Informatics & Nephrology How Can We Integrate the Computer in Our Daily Practice?

1. Informatics & NephrologyHow Can We Integrate the Computer in Our Daily Practice? YOUSEF A. BOOBES, M.D. Head Renal Division Tawam Hospital, Al Ain

2. Science is built up with facts as a house with stones. • Jules Henri Poincaré, 1908 • But a collection of facts is no more a science than a heap of stones is a house.

3. Introduction • The volume and complexity of medical knowledge and data today have far outstripped any physician’s ability to function optimally without the support of information management tools. • Yet many physicians are uncertain how to implement these tools in their daily medical activities. J. Osheroff, Computer in Clinical Practice

4. Transcribed Dictation Dialysis TRT Data BP Values Pre Tx Evaluation V & A Pressures Infectious Disease Nursing Charting Knowledge Database Presc. Drugs BV% Changes B. pump ECG Decision Making Processor, Data And Time Driver Intradialytic Complications INTEGRATED CLINICAL DATA BASE Dialysis Schedule X-Rays Data Review Alerts Computations Interpretations Protocols Laboratory Diet Others Dialysis Kt/V Blood TX Admission Medical Records Vascular Access Social Rehab OUTCOME

5. What is Medical Informatics? • Simple definition: • Computer applications in medical care • Complicated definition: • The systematic processing of data, information and knowledge in medicine and health care.

6. Fields of Medical Informatics • Information (knowledge & data) management and decision making • Communication tasks of medical practice • Basic science and clinical research • Medical education • Planning and policy issues

7. Fields of Medical Informatics • Information (knowledge & data) management and decision making • Communication tasks of medical practice • Basic science and clinical research • Medical education • Planning and policy issues

8. Knowledge

9. Traditional Sources of Knowledge • Print-based textbooks and journals • Personal or through health science library • Colleagues: • Consultation • Informal questions • Referrals to Academic health care centers • CME • Conferences • Courses

10. Printed textbooks & journals Colleagues: Consultation Referrals to Academic health care centers Informal questions CME Conferences Courses Clinical computer software applications Web sites Colleagues: Telemedicine Internet Group of discussion The Web cyberConferences Online Courses Computerized Sources of Knowledge

11. Clinical Computer Software • Electronic medical textbook and encyclopedia • Bibliographic and full-text information retrieval systems • Clinical decision-support systems (CDSS)

12. Clinical Textbooks in Electronic (CD-ROM) Format • Examples of electronic textbooks: • UpToDate • The Kidney “Brenner and Rector” • Oxfords Textbook of Clinical Nephrology • Reference (PDR) • Some are accessible via the internet

13. Bibliographic & Information Retrieval Software • The National Library of Medicine has developed MEDLINE-based resources such as: • PubMed • Grateful Med • LOANSOME DOC • Bibliographic search software, such as • Ovid • Aries Knowledge Finder • SilverPlatter • PaperChase

14. The World Wide Web • Clinically useful information can be found on the Web • Many of Web information unsuitable for direct clinical application • Known High Quality Web Sites • Government agencies (in U.S. and other) • Academic health care centers • Professional specialty organizations • Peer-reviewed journals • Others

15. => Drinking Water From a Fire Hose • Internet can be helpful for: • Answering clinical questions • Providing the latest relevant information • It could be time - consuming • Retrieve huge number of sites • Then, retrieve large set of relevant publications

16. E-mail Based Discussion Groups (Listservs) • NEPHROL: • General nephrology, including renal pathology & Tx. • NEPHJNL: • Nephrology/transplantation journal club. • NEPJHIST: • history of renal medicine, ISN Video Legacy Project interview transcripts. • NEPHCNPT: • discussions of individual clinical nephrology cases. • NEPHNPPT: • discussions of individual renal biopsy cases.

17. Clinical Decision-Support Systems (CDSS) • Examples • Dxplain, ILIAD, Meditel • Given a set of patient findings • Explain differential diagnoses • Show relevant laboratory tests • Suggest possible workup protocols • Provide links to relevant biomedical literature

18. Patient’s Data

19. Categories of Clinical Computer Software • Electronic medical record systems (EMRSs) • Haemodialysis Data Management software

20. Electronic Medical Record Systems • Very efficient for storing and retrieving: • Patient data • Clinician's orders • Clinicaltextual reports (e.g., history and P.E.,progress notes, nursing notes, X-Rreports,..) • Laboratory results, • Pharmacy information, • Billing information, • Census data, • Outcome data.

