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HIT, Disparities and MCH 2.0

HIT, Disparities and MCH 2.0. PFRHS Seminar Series M. Chris Gibbons, MD, MPH. Health research in the 21 st century. Recent advances in the computer and information sciences have led to methodologic and analytic revolutions in the molecular and clinical sciences NEJM 2006.

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HIT, Disparities and MCH 2.0

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  1. HIT, Disparities and MCH 2.0 PFRHS Seminar Series M. Chris Gibbons, MD, MPH

  2. Health research in the 21st century Recent advances in the computer and information sciences have led to methodologic and analytic revolutions in the molecular and clinical sciences NEJM 2006

  3. Health information in the 21st century The internet is changing the way Americans engage with information, whether they are choosing a president or making health care decisions. Fox, 2008

  4. Health information in the 21st century Over 160 million people (84% of adult users) use the internet to search for health information Disability, Disease tend to increase utilization 31% say they have been significantly helped

  5. eHealth eHealth is the use of emerging information and communication technology, especially the Internet, to improve or enable health and health care Eng, 2001

  6. Molecular Biology Chips Arrays Genome analysis Proteomics / Phenomics Information Technology Revolution

  7. Molecular Biology Chips Arrays Genome analysis Proteomics/Phenomics Behavioral Sciences Mass Customization Behavioral Libraries Community Arrays “Populomics” Information Technology Revolution Gibbons, Journal of Medical Internet Research 2005

  8. Disparities research in the 21st century Disease causation in general and health disparities in particular, result from complex interactions of many factors that simultaneously and often cooperatively act across more than one level of influence, over time. Journal of Urban Health 2007

  9. Mechanistic Models

  10. Disparities research in the 21st century It is not possible to completely characterize Disparities at only one level of analyses

  11. Transdisciplinary Disparities Research This type of work will require large and complex studies that yield exceedingly large and diverse data sets. Require enhanced reliance on computers and IT

  12. Populomics "An emerging discipline focused on population level, transdisciplinary, systems integrative disease/risk characterization, interdiction and mitigation that relies heavily on innovations in computer and information technologies. Gibbons MC, Stud Health Technol Inform 2008(137) 265-8 Gibbons MC, J Med Internet Res 2005;7(5):e50

  13. A new “Basic” Disparities Research model “Socio-Behavioral Phenotypes” Groups of individual and population level factors that predictably coexist and are thought or known to act cooperatively to influence discrete health outcomes among specified populations

  14. A new “Basic” Disparities Research model “Causal profiles” Sociobehavioroal Phenotypes linked with underlying biophysiologic and molecular mechanisms

  15. A new “Basic” Disparities Research model PheGe Analysis Next generation GWAS that begin at the population based phenotypic level, which then seeks to elucidate the underlying biophysiologic and molecular mechanisms

  16. A new “Basic” Disparities Research model PheGe Analysis Vs. GxE Studies

  17. New Insights and Strategies Populovigilance A science of collecting, monitoring and evaluating data from defined Populations, on the adverse effects of disparate care, environmental hazards, behavior and policies, specifically to 1) identify hazards and/or sentinel events associated with the existence of disparities and to 2) prevent harm to patients and individuals among the target subpopulations

  18. New Insights and Strategies Disparities Harm Reduction Research Transdisciplinary research with a primary focus of identifying and evaluating Clinical and/or Public Health treatments and strategies designed to mitigate the adverse health effects associated with a defined Disparity and target population.

  19. Looking Beyond The role of technology in MCH and Disparities research is not limited to improving our understanding of the etiology and pathogenesis of disease.

