1 What is Medical Informatics? Nancy B. Clark, M.Ed. Director of Medical Informatics Education Florida State University 2 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 5 Health Informatics Defined Information Technology Health care Research Education Fundamentals Communication Knowledge Management Decision support Clinical Information Management 6 Medical Informatics Knowledge Management Communication Clinical Information Management Decision Support 7 Informatics Use in Health Care 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 8 Medical Informatics Changing Medicine Knowledge Management Communication Information Management Decision Support 9 Institute of Medicine 10 Vision of Quality Chasm Report Standardized information infrastructure Support care teams - Enhances patientcentered care Supports care coordination Measure outcomes - Improve outcomes Enhance safety - Reduces errors Enables quality measurement/monitoring Reward quality 11 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?” 12 Reducing Errors Order entry systems Reduce medication errors Detect potential drug interactions Clinical decision support systems Improve drug dosing Improve preventive care Not diagnosis 13 Informatics Programs Degree Fellowships Certificates Short courses Medical schools Information Studies Nursing schools Public health schools Dental schools Health care organizations https://www.amia.org/informatics-academic-training-programs 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 15 Informatics Education Research Comparisons traditional to electronic Retention Satisfaction Medical Education Cost effective CME Informatics skills Not evidence based practice skills 16 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 18 Regulatory/Policy Barriers to Achieving Vision Concerns over privacy Unsupportive laws Lack of financial resources Lack of/bad experiences Lack of standards 19 Internal Barriers 35% 34% 14% 3% 14% Stakeholder Attitudes and Perceptions Rogers, E. M. & Shoemaker, F. F. (1971). Communication of Innovation. New York: The Free Press. Innovators Early Adopters Early Majority Late Majority 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 21 Educational Strategies Didactic vs problem solving Competencies Word processing Information retrieval Information management Data analysis Presentation Communication skills E-mail, file transfer, web 22 AAMC MSOP Medical School Objectives Project Informatics competencies for medical students http://www.aamc.org/meded/msop/msop2.pdf 23 Informatics Curriculum 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 24 Infrastructure to Support Informatics Curriculu. Hardware/Software Support Issues Workflow/Mindset Issues Training Issues Budgeting Issues 25 Infrastructure Student and Faculty PDAs Essential Evidence Plus PEPID ePocrates Harrison’s Pracrtice Pediatric Care Online GAYF Virtual Library Resources Data Collection and Evaluation System Arcstream System Avantgo Server SQL Server College of Medicine Network Infrastructure Technology Enhanced Classrooms Campus Wide Wireless Coverage Video Conferencing File, Exchange, Web Servers Student Wireless Tablet PCs Microsoft Office Professional Stedman’s Medical Spellchecker Photoshop Elements Endnote Blackboard Courseware All Courses IT Section Support Database Development Web design Video Editing Tech Support 26 Technology 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 27 2001-2002 Issued Palm devices to first class InfoRetriever ePocrates Drug Reference Avantgo PDxMD Stedman’s Medical Dictionary 28 2010-2011 Switched from HP iPAQ to iPod Touch Epocrates Essentials PEPID Essential Evidence Plus Dynamed Harrison’s Practice Pediatric Care Online 29 Hands on Experience Knowledge Management Decision Support Clinical Information Management Order entry, EMR, Billing Communications 30 Medical Education 31 Basic Sciences Classes Anatomy lab video enabled BacusLabs digital webslide program Gold Standard Multimedia* Cross Sectional Anatomy QuestionMark Testing Program Question bank Computer-based testing Item analysis/grading United Streaming Videos Anatomy Histology WebPath 32 Knowledge Management 33 Knowledge Management 20th Century Medical Library Bricks and morter Print journals, books, quick reference manuals Interlibrary loans Microfiche, Microfilm, dimes 21st Century Medical Library 34 Books, Journals and Manuals 35 Point of Care Clinical Tools EBM Resources Online Point of Care Resources Drug Resources Patient Education Resources 36 Decision Support 37 Handheld Applications ePocrates 5 Minute Clinical Consult Medical Calculators Immunization schedule 38 Communications 39 Secure E-mail Private, secure e-mail between Doctor and Patient http://www.medocs.net 40 Clinical Information Systems 41 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 42 Field Trip to Doctors Office 43