1. Overview of Medical Computing
James J. Cimino, M.D.
Department of Medical Informatics
Columbia University

2. Medical Informatics
Medical
Information
Science

3. We are all Medical Informaticians
Medical education
Patient data collection and recording
Clinical Information retrieval
Medical knowledge retrieval
Medical decision making

4. 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

5. 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

6. 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

7. Research databases Initially, built from scratch
Now built from clinical information systems
Next expansion: outcomes research

8. Medical Knowledge Sources
Medline
Colleague - full-text
Electronic textbooks
Next expansion: Visible Human Project

9. Computer-Assisted Instruction
Electronic quiz
Hypertextbooks
Simulations
Next expansion: customized learning

10. 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

11. Decision support systems
Decision analysis systems
Help
CPMC alerting system
Next expansion: managed care

12. 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

13. Systems
Columbia IAIMS
Life&Death
Medline buttton
DSE
DOP
WWW

14. Current Challenges Clinical data representation
Controlled vocabularies
User interface design
Confidentiality
System integration
Implementing critical pathways