Chemicals
Anti-Violence Against
Women and Their Children confidentiality of records pertaining to cases of violence against women and
Act of 2004, Republic Act their children
No. 9262
Section 24: Grounds for reprimand, suspension or revocation of registration
The Medical Act of 1959, certificate:
Republic Act No. 2382 (12) Violation of any provision of the Code of Ethics as approved by the
Philippine Medical Association
Rules of Court and Administrative Rules
The following persons cannot testify as to matters learned in confidence in the following cases:
● A physician, psychotherapist or person reasonably believed by the patient to be authorized
to practice medicine or psychotherapy cannot in a civil case, without the consent of the
Rule 130, Section 24: Disqualification patient, be examined as to any confidential communication made for the purpose of
by reason of privileged diagnosis or treatment of the patient’s physical, mental or emotional condition, including
communication alcohol or drug addiction, between the patient and his or her physician or psychotherapist.
This privilege also applies to persons, including members of the patient’s family, who have
participated in the diagnosis or treatment of the patient under the direction of the physician
or psychotherapist
● To provide the best possible facilities for the care of the sick and injured at all times;
● To constantly upgrade and improve methods for the care, the cure, amelioration and
Hospital Code of Ethics prevention of disease; and
● To promote the practice of medicine by Physicians within the institution consistent with the
acceptable quality of patient care.
Philippine Health Insurance sets as a standard, the need for the organization to document and follow policies and procedures
Corporation (PHIC) Accreditation for addressing patients’ needs for confidentiality and privacy
Auditory and Visual Privacy: A hospital and other health facilities shall observe acceptable
Department of Health (DOH) sound level and adequate visual seclusion to achieve the acoustical and privacy requirements in
designated areas allowing the unhampered conduct of activities.
Joint Commission International (JCI)
Accreditation Standards for also include the requirement of confidentiality of patient information
Hospitals
Right to Privacy and Electronic Data
provides that any person with access to electronic data messages or

Electronic Commerce Act documents has the obligation of confidentiality or the duty not to convey
of 2000 the information to, or share it with any other person. Unauthorized access
to computer systems is punishable by a fine and mandatory imprisonment.
Republic Act No. 4200 may be applied in instances, where a person who is not authorized by
(Anti-wiretapping law) parties to a private communication record or communicate its contents.
In the view of the use of health information technology, there is now a
legislation specific to data protection in relation to medical privacy. A
Republic Act No. 10173,
comprehensive and strict privacy legislation “to protect the fundamental
(Data Privacy Act of 2012)
human right of privacy, of communication while ensuring free flow of
information to promote innovation and growth.”
The rule of the confidentiality of physician-patient communication and patient records is not absolute;
there are exceptions under the following circumstances:
Exceptions to the Right to Privacy

1.Upon patient
a. Upon waiver or authority of the patient to release such information
consent or
b. For purposes of insurance compensation
waiver
a. Republic Act No. 3753 (Law on Registry of Civil Status) - Births and deaths should
be registered
b. Republic Act No. 3573 (Law of Reporting of Communicable Diseases) – Reporting
of certain communicable diseases is mandatory (COVID-19 pandemic)
c. Executive Order No. 212 – requires medical practitioners to report treatment of
patients for serious and less serious physical injuries
2. In the
d. Presidential Decree No. 603, (Child and Youth Welfare Code) – practitioners are
interest of
required to report cases of child abuse or maltreatment
public order
e. Comprehensive Dangerous Drugs Act of 2002, Republic Act No. 9165
and safety
f. Republic Act No. 9745 (Anti-Torture Act of 2009) – a person claiming torture by
the authorities is given the right to a physical examination and psychological
evaluation, to be contained in a medical report
g. Code on Sanitation of the Philippines (Presidential Decree No. 856) –
authorizes the Court and police authorities to order the performance of an autopsy
on the remains of an individual
The rule of the confidentiality of physician-patient communication and patient records is not absolute;
there are exceptions under the following circumstances:
Exceptions to the Right to Privacy
3. Upon Quasi-judicial body may be referred as any of these agencies: e.g., NBI, PAO, BOC
lawful order
of the court a. Release of health information may occur upon service of a valid subpoena, warrant,
or a or adjudicative order from a court, a law enforcement agency, an administrative agency
quasi-judicial authorized by law, or an arbitration panel
body
• The National Ethical Guidelines for Health Research permits review of medical
4. For records without consent for purposes of research provided the data are de-
research identified or anonymized and are nonsensitive
purposes: • Institutional Ethics Review Committees – determines which data are non-
sensitive and not on individual investigators or researchers.
The following key issues with respect to health information
privacy in the Philippines:
1. W h i l e the right to privacy is guaranteed by the Constitution and protected by

existing laws, there currently is no standard health information privacy
policy in the Philippines.
2. Implementation and enforcement are difficult to monitor, specifically
because the policy is scattered across several statutes.
3. The Philippines seems to lack a “privacy culture”
4. Individuals and institutions transitioning to electronic medical records must
understand and search for the presence of security measures as role-based
access control, data encryption, and authentication mechanisms in the systems
they are purchasing or developing.
5. The pervasiveness of the issue of health information privacy requires
urgent, sustainable action at the national level coupled with implementation
at the institutional and individual level.
WHAT SETS US APART?
The Philippines could take a cue from These privacy policy codes lay
developed countries that adopted a down, in concrete terms:
unified health information privacy
policy: ❑ the rules governing collection,
storage and utilization of health
❑ New Zealand’s Health information;
Information Privacy Code ❑ the roles and responsibilities of the
❑ Australia’s Privacy Act of 1998 different stakeholders;
❑ Pan-Canadian Health ❑ the scope and limit of health
Information Privacy and information privacy;
Confidentiality Framework ❑ the safeguards (policy,
❑ The USA’ Health Insurance administrative, institutional,
Portability and Accountability environmental, and technical) to
Act (HIPAA) maintain health information privacy
Challenges in
Managing
Patient
Information
M A S A H I RO S. KU RONAGA JR.
Y EA R III
Challenges in Management of Patient Information
● Design and Development challenges

● Implementation and Use challenges
● Monitoring, Evaluation, and Optimization
challenges
Design and Development challenges
● Developing proactive models, methods, and tools to

enable risk assessment
● Developing standard user interface design features
and functions
● Ensuring the safety of software in an interfaced,
networked clinical environment
● Implementing a method for unambiguous patient
identification
1. Developing proactive models, methods, and tools to enable risk assessment
Challenge: A complex health IT–

based clinical application can create
risks to patients, the organization
responsible for their care, or even
the developers of these systems.
Measure: derive an overall proactive

risk for an error class and
strengthening knowledge, experience
and competencies appropriate to
undertaking the clinical risk
management tasks
2. Developing standard user interface design features and functions
Challenge: Poor user interface design

leads to errors in data input and
comprehension.
Measure: better and more

standardized ways of allowing users
to enter data, as well as automatically
checking that the entered data are
correct for a particular patient and
follow well-established standards for
design, development, and testing of
safety-critical software.
3. Ensuring the safety of software in an interfaced, networked clinical
environment
● Challenge: The entire process of

developing, implementing, patching,
and updating should be error free.
● Measure: Develop fail-safe software

design, development, or testing
methodologies and
“pre-certification” program that will
certify software developers rather
than individual projects is a step in
the right direction that attempts to
balance safety and innovation.
4. Implementing a method for unambiguous patient identification
Challenge: One of the greatest patient

safety risks involves accurate patient
matching within and across EHRs,
organizations, communities, and nations.
Measure: assign each individual a unique

number, and then requiring its use, utilizing
one or more biometric identifiers,
Establishing a common set of identifying
characteristics and probabilistic methods
to combine them
Implementation and Use challenges
● Developing and implementing decision support

which improves safety
● Identifying and implementing practices to safely
manage IT system transitions
5. Developing and implementing decision support which improves safety
Challenges: Busy clinical application users
will continue to make errors and mistakes
Measure: Health IT should act as a cockpit

and also as a “safety net” both to make it
easier to do the right thing, as well as catch
errors.
Providing the appropriate amount and

ensuring the safety and reliability of
artificial intelligence (AI)-driven
automation while also ensuring that the
human is aware of what is happening and
is “in the loop” are critical to successful
health IT.
6. Identifying and implementing practices to safely manage IT system
transitions
Challenge: De novo system implementation,

transitions from an in-house developed EHR to
a commercial off-the-shelf EHR or from one
commercial EHR to another, and even major
upgrades of an existing EHR introduce safety
risks.
Measure: implement best practices to manage

the different types of system transitions
including partial implementation (hybrid
record system), record migration, software
updates, and downtime.
Monitoring, Evaluation, and Optimization challenges
● Developing real-time methods to enable automated

surveillance and monitoring of system
performance and safety
● Establishing the cultural and legal framework/safe
harbor to allow sharing information about hazards
and adverse events
● Developing models and methods for
7. Developing real-time methods to enable automated surveillance and
monitoring of system performance and safety
Challenges: Organizations today do

not have rigorous, real-time, or even
close-to-real-time, approaches to
routinely assess the safety of their
health IT systems and identify safety
hazards.
Measure: Develop real-time

assessment of health IT system
safety.
8. Establishing the cultural and legal framework/safe harbor to allow sharing
information about hazards and adverse events
Challenge: The vast majority of EHR-related

patient safety concerns, “broadly defined as
adverse events that reached the patient, near
misses that did not reach the patient, or
unsafe conditions that increase the
likelihood of a safety event” are not
identified, let alone reported.
Measure: creation of a mandatory,

blame-free, national or international health
IT reporting system that gathers and
investigates serious patient safety issues with
the help of dedicated experts
9. Developing models and methods for
Challenge: Role of consumers and
their caregivers in detecting and
mitigating IT related errors
Measure: Patients should have a way

to report medication order errors
experience in the pharmacy and
accessibility of progress notes and
other clinical data
References :
● ETHICAL ISSUES IN MANAGING PATIENT INFORMATION
Langarizadeh, M., et.al. (2017) Application of Ethics for Providing Telemedicine
Services and Information Technology.
6 Ethical Issues in Healthcare in 2020. (2020).

