Informatics & NephrologyInformatics & Nephrology

How Can We Integrate the How Can We Integrate the Computer in Our Daily Computer in Our Daily Practice?Practice?

YOUSEF A. BOOBES, M.D.YOUSEF A. BOOBES, M.D.

Head Renal DivisionHead Renal Division

Tawam Hospital, Al AinTawam Hospital, Al Ain

• Science is built up with facts Science is built up with facts as a house with stonesas a house with stones..

– Jules Henri Poincaré, 1908

• But a collection of facts is no But a collection of facts is no more a science than a heap of more a science than a heap of stones is a house. stones is a house.

IntroductionIntroduction

• 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

V & A Pressures

BPValues

BV% Changes

KnowledgeDatabase

Data ReviewAlerts

ComputationsInterpretations

Protocols

OUTCOME

INTEGRATEDCLINICAL

DATABASE

Dialysis TRT Data

B. pumpECG

Presc.Drugs

InfectiousDisease

Pre TxEvaluation

TranscribedDictation

NursingCharting

IntradialyticComplications

Laboratory

SocialRehab

AdmissionMedicalRecords

DialysisSchedule

Diet

X-Rays

DecisionMaking

Processor,Data And

Time Driver

BloodTX

VascularAccess

DialysisKt/V

Others

What is Medical What is Medical Informatics?Informatics?

• Simple definition: – Computer applications in medical care

• Complicated definition:– The systematic processing of data,

information and knowledge in medicine and health care.

Fields of Medical Fields of Medical InformaticsInformatics

• Information (knowledge & data) management and decision making

• Communication tasks of medical practice

• Basic science and clinical research

• Medical education

• Planning and policy issues

Fields of Medical Fields of Medical InformaticsInformatics

• Information (knowledge & data) management and decision making

• Communication tasks of medical practice

• Basic science and clinical research

• Medical education

• Planning and policy issues

Knowledge Knowledge

Traditional Sources of Traditional Sources of Knowledge 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

Computerized Sources of Computerized Sources of

KnowledgeKnowledge • 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

Clinical Computer SoftwareClinical Computer Software

• Electronic medical textbook and encyclopedia

• Bibliographic and full-text information retrieval systems

• Clinical decision-support systems (CDSS)

Clinical Textbooks in Clinical Textbooks in Electronic (CD-ROM) FormatElectronic (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

Bibliographic & Information Bibliographic & Information Retrieval SoftwareRetrieval 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

The World Wide WebThe 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

=> Drinking Water From a Fire Hose=> 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

E-mail Based Discussion E-mail Based Discussion Groups (Listservs)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.

Clinical Decision-Support Clinical Decision-Support Systems (CDSS) 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

Patient’s DataPatient’s Data

Categories of Clinical Categories of Clinical Computer SoftwareComputer Software

• Electronic medical record systems (EMRSs)

• Haemodialysis Data Management software

Electronic Medical Record Electronic Medical Record Systems Systems

• Very efficient for storing and retrieving:– Patient data

– Clinician's orders

– Clinical textual reports (e.g., history and P.E.,

progress notes, nursing notes, X-R reports,..)

– Laboratory results,

– Pharmacy information,

– Billing information,

– Census data,

– Outcome data.

Haemodialysis Data Haemodialysis Data Management software Management software

• Fresenius: Finesse System

• Hospal: Communication System

Others Uses of ComputerOthers Uses of Computer

• Telemedicine

• Dialysis Kinetics and Modeling

• Education:– Resources– Slide Presentation

• Research– Basic science and clinical research

• Planning and policy issues

How Can We Integrate the How Can We Integrate the Computer in Our Daily Computer in Our Daily Practice?Practice?

Handheld Computers

CategoriesCategories

• Palm-size:– Small enough to fit in

one hand

• Handheld PC (H/PC):– Two-handed size with

keyboard and bigger display

PROS and CONS: PROS and CONS: Palm-sizePalm-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

PROS and CONS: PROS and CONS: H/PC 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

Classification of Handhelds Classification of Handhelds According OSAccording 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

Palm-Size:Palm-Size:Palm OS vs. Windows CEPalm 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

ApplicationsApplications

• Medical Records

• Personal Organization

• Reference tools

• Calculation tools

• Specialty Applications

• Fax

• Beeper

• Cell phone

• Internet Access

Tasks Best Suited for Palm-Tasks Best Suited for Palm-size Devicessize Devices

• 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

Things Can be Done with Things Can be Done with Palm-Size Devices,1Palm-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

Things Can be Done with Things Can be Done with Palm-Size Devices, 2Palm-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.

Things Can be Done with Things Can be Done with Palm-Size Devices, 3Palm-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.)

Things Can be Done with Things Can be Done with Palm-Size Devices, 4Palm-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

Palm Devices & Renal Fellowship Palm Devices & Renal Fellowship Program - Program - University of MinnesotaUniversity 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

Where to Get More Where to Get More Information?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