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Informatics

VIEWS: 63 PAGES: 43

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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


                                               3
      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.

                                                   4
      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

                                        6
     Medical Informatics

   Knowledge     Clinical Information
  Management     Management



Communication      Decision Support



                                   7
      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




                                                                        8
        Medical Informatics
        Changing Medicine

   Knowledge        Information
  Management        Management



Communication         Decision Support



                                     9
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
   http://www.amia.org/resource/acad&training/f1.html
                                                        14
        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.




                                                                                             17
         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
                                                                                                                   20
        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



                                                  24
         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                    Student
                                      Arcstream System
  and Faculty PDAs                     Avantgo Server              Wireless Laptops
Stedman’s Medical Dictionary             SQL Server              Microsoft Office Professional
      InfoRetriever                                             Dorland’s Medical Spellchecker
        ePocrates                                                    Photoshop Elements
          PDxMD                                                          InfoRetriever
                                 College of Medicine
       CPOnhand                                                             Endnote
                                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
           InfoRetriever            Faculty development
                                                            27
                          2003-2004

 Switch from Palm OS
  to PocketPC
     Dell Axim
         InfoRetriever
         ePocrates Drug
          Reference
         Avantgo
         PDxMD
         Stedman’s Medical
          Dictionary


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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




                    30
          Basic Sciences Classes

 Anatomy lab video         LXR Testing Program
  enabled                       Question bank
                                 Computer-based testing
 BacusLabs digital web-     

                                Item analysis/grading
  slide program
                            United Streaming
 Gold Standard              Videos
  Multimedia*                   Anatomy
 Cross Sectional               Histology
  Anatomy                   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

   StatRef
   Pubmed
   PDxMD
   MDConsult
   Dynamed




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    Consumer Health Information

 Health Finder
 Familydoctor.org
 More consumer health websites




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      Evidence Anyway You Want It

 Cochrane Collaboration
 InfoRetriever
     Web
     Desktop
     PDA




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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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                    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

 Practice Partner Electronic Medical Record
  System
     Drug Interaction
     Allergy checks
     Internal e-mail
     Integrated with billing and appointments
     Links to knowledge base
     Patient Education handouts

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Field Trip to Doctors Office




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