https://online.ahu.edu/blog/ethical-issues-in-healthcare/
● LEGAL ISSUES IN MANAGING PATIENT INFORMATION

Antonio, C. A. T., Patdu, I.D., & Marcelo, A. B. (2016). Health information privacy in the
Philippines: Trends and challenges in policy and practice. Acta Medica
Philippina, 50(4).
● CHALLENGES IN MANAGING PATIENT INFORMATION

Current Challanges in health information technology:
https://journals.sagepub.com/doi/full/10.1177/1460458218814893
Managament of Patient Information Trends and Challanges in Member states -

World Health Organization
ISSUESOFPRIVAC Y OF PRIVACY
ISSUES
ANDAND CONFIDENTIALITY
IN TELEMEDICINE
CONFIDENTIALITY
BULOS, MADERA, JIMENEZ
PRIVACY AND
CONFIDENTIALITY IN
TELEMEDICINE
BULOS, FLORIE LEI
MD III
PRIVACY
➔ right of an individual to have control over
how his information is collected, used and/or
disclosed
CONFIDENTIALITY
➔ duty to ensure important information are
kept in secret between two or a group of
individuals until the person to whom the
information belongs to permits to disclose
it.
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Categories of Security andPrivacyAttacks
an attack on availability(A) of information. Information

INTERRUPTION becomes unavailable or gets destroyed
an attack on confidentiality(C) of information. An unauthorized third

INTERCEPTION party gets access to information.
an attack on the integrity(I) of information. An unauthorized third party

MODIFICATION not only accesses the information but also tampers with it.
an attack on authenticity of information. An unauthorised third

FABRICATION party enters fabricated message into the information
GENERAL PRIVACY, CONFIDENTIALITY
AND SECURITY ISSUES
IRENE FRANCES MADERA

Privacy and Security Concerns in
Telehealth
Privacy risks involve a lack of control over the collection, use,
and sharing of data
● Home telehealth devices and sensors designed to detect falls may

collect and transmit information on activities in the household that a
patient wishes to keep private, such as substance abuse or that the
house is unoccupied at particular time
● Smartphone apps may share sensitive data—such as sensor data on
location—with advertisers and other third parties in ways not
anticipated by users.
https://journalofethics.ama-assn.org/article/privacy-and-security-concerns-telehealth/2014-12
Privacy and Security Concerns in Telehealth
Existing regulations are insufficient to provide strong privacy and risk
protections for users
● Currently, the Health Insurance Portability and Accounting Act (HIPAA) contains
the primary set of regulations that guide the privacy and security of health
information
● HIPAA requires that identifiable health information be encrypted so that only those
authorized to read it can do so
● HIPAA, however, applies only to “covered entities”—health care providers and
insurers—not to patients
● The Food and Drug Administration (FDA) regulates medical devices but not
consumer-facing devices and apps, focusing on technical issues related to the
security and integrity of information. In this way, the FDA ensures patient safety
but not patient privacy
● Hall and McGraw propose that Congress authorize a single federal agency, the Federal
Trade Commission (FTC), to create and enforce telehealth privacy and security
regulations
https://journalofethics.ama-assn.org/article/privacy-and-security-concerns-telehealth/2014-12
Health Information Privacy in the Philippines:
Trends and Challenges in Policy and Practice
1. Broader audience for patient information

● includes software developers, programmers, network operators, and other
individuals operating behind the scenes to maintain the system
● Non-uniform adoption and application of privacy policies by individual
telecommunications companies and Internet service providers
1. Aggregation of patient data into large, networked databases, which are intended to
facilitate access by, and link information from, different co-managing health
providers
2. Implication of the use of information and communications technology to disseminate
private health data for non-health and non-educational purposes
3. 4. Data transmitted through electronic channels may theoretically be stored
indefinitely
https://www.actamedicaphilippina.org/api/v1/articles/6849-health-information-privacy-in-the-philippines-trends-and- 77
challenges-in-policy-and-practice.pdf
Key issues with respect to health information
privacy in the Philippines
1. There currently is no standard health information privacy policy in the
Philippines.
○ What is available are general statutory provisions (see the Legal and
Ethical Framework section above) and guidance documents, which
individual institutions and providers may adapt for use in their facilities.
○ With respect to existing legislation, the provisions are either too generic
(encompassing privacy of communication in general) or too focused
(mandating privacy and confidentiality in specific circumstances)
2. Philippines seems to lack a “privacy culture”.
○ The synergistic action of the culture of tsismis widely prevalent in the
Philippines coupled with the ubiquity of Internet and cellular phone access
throughout the country is a real and present danger to patient information
privacy
VITAL ISSUES
1. Are health workers and patients aware of the extent to which private health information is
available to and accessible by people other than the patient and the provider?
2. Will information regarding the use of health information technologies adversely affect patients’
willingness to disclose relevant personal information and damage the quality of care that
patients receive?
3. How will existing statutory and ethical guidelines be applied in the context of health information
system use in patient care?
4. Are current local legal frameworks sufficient to guide stakeholders on health information privacy
and if not, what gaps in policy need to be filled?
5. Should non-health professionals involved in handling patient data be bound by codes of ethics
similar to healthcare workers?
SOME EMERGING PRIVACY,
CONFIDENTIALITY AND
SECURITY CONCERNS
FOR TELEMEDICINE
/ JOHN KIN JIMENEZ SGD-5 /
80
•A lack of uniform/standard
confidentiality and privacy
legislation in terms of the transfer
of health informationin
telemedicine encounters
(just as
there is with respect to
health
information
generally).
81
•Clinician-patient session via telemedicine
consultation can be recorded. Thus, the
health professional may face his/her own
privacy issues under these circumstances
Example
Unlike standard medical record documentation in which the practitioner has
discretion to selectively record his or her findings, most interactive Telemedicine
consultations are recorded in toto, resulting to practitioners having less discretion
to remove sensitive items that they might otherwise not record
•From the patient
perspective, the
patient
may not be able to "see"
who else is
viewing the
session along with
side of the long distance
the
consultation
clinician on the other
• a technical outsider, like an engineer, may be privy to the consultation
•Telemedicine may
involve the
transmission of
personal data over
unsecure connections
•Increased access to
medical information
for everyone
•What will happen to
telemedicine after
this pandemic?
GUIDELINESAND PROTOCOLS
OFTELEMEDICINE
Reference:DOH-UPM JMC No. 2020-0001 entitled "Telemedicine Practice Guidelines"
Carillo, Dineros, Gonzales

DECLARATION OFPRINCIPLES
Christian John M. Carillo
DECLARATION OF PRINCIPLES
1. Physicians shall exercise their professional judgement to decide whether
telemedicine consultation is appropriate in a given situation and based on
complexity of patient’s health condition.
a. Telemedicine shall be employed when a physician is physically inaccessible (e.g. such as during
a national emergency with community quarantine in effect, among others), in the
management of chronic health conditions, or follow-up consultations after initial treatment.
b. Emergency and serious conditions, where face-to-face assessment and physical contact are
most essential, should not be managed via telemedicine.
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2. The patient-physician relationship shall be founded on mutual trust and respect in
which they both identify themselves reliably during a telemedicine consultation.
● Telemedicine consultation should not be anonymous. Both patient and the physician
should be able to know, verify and confirm each other’s identity at the start of the
telemedicine consultation.
3. Proper informed consent must be obtained from the patient prior to any collection
of personal data and the offering of any telemedicine service regardless if it is an
initial consultation or a follow-up consultation.
● Consent shall be evidenced by written, electronic or recorded means