  20. Clinical technology enabled Treatment strategies EMR’s CPOE e-consultation Telemedicine Remote monitoring Intelligent Devices Sensor Technology Programmed Evidence-Based Processes (PEP’s)

  21. Public Health technology enabled Intervention strategies Distributed Networks Grid Computing Cloud Computing Web 2.0/3.0 Health Gaming “On Demand” Population Health Technologies

  22. New Intervention strategies Consumer Health Informatics Consumer health informatics (CHI) is the branch of medical informatics that “analyzes consumers’ needs for information, studies and implements methods of making information accessible to consumers, and models and integrates consumers’ preferences into medical information systems.” Eysenbach G. BMJ 2000; 320(7251):1713-6

  23. Intervention strategies Examples of Consumer Health Informatics Web sites providing self-care information Internet-based disease management tools personal health records (PHRs) online support groups

  24. Is there any evidence that CHI toolswork? Consumer health informatics (CHI) Any electronic tool, technology or electronic application that is designed to interact directly with consumers, with or without the presence of a healthcare professional, that provides or uses individualized (personal) information and provides the consumer with individualized assistance, to help the patient better manage their health or healthcare.

  25. Key Questions What’s the evidence of CHI impact on Health Outcomes What are the barriers to utilization or implementation? What is the evidence for cost benefit, and net value? What are the knowledge deficits?

  26. Methodology Developed a theoretic model Defined Search strategy RCT’s Only (Key Question #1) All study designs (Key Questions #2, #3, #4) Databases Scientific literature and Gray literature Exclusion Criteria No health informatics application, Application does not apply to the consumer, General health information application (general Web site) and is not tailored to individual consumers, “Point of care” device (defined as requiring a clinician to use or obtain and is part of the regular provision of care), or No original data provided.

  27. Methodology Quality assessment Jadad Criteria GRADE Working Group Criteria Double data review and quality assessment Iterative feedback and review by technical expert panel (TEP) & External Advisors

  28. Results Despite study heterogeneity and some data paucity, CHI applications may improve certain adult clinical and intermediate health outcomes (mental health and smoking cessation) Effective interventions often employ tailored content, personalized messages and appropriate, ongoing behavioral feedback The role of CHI applications among children, priority populations, on healthcare processes or economics has not been adequately evaluated Many personal and systems level utilization barriers exist Knowledge gaps include the health impact of social networking technologies, CHI impact on Disparities or Social Determinants of health The role of CHI in acute disease management and disease prevention Next steps should include the development of a standardized nomenclature and CHI registry to facilitate research and reporting

  29. Technology and Disparities Early evidence suggests differential access, utilization patterns and preferences regarding technology among population subgroups. Unless these differences and their implications are understood in greater detail, these realities may lead to differential health benefits from technology enabled interventions and as such may result in an increase in Disparities

  30. HIT Challenges Design & Development • UCD, HCI • Human Factors • Usability Testing • CID

  31. HIT MCH Opportunities Consumer utilization • Patient’s • Caregivers • Family members • Friends/Associates • Ancillary/Allied health (HHC, CHW)

  32. MCH HIT Opportunities Across the Health and Care Continuum • Harm Reduction • Prevention/Wellness • Screening • Diagnosis • Medical Treatment • Self care/ Self Management • Survivorship

  33. Current Projects Impact of Consumer Health Informatics Role of Technology in Patient Centered Care Role of Technology in Under Resourced Settings CHW LifeGuard Project Birth Outcomes Intervention Pilot

  34. A vision of HIT & Health In this world Clinicians and researchers know and understand how all social, environmental and biological factors that collectively contribute to ill health Health risks are managed before they become diseases and before patients ever need to go to the hospital

  35. A vision of HIT & Health In this world Health interventions are delivered via a variety of formats (web, game console, TV, cell phone, PDA’s etc) The efficacy of traditional interventions is enhanced via technological adjuncts to treatment or care

  36. A vision of HIT & Health In this world Clinical and/or Public Health interventions can be delivered anywhere and at any time as needed. A variety of intervention genres enable exquisite customization and tailoring

  37. A vision of HIT & Health In this world healthcare is proactive not reactive Patients don’t delay seeking care Medical errors rarely made Health information is always accessible in both provider and patient centric forms

  38. A vision of HIT & Health Over time, there exists real potential to make significant progress towards the goals of 1) improving some of the most challenging MCH health problems 2) reducing/eliminating disparities in health care access, utilization and outcomes 3) addressing disparities in health status

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