21. Haemodialysis Data Management software • Fresenius: Finesse System • Hospal: Communication System

22. Others Uses of Computer • Telemedicine • Dialysis Kinetics and Modeling • Education: • Resources • Slide Presentation • Research • Basic science and clinical research • Planning and policy issues

23. How Can We Integrate the Computer in Our Daily Practice? Handheld Computers

24. Categories • Palm-size: • Small enough to fit in one hand • Handheld PC (H/PC): • Two-handed size with keyboard and bigger display

25. PROS and CONS: Palm-size • PROS • Lighter and smaller • Longer battery life • CONS: • Not practical for extensive data input without a keyboard attachment • Less likely to have internal modems

26. PROS and CONS: H/PC • PROS • Much better for data entry or writing than palm-size • Larger screen • More PC-like interface • CONS: • Costs more than Palm-size • Not practical for extensive typing

27. Classification of Handhelds According OS • Palm OS: palm-size • Palm, HandSpring: Visor, Sony Clie • Windows CE: H/PC, palm-size • Compaq iPaq 3630 • HP Jornada 545 • Casio Cassiopeia E-115 • Psion, (Symbian): H/CP

28. Palm-Size:Palm OS vs. Windows CE • Both have pluses and minuses • Windows CE devices • Have more memory and faster processor • But practically => same • Special version of the most popular PC app (Word, Excel, ..) => synchronizing the information with PC is easier • Palm OS devices dominate the market (>80%) • Have > 70,000 third-party developers creating tons of applications • Cheaper & longer battery Life

29. Medical Records Personal Organization Reference tools Calculation tools Specialty Applications Fax Beeper Cell phone Internet Access Applications

30. Access existing data Access reference material Personal information manager Access information networks via modem or wireless Cellular phone material Beeper Access Fax - send and receive Calculator Tasks Best Suited for Palm-size Devices

31. Things Can be Done with Palm-Size Devices,1 • Personal information manager • Ideal for keeping track of small pieces of information such as • Telephone numbers, addresses and appointments. • To take short notes, • Read documents and manage your email all while away from the desktop. • Take your personal notes with you • Download abstracts or other text to read them latter, lunch, etc. • Download web pages, email,… to read them latter

32. Things Can be Done with Palm-Size Devices, 2 • Electronic Medical Records/Patient Tracking • Storing: • Personal and demographic information of patients • Lab data, medical history, clinical data and prescriptions. • Using: • Patient data is downloaded at the start of each ward round • Modifications done during rounds are synchronized at the end • With a radio network card => mobile access to main hospital server • Palm devices are more useful than the desktop PC: • All charts & records are easily viewed at the bedside • Notes or prescriptions can be added easily at the bedside.

33. Things Can be Done with Palm-Size Devices, 3 • Store reference material in your pocket • Text books: • NephroToGo, Harrison • Drug guides: • ePocrate • Medical calculators • Perform almost any complex calculation: • Quickly receive the results of a number of preloaded equations (i.e., kt/v, Creat. clearance, anion gap, etc.)

34. Things Can be Done with Palm-Size Devices, 4 • Internet access • ability to access and store a tremendous amount of information from online archives, newsgroups and others • Software: • AvantGo: • They are not ideal for simple browsing of the web, but for quick trips to find relevant information they can prove pretty convenient. • Because these devices are extremely customizable, the functionality is only limited by your imagination

35. Palm Devices & Renal Fellowship Program - University of Minnesota • Palm provides "just-in-time information" for both fellows and faculty • A web page that allows fellows to download schedules, announcements, forms, and lecture notes to their Palm • "NephroToGo": a handbook of nephrology that can be downloaded for free • Diagnostic and technical info as well as renal calculators • WWW.nephrotogo.com

36. Where to Get More Information? • The 2000 Guide to Handheld and Palmtop Computing Resources for Health CareProfessionals. • http://themedicalguide.hypermart.net/  • Medical Software Reviews 2000 Index • http://www.crihealthcarepubs.com/indx00c.html  • WWW Sites • www.acponline.org, www.palm.com, www.pilotgear.com • www.palmcentral.com, • http://palmtops.about.com/gadgets/palmtops/cs/reviewresources/index.htm?terms=palmtop