Paradigm Shifts in Health

Informatics
Luca Dan Serbanati and Serban Radu
Politehnica University, Bucharest, Romania

HEALTHINF 2013 - 6th International Conference on Health Informatics

11-14 February 2013
 Agenda
1
1. What is a paradigm?
◦ “Canon of proportions” => “Vitruvian Man”
2. How can we use a paradigm?
p g
3. New paradigms in healthcare
◦ “Pay for performance“, “Personalized medicine”, etc.
◦ “Patient-Centered Care”
4. Shift of paradigms from business to healthcare
◦ “Business
Business Meta-Model
Meta-Model”
◦ “HL7 RIM Meta-Model”
5. Paradigm
g shifts of from information engineering
g g to ehealth
◦ “Interconnecting Health”
◦ “Integrating health”
6
6. New paradigms in health informatics
◦ Multi-agent system
◦ “R2V2R - Real-to-Virtual-to-Real”
◦ “Ecosystem”
7. Conclusions
 Example of Paradigm Shift
y Vitruvius described the human figure as Homo Vitruvianus
being the principal source of proportion
among the classical orders of architecture.
Architecture
y P di
Paradigm:
Canon of Proportions:
Paradigm
Human body proportions
shift
are the golden proportions
of architectural styles
y

Cosmography of the
microcosm,
i A
Art, SScience
i

y Leonardo da Vinci believed the

workings
ki off th
the hhuman bbody
d tto be
b an
analogy for the workings of the universe.
What is a pparadigm?
g
Definition:
A reference
f model
d l off fundamental
f d t l value
l widely
id l
accepted in a particular field because it is an
expression of a comprehensive belief system or
world view in that field.
f
◦ Usually a paradigm emphasizes relationships
between some fundamental concepts that
shape the thinking.
◦ A paradigm is derived from a specific way of
g, communicatingg and viewingg the
thinking,
world.
 Agenda
1
1. What is a paradigm?
2. How can we use a paradigm?
3. Paradigms in healthcare
4. Shift of p
paradigms
g from business to
healthcare
5
5. Shift of paradigms from information
engineering to ehealth
6
6. New paradigms in health informatics
7. Conclusions
 How to use a paradigm?
y A paradigm influences how an individual
perceives
i an area off the
h reall world
ld or reacts to
this perception.
y A paradigm
di guides
id researchh and d practice
ti ini the
th
field of interest.
y It can be used as:
◦ a structuring schema in both teaching and
model-driven design processes;
◦ a benchmark to assess methods or conceptual
tools that are related to the paradigm goal or
idea, and
◦ as this research claims,, we can use pparadigms
g
for transferring knowledge across domains.
Model--based design process
Model

1. Choose a simple
schema to be the first
model of the future
system

2.Validate the model against

the design target

[Th model
[The d l is
i 4 Describe the model in
4.
satisfactory] a design specification
[The model is not language
y]
satisfactory]
3. Refine the model 5. Use the model to
implement the system
 Agenda
1
1. What is a paradigm?
2. How can we use a paradigm?
3. Paradigms in healthcare
4. Shift of p
paradigms
g from business to
healthcare
5
5. Shift of paradigms from information
engineering to ehealth
6
6. New paradigms in health informatics
7. Conclusions
New paradigms in healthcare
y New paradigms are arising in healthcare to
mark epochal changes in the domain:
◦ "pay for performance“ focuses on cost control
◦ "personalized
p medicine" and "evidence-based
medicine“ focus on the quality of services
◦ "patient-centered
patient centered care”
care and "patient
patient
empowerment" focus on the citizens’ perception
concerning the quality and efficiency of
healthcare.
“Patient--Centered Care” Paradigm
“Patient g
"Nothing about me without me“
Or:
The right care in the right way at the right time.
Method
y Four new communication behaviors:
◦ Understanding and validating the patients’ perspective
◦ Extension of understanding the patient to his / her
global psychosocial context
◦ Shared understanding with the patient of his / her
health problem and its treatment
◦ Partnership with “empowered”
empowered patients in decision
making, power and responsibility.
 Agenda
1
1. What is a paradigm?
2. How can a paradigm be used?
3. Paradigms in healthcare
4. Shift of pparadigms
g from business to
health
5
5. Shift of paradigms from information
engineering to ehealth
6
6. New paradigms in health informatics
7. Conclusions
 )
A business meta-model
meta- *

<<situation>>
intends/ is
concerned to
Objective achieves

decides/controls/
<<role>> performs <<act>>
Agent Activity
BusinessRules
(constraints)
(co st a ts)
creates/ uses/
extends uses as a aids to carry modifies
means out
plays
<<role>>
role <<role>>
Tool Object
is applied to
plays

