Econ Final

Precision Medicine

Precision Medicine

1. Uses patients genetics and molecular profiles to deliver targeted therapies and treatments

2. Paradigm transitioning clinical care to a personal level

3. PM Programs provide specialized platforms for accessing, designing, and implementing unique treatment plans

4. Goal- use all healthcare information available to maximize the possible benefit from treatment a patient may see

5. Can better classify, delineate, detect, monitor, and stratify disease via informatics tools

6. A prominent area where PM shines is gene therapy

7. During the pandemic, PM was used to recommend acute solutions that would maximally benefit patients in both the short and long term management and prevention of the virus (PM guided vaccine recommendations regarding age groups)

8. Can be used for disease detection, prevention and treatment

9. Two subsets- consumer genetics and pharmacogenomic testing

Equity v Equality

1. Equity- Provision of resources based on need in order to achieve as equal an outcome as possible

2. Equality- Provision of the same resources/services to everyone

Interoperability

1. Def- Refers to ability of different information systems, devices, and applications to access, exchange, integrate, and use data cooperatively in a coordinated manner

2. Key factors DRIVING- government mandates, desire to increase efficiency, desire to limit paperwork, desire to create real-time communication, higher ROI

3. Key factors INHIBITING- Poor quality of data, inconsistent tech standards, complexity of interoperability, privacy issues

4. Congress passed “21st century cures act final rule” which outlines rules that promote interoperability

5. Does not necessarily mean the same thing as HIE

Redundancy

1. Health informatics database challenge (must aim to eliminate this)

2. Overlapping and fragmented information sources

3. Unnecessary cost

4. Multiple systems used in various jurisdictions that do not communicate with one another may lead to this

PARO

A robotic animal, is an example that can stimulate pet-like interactions

Drug delivery and nanomedicines

Most well-developed functionality of nanomachines is drug delivery

Drawbacks of robots in medicine

While robots are not prone to fatigue and can be programmed for any task, they don’t have the capacity for emotional intelligence, empathetic decision-making,  adaptability, and the dexterity range of humans

When robotics started to be used in healthcare?

1980s

3D printing (year)

1980

Digital therapeutics

1. Def- Serves as a another technology to provide diagnosis and treatment for various health conditions

2. Can provide reminders of medication regiments, provide recommendations in wake of emerging symptoms and can provide diagnoses for various conditions

Digital therapeutics and health conditions

Serves as a another technology to provide diagnosis and treatment for various health conditions (ex. epilepsy, neurological disorders and diabetes)

Smart skin adhesive patches

1. Uses skin to monitor vital physiologic signals via real-time health monitoring systems

2. Continuously measures… ECG, heart rate, heart rate variability, resp rate, temp

Internet of things and proximity layer

1. Sensors within a pendent, in house devices

2. Proximity layer = Tele

In vivo sensor

1. Implantable, ingestible or otherwise invasive sensors that go beyond wearable applications

2. Ex. pressure sensors, electronic pills, strip-type glucose monitoring systems and smart tattoos

Electronic pill

1. Ingestible digital capsules that pass through the GI tract, delivering real time informatics to the healthcare professionals data monitoring device

2. Gathers temp, pH, and pressure info

Challenges to privacy with regulations for health data

1. Lack of consensus around how to handle data***

2. An ethical dilemma between public protection and individual protection

3. While there are punishments for data breaches, malicious code will always exist when tech is involved

4. There will always be breaches we know and don’t know about

5. As tech evolves, the depth and reach of info accessed will only grow

6. There will be increasing ways to access data in different forms and more reliance on electronic data to influence and guide decision-making

7. Any risks pose a bigger threat to consumers and patients

8. Tech will continue to fail if employees do not follow regulations

9. No matter how robust security systems are, human error will continue to pose problems for data privacy

Paper breaches

Most common form of data breach but network breaches affect more people

HIPAA

1. Healthcare providers are mandated to report security breaches under HIPAA

2. Est. 1996

3. Insurances deal with cyber attacks

Phishing tests

Email phishing remains a prevalent issue and is believed that even when trained, 20% of employee in an organization will fail these tests

Wearable technology

1. Rapidly growing facet of mobile health

2. Provides a way for patient health data to be updated more regularly, thus impacting a patient's diagnosis, treatment and healthcare management

Benefits of genetic testing

1. Learning about ancestry

2. Addressing medical health issues

3. Curiosity

Chi tool

1. CHI provides tools to help identify population trends, engage healthcare consumers, and predict outcomes

2. Examples- genomic, mobile health, precision medicine, patient engagement, and telehealth

Benefits of Chi

1. Engage patients, generate knowledge, aid clinical decisions, transmit health info, improve interactions and support

2. Messaging capabilities through CHI tools allow for active communication between patients and healthcare providers

Examples of Chi

1. Personal health records

2. Telehealth

3. Mobile health

4. Precision medicine

5. Consumer genetics

Health literacy in regards to Americans AND % that are literate

Only 12 % of American adults are health literate and can manage self-care

Consumer health informatics

1. CHI analyzes consumer needs and uses strategies to make healthcare information easily accessible

2. Can share data surrounding health promotion, treatment, and disease management and prevention

Telehealth and telemedicine

1. Telehealth- allows patients to engage with healthcare providers at the patients home as family members and the patient themselves monitor and track results

2. Synchronous- real-time; live interactions

3. Asynchronous- not live; can involve wearables that forward data on a regular basis

CDSS

1. Computer-based software that empowers physicians, healthcare staff, and patients with key info targeted on specific individuals or situations

2. Can improve patient safety, assist with clinical management, reduce cost, manage administrative functions, assist ordering tests and procedures, and provide diagnostic and patient decision support

3. "The Five Rights"- right information, delivered to the right people, at the right time, in the right format, with the right channeling

Core elements of CDSS design

Data management layer, processing layer, and user interface

Types/characteristics to distinguish types of malware

1. Self-replication: the ability of malware to copy itself

2. Population growth: overall change in malware instances resulting from self replication

3. Parasitic- whether it requires another piece of code to function

HIPAA and the EU

EU doesn’t have HIPAA they have another form

Difference between a virus, worm, trojan, and spyware

1. Virus- A computer program or software that connect itself to another software or computer program to harm computer system. When the computer program runs attached with virus it perform some action such as deleting a file from the computer system. Virus can’t be controlled by remote.

