USE OF NEW TECHNOLOGIES IN HEALTHCARE SETTINGS, MANDATE OR AN OPTION

1. USE OF NEW TECHNOLOGIES IN HEALTHCARE SETTINGS, MANDATE OR AN OPTION Presented by: Dr hatem salem, CPhq Aseer central hospital ksa

2. Objectives • Technological advances • Healthcare system current situation • Proposal using current technologies to improve the current situation • Needed activities to reach our goal

3. Personal Introduction • Dr. Hatem Salem • Anesthetist • Master of anesthesia, Total Quality Management Diploma AUC, Certified Professional in Healthcare Quality • Aseer central hospital, 450 bed referral hospital in southern region KSA • Accredited by Central Board of Accreditation for Healthcare Institutions 2010 and Joint Commission International 2013

4. Introduction • “Concern for man himself and his safety must always form the chief interest of all technical endeavors.” Albert Einstein • Evolution of technologies, costs and our perception of their capacities and benefits and our needs governs implementation and use of such technologies in our business

5. Availability Use of Technology Affordability Need

6. TECHNOLOGICAL ADVANCES • COMPUTER & STORAGE • TECHNOLOGIES

7. 1/3 price 300,000 times HDD 500,000 Times RAM

9. Why? • Market size • More vendors • Competition

10. 2. INTERNET & NETWORK TECHNOLOGIES

13. 3. TELECOMMUNICATION

15. Why? • Market size • More vendors • Competition

16. 4. SECURITY & IDENTIFICATION

17. BIOMETRIC IDENTIFICATION • Biometric identifiers are the distinctive, measurable characteristics used to label and describe individuals.[1] • Biometric identifiers are often categorized as physiological versus behavioralcharacteristics.[2] • 1 Jain, A., Hong, L., & Pankanti, S. (2000). "Biometric Identification". Communications of the ACM, 43(2), p. 91-98. DOI 10.1145/328236.328110 • 2 Jain, Anil K.; Ross, Arun (2008). "Introduction to Biometrics". In Jain, AK; Flynn; Ross, A. Handbook of Biometrics. Springer. pp. 1–22. ISBN 978-0-387-71040-2.

18. Physiological characteristics are related to the shape of the body. Examples include, but are not limited to fingerprint, face recognition, DNA, palm print, hand geometry, iris recognition, retina and odour/scent. • Behavioral characteristics are related to the pattern of behavior of a person, including but not limited to typing rhythm, gait, and voice

19. IRIS RECOGNITION • In 2010, Leon, Mexico, deployed iris scanners in public spaces, that can identify up to fifty people at once.Saylor, Michael (2012).The Mobile Wave: How Mobile Intelligence Will Change Everything. Perseus Books/Vanguard Press. p. 98. ISBN 978-1593157203 • On May 10, 2011, Hoyos Group demonstrated a device called EyeLock using iris-recognition as an alternative to passwords to log people into password-protected Web sites and applications, like Facebook or eBay.Whitney, Lance (2011-05-12). "Iris recognition gadget eliminates passwords". CNET. Retrieved 2011-05-12. • SRI International Sarnoff has been developing an "Iris on the Move" system and set of products,  Most recently, they have specialized in a product where drivers can be identified without needing to leave their vehicle."SRI International Sarnoff launches iris biometric vehicle access control system". Biometric Update. 2013-04-10. Retrieved 2013-07-15.

20. Healthcare System • In December 1999, the Institute of Medicine (IOM) reported that medical errors cause up to 98,000 deaths and more than 1 million injuries each year in the United States.(*) (*)Kohn LT, Corrigan JM, Donaldson MS, eds. To err is human: building a safer health system. Washington, DC: National Academies Press, 1999.

21. The majority of medical errors do not result from individual recklessness or the actions of a particular group. More commonly, errors are caused by faulty systems, processes, and conditions that lead people to make mistakes or fail to prevent them. (*) • Mistakes can best be prevented by designing the health system at all levels to make it safer--to make it harder for people to do something wrong and easier for them to do it right (*) • (*)Kohn LT, Corrigan JM, Donaldson MS, eds. To err is human: building a safer health system. Washington, DC: National Academies Press, 1999.

22. In response, accreditation bodies, payers, nonprofit organizations, governments, and hospitals launched major initiatives and invested considerable resources to improve patient safety (*) • (*)Agency for Healthcare Research and Quality. Medical errors & patient safety. Rockville, MD: AHRQ. (http://www.ahrq.gov/qual/errorsix.htm.)

