Technology and the Future of Medicine James J. Cimino, M.D. ‘81.

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Presentation transcript:

Technology and the Future of Medicine James J. Cimino, M.D. ‘81

Technology and the Future of Medicine Future of technology Impact on the modern hospital Impact on the operating suite Impact on physician practice

Technology Future of Medicine Informatics

What I’ll Really Talk About What is medical informatics? What we’re doing at Columbia Medical informatics training Medical informatics career paths Impact on future physicians

What is Medical Informatics? “Computers in medicine” The study the role of information in the biomedical sciences and the application of techniques for improving its management

Domains of Medical Informatics Bioinformatics Imaging and signal processing Public health informatics Clinical informatics

Clinical Informatics Clinical Information Systems Educational Resources Decision support systems Standards

Electronic Medical Records Billing systems Laboratory reporting systems Central repositories Decision support Communication and coordination

Educational Resources Medline Pubmed On-line textbooks Web resources Palm-based resources

Expert Systems Greek oracle model Reminders and alerts Guidelines Integration into process of care

New York Presbyterian Hospital Clinical Information Systems Architecture Medical Entities Dictionary Database Monitor Medical Logic Modules Alerts & Reminders Research Administrative Results Review... Radiology Laboratory Discharge Summaries Reformatter Clinical Database Database Interface

Linking to Expert Systems

Medical Entities Dictionary Medical Entity Laboratory Procedure CHEM-7 Plasma Glucose Test Laboratory Specimen Plasma Specimen Substance Sampled Part of Has Specimen Event Laboratory Test Diagnostic Procedure Substance Measured Glucose Plasma Anatomic Substance Bioactive Substance Chemical Carbo- hydrate

Medical Entities Dictionary

Translations with the MED Gentamicin Injectable Gentamicin Gentamicn Sensitivity Test Serum Gentamicin Level Gentamicin Toxicity Etiology Measures Sensitivity Substance Measured Has ingredient Decision Rule Expert System Drug Information

Chest X ray Congestive Heart Failure Intravascular CK Test Creatine Kinase Chest X ray 2 View Cardiac Enzyme Angina Lab :1/1/99 Cardiac Enzyme Test Radiology :2/23/99 Chest X Ray Radiology :2/28/96 Head CT Lab :12/28/96 Sickle Cell Test Admission :3/14/96 Stroke Admission :2/14/98 Angina Lab :1/1/99 Blood Type Test Radiology :2/1/97 Knee X Ray Concept-Oriented View: Heart Disease Chest Discharge :1/15/99 CHF CHF Discharge :1/15/99 CHF CHF Admission :2/14/98 Angina Lab :1/1/99 Cardiac Enzyme Test Radiology :2/23/99 Chest X Ray

Active Log-Ons by User

Telehealth Evolution 3 Months Glucose Lipids Smoking Weight BP

Home telemedicine unit (HTU) IDEATel Informatics for Diabetes Education And Telemedicine

HTU Launchpad

PalmCIS Errors: slips and mistakes Proximal causes of errors: –Inadequate access to information –Ineffective communication.coordination Measure proximal causes Interventions: –Virtual white board –Infobuttons –Extension to palm-based wireless medium Controlled clinical trial

Medical Informatics Training Self-teaching Computer classes Externships (NLM) Degrees (Masters, Ph.D.) Fellowships

Medical Informatics Career Paths User Power user/advisor Provider organizations Vendors/developer Government/Standards Consultant Academic

Impact on Future Physicians Length of stay Case management Evidence-based Medicine Error reduction Genomics

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