1. The Internet - How Will It Transform the Practice of Medicine? James J. Cimino - Columbia University Daniel Nutkis - Medtegrity Harry Jacobson - Web EBM and Vanderbilt University Medical Center

2. Practice of Medicine: Pre-Internet Patient Payor Services Provider

3. Practice of Medicine: Post-Internet Other Roles? Information Resources Expert Systems

4. More Questions than Answers  How will the consumer (aka "patient") make informed decisions?  How will care be coordinated?  How will it be reimbursed?  How will we know when we are improving care?  What new roles will there be?

5. Agenda for the Panel  Jim Cimino - Medical informatics  Dan Nutkis - Privacy and security  Harry Jacobson: Evidence-based medicine

6. AMIA 2000 Symposium Report  Rating health information on the Net  Coordinating diverse data sources  Multimedia data capture and display  Remote biomonitoring  Usability of Web-based systems  The Web and legacy systems  Peer review  Education at a distance

7. Patient Clinical Information System (PatCIS)  New York Presbyterian Hospital clinical data repository  Web-based Clinical Information System (WebCIS)  National Information Infrastructure contract from NLM: –give patients WebCIS –see what happens  Pilot study conducted

12. “Televaluation” of PatCIS Patient 1. Video Based Usability Testing - in laboratory Interact via WWW Patient Information System (PatCIS) 2. Telephone Interviews (audiotape) 5. On-line Questionnaire Data (sequenced forms) 4. Tracking User Actions - System Usage Database (log files) 3. E-mail (to evaluators)

13. Average Monthly Log-Ons

14. Average Session Time by User

15. Function Usage  Data entry: 73 total  Data review: 1831 total –1518 laboratory –36 vital signs –35 diabetes flow sheets –212 reports (81 radiology, 35 pathology) –30 Microbiology  Education: 53 total  Advice: 6 total

16. Patients and Physicians Interviews  Subjects felt that use of PatCIS had a direct impact on doctor-patient communication  For patients –Improved communication resulting from following their own lab results (review of data function) prior to meeting with their physician  For physicians –Allows for focus on issues of decision making and patient compliance during during doctor-patient interviews (rather than review of data)

17. Excerpts from Patient Interviews “ Communication is less in the way of getting information now, and more in the way of discussing treatment options and agreeing on a course of action, so to me its more efficient than the old way” “ I look for trends in my medical data and if I see something I can contact the doctor to see what’s going on, what we can do, change meds or whatever”

18. Excerpts Physician Interviews “ Right now most of the communication takes place during the ten or fifteen minute visit and if I throw a lot of information at the patient about their condition or what I want them to do, its very hard for them to absorb all that. It (PatCIS) gives them a chance to go back and look at things about their health record that they can then ask better questions about in the limited time that we have during the visit. Its another channel of communication” It (PatCIS) gives them a chance to go back and look at things about their health record that they can then ask better questions about in the limited time that we have during the visit. Its another channel of communication”

19. The Role of Medical Informatics  Understanding information needs  Providing educational and information resources  Integration of clinical, educational, administrative, financial and research resources  New forms of decision support  Facilitation through the Internet