4. The practice of telemedicine shall follow the standards of practice of medicine as
defined under RA 2382 (The Medical Act of 1959) and its Implementing Rules and
Regulations, the Philippine Medical Association (PMA) Code of Ethics and other
applicable policies and guidelines, taking into account the absence of physical
contact.
● All physicians practicing telemedicine shall uphold the same standards of care as in a
face-to-face consultation but within the intrinsic limits of telemedicine.
5. The patient-physician relationship shall be based on full knowledge of the patient’s
medical history and a physical examination given the circumstances of a lack of
physical contact (i.e., by virtual physical exam only).
a. Physicians shall use their professional discretion to gather the type and extent of patient
information required to be able to exercise proper clinical judgment.
b. If physical examination is critical information for consultation, the physician should not
proceed until a physical examination can be arranged through a face-to-face consultation.
Wherever necessary, depending on the professional judgment of the physician, the physician
shall be responsible for the coordination of care.
6. The patient-physician relationship shall respect both patient and provider autonomy.
a. The physician can choose not to proceed with the telemedicine consultation at any time as
guided by both law and ethics. At any step, the physician can refer or request for a face-to-face
consultation.
b. At any stage, the patient has the right to choose to discontinue the telemedicine consultation.
7. The right to privacy of health information shall be protected at all times.
a. All health care providers shall uphold the data privacy rights of patients, and shall provide the
mechanisms for the patients for the effective exercise of these rights
b. The processing of health information of patients consulting through telemedicine shall be in
accordance with the privacy and data protection requirements provided under RA 10173 (Data
Privacy Act of 2012), its IRR and other relevant issuances from the NPC, and shall adhere to the
principles of transparency, legitimate purpose, and proportionality.
8. Only secure, privacy-enhancing and non-public-facing platforms shall be used for
telemedicine consultations.
● All health care providers shall exercise their professional autonomy and discretion on the
best platform to use for telemedicine taking into account what is appropriate and
adequate to deliver proper care, and as provided by existing laws and regulations on
privacy and data protection, among others.
GUIDELINES FOR TELEMEDICINE
A. RECOMMENDED PHYSICALAND TECHNICALREQUIREMENTS
B. WEBSIDE MANNERS DURINGATELEMEDICINE CONSULTATION
JanAliah R. Dineros
102
RECOMMENDED PHYSICAL AND TECHNICAL REQUIREMENTS
Recommended
minimum technology
requirements
Telemedicine
workstation
Choosing the right

telemedicine
platform
Recommended Physical and Technical Requirements
Recommended minimum technology requirements shall be as follows:
a. A stable internet connection

b. Communication device with or without video capabilities:
c. Noise-cancelling headphones
d. Speakers and microphones
e. Secure, privacy-enhancing and non-public-facing videoconferencing or communication software; or a
videoconferencing facility integrated with an electronic medical record system, if available
5 ways to get medical care through your phone
MedgatePH AIDE KonsultaMD MyPocketDoctor HEYPHIL

In setting up the telemedicine workstation, the health care provider is recommended to
observe the following measures:
a. Ensure room is quiet, interruption-free, secure, and private with adequate lighting
b. Wear headphones for better audio, if available
c. Test every speaker and microphone before every visit
d. Learn about the platform or software that will be used for the telemedicine consultation. Always test ahead of the visit,
download, or install any updates needed
e. Check internet speed
f. Turn off other web applications and notifications
g. Angle the screen so no one can walk by and see the consultation.
h. Wear same level of professional attire as in face-to-face consultation.
i. Avoid visual distractions such as busy patterned shirts, messy desks, food and drinks, photos and posters on
background wall.
j. No virtual background
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In choosing the right telemedicine platform, consider the following:
a. The platform is supportable across all devices (e.g. laptop/desktop computer or tablet, etc.), and
possibly, can be integrated to a new EMR system,or interoperable with an existing EMR system.
b. The quality of service with the use of the platform is equal or better than face-to-face consultation
c. Theplatform allows for remote patient monitoring, and clinical validation.
d. The website manners are properly observed and addressed when using the platform.
e. The platform is as easy as possible for patients to access and use, and for the physician to manipulate
its features and present oneself appropriately to the patient
f. Theplatform is secure, privacy-enhancing and non-public facing.
WEBSIDE MANNERS DURING A TELEMEDICINE CONSULTATION
Greeting
Maintaining
Etiquette
Empathy &
Communication
Webside Manners during a Telemedicine Consultation
Greeting
1. Introduce self and your role. Ask patient to introduce himself/herself and family members or other
companions in the room,if assisted.
2. Confirm with patient that s/he can see and hear you clearly.
3. Acknowledge the use of the new technology. Normalize any discomfort with the use of the platform.
4. Demonstrate confidence in the technology and reason for use. Include instructions on what to do in case
of disconnection.
Maintaining Etiquette
1. Be aware of one’s actions since these will be magnified on camera. Sit fully upright.
2. Do not fidget, scratch, play with your hair, or touch your face.
3. Disable picture-in-picture function.
4. Look directly at the camera. This can be perceived by the patient as making eye contact.
5. Position video window of patient’s image at the top of your screen below the webcam.
6. Explain and narrate all your actions.
Empathy & Communication
1. Speak slowly and clearly. Pause longer between statements to allow for transmission delay.
2. Type into the chat window to reiterate instructions or next steps.
3. Check in frequently to elicit reactions and confirm understanding.
4. Use non-verbal cues even on virtual visits: Smile often. Use a warm tone of voice.
5. Increase the frequency of empathetic statements to show that you are listening.
6. Inform the patient when occupied such as when writing notes or looking at radiologic images or
laboratory results.
7. Summarize and clarify questions in case of delay or signal interference.
8. In case of disconnection during video consultations, inform the patient how to continue the
consultation.
D. TELEMEDICINE CONSULTATION PROCESS FLOW
C. ACTIVITIES WITHIN CONSULTATION AS APPLIED TOTELEMEDICINE
Anne Carmina C. Gonzales
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ACTIVITIES WITHIN A CONSULTATION AS APPLIED TO TELEMEDICINE
Proper Informed Consent
General Recommendations
for Conducting Virtual PE
ePrescriptions
General Documentation
Requirements
Activities Within a Consultation as Applied to Telemedicine
PROPER INFORMED CONSENT
1. How telemedicine works, including the services to be provided, expected benefits, and
billing and insurance, if any, within the telemedicine consultation
2. Limitations of telemedicine, including risk of technology failures, and service limitations
3. Manner of processing of health information, including submission to public health
authorities such as DOH for health policy and planning purposes
4. Privacy and security measures and concerns
5. Protocol on referral or care coordination
6. Documentation of the patient consent
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GENERAL RECOMMENDATIONS FOR CONDUCTING VIRTUAL PHYSICAL EXAM
1. Take a thorough medical history

2. Have a keen eye for observing the patient’s condition
3. Consider what can be examined while going through the Review of Systems
4. Partner with the patient or his/her companion to gain valuable clinical insight
a. Using home monitor, request patient or relative to take vital signs
b. Request a family member or relative to conduct palpation maneuvers or assist in
physical examination while giving instructions.
5. Take advantage of available technology.
a. Sharing photos or videos that are difficult to visualize on webcam.
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ePRESCRIPTIONS
1. All physicians shall issue electronic prescriptions in accordance with FDA Circular No.
2020-007 and any subsequent FDA guidelines, and pursuant to RA 2382
GENERAL DOCUMENTATION REQUIREMENTS
1. All telemedicine consultations should have proper documentation, which includes, but not limited
to, the following:
a. Patient and provide location
b. Family members or other companions present during the telemedicine consultation;
c. Patient consent
d. Referring physician, if applicable
e. Telemedicine platform or videoconference or communication software used
f. Patient’s feedback about the telemedicine consultation
2. All health care providers whose services are sought through telemedicine shall keep records of all
electronic clinical abstracts/consultation summaries, prescriptions and/or referral forms issued
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TELEMEDICINE CONSULTATION PROCESS FLOW
Before Telemedicine
Consultation
During Telemedicine
Consultation
After Telemedicine
Consultation
Telemedicine Consultation Process Flow
BEFORE TELEMEDICINE CONSULTATION
a. Prepare technical set up of the telemedicine workstation.

b. Determine if the patient is suitable for a certain telemedicine service. Normalize
any discomfort with the telemedicine platform,if any.
c. Prepare the patient’s previous medical records, if applicable.
d. Ensure that both signal/audio/video are clear on both the patient’s and
provider’s side
e. Give introductions. Family members or other companion present should also be
introduced
f. Set expectations and secure consent
DURING TELEMEDICINE CONSULTATION
a. Determine mutually agreeable agenda items.

b. Explain to the patient how you will get the information you need for diagnosis and plan
of management.
c. Conduct your history taking and virtual physical examination.
d. Obtain patient feedback.
AFTER TELEMEDICINE CONSULTATION
a. Summarize key points and ask for clarifications. Have the patient repeat back what they un
b. Explain plan for laboratories and ancillaries
c. Explain e-Prescription instructions
d. Arrange for a face-to-face follow-up consultation, or give instructions to go to the nearest he
worsening symptoms or emergencies post telemedicine consultation
e. Ask if the patient was comfortable with the telemedicine set-up
f. Give a clear sign to the patient that the consultation is coming to an end. Thank the patient
g. Complete the documentation
h. Email the patient a password-protected file of a summary on what was discussed during the tel
BEFORE DURING AFTER
Teleconsultation Teleconsultation Teleconsultation
• Determine mutually agreeable • Summarize key points and ask for

clarifications. Have patient repeat back
agenda items.
• Prepare technical set up, room location what they understood
• Determine if the patient is suitable •forExplain
a
how you will get the • Explain plan for laboratories, ancillaries
• Explain e-Prescription instructions
information you need for
certain telemedicine service. • Arrange for a face-to-face follow-up
diagnosis and treatment.
• Prepare the patient’s previous medical consultation, or give instructions to go
• Conduct your history taking & to the nearest health facility in case of
records, if applicable. worsening symptoms or emergencies
virtual physical examination.
• Ensure if signal/audio/video are clear on post telemedicine consultation
• Get patient feedback. • Ask if the patient was comfortable with
the patient’s side
the telemedicine set-up
• Give introductions. Family members or other • Give a clear sign to the patient that the
companion present should also be consultation is coming to an end. Thank
the patient
introduced • Complete the documentation
• Email the patient a password-protected
file of a summary on what was
discussed during the telemedicine
• Secure consent
129
THANK YOU!
MEDICAL
INFORMATICS
Arienda,Kristine Marie Galvez, Jessa Jhen

