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What is Medical Informatics?



        Nancy B. Clark, M.Ed.
 Director of Medical Informatics Education
          Florida State University



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     Health (Medical) Informatics

Simplistic definition:
 Medical informatics is the application of
  computers, communications and information
  technology and systems to all fields of
  medicine - medical care, medical education
  and medical research.
 MF Collen, MEDINFO '80, Tokyo


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      Health (Medical) Informatics

 Medical informatics is the rapidly developing
  scientific field that deals with resources,
  devices and formalized methods for
  optimizing the storage, retrieval and
  management of biomedical information for
  problem solving and decision making.
  Edward Shortliffe, M.D., Ph.D. What is medical
  informatics? Stanford University, 1995.

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      Health (Medical) Informatics

 Medical Informatics is the branch of science
  concerned with the use of computers and
  communication technology to acquire, store,
  analyze, communicate, and display medical
  information and knowledge to facilitate
  understanding and improve the accuracy,
  timeliness, and reliability of decision-making.
  Warner, Sorenson and Bouhaddou, Knowledge Engineering
  in Health Informatics, 1997

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         Health Informatics Defined
 Information Technology
     Health care
     Research
     Education
 Fundamentals
     Communication
     Knowledge Management
     Decision support
     Clinical Information Management

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     Medical Informatics

   Knowledge     Clinical Information
  Management     Management



Communication      Decision Support



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      Informatics Use in Health Care
 Communication                      Decision Support
     Telemedicine                        Reminder systems
     Tele-radiology                      Diagnostic Expert Systems
     Patient e-mail
                                          Drug Interaction
     Presentations
                                     Information Management
 Knowledge management
                                          Electronic Medical Records
     Journals
     Consumer Health information         Billing transactions
     Evidence-based medical              Ordering Systems
      information




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        Medical Informatics
        Changing Medicine

   Knowledge        Information
  Management        Management



Communication         Decision Support



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Institute of Medicine




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               Vision of
         Quality Chasm Report
 Standardized information infrastructure
 Support care teams - Enhances patient-
  centered care
 Supports care coordination
 Measure outcomes - Improve outcomes
 Enhance safety - Reduces errors
 Enables quality measurement/monitoring -
  Reward quality

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   The Case of Betsy A. Lehman


“How long, Oh Lord, must this continue?
…That’s 21 years ago…Isn’t it time that
   basic computerization be part of the
 expected, and required, care at medical
               facilities?”

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               Reducing Errors

 Order entry systems
     Reduce medication errors
     Detect potential drug interactions
 Clinical decision support systems
     Improve drug dosing
     Improve preventive care
     Not diagnosis

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                Informatics Programs

    Degree                Medical schools
                           Information Studies
    Fellowships
                           Nursing schools
    Certificates
                           Public health schools
    Short courses         Dental schools
                           Health care organizations
https://www.amia.org/informatics-academic-training-programs
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        Innovative Continuing
    Education/Schools in Informatics

 NYU Medical Center Educational Services
  Department
 U of Utah School of Nursing
 U of Sheffield, UK
 Stanford Medical School
 Stanford Center for Advanced Technology in
  Surgery
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   Informatics Education Research

 Comparisons traditional to electronic
     Retention
     Satisfaction
 Medical Education
     Cost effective
 CME
     Informatics skills
     Not evidence based practice skills
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Barriers to Implementation of Technology
 Rogers, P. L. (2000). Barriers to adopting emerging technologies in education. Journal of
 Educational Computing Research, 22(4), 455-472.




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         Educational Barriers to
           Achieving Vision

 Lack of resources
 Relationship/behavioral changes required
 Variability and lack of receptivity
 Discipline specific issues
 Continuing education restrictions

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     Regulatory/Policy Barriers to
          Achieving Vision

 Concerns over privacy
 Unsupportive laws
 Lack of financial resources
 Lack of/bad experiences
 Lack of standards

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                                               Internal Barriers

            35%
                                                                                                   34%




                        14%                                                       14%
                                                    3%                                            Innovators
                                                                                                  Early Adopters
                                                                                                  Early Majority
              Stakeholder Attitudes and Perceptions                                               Late Majority
Rogers, E. M. & Shoemaker, F. F. (1971). Communication of Innovation. New York: The Free Press.
                                                                                                  Laggard
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        External Barriers in Medicine
Lack of:
 Universally agreed-on medical vocabulary
 Principled and standard formats for laboratory
  data, medical images, medical record…
 Standardization of medical literature formats--
  structured abstracts
 Health care standards -- treatment guidelines
 Standards for health data exchange


