Contemporary Issues in Medical Informatics James J. Cimino Department of Medical Informatics Columbia University

Applications Diagnosis Treatment –Training –Telepresence –Decision support

Technologies Electronic medical records Bioinformatics Controlled medical terminologies Knowledge bases Internet

Applications  Technologies DX Training Presence Support EMRs Bioinf. CMTs KBs Internet Improved Care Case Based Learning Shared Information Automated Integration Prediction/ Prognosis Effective Planning Predictive Probability Repre- sentation Linkages Bridging Expert Systems Guidelines Collaboration Resources

History Taking New model for medical record Granularity of terminology Teach patients to give histories

Summary of Presentations James J. Cimino Department of Medical Informatics Columbia University

Summary of Presentations Presentations Issues Topics for discussion

Presentations - David Williams Decay of training Pharmacology is unknown Think about requirements MD on Board

Presentations - Sam Pool Pharmacodynamics and pharmacokinetics have implications for evidence-based medicine What medications? What equipment?

Presentations - Jay Sanders The rule Mars to Main Street Focus on history-taking

Presentations -Jeff Sutton Smart systems for Rx and monitoring Novel sensors Novel therapeutic modalities Remote fabrication Intelligent systems for mentoring/training

Presentations - Terry Clemmer Complex adaptive systems Setting the vision is the attractor Clockware vs. Swarmware The human on a bike (AI-RHEUM) Rapid cycle trials - process oriented Protocol development

Presentations - Dan Masys How much will we know in the next 25 years? Human genome project: a parts list Task of functional genomics is to map the patterns to the clinical picture Interrupt command and control mechanisms

Presentations - Michael Ackerman Interactivity is an issue Things to pack Lessons from submarines Risk/benefit analysis

Presentations - Larry Weed Decouple data collection from heuristics Stop relying on what’s in doctors’ heads New tools are needed A new science of medical practice

Issues What do we need to learn? What do we need to build?

Issues - What do we need to learn? How to do interviews - but what about psychiatric ones? Study what gets used in subs, space station, islands, Poles - what are the cognitive issues? Can we apply informatics to backward chain in collecting evidence?

Issues - What do we need to learn? Heuristics and EBM Swarmware and chaos theory - it’s ok to kill a few termites Genomics - functions vs. markers Pattern matching and gestalt - if we can model human physicians, why not just model human astronauts?

Issues - What do we need to build? My first aid kit Lab on a chip - a super dipstick? Expert systems - which part is the bicycle and which part is the human?

Topics for Discussion How will we practice evidence-based health care? What to pack: hardware vs. warmware