Arevalo,Jackie Lyn Jazareno,Janella Mariz
Bendal, Beverly Mejia, NelsonHenry
Cabarles, Jerick Mohametano, Emmanuel
Canales, Ma.Kristel Hazel Joshua Zaragoza,Andrea
Chito, Siennah Nicole
YEAR III |GROUP 6

Topic Outline:
01 CAREERS INHEALTHANDMEDICALINFORMATICS
Canales, Chito,Cabarles
02 COMPARATIVECOSTANDEFFECTIVENESS OFMEDICALINFORMATICS
Jazareno,Galvez,Arevalo
03 THEFUTUREOFHEALTHANDMEDICALINFORMATICS
Mejia,Zaragoza,Bendal
04 INNOVATIVEPRACTICESINMEDICALINFORMATICS
Mohametano,Arienda
CAREERS IN HEALTH / MEDICAL
INFORMATICS
Canales, Ma.Kristel Hazel

Cabarles, Jerick
Chito, Siennah
With the onslaught of this worldwide pandemic, we cannot deny the
necessity and importance of technology (including technological devices) and
online communication in our current daily lives. This has surely brought about an
influx of skilled personnel able to keep up with the rise of technological
advancements in the field of healthcare.
Professionals in “health informatics,” a rapidly growing field that involves

collecting and analyzing healthcare data, are blazing a new path in an era where
computers and care providers work together.
Careers in health informatics vary depending on the size of the employer

and what types of health data they manage. Most jobs involve gathering data and
analyzing them, designing workflows, measuring impact, educating and training
end users, managing a system or acting as a liaison between users and coders.
KRISTEL CANAL ES |YEAR 3 |SGD 6

CAREERS IN HEALTH/MEDICAL INFORMATICS
HEALTH INFORMATICS CONSULTANT
Description:
This independent position allows healthcare facilities to
meet federal mandates while keeping employment overhead
costs low. Commonly, health informatics consultants hold a
master’s degree.
Duties and Responsibilities:

● Updating networks
● Installing software
● Monitoring systems and troubleshooting
● Training teams
KRISTEL B. CANAL ES |YEAR 3 |SGD 6
HEALTH INFORMATICS DIRECTOR
Description:
This executive level leader combines a penchant for technology with a wide
array of “people skills” aimed at integrating and organizing the flow of data across
different divisions.
● Training teams on new technology

● Meeting with stakeholders and constituents such as physicians, nurses, and
pharmacy staff to roll out technological protocol changes
● Recording, analyzing and mitigating technology issues and challenges

CHIEF MEDICAL INFORMATION OFFICER
Description:
The roles and responsibilities will vary depending on the type of organization or agency.
Overall, they are responsible for the effective and efficient flow of information and construction
of IT systems to support a high quality of patient care across multiple information systems.
They may work in a variety of settings such as in clinical and academic settings as well as,
policy-making government agencies.
● Conducting data analytics to improve IT infrastructure

● Participating on a variety of IT governance boards
● Designing and applying software applications
● Training software development teams
KRISTEL B. CANALES |YEAR 3 |SGD 6
NURSING INFORMATICS SPECIALIST
Description:
Nurse informaticists are liaisons between nurses and developers. They study workflows
to help developers build tools that nurses can use and relay concerns and limitations to find
solutions that work for both the programmers and the users.
● Training other nurses on changing record-keeping protocol

● Working toward reducing redundancy and inaccuracy in patient care plans
● Analyzing and addressing logistics of technology in direct patient care
● Design systems and build functions that allow nurses to make the best use of data

ELECTRONIC MEDICAL RECORD KEEPER
Description:
They input specific patient data, such as symptoms, conditions, diagnoses,

treatments, and other pertinent information into software programs and applications used
by the healthcare facility. Hospital administrators, medical researchers and insurance
companies use the information compiled by electronic medical record keepers to help plan
future movement of the organization.
KRISTEL B. CANALES |YEAR 3 |SGD 6

ELECTRONIC MEDICAL RECORD KEEPER
● Ensure patient records are filled out properly, accurately, and completely
● Assign codes to patient data within electronic medical record systems
● Consult with physicians to ensure the accuracy of patient record(s)
● Collect information for medical researchers and studies
● Disperses information to those allowed to receive medical information such as
insurance companies, family members, guardians etc.

HealthcareIT ProjectManager
❏ coordinates and maintains DUTIES AND RESPONSIBILITIES:
communication with project
members ➔ creates and execute project
❏ to ensure objectives and plans while revising as needed to
goals are met meet changing needs and
requirements
❏ to ensure projects are
➔ identify necessary resources
completed on time
❏ typically focuses on overseeing needed for project completion
the larger and often highly ➔ discuss and review deliverables
complicated projects involving with project members
technology advancements ➔ minimize errors and risk
exposure
JERICK E. CABARLES |YEAR 3 |SGD 6

Clinical Informaticist
❏ can be applied to a range of DUTIES AND RESPONSIBILITIES:
responsibilities
❏ smaller settings:such as a doctor’s ➔ making the information available
office or a small medical practice, a to health care providers, staff,
clinical informaticist might be and patients
responsible for organizing and ➔ educating the end users in the
managing patient data current systems
❏ large organization: such as a ➔ optimizing information
network of hospitals, those duties technology (IT) use
might be split up among multiple ➔ receiving feedback and requests
informaticists from users

Pharmacyor NutritionInformaticist
DUTIES AND RESPONSIBILITIES::
❏ On a smaller scale, informatics is ➔ Pharmacy informaticists: use data

to monitor dosing and adverse
useful when using patient and reactions and ensure more accurate
and detailed prescriptions from
prescription data to make physicians to improve patients’
results.
medication safer and more ➔ Nutrition informaticists: use patient
data to make more informed
efficient. decisions about food planning,
whether the goal is to reduce
allergic reactions, or improve a
treatment plan.

InformaticsAnalyst
❏ the informatics analyst job can DUTIES AND RESPONSIBILITIES::
involve a lot of face-to-face
education and problem solving ➔ health informatics analyst studies
❏ the analyst's job is focused on data and develops models of
working with data events and concepts that can
❏ What is analyzed -- from study provide answers to clinical
design to insurance claims, patient questions
readmission, and education ➔ some analysts also collect data
outcomes -- depends on the or support the collection and
employer. systems used to manage the
data

InformaticsSpecialist
❏ Informatics specialists often work
with an organization’s leadership ➔ If a hospital chief executive
on directives, quality initiatives, and officer wants to reduce patient
governance to ensure IT systems readmissions and post-surgical
that collect, manage, and secure infections, the informatics
data are working for the group. specialist is responsible for
defining progress toward those
goals and for identifying and
testing solutions with data

InformaticsManager
❏ responsible for making sure ➔ they facilitate access to data,

systems are working when they check that collected data are
are needed accurate and ensure all the
❏ a clinical informatics manager information is in compliance with
might oversee tasks for an entire federal and state guidelines
hospital or medical practice

Informatics Director
Most lucrative job for those with IT or hospital administration

experience
Duties & responsibilities

● Promoting informatics system within an organization
● Making those systems work for the organization
● Gauging feedback and staying up to date with the best tools
available for the organization’s goals
SIENNAH T. CHITO | YEAR 3 | SGD 6

Clinical Systems Analyst
Duties & responsibilities: Skills:
● Manage the computer networks ● Strong technical skills
in hospitals and other medical ● Quick problem solving to
facilities ensure that computer
networks function effectively
● Provide system upgrades and
for staff
maintenance
● Attention to detail
● May troubleshoot computer ● Good communication skills
problems
● Train new staff to use the
system
Public Health Informaticist
● Improves public health through ● Good communication and
research and information sharing interpersonal skills
by using information technology ● Able to make data-driven
decisions
● Track public health issues
● Close attention to detail
● Help educate the public about
maintaining good health
● Translates data into easily
understood health
recommendations
Health Data Visualization Specialist
● Presents data in image form ● Analytical skills
helping people understand its ● Critical thinking
significance ● Storytelling abilities
● Computer and technical skills
● Help the public understand
● Ability to translate large
issues that impact their health amounts of data into
easy-to-understand visual
formats

Health Care App Developer
● Create new technology solutions ● computer programming skills
for doctors and patients to ● ability to solve complex
streamline the management of problems
their health care information ● attention to detail
● Creativity