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               Educational Strategies

 Didactic vs problem solving
 Competencies
     Word processing
     Information retrieval
     Information management
     Data analysis
     Presentation
     Communication skills
          E-mail, file transfer, web
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               AAMC MSOP

 Medical School Objectives Project
 Informatics competencies for medical
  students
 http://www.aamc.org/meded/msop/msop2.pdf




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         Informatics Curriculum

 Computer Literacy       Research
      Word processing        Data analysis
      Graphics           Communication skills
 Life-long learning          E-mail, web,
 Medical Reference            presentation

 Clinical Information    Evidence Based
  management               Medicine



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         Infrastructure to Support
          Informatics Curriculu.

 Hardware/Software
 Support Issues
 Workflow/Mindset Issues
 Training Issues
 Budgeting Issues



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                          Infrastructure
                             Data Collection and
     Student                 Evaluation System
and Faculty PDAs                 Arcstream System                  Student
                                  Avantgo Server
Essential Evidence Plus             SQL Server
                                                             Wireless Tablet PCs
        PEPID                                                Microsoft Office Professional
       ePocrates                                           Stedman’s Medical Spellchecker
  Harrison’s Pracrtice                                           Photoshop Elements
 Pediatric Care Online      College of Medicine                        Endnote
         GAYF              Network Infrastructure
                          Technology Enhanced Classrooms
                          Campus Wide Wireless Coverage
                                  Video Conferencing

   Virtual Library
                            File, Exchange, Web Servers        Blackboard
     Resources                                                 Courseware
                                                                 All Courses
                            IT Section Support
                             Database Development
                                  Web design
                                 Video Editing
                                 Tech Support




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                       Technology
 Wireless Laptops for       PDAs for each student
  each student
                                 Evidence Based Ref.
      Microsoft Office
                                 Disease Reference
       Professional
                                 Medical Calculator
      Stedman’s Medical
       Spellchecker              Drug Reference
      Endnotes                  Medical Dictionary
      Adobe Photoshop           The CDCS system
       Elements              Computer Lab
      Medical References        Student teaching
                                 Faculty development
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                         2001-2002

 Issued Palm devices to
  first class
        InfoRetriever
        ePocrates Drug
         Reference
        Avantgo
        PDxMD
        Stedman’s Medical
         Dictionary



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                       2010-2011

 Switched from HP
  iPAQ to iPod Touch
     Epocrates Essentials
     PEPID
     Essential Evidence Plus
     Dynamed
     Harrison’s Practice
     Pediatric Care Online


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       Hands on Experience


      Knowledge         Clinical Information
   Management           Management
Decision Support        Order entry, EMR, Billing




              Communications

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Medical Education




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          Basic Sciences Classes

 Anatomy lab video         QuestionMark Testing
  enabled                    Program
                                Question bank
 BacusLabs digital web-
                                Computer-based testing
  slide program
                                Item analysis/grading
 Gold Standard             United Streaming
  Multimedia*                Videos
 Cross Sectional               Anatomy
  Anatomy                       Histology
                            WebPath
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Knowledge Management




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          Knowledge Management

 20th Century Medical Library
     Bricks and morter
     Print journals, books, quick reference manuals
     Interlibrary loans
     Microfiche, Microfilm, dimes
 21st Century Medical Library



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Books, Journals and Manuals




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Point of Care Clinical Tools

         EBM Resources
         Online Point of Care
          Resources
         Drug Resources
         Patient Education
          Resources


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Decision Support




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         Handheld Applications

 ePocrates
 5 Minute Clinical
  Consult
 Medical Calculators
 Immunization schedule




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Communications




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               Secure E-mail

 Private, secure e-mail between Doctor and
  Patient
 http://www.medocs.net




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Clinical Information Systems




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      Clinical Information Systems

 SOAPware Electronic Medical Record
  System
     Loaded on each student computer
     Used all 3rd year in Longitudinal weekly clinic
     Follow 6 patients with chronic disease
     Build entire medical record
     Use Flow Sheets, Reminder System


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Field Trip to Doctors Office




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