Department of Social InformaticsDepartment of Social InformaticsGraduate School of InformaticsGraduate School of Informatics

Kyoto University, Japan July 8, 2004Kyoto University, Japan July 8, 2004

The Social Informaticsof Healthcare Infrastructure

Bruce R. SchatzSchool of Library & Information Science

School of Biomedical & Health Information SciencesUniversity of Illinois at Urbana-Champaign, USA

schatz@uiuc.edu , www.canis.uiuc.edu

The Solution to The Problem The Solution to The Problem Social Informatics

Information technology solution to important social problem

(Distributed System for Data Analysis)

Healthcare InfrastructureManaging the Health of Populations(Health System for All People)

Healthcare InfrastructureHealthcare Infrastructure

Infrastructure is the Whole SystemHospital, Clinic, HomeDoctors, Nurses, Brochures, Internet

NO Viable Model for Health SystemToo much Cost! Too Much Volume!

Health SystemsHealth Systems

Healthcare is THE Economic IssueBIGGEST item in modern societiesFast growing due to aging population

Healthcare will BREAK Every NationNations go bankrupt and People die!

The Fundamental Cause 1The Fundamental Cause 1

Medicine versus HealthCure Sick in BIG HospitalMaintain Wellness in small Clinic

Recent Rise of Chronic IllnessNo cure with drugs & surgery only manage with diet & exercise

The Fundamental Cause 2The Fundamental Cause 2

Health Systems now for Acute IllnessHospitals are Profitable Business butClinics are supported by Government

Systems cannot handle Chronic IllnessChronic Illness now dominates Costs

and Systems cannot handle Volume

The Viable Solution 1The Viable Solution 1 Independent Clinics are Doomed

1990s America -- small Clinics failedwhen Government support reduced.

Health Systems start HMOsHealth Maintenance Organizations2000s America – HMOs all failing.2000s Japan – small Clinics will failwhen Government support reduced.

The Viable Solution 2The Viable Solution 2 Need Complete Provider Pyramids

High Level for High Quality at High CostLow Level for Low Quality at Low CostHandle Volume by Pushing Cases DownBottom Levels handle MOST CASES

Viable Healthcare InfrastructureHospitals with Doctors for Surgery, Clinics

with Nurse for Drugs, Homes with Patients for nearly all Health Interactions!

Social InformaticsSocial Informatics Need New Viable Infrastructure

Health Information TechnologyProvides Support for Patients in HomesCreates Bottom of Pyramid to Offload

Informatics can Solve this ProblemPatients themselves create population

health database via social informatics that automatically routes healthcare

Informatics TechnologiesInformatics Technologies Measure Population Health

Adaptive Question Asking of Quality of Life Questionnaires

Answers for Individuals creates Database for the Population

Manage Population HealthStructured Health Vectors from

normalized patient recordsStatistical Information Retrieval cluster

patients into care cohorts

Measure Population Health 1 Measure Population Health 1 Quality of Life Questionnaires

Self-Assessment directly by PatientsGeneral Status questions, e.g. SF-36Specific Disease questions, e.g. Arthritis: Can you walk without pain? Heart Disease: Do your ankles swell?

QoL correctly does coarse predictionVA Heart Study: SF-12 better than

surgeon about patient survival

Measure Population Health 2Measure Population Health 2 Electronic Records for fine prediction

Paper supports 10s of questionsElectronic supports 100s or 1000s

Adaptive Question AskingChoose questions by weighted treewalkEach session asks 10s of questions

customized to particular condition Generate Population Database

Daily individual records from all homes

Manage Population HealthManage Population Health Structured Health Vectors

Patient answers Questions dailyAverage scores generate Health VectorElements of Vector are Meaningful

Cluster Patient CohortsNormalize Vectors for Similar ClustersWeight Question Groups MedicallyRoute Care into Pyramid using

Clusters to Determine Cohorts

Theory ExperimentTheory Experiment Questionnaire from Merged QoL

120 questions from 20 questionnairesGeneral plus some Specific questions

Simple Clusters do coarse predictionStudents simulate sick or well patientsK-means with random seeds does

correct clustering from actual health monitor sessions with 100 answers

Practice ExperimentPractice Experiment Practical Risk Assessment Possible?

Need 4 Cohort Clusters correctly predicted: hospital, clinic, telephone, home

Is 120 questions (10*more) enough? What Clusters can do fine prediction?

Use Historical Database of Real Patients answering Paper QoL Questionnaires

Agglomerative with complete link always consistent but always correct? May need appropriate structured vector weighting

Clinical ExperimentClinical Experiment Real Patients in Real Settings

1000 senior patients with heart diseaseUse in Medicare Coordinated CareTelephone Interface via voice responseDetermine Care Levels automatically

Demonstrate Feasible TechnologiesAdaptive Question Asking with

Faceted Category ClassificationStatistical Cohort Clustering with

Structured Vector Weighting

Current Prototype StatusCurrent Prototype Status Theory Experiment

Completed in LIS 450MIH and LIS 429Health Informatics & Information Retrieval

Practice ExperimentOn-going collaboration with Carle HospitalAdaptive Faceted being DevelopedHistorical Databases being Analyzed

Clinical ExperimentMulti-Year Trial Proposal to US AHRQ

Agency for Healthcare Research &Quality

Clinical RationaleClinical RationaleClinical RationaleClinical Rationale

Population Monitoringof

Average Health

Healthcare InfrastructureHealthcare Infrastructure

Provider PyramidsScale to Volumes for Chronic Illness

Risk AssessmentAutomatically Determine Level of Care

The Future of Health SystemsThe Future of Health Systems

Effective PreventionInfrastructure supports Routine CareHealthcare biggest use of Internet

Historical NexusTelephone: Everyone is an OperatorHealthcare: Everyone is a Doctor

Further InformationFurther Information Papers

See articles on Internet Health Monitors and on Monitoring Population Health by R. Berlin, MD, and B. Schatz, PhD, at www.canis.uiuc.edu under Publications under Papers.

DemosTry prototypes and view analysis at

www.canis.uiuc.edu under MedSpace at bottom of web page.