COMPARATIVE COST AND
EFFECTIVENESS OF MEDICAL
INFORMATICS
Jazareno,Janella Mariz
Arevalo,Jackie Lyn
Galvez, Jessa Jhen
Cost effectiveness of telemedicine is related to 3
major factors:
1. Cost sharing
2. Effectiveness of telemedicine
3. Indirect cost savings
Cost sharing
● adequate patient volume
● sharing of telemedicine infrastructure amongst
various clinical users (telemedicine hardware,
software, and ancillary equipment)
● cost of clinic space, building maintenance, and
utilities
● personnel costs (annual salary and fringe benefits)
Effectiveness of telemedicine
● patient utility
● successful clinical consultations
Indirect cost saving
● travel and lodging expenses
● lost productivity cost
Telemedicine: a
systematic review of
economic evaluations
BACKGROUND
•Telemedicine is an expanded term in health
information technology that comprises
procedures for transmitting medical
information electronically to improve
patients’ health status.
BACKGROUND
● Conclusions from previous studies:
○ Improved efficiencies in the health services
○ Practical usability
○ Increased access to health services
○ Improved quality of care
○ Enhanced quality of life
● Still in question: Cost-effectiveness of telemedicine
○ Purpose of the study: to evaluate cost-effectiveness of
telemedicine interventions in various specialty fields
METHODS
● The Cochrane Library and Centre for Review and
Dissemination were searched up to February 2013 using
Mesh.
● Studies that compared any kind of telemedicine with

any other routine care technique and used cost per
health utility unit’s outcomes were included.
○ Included 21 studies
RESULTS: CARDIOLOGY
○ Cost-effective:
■ Nurse-administered telemedicine via telephone for control of
hypertension among veterans
■ Telestroke: a 2-way audiovisual technology that links stroke
specialists to remote emergency department physicians and
their stroke patient
○ Cost-prohibitive:
■ 5-yr teleconsultation services for children with cardiac
pathologies
■ Public campaign and prehospital telemedicine diagnostics to
reduce thrombolytic delay for AMI
● Expensive, little impact on AMI fatality
RESULTS: PULMONARY
○ Cost-effective:
■ Outpatient pulmonary care to rural populations w/c have
limited access to specialized services
● Telemedicine vs. Usual care vs. On-site care
($335/pt/yr vs. $585/pt/yr vs. $1166/pt/yr)
■ Tele-endoscopy to determine presence of cancer of the
airways
○ Inefficient:
■ Mobile technology asthma control
RESULTS:
OPHTHALMOLOGY
● 3 STUDIES WERE DONE:
1. (Rein et al.) Cost-effectiveness of three screening alternatives for patients aged
30 or older with type 2 diabetes with no or early diabetic retinopathy.
o Telemedicine increased costs by $3,343,
o Biennial evaluation by $3,636, and
o Annual evaluation by $4,809;
● CONCLUSION: They found that telemedicine is not cost-effective for
low-risk patients for annual eye evaluation But it is a costly diagnostic
eye-care evaluation
JESSA JHEN M . GALVEZ YR III

RESULTS:
OPHTHALMOLOGY
2. (Aoki et al.) Compared two screening strategies for
analysis of teleophthalmology and non-teleophthalmology
cost-effectiveness in order to detect diabetic retinopathy in
prison inmates with Type 2 diabetes.
● FINDINGS SHOWED:
o Health benefits were discounted at an annual rate of 3%.
o The teleophthalmology strategy resulted in an average of 18.73 QALYs
§ 12.4% of patients reached blindness
§ The total cost per patient was $16,514
o The non-teleophthalmology strategy in an average of 18.58 QALYs.
§ 20.5% of patients reached blindness in the non-teleophthalmology strategy.
§ The total cost per patient was $17,590 in the non-teleophthalmology group.
o The absolute risk reduction for blindness was 8.1%.
o The number needed-to-screen was 12.4.
● CONCLUSION: Teleophthalmology is more cost-effective than face-to-face examination for evaluating
diabetic retinopathy
RESULTS:
OPHTHALMOLOGY
3. (Jackson et al.) Studied cost-utility analysis of
telemedicine and standard ophthalmoscopy for retinopathy of prematurity management.
oFor infants with birth weight less than 1500g the costs per quality-adjusted life
year (PQALY) gained $3193 with telemedicine
o $5617 with standard ophthalmoscopy.
● CONCLUSION: Telemedicine is more cost-effective than standard
ophthalmoscopy for retinopathy of prematurity (ROP) management and both of
them are highly cost-effective compared with other health care interventions

RESULTS:
DERMATOLOGY
1. (Eminović et al.) Analyzed the cost minimization of
teledermatology, and conventional process costs based
on clustered randomized trial to investigate what extent and under which conditions
store-and-forward teledermatology can reduce costs from a societal perspective.
o Total mean costs of teledermatology process (€387) were higher than the total mean
costs of conventional process costs (€354);
● CONCLUSION:
○ It means teledermatology process costs in 89% of all simulations were more
expensive
○ Thus it should be applied in only those cases with a reasonable probability
that a live consultation can be prevented (Ex: Pandemic situations)
RESULTS:
DERMATOLOGY
2. (Loane et al.) Performed a randomized controlled trial on
the health economics of teledermatology care with conventional
outpatient care in urban and rural perspective.
o From the patient perspective, telemedicine was cheaper than conventional care as it involved
less travel and time costs.
oFrom the hospital perspective, telemedicine was only marginally more expensive than
conventional care when current equipment prices were used in the calculations.
§ Indeed, from the hospital viewpoint, the marginal cost of the telemedicine consultation was
lower than that of the conventional consultation when current prices were used.
● CONCLUSION:
o Using a real-world scenario in urban areas the average cost of telemedicine and conventional
consultation were about equal,
o In rural areas the average cost of telemedicine consultation was less than that of conventional
consultation JESSA JHEN M . GALVEZ YR III
RESULTS:
DERMATOLOGY
3.(Wooton et al.) Demonstrated that in four health center (two
urban, two rural) and two regional hospitals with 204 dermatology
patients. 102 teledermatology patients and 102 to traditional
outpatient consultation.
o The net societal cost of initial consultation was $132.10 per patient for teledermatology
o The net societal cost of initial consultation was $ 48.73 for conventional consultation.
oSensitivity analysis revealed that if each health center had allocated one morning session
a week to teledermatology and the average round trip to the hospital had been 78 km instead
of 26km, the costs of the two methods of care would have been equal.
● CONCLUSION:
o Real time teledermatology was clinically feasible but not cost-effective compared with
conventional dermatological outpatient care.
OTHER INDICATIONS
OF USE:
1. (Graves et al.) Indicated that telephone-counseling intervention for
PHYSICAL ACTIVITY AND DIET compared with usual care was
not cost-effective ($ 78,489 per QALY gained).
oUsual care (brief intervention) compared with real practice (Real Control) was cost-
effective ($ 12,153 per QALY gained).
oThe decision to adopt telephone-counseling program in real practice (Real Control)
seems to be cost effective.
2. (Crow et al.) Found that COGNITIVE BEHAVIOR THERAPY FOR BULIMIA NERVOSA
provided by telemedicine may be cost-effective than face to face therapy in a broad geographic
area.
o This alternative approach offers hope for treatment with high expertise in the field of
eating disorders and may be used in other types of psychopathology
OTHER INDICATIONS
OF USE:
3. (Franzini et al.) estimated the COSTS AND COST-EFFECTIVENESS OF A
TELEMEDICINE INTENSIVE CARE UNIT (ICU) (TELE-ICU) PROGRAM with an
observational study on an independent group of patients.
● Ffg. are all measured:
i. ICU care complications,
ii. The length of stay, and
iii. Short-term mortality
● The cost of the tele-ICU program consisted of hourly, monthly per bed fees and telemedicine ICU capital
costs were annualized.
o After the implementation of the tele-ICU, the increase of:
o Hospital daily cost (24%);
o Hospital cost per case, (43%); and
o the cost per patient (28%) were seen.
● CONCLUSION:
o They showed tele-ICU, was cost-effective in the sickest patients because it decreased hospital
mortality without increasing costs significantly.
OTHER INDICATIONS
OF USE:
4.(Stoloff et al.) Found that if telemedicine were AVAILABLE TO THE FLEET, ship
medical staffs would initiate nearly 19, 000 consults in a year-7% of all patient visits.
o Telemedicine would enhance the quality of care in two-thirds of these consults.
● CONCLUSION:
o 17% of the (medical evacuations) MEDEVACs would be preventable with telemedicine, with a savings of
$4400 per MEDEVAC.
oNOTE: If the ship's communication capabilities were available, e-mail and internet and telephone and
fax would be cost-effective on all ships.
4.(Simon et al.) Studied on incremental BENEFIT AND COST of telephone care management and TELEPHONE
PSYCHOTHERAPY FOR DEPRESSION in seven primary care clinics of a prepaid health care plan in Washington.
o They found structured telephoneprogram including care management and cognitive behavioral
psychotherapy with a m odest increase in health services cost has more clinical benefit than current
primary care practice.
OVERALL DISCUSSION:
● The present study is one of the few studies that systematically review the economic evaluation studies in the
field of telemedicine.
● According to the included studies and telemedicine indications of useit seems that using telemedicine in:
+ Cardiology can be effective and cost-effective enough.
o But in this field, one of the included papers expressed that prehospital telemedicine
diagnostics program are likely to have little impact on acute myocardial infarction fatality.
+ In Pulmonary Indications Of Use
o One paper showed that telemedicine can be a cost-effective strategy for delivering
outpatient pulmonary care to rural populations which have limited access to specialized
services,
o Two papers expressed that telemedicine isn’t cost effective in asthma and airways cancer
+ In O phthalmology, four studies found that in diabetic retinopathy, the use of telemedicine is a
cost-effective tool for diagnosis of this disease.
+ In Dermatology, three papers expressed that telemedicine in dermatology isn’t cost effective
enough in comparison of conventional cares
OVERALL DISCUSSION:
+ In other fields such as:
i. Physical Activity And Diet,
ii. Eating Disorder,
iii. Tele-Icu,
iv. Psychotherapy For Depression and
v. Telemedicine On Ships,
● Our findings showed that all included studies were conducted in HIGH-INCOME COUNTRIES. 12 studies in USA, 3
in Australia, 2 in the UK, and one study in Canada, Denmark, and Scotland and Netherlands was conducted.
○ Included studies found that telemedicine can be used as a cost-effective tool for cares and treatments
● Our findings surprisingly showed that telemedicine in low-income countries with limited resources are
underused.
○ Telemedicine in LOW-INCOME COUNTRIES with:
i. Lack of resources,
ii. Inadequate infrastructure
iii. Shortage of doctors and other health care workforce,
● Can be used as an innovative solution that reduces many costs, including travel costs and increase access to health
care; given that telemedicine requires the application of modern technology, it is used less in such settings.
● Considering cheaper and non-real-time (store-and-forward) telemedicine that has the largest applicability in these
settings, we recommended pilot projects on cost-effectiveness of telemedicine programs in low-income countries.
LIMITATIONS OF THE STUDY:
● Our evidence for the cost-effectiveness of telemedicine was inconsistent,
across a wide range of fields. It suggested future studies focus on special
telemedicine intervention.
● Also because of existing country-specific variations in the health systems, it is
problematic to generalize the cost-effectiveness of telemedicine
interventions from one country to another.
oGeneralizability of cost-effectiveness of telemedicine interventions
depends on the exclusive contextual aspects of the telemedicine service
being implemented.
oHence, it is suggested, especially in regions with low resources to
conduct local cost-effectiveness analysis of the telemedicine systems.

