Overview of Medical Computing James J. Cimino, M.D. Department of Medical Informatics Columbia University
Medical Informatics Medical Information Science
We are all Medical Informaticians Medical education Patient data collection and recording Clinical Information retrieval Medical knowledge retrieval Medical decision making
Categories of Medical Computing Financial databases Clinical information systems Research databases Medical knowledge systems Expert systems Decision support systems Computer-assisted instruction Putting it all together
Financial databases Initial impetus for clinical information systems Started with billing Grew to capture billable clinical information Expanded capabilities for prospective payment Next expansion: managed care
Clinical information systems Ancillary systems Central repositories added onto financial systems Comprehensive clinical systems Clinician applications and workstations Next expansion: computer-based patient record systems
Research databases Initially, built from scratch Now built from clinical information systems Next expansion: outcomes research
Medical Knowledge Sources Medline - 1966 Colleague - full-text - 1984 Electronic textbooks Next expansion: Visible Human Project
Computer-Assisted Instruction Electronic quiz Hypertextbooks Simulations Next expansion: customized learning
Expert Systems First medical computing application: 1950 Mycin Acid-base calculators Internest-I and QMR DXplain “Attending” systems Pattern-recognition systems Next expansion: decision support systems
Decision support systems Decision analysis systems Help CPMC alerting system Next expansion: managed care
Putting It All Together Multiple applications on line IAIMS - one-stop information shopping Integration of clinical information systems medical knowledge resources educational systems expert systems decision support systems Next expansion: Internet and the World Wide Web
Systems Columbia IAIMS Life&Death Medline buttton DSE DOP WWW
Current Challenges Clinical data representation Controlled vocabularies User interface design Confidentiality System integration Implementing critical pathways