<< tit >>

<<entity>>
plays
Entity

*) L. D. Serbanati, Integrating Tools for Software Development,Yourdon Computing Series, Prentice Hall, 1992.
 )
A Business Model of Clinical Trials *
Organisation:
Coordinator Center (CC)
Agents: Management
CT Coordinator of clinical trial
Statistical unit
Data Safety Board

starts

Organisation:
Investigator centre Managment of
Agents: statistical
t ti ti l units
it
Chief investigator
CRF data collector creates

Environment:
Clinical ward Medical treatment of
enrolled patients Master Startup
A
Agents:
t
File experimentation
Health care providers

Patient
Compiled Information
Patient Investigator CRF
Enrollment Patient
management Investigator CT Protocol
monitoring
Directives Patient
Information Resource
Directives

Compiled
CRF Experimentation Investigator
Directives closure

*) L. Collada Ali, P. Fazi, D. Luzi, F.L. Ricci, L.D. Serbanati, M. Vignetti, Toward a Model of Clinical Trials,
ISBMDA 2004, 5th International Symposium of Biological and Medical Data Analysis, Barcelona, 2004.
 The RIM HL7 V3 Meta-
Meta-model *)

R l Li k
RoleLink Act
Relationship
0, * 0, * 0, * 0, *
Playes
0..1 0, * 1 1 1 1
1 0, * 0, * 1
Entity 0..1 0, * Role Participation Act
Scopes

*) Health Level Seven International, HL7 version 3, http://www.hl7.org

HL7 Domain Analysis Model (DAM) for
the
th LuMiR
L MiR Healthcare
H lth D
Domain
i
Domain Message Information Model
(D-MIM) of the Contact concept
HL7 generated
message
 Agenda
1
1. What is a paradigm?
2. How can a paradigm be used?
3. Paradigms in healthcare
4. Shift of p
paradigms
g from business to
healthcare
5. Shift of paradigms from information
engineering to ehealth
6
6. New paradigms in health informatics
7. Conclusions
The “Interconnecting health”
paradigm
di
y Progress in IT has made possible the
development of some new paradigms in health
informatics.
informatics
y Interconnecting health focuses on the ability to
connect health organizations and systems,
systems and
the role of IT as an enabler in achieving this
connectivity
connectivity.
◦ The growth in importance of electronic health records
in the last two decades marked a technological but
also "cultural" shift.
◦ The evolution of “Interconnectingg health” was a
continuous broadening of the horizon of
interoperability in health.
 Virtual Health Record
(RHIO)
Electronic Health R f
Reference content

Patient Schedule

History & Allergies

Records
Drugs & Immunization

EMR
Patient Lab Data

Diagnostic Image
PHR
Reference content

Patient Schedule

History & Allergies

Drugs & Immunization

EMR
Patient Lab Data

Diagnostic Image

Reference content PHR

Patient Schedule

History & Allergies

PHR
Drugs & Immunization

Patient Lab Data

EMR Diagnostic Image

PHR
KB
Community
Reference content

Patient Schedule

History & Allergies

Hospitalization
EMR
Drugs & Immunization

Patient Lab Data

Diagnostic Image
Personal Health Record
Outpatient
specialist care
Reference content

Patient Schedule

History & Allergies

EHR
Drugs & Immunization
Drug
Reference content EMR
Patient Lab Data

Diagnostic Image prescriptions

Patient Schedule Reference content Residential
care
Patient Schedule

History & Allergies History & Allergies

Drugs & Immunization Reference content

Patient Lab Data

Emergency
g y Patient Schedule

Drugs
D & Immunization
I i i EMR Diagnostic Image History & Allergies

services Drugs & Immunization

Patient Lab Data

Patient Lab Data EMR Diagnostic Image

Home care
Diagnostic Image
EMR
Electronic Health Record

Electronic Medical Record

 )
Virtual Health Record *

RHIO)
Clinical

ation (R
documents

Patient

Notification
/Alarm
Drug and lab test prescriptions
Organiza

Past medical Current

history health status
Emergency Summary
Clinical Contacts Health
CAT analysis
Event conditions
ation O

Emergency Home Recovery

Lab test results Notification Hospitalization Patient
GP Encounter Clinical
summaries Event
Notification
Observations Therapy Medication

Clinical Trial
Evaluation Report
Health IInforma

Knowledge Base
• Service & Metadata Registry • Ontology
• Clinical guidelines
• Clinical Document • Process Templates Trends in
Repository Episodes of Care
Medical image and report Securityy & Privacyy Clinical
E
Event t
Repositories Notification
• Care consumers
• Care providers
Clinical • Care organizations
Event Clinical Pathways
• Role profiles
Notification Sickness Prevalence
gional H