CONCLUSION:
● In conclusion, the most of the included studies confirmed
that telemedicine is cost effective for applying in major
medical fields such as CARDIOLOGY, PULMONOLOGY,
OPHTHALMOLOGY AND SO ON, but just in dermatology,
papers could not confirm the positive capability of
telemedicine.

THE FUTURE OF HEALTH /
MEDICAL INFORMATICS
Bendal, Beverly
Mejia, NelsonHenry
Zaragoza,Andrea Nicole
•A discipline that combines information systems, data, communications and medical care and
is revolutionizing the health care industry.
•Large variety of these technologies are already available on the market
•Are there any more advancements in the field of health informatics that we can achieve?
•What kind of contributions of medical informatics as a scientific discipline are necessary

within the next years in order to keep intra- and interinstitutional information systems in
health care and medical research to be as efficient as necessary?
Beverly G. Bendal | SGD 6

Where it starts
•Current trends and issues in medicine and in the fields of information systems, health
information systems and information management.
•Information systems have to be adjusted continually to the changing demands stemming from
trends in medicine and health care
•These challenges will push medical informatics to solve these problems, thus the
advancements shall be derived from these issues.
•Need for collaboration among doctors, medical researchers, (software) engineers, lawyers,
business administrators, etc.

•Medical informatics will have a future with perspectives concerning intra- and
inter-institutional information systems and beyond.
•Medical informatics will surely play an essential role in medicine to continue

delivering high quality care efficiently to people worldwide.

Trends in Medicine,
Information Systems and
Information Management
Nelson Henry R. Mejia
Year III | SGD 6
Trends in Medicine and Health Care
Medicine and health care turn out to be increasingly driving economic factors
worldwide
● Information and communication technology being one of their most

important resources
Special need for effective and efficient information systems
● Adjusted continually to the changing demands stemming from trends in

medicine and health care
Mejia
Trends in Medicine and Health Care
● Patient-centered medicine and “continuity of care”

● Quality assurance as well as economic pressure call for access to and
support by current medical knowledge
● Evidence-based medicine needs clinical research
● Stress of competition among health care providers will increase
● Need for a more efficient support of information systems
● Molecular diagnostics will enable more appropriate selection and even
individual design of therapies
Mejia
Trends in Information Systems
● Service Oriented Architectures (SOA)

○ Another promising approach to overcome information systems
dominated by software of a single vendor and to support “best of
breed” architectures
○ Provides new chances for adapting HIS (Hospital Information System)
to the needs in medicine
■ BUT there are still problems
● Defining services appropriately
● Managing complex service integration tools
Mejia
Trends in Information Systems
● Green IT
○ Has a considerable impact on medicine and health care
○ Reduce costs, increase productivity and improve building
performance, while minimizing the negative environmental effects of
Information Technology
○ Emphasizes the need for close collaboration of information
management departments and facility management and technical
departments in a hospital in order to find solutions for energy recycling
○ Information management in health care has to be considered much
more as an integral as well as integrating part of hospital-wide
management
Mejia
Trends in Information Management
Only little research on information management in the sense of management of

information systems in medical informatics up to now
Well-established approaches from other industries like CobiT and ITIL are now
under deeper consideration in medicine and health care
Mejia
Trends in Information Management
● CobiT (Control Objectives for Information and Related Technology)

○ Has the potential of efficiently supporting the control of information
systems in health care
● ITIL (IT Infrastructure Library)
○ Provides considerable chances for better service delivery by
information management departments in hospitals
○ Main goal is high-quality service delivery
Mejia
Contributions of Medical
Informatics as a Scientific
Discipline
Andrea Nicole P. Zaragoza

Year III | SGD 6
Contributions of Medical Informatics as
a Scientific Discipline
● Due to the challenges mentioned, many
research and development topics can be
derived and this can be one of the
contributions of medical informatics as a
scientific discipline.
Contributions of Medical Informatics as a Scientific
Discipline
1. Information management in health care has to be better

integrated not only with enterprise management but also with
facility management.
● New concepts are necessary to overcome the detachment of
information and facility management. Those concepts can only be
developed in close cooperation of both medical informatics and
business administration experts.
Discipline
2.Health care provided by regional networks needs reliable and
trustworthy regional HIS.
● Reliability and trustworthiness: depend on the information
systems’ architecture.
● New methods for model-based design of even large, complex and
regional information systems’ architectures should be developed.
● Metrics and key performance indicators supporting quality
measurement of information systems have to be integrated.
Discipline
3. Reference models for a more strategic integration with IT

management should be developed.
INNOVATIVE PRACTICES IN
MEDICAL INFORMATICS
Arienda,Kristine Marie
Mohametano, EmmanuelJoshua
Emergence of E-health
● What is e-health?
○ "the use of ICT for health, which includes caring for patient,
conducting health research, educating the health workforce,
tracking diseases and monitoring population health" (WHO,
2012)
● As early as 1994 certain problems were identified:
○ The existence of major gaps in information
○ Inappropriateness of the available information
○ Information is not utilized for management at most levels
INTEGRATIVE MODEL OF E-HEALTH USE (IMEHU)
● Static information reading (passive receiver) →interactive health management
initiatives (active collaborator) →E-health →development of issues (e.g. digital
divide) →IMEHU
● A theoretical framework based on several information processing, media use,
and channel complementarity theories that suggests that macro-level disparities
in social structures are manifested in individual-level differences in motivation
and ability, thus connecting the broader structures in social systems with the
micro-level contexts within which these structures constrain and enable human
agency
Integrative Model of E-Health Use (IMEHU)
Philippines and ICT
● 80 million Filipinos have mobile phones and almost all rural

villages have cellular signals
● 63 of the 80 provinces having a fibre-based infrastructure
● One of the highest usage rates of short messaging systems
(SMS), has been dubbed the "texting capital of the world
● As of January 2020, Philippines tops world internet usage index
with an average of 10 hrs/day
Starting points of Philippine e-health
E-health Research and Innovation timeline
The National Unified Health Research Agenda
● spearheaded by the Philippine Council for Health Research and Development
– DOST (2011)
● serves as the country’s template for health research and development efforts
● serves as the research guide of the National Telehealth Service Program
(NTSP) that began in 2004
○ 2 components
■ Emergency Care and Coordination Services, (or Project ECCS)
● Automated Triage
● Expert Interface
● ESP
■ Project Lifelink
● RxBox
E-health research initiatives of DOH
● Unified Health Management Information
System (UHMIS)
○ Hospital Reporting System
○ National Health Data Dictionary
○ Integrated DOH Licensing Information System, (11)
○ National Electronic Injury Surveillance System
○ Field Health Services Information System
○ Kontra-Paputok Reporting System
○ Health Clinic Information System
○ Electronic Essential Drug Price Monitoring System
○ Filariasis Information System
○ Integrated Drug Test
○ Schistosomiasis Information System
○ Operations and Management Information System ○ Integrated Chronic Non-Communicable Registry
○ Adverse Drug Online Reporting System System
○ Health Record Number Registration System ○ Overseas Foreign Worker Clinic Uploading
○ Health Facility Database System System
○ Philippine Persons with Disability Registry ○ Philippine Organ Donor and Recipient Registry
○ System System
○ National Database on Health Human Resource ○ Electronic Philippine Integrated Disease
○ Integrated TB Information System Surveillance and Response (ePIDSR)
○ Surveillance in Post-Extreme Emergency and
Disaster (SPEED)
Networks providing platform for E-health education and
capacity building
● Philippine Research, Education and Government Information
Network (PREGINET)
○ the only research network which interconnects researchers, academicians,
and government institutions for sharing online information, resources, and
reference for their academic and research extension work
○ Set-up providers dedicated infrastructures for high-bandwidth internet
exchange for video-conferencing
○ Enables regular eLearning/video conferences of the Philippine General
Hospital Department of Surgery with counterparts in various University
hospitals in the Asia Pacific
Networks providing platform for E-health education and
capacity building
● Philippine Health Information Network (PHIN)

