CPT 493 Medical Informatics (Summer 2007 David Lubliner 973-596-2878 Lubliner@NJIT.edu Medical Informatics" by E.H

1. CPT 493Medical Informatics(Summer 2007 David Lubliner 973-596-2878 Lubliner@NJIT.eduMedical Informatics" by E.H. Shortliffe et al.) Classes: (The course will cover 75% Medical Informatics and 25% Human Physiology) (HW due following Monday) Mon 5/21 Chap 1: Emergence of the discipline Wed 5/23 Chap 2: Biomedical Data: Acquisition and storage HW (questions 2,3,5 pg 79 1-2 pgs max) Mon 5/28 Chap 3: Biomedical Decision Making Wed 5/30 Chap 4: Cognitive Science and Biomedical Computing HW (questions 1,3,4 ph 184) Mon 6/04 Chap 5: Essential Concepts of Biomedical computing Wed 6/06 Chap 6: System Design and Engineering HW (questions 1,2 pg 263) Mon 6/11UNIT II Chap 12: Electronic Heath Record Systems Wed 6/13 Chap 19: Information Retrieval and Digital Libraries HW Project 3 -5 pages go to the web page the National Library of Medicinewww.nlm.nih.gov select one of their database PubMed or Medline Plus. Research some disease, show results and use course information on how you would improve the features. Mon 6/18 Review Wed 6/20 Final Exam Questions part multiple choice on Physiology and part essay on Informatics. Grades: Homework 50% ( chapter questions 10 pts each) Project 20 pts Final Exam 50%

2. Book “Medical Informatics" by E.H. Shortliffe et al., Springer, 2005 Note: This is part of a series on Health Informatics at Springer.

3. What is wrong with this picture?

4. Outline • What kinds of HIT systems are there? • What major trends are emerging? • What are the benefits to adoption? • What are the barriers to adoption? • What is the current state of adoption? • How can you learn more?

5. Patient registration/ demographics Insurance validation Billing systems Appointment systems Computerized Physician Order Entry (CPOE) EMR/EHR/CPR Pharmacy systems Lab systems Imaging systems Telemedicine Patient education Decision Support Library resources Sensors HIT Applications

6. Sad Facts • Medical errors account for more deaths than breast cancer, AIDs and motorcycle accidents. • US has highest HC costs per capita in world • US has worst outcomes of industrialized nations. (infant mortality, lifespan, etc.) • Healthcare is 10-15 yrs behind business in adoption of IT

7. Microsoft Office OneNote Windows Journal Microsoft Educational Pack for Tablet PC Microsoft Experience Pack for Tablet PC Sticky Notes Snipping Tool Some Hospitals are using Tablet Capture Devices

8. Electronic Medical Records

9. Projected IT Priorities Source: 17th Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions

10. Top Business Issues Facing HealthCare Source: 17th Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions

11. Most Significant Barriers to Barriers to Implementing IT Source: 17th Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions

12. Most Important Applications Source: 17th Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions

13. Top Security Concerns of Computerized Medical Information Source: 17th Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions

14. Security Tools Source: 17th Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions

15. Technology Adoption Curve 75% 50% 25%

16. Technology Adoption (Next Two Years) Source: 17th Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions

17. Current Web Site Functions Source: 17th Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions

18. Intranet Functions Source: 17th Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions

19. 2006 Health IT Staffing Needs Source: 17th Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions

20. Goals

21. Payers Hospital Health Information Exchange Labs Data repository Network applications Outpatient RX Physician office Ambulatory centers Public health “Wiring” Healthcare Current system fragments patient information and creates redundant, inefficient efforts Future system will consolidate information and provide a foundation for unifying efforts Hospitals Public health Primary care physician Laboratory Pharmacy Specialty physician Payers Ambulatory center (e.g. imaging centers)

22. Sharing Medical Data • Increase patient safety • Lower Healthcare costs • Allow for coordination of care • Increase communication between providers • Banking analogy

23. Health IT Activities Over the Years • Selected activities to drive interoperability and standardization of health information technology: • 1996 – The Health Insurance Portability and Accountability Act (HIPAA) enacted • 1998 – The National Committee on Vital and Health Statistics (NCVHS) espoused a national health information infrastructure to promote American health • 2002 – Markle Foundation forms the Connecting For Health initiative that assembled public/private leadership in healthcare to promote common electronic standards

