Thursday, July 2, 2015

UDHC expanding Case-based-medical-informatics

Our EHR platform tries to expand the field of Case-Based-Medical-Informatics toward further development of 'Personalized Medicine.' 

Please see these links on the same: http://www.biomedcentral.com/1472-6947/4/19http://www.pitt.edu/~super1/lecture/lec53081/009.htm. The first link is a primer on case-based-medical-informatics but is unfortunately written in a manner that is difficult to digest and the second link is from a presentation that illustrates it in a different and hopefully simpler manner. Here is some more reading on Personalized Medicine:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3269464/ and Patient centered medicine:http://www.biomedcentral.com/1472-6947/13/6

We regularly use an interface that allows us to integrate our largely paper based workflow into our
open online EHRs. See these web-linked samples from some of our current EHRs below:

For Inpatients in our Medical College in Bhopal, India please find
linked below these 3 EHRs that also contains the Conversational
clinical decision support workflow):

http://www.udhc.co.in/INPUT/displayIssueGraphically.jsp?topic_id=1745,

http://www.udhc.co.in/INPUT/displayIssueGraphically.jsp?topic_id=1668,

http://www.udhc.co.in/INPUT/displayIssueGraphically.jsp?topic_id=1739

Our Telemedicine patients (again with the Conversational clinical
decision support workflow-scroll to bottom):

One sample EHR uploaded by the patient's caregiver in USA:
http://www.udhc.co.in/INPUT/displayIssueGraphically.jsp?topic_id=1751

One sample EHR from a patient in
Delhi:http://www.udhc.co.in/INPUT/displayIssueGraphically.jsp?topic_id=1617

One sample EHR from a patient in Mathabhanga, rural
India:http://www.udhc.co.in/INPUT/displayIssueGraphically.jsp?topic_id=1597

To take care of current globally felt problems of discordance between the doctor-patient
interface and doctor-computer interface, much of the interfacing with the computer is done by our trained PICMs
(Patient information communication managers) and here's a business model (http://userdrivenhealthcare.blogspot.in/2015/06/global-learning-toward-local-caring.htmlon how both the EHR and PICM can be effective toward addressing the very problems in India (ensuring access to medical services by the
poor, current congestion in most healthcare facilities) that some analysts feel make EHRs premature for India.

Most of our patients (many of them from rural India) are not able to understand the processing of their data by our participatory global health network and so the learning conversations/discussions are openly archived for viewing and further learning and mining by anyone who is interested in the data provided it is attributed under a creative commons license.
Some urban patients such as the one here:http://www.udhc.co.in/INPUT/displayIssueGraphically.jsp?topic_id=1751 from USA may be able to follow large part of the conversations and even put in a word (scroll down to the bottom of the history to see the conversations) through their primary care-givers in the forum (as the patient is otherwise de-identified per HIPAA in the EHR as well as the discussion forum).
For most of our rural patients (who may not be able to filter the chatter from hundreds of responses) the global physician moderator and PICM sends an output to the local PICM (community health-worker) through our online platform (see this early sample here:http://www.udhc.co.in/SOLUTION/viewSolution.jsp?solution_id=6&topic_id=166, also in the local language (Bengali) here:http://www.udhc.co.in/SOLUTION/viewSolution.jsp?solution_id=7&topic_id=166)

Currently i am doing this job of the global physician moderator along with my student Dr Kaustav Bera (you will find both of us mentioned in the above output link) and we have a few community-health-worker PICMs in Central and North Eastern India. We need more and more physicians and community-health-worker PICMs to scale our model and one of the ways we plan to train them is through our currently active Medical Elective program detailed here:http://promotions.bmj.com/jnl/bmj-case-reports-student-electives/. This is a global health case-report elective that incorporates most of the strategies and approaches our PICMs would employ. 

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