○ Launched in 2005
○ aims to create and to sustain a collaborative effort among different
organizations such as government agencies, donor organizations,
academe, private sector, and others involved in health information
E-health as part of the Philippine National Agenda
● Vision
○ ICT supporting Universal Health Care to improve healthcare access,
quality, efficiency, and patient safety and satisfaction, to reduce cost
and enable policy makers providers, individuals and communities to
make the best possible health decisions
● Mission
○ Effectively use ICT to improve healthcare delivery, administration
and management, and in communicating health
E-health as part of the Philippine National Agenda
● 5 goals
1. establishing enabling structures and policy
2. capacity building to achieve e-maturity among the health workforce
3. Infrastructure building
4. institutionalize knowledge management systems to promote knowledge
exchange and utilization especially at sub-national levels
TELEPSYCHIATRY
● The use of telecommunication technologies (radio, e-mail, tv, and
videoconference) with the aim of providing psychiatric services from a
distance
● Practiced by Canada and Australia since 1959
● Tool for improvement of mental health care limitations such as cultural,
educational, linguistically and nevertheless economical
● Improve the quality of mental health service
TELEPSYCHIATRY
Possible Applications
● Conduct treatment team with select skills- sign language and many foreign
languages staff
● Acute psychiatric assessments
● Discharge planning
● Follow up service
● Access to child, adult, geriatric, forensic and deaf services specialty staff
● Second opinion service between mental health professionals and GP`s
● Distance supervision and staff consultation
● Psycho education of family members
● Distance learning via case conferencing and best practice demonstration
● Consultations to other professionals
WELLNESS ONLINE PROGRAM
● An interactive Web based wellness program that offers three major
health-related components – health information, wellness activities that
users are required to perform every week, and interactive health
self-assessments
● Covers 6 domains of wellness; physical (fitness and diet), social, emotional,
intellectual, occupational and spiritual wellbeing
● Assessed through the TAM (Technology Acceptance Model) model
APP TO EXCHANGE E-HEALTH RECORDS & MEDICAL IMAGES IN
OPHTHALMOLOGY
● A Web -based application developed to store and exchange EHR and medical
images in Ophthalmology using HL7/CDA and XML technologies
● Contains information about patient affiliation information, patient precedents,
medical exploration and diagnostic
● Advantages
○ facilitates the interoperability between institutions and applications
○ transactions are secure
○ Web -based applications allow to improve data access for patient data management
● allows to store and display DICOM, JPEG images and other formats
● Used to detect diabetoc retinopathy
CLINICAL AND BIOMOLECULAR ONTOLOGIES FOR E-HEALTH
● Ontology
○ A semantic structure useful to standardize and provide rigorous definitions of the
terminology used in a domain and to describe the knowledge of the domain
○ Composed of:
■ Controlled vocabulary
■ Semantic network
○ Examples
■ The Open Biomedical Ontologies (OBO) foundry (http://obofoundry.org/)
■ foundational Model of Anatomy (fMA)
(http://sig.biostr.washington.edu/projects/fm/)
■ Gene Ontology (GO) (http://www.geneontology.org/)
■ Unified Medical Language System (uMls) (http://umlsinfo.nlm.nih.gov/)
● OntologIES
○ BioPax (http://www.biopax.org/)
○ eVOC (http://www.evocontology.org/)
○ ImMunoGeneTics (IMGT) Ontology (http://imgt.cines.fr/)
○ MGED vocabulary (http://www.cbil.upenn.edu/Ontology/MGED_ontology.html)
○ Molecular Biology Ontology
(http://www.cs.man.ac.uk/~stevensr/onto/node8.html)
○ Pharmacogenetics and Pharmacogenomics Knowledge Base (PharmGKB)
(http://www.pharmgkb.org/)
○ RiboWeb (http://smi-web.stanford.edu/projects/helix/riboweb.html)
Electronic Commerce for Health Products and
Services
● Electronically buying or selling of medical services and/or

products on online services or over the Internet
● Consumers can enjoy using the Internet to research and make
purchases
● Connects providers/suppliers directly with consumers
● Provides ongoing support and maintenance
● Meets millennials where they are – online
● Offers more choices in an easy-to-navigate format
Electronic Commerce for Health Products and
Services
● Four generally accepted types of e-commerce:

○ Business to Business (B2B)
○ Business to Consumer (B2C)
○ Government to Business (G2B)
○ Government to Citizen (G2C)
● ISSUE: only a few officially recognized companies offered certified
health products today
Telemedicine Consultations
Remote discussion of the clinical case via special computer
information and telecommunication system to get answers to
precisely formulated questions for the help in clinical decisions
Classifications of Telemedicine Consultations
● Synchronous:
○ All parties use the same telemedicine system in the
same time (in real time);
● Asynchronous:
○ All parties use the same telemedicine system with
time delay (sequential use).
Classifications of Telemedicine Consultations
● Formal
○ Two or more organizations were involved under a previously
signed contract/protocol/agreement;
● Informal
○ Free discussions of clinical cases in professional Internet societies
(via mailing lists, Web-forums);
● Second opinion
○ Teleconsultations for patients who contacted a medical
organization by email or via a special online form/forum.
Systems of Teleconsultation
● Inquirer: Legal or physical person representing a clinical

case for the teleconsultation. Most frequently inquirer is
the “face-to-face” physician/nurse, also – patient or
relatives (in case of self-reference for teleconsultation,
“second opinion”).
● Adviser: Expert or group of the experts considering the
clinical case which was presented for the teleconsultation
Sample scheme of Teleconsultation
Advantage of emergency telemedicine:
● Reduced mortality and health risk to patients by improving quality of

emergency health care in terms of: a) reduced waiting time for
emergency health care; b) immediate access to remote specialists; c)
improved convenience of transportation to the medical facility
● Organized medical and administrative staff in a more efficient and
effective way
● Reduced health care costs
Major challenges for emergency telemedicine
● Lack of reimbursement
● Malpractice liability issues
● Inadequate information structure
● Technical issues
Radio Frequency Identification (RFID) in Hospitals
● RFID is a technology used to identify, track, and trace a person or an object without using
a human to read and record data and enables the automated collection of important
business information (Asif and Mandviwalla, 2005)
● RFID enables a fully automated solution for information delivery at the patient’s bedside,
thus reducing the potential for human error and increased efficiency (ITU, 2005).
Radio Frequency Identification (RFID) Application in
Hospitals
Radio Frequency Identification (RFID) in Hospitals
Challenges for RFID in Hospitals
● High cost
● Lack of established standards
● Privacy and security issues
M-Health System for Remote Patient Care
● Application aimed to support ubiquitous patient care.

● This application modernizes a very few similar products traditionally used and
enhances and extends some of the capabilities offered by other systems.
● Mainly thought for clinical institutions, hospitals and geriatrics centers, in which
most of the medical staff need to perform a precise and continuous control of
elders and for those people with special cares.
● Scheduling of nurse rounds during the patient visits can be optimized using
mobile technologies because patient records are already available using the
PDA application.
Functionality And Main Features
● Only authorized hospital members may access to

different information levels depending on the role
assigned to each user type.
● Patient monitoring, evaluation, patient’s status and
check current medication.
● Insert comments on patient’s evolution