Demographics
*
Discharge Summary
Ongoing
treatments Workflow
Proces
s Engine
Instan
Reg

ce

Vital Sign Progress Report

Care Plan

*) L.D.Serbanati, F.Ricci, G.Mercurio, A.Vasilateanu, Steps towards a digital health ecosystem, J Biomed Inform, Elsevier, 2011
 Agenda
1
1. What is a paradigm?
2. How can a paradigm be used?
3. Paradigms in healthcare
4. Shift of p
paradigms
g from business to
healthcare
5
5. Shift of paradigms from information
engineering to ehealth
6
6. New paradigms in health informatics
7. Conclusions
Multi--Agent
Multi g System
y ((MAS))
y The MAS paradigm could be used to model, design and
implement software platforms that integrate software
applications in healthcare systems.
y MASs are a more natural way to represent many
situations that often occur in medical settings,
settings such as:
◦ absence of a comprehensive control system,
◦ limited or insufficient resources for a care provider to solve a
given
i problem,
bl andd
◦ geographical distribution of the needed information and
knowledge.
y On the other hand, in health systems we can identify many
recurrent features common to MASs:
◦ delegation of responsibility,
responsibility
◦ re-allocation of tasks,
◦ need to consider a large variety of user concerns and problems,
◦ planning the collaborative work ,
◦ think and work in open spaces, etc.
 R2V2R
Due to sensors and actuators, y In the case of “agentification”
information flows from Real to of a regional health
Digital and from Digital to Real information organization
(R2V2R): (RHIO), all stakeholders
(care providers, professionals,
Sensors
patients
i andd their
h i relatives)
l i )
Caregiver’s from the real should be
Caregiver
avatar represented
p as avatars: highly
g y
proactive agents acting with
Actuators
own initiatives on behalf of
an individual.
Sensors
Patient’s y Other virtual entities in the
avatar
system may represent real
Patient organizations
i i bbut also
l virtual,
i l
temporary, ad-hoc created
Actuators
Real world Virtual world organizations
g as teams of
People, ad-hoc-created
teams, organisations,
Avatars, virtual entities,
digital resources,
professionals involved in the
material and information applications patient’s care process.
resources, activities
 Ecosystem
y A natural ecosystem is a biological community of
interactingg organisms
g plus
p their physical
p y environment.
y Correspondingly, a health ecosystem can be defined as a
network consisting of a multitude of health service
suppliers and consumers
consumers, and healthcare organizations,
organizations
all of them supported by IT.
y Digital
g business ecosystem
y is a self-organising
g g digital
g
infrastructure aimed at creating a digital environment
for networked organisations that supports the
cooperation, the knowledge sharing, the development of
open and adaptive technologies and evolutionary
business models.
y Di ital health ecos
Digital ecosystem
stem (DHE) is an IT infrastructure
infrastr ct re
designed to work in synergy with the health ecosystem
by mainly supporting health activities in the real world.
 The health ecosystem and its digital
)
ecosystem *

Healthcare Ecosystem

Home Digital Healthcare Ecosystem Shared Resources

Regional Health EHR
Organization Clinical
Patient Mandate-based Infrastructure
Guidelines
Organization
Virtual
Health
Supervisor Record
Medical
Measurement VHR's Virtual Ontology
device PHR Entity
Patient's
Hospital
H it l Avatar E Government
HIS Organization e
Organizational Structure
Business’s Rules
Reports
Organization’s Gov. Agency's Governmental
Hospital EMR Roles Virtual Entity Agency
Hospital's
GP Office Virtual Entity
Research Laboratory
Virtual Team Care Organizational
g
O
Organization
i i Mediator
GP
E
Researcher
E
e GP's Virtual Researcher's
POS An ad-hoc Avatar e
Avatar e-
GP’s EMR Organization
CRFs

*) L.D.Serbanati, F.Ricci, G.Mercurio, A.Vasilateanu, Steps towards a digital health ecosystem, J Biomed Inform, Elsevier, 2011
 Agenda
1
1. What is a paradigm?
2. How can a paradigm be used?
3. Paradigms in healthcare
4. Shift of p
paradigms
g from business to
healthcare
5
5. Shift of paradigms from information
engineering to ehealth
6
6. New paradigms in health informatics
7. Conclusions
 Conclusions
y This paper aims to open a discussion on the
role of paradigms in our reasoning and
proposes the use of innovative paradigm-
paradigm
based solutions in one or another field of
activity.
activity
y A paradigm better captures the nature of the
diff
differences bbetween diff h to
different approaches
solve a problem.
y Paradigm shifts in health informatics are good
ggo-betweens in transferringg knowledge
g to
and from healthcare.
 THANK YOU!

luca@serbanati.com

This work was supported

pp byy the project
p j ERRIC No. 264207,,
FP7-REGPOT-2010-1.