2. Worm- Also a computer program like a virus but it does not modify the program. It replicate itself more and more to cause slow down the computer system. Worms can be controlled by remote.

3. Trojan- Does not replicate itself like virus and worms. It is a hidden piece of code which steal the important information of user. For example, Trojan horse software observe the e-mail ID and password while entering in web browser for logging.

4. Spyware- Malicious software designed to enter your computer device, gather data about you, and forward it to a third-party without your consent.

Gaps in public health informatics

1. Low uptake

2. Multiple systems used in various jurisdictions that do not communicate with one another which leads to both gaps and redundancy

4. Inconsistent and improper use of technology

Core function of public health

1. Assessment and surveillance

2. Health promotion

3. Health protection

4. Disease and injury prevention

5. Emergency management

Core disciple of public health

1. Behavioral science and health education

2. Biostatistics

3. Epidemiology

4. Environmental health

5. Health administration and policy

Big data analytics applications- Clinical

1. Can assist virtual nursing assistants in providing analysis and health recommendations for their patients while they respond remotely

2. Can help simplify imaging technology and combine image acquisition and reconstruction techniques to assist in diagnosing illnesses

3. Can benefit pathology, improving accuracy, precision, and consistency of disease predictions

4. Can be used in oncology to determine difference between benign and malignant growths

Big data analytics applications- Research

1. ML can make clinical trials quicker and less expensive by using predictive models to identify eligible subjects

2. Social media analysis (SMA) can assist in uncovering consumers' behaviors, preferences, and eventual satisfaction with their purchasing experience

3. Can be used for both patients and providers to extract patient discussions about treatment, emotions, medication side effects, and ratings for their providers

4. NNs can be used to monitor epidemics and outbreak predictions worldwide

Big data analytics applications- Administrative

1. Personalized care plans- enable insurance providers to tailor premiums and plans to chronic illness profiles and specific needs

2. Faster claims handling- power of BDA allows for processing unstructured information faster

3. Error detection- AI can help to systematically identify and correct errors in claims

Machine learning techniques

Supervised learning, unsupervised learning, reinforcement learning, and deep learning

Deep learning in regards to neural networks

1. Form of ML that uses neural networks

2. Neural networks consist of individual neurons (nodes in the system) that each take inputs of data, conduct mathematical computations, and then produce an output

8 V's of big data

1. Volume (size of data)

2. Velocity (speed of data generation)

3. Variety (type of data)

4. Veracity (accuracy of data)

5. Validity (accuracy of data for intended use)

6. Volatility (age of data)

7. Visualization (readability of data)

8. Value (desired worth of data)

Factors driving interoperability

Government mandates,  desire to increase efficiency, desire to limit paperwork, desire to create real-time communication, Higher ROI

EHR implementation

1. Epic, Cerner, Meditech are largest providers/vendors

2. Differences in vendors' functions can provide benefits and challenges to consumers

3. Variables include: area of clinical care, hospital size, financial management, other criteria

Advantages of EHR over EMR

1. Equally good health information and data management capabilities

2. Improved results management

3. Added decision support

4. Ease of administrative processes

5. More timely

6. More accessible by patients

Linked data bases

1. Can add value to an organizations database

2. Presents new security challenges and concerns

Peer reviewed literature

Secondary data source

Technical solutions for cyber security

1. Active antivirus programs

2. Limited medical device interconnectivity

3. Data encryption

Quantitative data examples

Test scores, experimental results, surveys, or market reports

Who interacts with EHR the most

Nurses

Hitech act

1. Prompted healthcare facilities to adopt EHRs for patient accessibility

2. Allows for patients to view their records online, manage, and restrict health information disclosure

3. Other goals included improved and efficient care coordination

4. This included augmented hospital collaboration to streamline diagnosis and patient referrals

Call bell

Call light technology serve as a means of communication for patients to their care providers that are outside of the patient's room.

Oncology informatics

BDA and AI can be used in oncology to determine difference between benign and malignant growths

Direct to consumer genetic testing

1. Faces concerns regarding the ability of providers to make claims about their testing capability

2. Companies also do not understand when clients may need this kind of testing or whether result interpretation is appropriate

3. When informing patients regarding genomic sequencing results, healthcare providers require skill and tact to manage uncertainties and provide effective responses

Access to electronic devices

Patients have improved access to electronic devices and can have their data tracked to help inform clinical decisions

Health informatics and health care delivery

1. Intersection of healthcare delivery and public education

2. Information provided should be relevant, allow for patients to understand their choices, and promote quality healthcare delivery

3. A CHI advantage is improved safety, effectiveness and cost of medical care delivery

AI and machine learning

1. AI and machine learning in conjunction with robotics Influence surgical procedures, living support for the elderly, virtual physical therapy, end of life support, teleassessment, and training

2. Both predict patterns/trends

Penalties for HIPAA; criminal and/or civil

1. Civil- managed by HHS office of civil rights (4 tiers)

2. Criminal- Dept of justice (3 tiers); Face prison time

CAS9

a CRISPR-associated (Cas) endonuclease, or enzyme, that acts as “molecular scissors” to cut DNA at a location specified by a guide RNA