● Introduction of vital constants
● Query the evolution of patient’s constants
● Incidents
● Maintenance
● Care agenda
● Medical agenda
● Common infrastructure
● Communication between clients
● Only authorized user with appropriated permissions can access patient
records
● Can be used for home healthcare in a transparent form by means of
appropriate wireless radio protocols
Mobile Health Applications and New Home Care
Telecare Systems
● Form of e-health evolution from traditional desktop telemedicine

to wireless mobile configurations.
● M-H provides remote medical service delivery (especially the
monitoring of biomedical signals) even while patient is in a move
and regardless of geographical location of the patient
● Home care systems, on the other hand, provide usually more
functionality but these systems have the reduced range of
mobility.
Telecare Systems
Advantages of using the modern m-health and home care

applications
● Medical treatment even when the patients are not situated in

medical institution
● Continuous, “real time” or store-and-forward insight into patient’s
health parameters
● Mobility and comfort of patients while medically treated
Telecare Systems
Major Drawbacks of using the modern m-health and home care

applications
● Lack of relationship between devices

● Networks
● Standards for mobile devices
REFERENCES
● CAREERS IN HEALTH/MEDICAL INFORMATICS:
Top 7 Health Informatics Career Paths. (n.d.). Retrieved from The University of Scantron: A Jesuit University:
https://elearning.scranton.edu/resource/health-human-services/top-7-health-informatics-career-paths?fbclid=
IwAR3L5JmrlXtGV2PvY1L44BVFJpXTPBr_-Okn70KullpmAkLcw4PnJ-16dns
Health Informatics Careers for Graduates with and MSHI. (n.d.). Retrieved from University of Illinois Chicago:
https://healthinformatics.uic.edu/blog/health-informatics-careers-for-graduates-with-an-mshi/?fbclid=IwAR1iU
dZxGL4dk2ZwLWNy8jfTHUiLnp-KSaV90zJr9qIs97MWJceKlFi-pq4
USF Health Morsani College of Medicine. (n.d.). Retrieved from USF Health Morsani College of Medicine:
https://www.usfhealthonline.com/resources/career/health-informatics-jobs-health-informatics-salary/
REFERENCES
● COMPARATIVE COST AND EFFECTIVENESS OF MEDICAL INFORMATICS:
Agha, Z., Schapira R.M., Maker A.H., (2002). Cost Effectiveness of Telemedicine for the Delivery of Outpatient
Pulmonary Care to a Rural Population. Telemedicine Journal and E-Health. 8(3):281-91.
https://doi.org/10.1089/15305620260353171
Graves N, Barnett AG, Halton KA, Veerman JL, Winkler E, Owen N, et al. Cost-effectiveness of a telephone-delivered
intervention for physical activity and diet. PloS one. 2009;4(9):e7135.
Jackson KM, Scott KE, Zivin JG, Bateman DA, Flynn JT, Keenan JD, et al. Cost-utility analysis of telemedicine and
ophthalmoscopy for retinopathy of prematurity management. Arch Ophthalmol-Chic. 2008;126(4):493-9.
Loane MA, Bloomer SE, Corbett R, Eedy DJ, Evans C, Hicks N, et al. A randomized controlled trial assessing the
health economics of real time teledermatology compared with conventional care: an urban versus rural perspective.
J Telemed Telecare. 2001;7(2):108-18.
REFERENCES
Rein DB, Wittenborn JS, Zhang X, Allaire BA, Song MS, Klein R, et al. The Cost‐Effectiveness of Three Screening
Alternatives for People with Diabetes with No or Early Diabetic Retinopathy. Health Serv Res.
2011;46(5):1534-61.
Simon GE, Ludman EJ, Rutter CM. Incremental benefit and cost of telephone care management and telephone
psychotherapy for depression in primary care. Arch Gen Psychiat. 2009;66(10):1081-9.
Crow SJ, Mitchell JE, Crosby RD, Swanson SA, Wonderlich S, Lancaster K. The cost effectiveness of cognitive
behavioral therapy for bulimia nervosa delivered via telemedicine versus face-to-face. Behav Res Ther. 2009;
47(6):451-3.
Delgoshaei, B., Mobinizadeh, M., Mojdekar, R., Afzal, E., Arabloo, J., & Mohamadi, E. (2017). Telemedicine: A
systematic review of economic evaluations. Medical journal of the Islamic Republic of Iran, 31, 113.
https://doi.org/10.14196/mjiri.31.113
REFERENCES
Eminović N, Dijkgraaf MG, Berghout RM, Prins AH, Bindels PJ, de Keizer NF. A cost minimisation analysis in
teledermatology: model-based approach. BMC Health Serv Res. 2010; 10(1):1.
Franzini L, Sail KR, Thomas EJ, Wueste L. Costs and cost-effectiveness of a telemedicine intensive care unit
program in 6 intensive care units in a large health care system. J Crit Care. 2011; 26(3):329-e1.
Aoki N, Dunn K, Fukui T, Beck JR, Schull WJ, Li HK. Cost effectiveness analysis of telemedicine to evaluate diabetic
retinopathy in a prison population. Diabetes care. 2004;27(5):1095-101.
Stoloff P, Garcia F, Thomason J, Shia D. A cost-effectiveness analysis of shipboard telemedicine. Telemed J.

1998;4(4):293-304.
Rein DB, Wittenborn JS, Zhang X, Allaire BA, Song MS, Klein R, et al. The Cost ‐Effectiveness of Three Screening
Alternatives for People with Diabetes with No or Early Diabetic Retinopathy. Health Serv Res. 2011;46(5):1534-61.
REFERENCES
● THE FUTURE OF HEALTH/MEDICAL INFORMATICS:
Bates, D. W., Cresswell, K. M., Wright, A., & Sheikh, A. (2018). The Future of Medical Informatics. In D. W.
Bates, K. M. Cresswell, A. Wright, & A. Sheikh, Key Advances in Clinical Informatics (p. 293). Academic Press.
Haux, R. (2010). Medical informatics: Past, present, future. International Journal of Medical Informatics 79,
599-604.
Winter, A. (2009). The Future of Medical Informatics Some Perspectives of Intra- and Inter-institutional
Information
Systems. Methods of Information in Medicine, 62-63
Mack, J. (n.d.). University of San Diego. Retrieved from University of San Diego:
https://onlinedegrees.sandiego.edu/8-technologies-changing-healthcare/
REFERENCES
● INNOVATIVE PRACTICES IN MEDICAL INFORMATICS:
Emerging E-Health Directions in the Philippines. Manila: IMIA Yearbook of Medical Informatics.
Lazakidou, A., & Siassiakos, K. (2009). Handbook of Research on Distributed Medical Informatics and E-Heal New
York: Medical Information Science Reference.
Lazakidou, A. A., & Siassiakos, K. M. (2009). Handbook of research on distributed medical informatics and e-health.
Hershey, PA: Medical Information Science Reference.

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History and Evolution of

2. THE POSITION OF MEDICAL INFORMATICS IN

3. FIVE GENERATIONS IN DEVELOPMENT OF

4. PERSPECTIVES OF THE DEVELOPMENT OF

“MEDICAL INFORMATICS IS THE

“MEDICAL INFORMATICS ATTEMPTS TO

“THE MEDICAL INFORMATICS IS THE

● FOUNDATION FOR UNDERSTANDING AND PRACTICE

● INFORMATION THEORY, ● CLASSIFICATION THEORY,

➔ In 1960, the National Institute for Health Care in USA

➔ European Pioneers: Peter L. Reichertz

1974 – 11 world congresses on medical informatics

1976 - 20 European congresses organized by European

➔ Artificial intelligence was being introduced as separate disciplin

➔ The appearance of electronic computers with network of terminals s

● By 1965 the College of Ameíican Pathologists developed a nomenclatuíe (deteímined

● developments bíought us into an eía of health infoímation exchange

● use of netwoík systems and a gíeat numbeí of ‘bed side teíminals’

● telemedicine and telecaíing will be fuítheí impíoved

○ health caíe infoímational systems will be stíengthened with the synthesis of

● in the ﬁeld of data píotection new solutions aíe also expected

● woíking on unique standaíds cíeation, classiﬁcations, nomenclatuíes and coding

● integíation of national health caíe infoímational systems and tíanspoítability of

● Standaíds of coding of alphanumeíic data and text

□ Evidence based medicine (EBM) - the conscientious, explicit, judicious and

□ "Evidence-based health care - the conscientious use of current

□ Evidence-based practice - conscientious, problem-solving approach to

□ Producing evidence (research)

□ Critical Appraisal Process

□ What was done to address bias?

□ The Audit step in Evidence-Based Practice (EBP) is one of self-evaluation.

■ Need & demand:

■ relied on the advice of more experienced colleagues,

■ The three major aspects of evidence that you need to

■ Establishing the question type allows you to:

REMEMBER: the best available

■ synthesises the results from all available studies in a particular

■ opinion with selective illustrations from the literature

■ appraises the quality of a study and recommend its application in practice

■ original research studies that have not yet been synthesized or

NAPOLIS | PUBLICO | UTOD

Delivery of health care services, where patients and providers are

World Health Organization, 2016

Can contribute to achieve universal health coverage by improving

World Health Organization, 2016

● Make health care accessible to people who live in rural or isolated

● Make services more readily available or convenient for people with

● Provide access to medical specialists.

● Improve communication and coordination of care among members of a

● Provide support for self-management of health care.

-Real-time telephone or live audio-video interaction typically with a patient using a

Remote patient monitoring:

- consultation via online video

- Web-based or mobile apps

1.Beneficial to patients in isolated communities and remote regions, who can

2.Allow healthcare professionals in multiple locations to share information and

4. Preferable for patients with limited mobility

5.Facilitate medical education by allowing workers to observe experts

6.Eliminate the possible transmission of infectious diseases or

1. Limited access to technological devices (e.g., smartphone, tablet,

2. Situations in which in-person visits are more appropriate due to urgency,

3. The need to address sensitive topics, especially if there is patient

4. Level of comfort with technology for HCP and patients