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Technology and the Future of Medicine

Technology and the Future of Medicine. James J. Cimino, M.D. ‘81. Technology and the Future of Medicine. Future of technology Impact on the modern hospital Impact on the operating suite Impact on physician practice. Technology. Future of Medicine. Informatics. What I’ll Really Talk About.

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Technology and the Future of Medicine

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  1. Technology and the Future of Medicine James J. Cimino, M.D. ‘81

  2. Technology and the Future of Medicine • Future of technology • Impact on the modern hospital • Impact on the operating suite • Impact on physician practice

  3. Technology Future of Medicine Informatics

  4. What I’ll Really Talk About • What is medical informatics? • What we’re doing at Columbia • Medical informatics training • Medical informatics career paths • Impact on future physicians

  5. What is Medical Informatics? • “Computers in medicine” • The study the role of information in the biomedical sciences and the application of techniques for improving its management

  6. Domains of Medical Informatics • Bioinformatics • Imaging and signal processing • Public health informatics • Clinical informatics

  7. Clinical Informatics • Clinical Information Systems • Educational Resources • Decision support systems • Standards

  8. Electronic Medical Records • Billing systems • Laboratory reporting systems • Central repositories • Decision support • Communication and coordination

  9. Educational Resources • Medline • Pubmed • On-line textbooks • Web resources • Palm-based resources

  10. Expert Systems • Greek oracle model • Reminders and alerts • Guidelines • Integration into process of care

  11. Medical Logic Modules Clinical Database Alerts & Reminders Database Monitor Results Review Database Interface Administrative Medical Entities Dictionary Research Reformatter Reformatter Reformatter . . . . . . Radiology Discharge Summaries Laboratory New York Presbyterian HospitalClinical Information Systems Architecture

  12. Linking to Expert Systems

  13. Linking to Expert Systems

  14. Linking to Expert Systems

  15. Linking to Expert Systems

  16. Substance Laboratory Specimen Event Chemical Anatomic Substance Plasma Specimen Diagnostic Procedure Substance Sampled Plasma Laboratory Test Laboratory Procedure Has Specimen Carbo- hydrate Bioactive Substance Part of Glucose Substance Measured Medical Entities Dictionary Medical Entity CHEM-7 Plasma Glucose Test

  17. Medical Entities Dictionary

  18. Has ingredient Substance Measured Decision Rule Measures Sensitivity Etiology Drug Information Expert System Translations with the MED Injectable Gentamicin Serum Gentamicin Level Gentamicin Gentamicn Sensitivity Test Gentamicin Toxicity

  19. Cardiac Enzyme Heart Disease Chest Creatine Kinase Chest X ray Congestive Heart Failure Angina Intravascular CK Test Chest X ray 2 View Admission :2/14/98 Angina Discharge :1/15/99 CHF Radiology :2/23/99 Chest X Ray Lab :1/1/99 Cardiac Enzyme Test Concept-Oriented View: Heart Admission :3/14/96 Stroke Lab :12/28/96 Sickle Cell Test Radiology :2/28/96 Head CT Lab :1/1/99 Blood Type Test Radiology :2/1/97 Knee X Ray Admission :2/14/98 Angina Discharge :1/15/99 CHF Radiology :2/23/99 Chest X Ray Lab :1/1/99 Cardiac Enzyme Test

  20. Active Log-Ons by User

  21. Telehealth Evolution 3 Months Glucose Lipids Smoking Weight BP

  22. IDEATelInformatics forDiabetesEducationAndTelemedicine • Home telemedicine unit (HTU)

  23. HTU Launchpad

  24. PalmCIS • Errors: slips and mistakes • Proximal causes of errors: • Inadequate access to information • Ineffective communication.coordination • Measure proximal causes • Interventions: • Virtual white board • Infobuttons • Extension to palm-based wireless medium • Controlled clinical trial

  25. Medical Informatics Training • Self-teaching • Computer classes • Externships (NLM) • Degrees (Masters, Ph.D.) • Fellowships

  26. Medical Informatics Career Paths • User • Power user/advisor • Provider organizations • Vendors/developer • Government/Standards • Consultant • Academic

  27. Impact on Future Physicians • Length of stay • Case management • Evidence-based Medicine • Error reduction • Genomics

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