Medical Informatics: Improving Healthcare Decision-making with Technology

2. What is Medical Informatics? Nancy B. Clark, M.Ed. Director of Medical Informatics Education Florida State University

3. 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

4. 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.

5. 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

6. Health Informatics Defined • Information Technology • Health care • Research • Education • Fundamentals • Communication • Knowledge Management • Decision support • Clinical Information Management

7. Medical Informatics Knowledge Management Clinical InformationManagement Communication Decision Support

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

9. Medical Informatics Changing Medicine Knowledge Management InformationManagement Communication Decision Support

10. Institute of Medicine

11. 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

12. 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?”

13. Reducing Errors • Order entry systems • Reduce medication errors • Detect potential drug interactions • Clinical decision support systems • Improve drug dosing • Improve preventive care • Not diagnosis

14. Degree Fellowships Certificates Short courses Medical schools Information Studies Nursing schools Public health schools Dental schools Health care organizations Informatics Programs https://www.amia.org/informatics-academic-training-programs

15. 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

16. Informatics Education Research • Comparisons traditional to electronic • Retention • Satisfaction • Medical Education • Cost effective • CME • Informatics skills • Not evidence based practice skills

17. 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.

18. Educational Barriers to Achieving Vision • Lack of resources • Relationship/behavioral changes required • Variability and lack of receptivity • Discipline specific issues • Continuing education restrictions

19. Regulatory/Policy Barriers to Achieving Vision • Concerns over privacy • Unsupportive laws • Lack of financial resources • Lack of/bad experiences • Lack of standards

20. Internal Barriers Stakeholder Attitudes and Perceptions Rogers, E. M. & Shoemaker, F. F. (1971). Communication of Innovation. New York: The Free Press. 

21. 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

22. Educational Strategies • Didactic vs problem solving • Competencies • Word processing • Information retrieval • Information management • Data analysis • Presentation • Communication skills • E-mail, file transfer, web

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

24. Computer Literacy Word processing Graphics Life-long learning Medical Reference Clinical Information management Research Data analysis Communication skills E-mail, web, presentation Evidence Based Medicine Informatics Curriculum

25. Infrastructure to Support Informatics Curriculu. • Hardware/Software • Support Issues • Workflow/Mindset Issues • Training Issues • Budgeting Issues

26. Infrastructure

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

28. 2001-2002 • Issued Palm devices to first class • InfoRetriever • ePocrates Drug Reference • Avantgo • PDxMD • Stedman’s Medical Dictionary

29. 2010-2011 • Switched from HP iPAQ to iPod Touch • Epocrates Essentials • PEPID • Essential Evidence Plus • Dynamed • Harrison’s Practice • Pediatric Care Online

30. Hands on Experience KnowledgeManagement Clinical InformationManagement Order entry, EMR, Billing Decision Support Communications

31. Medical Education

32. Anatomy lab video enabled BacusLabs digital web-slide program Gold Standard Multimedia* Cross Sectional Anatomy QuestionMark Testing Program Question bank Computer-based testing Item analysis/grading United Streaming Videos Anatomy Histology WebPath Basic Sciences Classes

33. Knowledge Management

34. Knowledge Management • 20th Century Medical Library • Bricks and morter • Print journals, books, quick reference manuals • Interlibrary loans • Microfiche, Microfilm, dimes • 21st Century Medical Library

35. Books, Journals and Manuals

36. Point of Care Clinical Tools • EBM Resources • Online Point of Care Resources • Drug Resources • Patient Education Resources

37. Decision Support

38. Handheld Applications • ePocrates • 5 Minute Clinical Consult • Medical Calculators • Immunization schedule

39. Communications

40. Secure E-mail • Private, secure e-mail between Doctor and Patient • http://www.medocs.net

41. Clinical Information Systems

42. 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

43. Field Trip to Doctors Office