24. Health IT Activities Over the Years • Selected activities to drive interoperability and standardization of health information technology: • 2003 – The Federal Health Architecture (FHA) is established in the HHS Office of the Chief Information Officer and is tasked with defining a framework and methodology for establishing the target architecture and standards for interoperability and communication throughout the federal health community • 2003 – President Bush signs the Medicare Prescription Drug Improvement and Modernization Act (MMA) allowing CMS to establish key infrastructure for health information technology such as e-prescribing

25. Office of the National Coordinator for Health IT Established by Executive Order 13335 (April 27, 2004) • Responsible for realizing the President’s vision of Health IT: • Widespread adoption of interoperable EHR within 10 years • Medical information follows consumer • Clinicians have complete, computerized patient information • Quality initiatives measure performance and drive quality-based competition • Public health and bioterrorism surveillance are seamlessly integrated into care

26. Goals • Develop a nationwide health information network (NHIN) • Establish standards for data transfer and storage: • Continuity of care records • Develop Regional Healthcare Information Organizations (RHIOs) • See article: Burton, et al. Using electronic health records to help coordinate care. Milbank Quarterly. V(82);457-81. 2004

27. Status of Regional Health Information Organization (RHIO) Source: 17th Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions

28. Needed for CCR • 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

29. Patient: John Doe MRN: 123-0 Diagnosis: 410.0 WBC: 14,000/cm3 Clinical Data Standards • Current • HL7 messages for most lab data • DICOM messages for images • LOINC for laboratory results content • CPT-4 for procedures content • ICD-9 for diagnoses content (10 coming) • NDC ▬► RxNorm for medication content • Anticipated medical vocabulary • SNOMED/UMLS Concept Unique Identifiers for microbiology content

30. Resources - Books “Medical Informatics" by E.H. Shortliffe et al., Springer, 2005 Note: This is part of a series on Health Informatics at Springer.

31. Resources - Books “Handbook of Medical Informatics,” J.H. van Bemmel and M.A. Musen, Springer 1997.

32. Resources - Books “Healthcare Information Systems” Ed. By K. Beaver (Auerbach) 2002.

33. Journals • JAMIA – J. of the American Medical Informatics Assoc. • Telemedicine and e-Health • IEEE Trans. on Information Technology in Biomedicine • Health Informatics • Studies in Health Technology and Informatics • Biosensors and Bioelectronics • Healthcare Informatics Online (Magazine) • IEEE Technology and Society • British Computer Society

34. More Journals • Artificial Intelligence in Medicine (Elsevier) • Computers in Biology and Medicine (Pergamon Press) • Computers in Biomedical Research (Academic Press) • Computer Methods and Programs in Biomedicine (Elsevier) • IEEE Engineering in Medicine and Biology Magazine • Journal of Medical Systems (Plenum Press) • MD Computing (Springer-Verlag) • Medical Informatics & The Internet in Medicine (Taylor & Francis) • Methods of Information in Medicine (Schattauer) • Yearbook of Medical Informatics (Schattauer)

35. Conferences • HIMSS: regional and national conferences • AMIA: Annual Symposium (and Spring Congress) • HEALTHCOM: Health Communication Conference • MEDINFO: (every 3 years, next in 2007), run by the IMIA (International Medical Informatics Association) • MGMA: 2007 MGMA Health Care Information Technology Forums

36. Web Sites/Organizations • American Medical Informatics Association (AMIA) • Healthcare Informatics • Healthcare Information and Management Systems Society (HIMSS) • Medical Group Management Association (MGMA) • The Informatics Review • To Err Is Human: Building a Safer Health System (IOM) • Crossing the Quality Chasm (IOM) • Health Professions Education (IOM) • Patient Safety: Achieving a New Standard for Care (IOM)

37. Training • AMIA/Oregon Health Sciences 10 x 10 program http://www.amia.org/10x10/partners/ohsu/

38. Health IT Conclusions • Patient Centric Focus • Customer Satisfaction • Patient Safety • Financial Support for Health IT on-going concern • High-speed networks, Intranet and wireless information systems currently in use, to be expanded across regions • Electronic Medical Records (EMR) and Computerized Physician Order Entry (CPOE) most important applications • Interoperability is a must for Health IT