25. Healthcare System Current Situation • There were an estimated 161,655 medical errors in 2008 and 170,201 medical errors in 2009 (1) • Uniformly reliable safety in healthcare has not yet been achieved.(2) • Every day, patients are still harmed, or nearly harmed, in healthcare institutions across the country. This harm is not intentional; however, it usually can be avoided. (2) • (1) David G et al Economic measurement of medical errors using a hospital claims database Value Health. 2013 Mar-Apr;16(2):305-10. doi: 10.1016/j.jval.2012.11.010 • (2) NQF, Safe Practices for Better Healthcare– 2010 Update .A CONSENSUS REPORT WHY?

26. Integrated Human And Machine System HMS MACHINE DEPENDANT SYSTEM

27. Healthcare system is dependent on human behavior in many areas including : Prone to failures due to: Human errors At risk behaviors Reckless behaviors Outcome Engineering. An introduction to just culture. Dallas, Tex: Outcome Engineering, Inc; 2005 • Clinical activities • Documentation • Communication • Monitoring • Decision Taking • Etc.

28. The need to include human factors (HF) considerations in the design and safety assessment processes of socio-technical systems is nowadays widely recognized • The critical role assigned to HF is further enhanced by the common sense appreciation that it is impossible to conceive a plant that is totally “human-error free”. • P.C. Cacciabuea, G. VellaHuman factors engineering in healthcare systems:Theproblem of human error and accident management international journal of medical informatics 7 9 ( 2 0 1 0 ) e1–e17

29. Smith, Dr David J. “Reliability and Maintainability and Risk” appendix 6 7th edition Elsevier, 2005 • In any particular situation the human response reliability will be governed by a number of shaping factors which include: • Environmental factors : • Physical • Organizational • Personal

30. Intrinsic error • Selection of Individuals • Training • Experience • Stress factors • Personal • Circumstantial

31. Smith, DrDavid J. “Reliability and Maintainability and Risk” appendix 6 7thedition Elsevier, 2005

35. Notes from Appendix 6 • the error rate drops as we move upward from Complicated non-routine task (1 error in 10), to Routine task with care needed (1 error in 100), Routine simple task (1 error in 1000), and Simplest possible task (1 error in 10,000) • Read a 5-letter word with poor resolution wrongly' can be changed from 3 errors per 100, to 3 errors per 10,000 (a 100 times reduction in misreads) by making it into 'Read 5-letter word with good resolution wrongly • Smith,Dr David J. “reliability and Maintainability and Risk” 7th edition Elsevier, 2005

36. 'Fail to recognize incorrect status in roving inspection‘ can be changed from an error rate of 1 in 10,to error rate 3 in 1,000 if you get your people to use checklists with specific criteria to check, instead of doing what they can remember to do .'Wrongly carry out a visually inspection for a defined criterion (e.g. leak)'

37. Can We Remove human influence completely in healthcare system? NO

38. Can we minimize the human influence in healthcare system? HOW? YES

39. Replacing as much human activities with well designed automated machinery activities utilizing recent advances in technology and evidence based medicine

40. Smith, Dr David J. “Reliability and Maintainability and Risk” appendix 4 7th edition Elsevier, 2005

41. Current Technological Advances • Communication: i.e. Internet, personal devices like mobiles and tablets • Information management: i.e. Networks and internet • Security: i.e. network security and use of biometric identification

43. What is our proposal? • Mandating unified worldwide intelligent electronic medical record system designed in collaboration with experts, governments, third party payers, accrediting bodies and related entities.

44. What is our proposal? Cont. • Integrating practice guidelines and evidence based medicine with the electronic medical record system

45. What is our proposal? Cont. • Data entering and retrieval through tablets with voice recognition dictation

46. What is our proposal? Cont. • Use of biometric identification i.e. Finger print or iris print for patient during initial identification

47. What is our proposal? Cont. • Use of barcoding for patients during hospital stay

48. What is our proposal? Cont • Use of iris print for identification of healthcare provider with every data entry or intervention

49. What is our proposal? Cont. • Mandating barcoding activities related to patient identification ie. Medication use, lab specimen collection, blood product use, invasive procedure performance, etc.

50. What is our proposal? Cont. • Mandating use of programmable vehicles that are programmable by the patient barcode and opens only after matching with patient barcode. That can be used for medications, blood product, food, etc.