CPT 493 Medical Informatics (Summer 2007 David Lubliner 973-596-2878 [email protected] Medical Informatics" by E.H. Shortliffe et al.) [email protected]

CPT 493CPT 493Medical InformaticsMedical Informatics

(Summer 2007 David Lubliner 973-596-2878 (Summer 2007 David Lubliner 973-596-2878 [email protected]@NJIT.eduMedical Informatics" by E.H. Shortliffe et al.)Medical Informatics" by E.H. Shortliffe et al.)

Grades: Homework 50% ( chapter questions 10 pts each) Project 20 pts

Final Exam 50%

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 Medicine www.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.

mailto:[email protected]

http://www.nlm.nih.gov/

BookBook

“Medical Informatics" by E.H. Shortliffe et al., Springer, 2005

Note: This is part of a series on Health Informatics at Springer.

What is wrong with this picture?What is wrong with this picture?

Outline 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?

HIT ApplicationsHIT Applications• 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

Sad FactsSad 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

Some Hospitals are using Tablet Capture DevicesSome Hospitals are using Tablet Capture Devices

• Microsoft Office OneNote

• Windows Journal• Microsoft Educational

Pack for Tablet PC• Microsoft Experience

Pack for Tablet PC• Sticky Notes• Snipping Tool

EElectroniclectronic M Medical edical RRecordsecords

Projected IT PrioritiesProjected IT Priorities

Source: 17th Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions

Top Business Issues Facing Top Business Issues Facing HealthCareHealthCare


Most Significant Barriers to Most Significant Barriers to Barriers to Implementing ITBarriers to Implementing IT


Most Important ApplicationsMost Important Applications


Top Security Concerns of Top Security Concerns of Computerized Medical InformationComputerized Medical Information


Security ToolsSecurity Tools


Technology Adoption CurveTechnology Adoption Curve

50%

25%

75%

Technology Adoption Technology Adoption (Next Two Years)(Next Two Years)


Current Web Site FunctionsCurrent Web Site Functions


Intranet FunctionsIntranet Functions


2006 Health IT Staffing Needs2006 Health IT Staffing Needs


GoalsGoals

““Wiring” HealthcareWiring” Healthcare

Hospitals

Primary care physician

Specialty physician

Ambulatory center (e.g.

imaging centers)

Payers

Pharmacy

Laboratory

Public health

Current system fragments patient information and creates redundant, inefficient efforts

Future system will consolidate information and provide a foundation for unifying efforts

Hospital

Data repository

Health Information Exchange

Network applications

Server

Payers

Labs

Outpatient RX

Physician office

Ambulatory centers Public health

Sharing Medical DataSharing Medical Data

• Increase patient safety

• Lower Healthcare costs

• Allow for coordination of care

• Increase communication between providers

• Banking analogy

Health IT Activities Over the YearsHealth 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

Health IT Activities Over the YearsHealth 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

Office of the National Office of the National Coordinator for Health ITCoordinator 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

GoalsGoals

• 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

Status of Regional Health Status of Regional Health Information Organization (RHIO)Information Organization (RHIO)


Needed for CCRNeeded 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

Patient: John DoeMRN: 123-0Diagnosis: 410.0WBC: 14,000/cm3

Patient: John DoeMRN: 123-0Diagnosis: 410.0WBC: 14,000/cm3

• 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

Clinical Data StandardsClinical Data Standards

Resources - BooksResources - Books

“Medical Informatics" by E.H. Shortliffe et al., Springer, 2005

Note: This is part of a series on Health Informatics at Springer.


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


“Healthcare Information Systems” Ed. By K. Beaver (Auerbach) 2002.

http://www.amazon.com/gp/reader/0849314984/ref=sib_dp_pt/102-2194790-2871351

Journals 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

More Journals 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)

Conferences 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

Web Sites/Organizations Web Sites/Organizations

• American Medical Informatics Association (AMIA)• Healthcare Informatics• Healthcare Information and Management Systems Socie

ty (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)

http://www.amia.org/

http://www.healthcare-informatics.com/

http://www.himss.org/ASP/

http://www.himss.org/ASP/

http://www.mgma.com/

http://www.informatics-review.com/

http://www.nap.edu/books/0309068371/html/




TrainingTraining

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

http://www.amia.org/10x10/partners/ohsu/

Health IT ConclusionsHealth 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

Documents

CPT 493 Medical Informatics (Summer 2007 David Lubliner 973-596-2878 [email protected] Medical Informatics" by E.H. Shortliffe et al.) [email protected]