Transcript hat is medical informatics?

Informatics & Nephrology
How Can We Integrate the
Computer in Our Daily
Practice?
YOUSEF A. BOOBES, M.D.
Head Renal Division
Tawam Hospital, Al Ain
• Science is built up with facts as
a house with stones.
• But a collection of facts is no
more a science than a heap of
stones is a house.
– Jules Henri Poincaré, 1908
Introduction
• The volume and complexity of medical
knowledge and data today have far
outstripped any physician’s ability to
function optimally without the support of
information management tools.
• Yet many physicians are uncertain how to
implement these tools in their daily
medical activities.
J. Osheroff, Computer in Clinical Practice
Knowledge
Database
Transcribed
Dialysis TRT Data
Dictation
V&A
Infectious Pre Tx
BP
Nursing
Evaluation
Disease
Charting Pressures
Values
Presc.
Drugs
B. pump
ECG
Decision
Making
Processor,
Data And
Time Driver
X-Rays
Data Review
Alerts
Computations
Interpretations
Protocols
OUTCOME
BV%
Changes
Intradialytic
Complications
INTEGRATED
CLINICAL
DATA
BASE
Dialysis
Schedule
Laboratory
Diet
Others
Admission
Medical
Records
Dialysis
Kt/V
Blood
TX
Social
Rehab
Vascular
Access
What is Medical
Informatics?
• Simple definition:
– Computer applications in medical care
• Complicated definition:
– The systematic processing of data,
information and knowledge in medicine
and health care.
Fields of Medical
Informatics
• Information (knowledge & data)
management and decision making
• Communication tasks of medical
practice
• Basic science and clinical research
• Medical education
• Planning and policy issues
Fields of Medical
Informatics
• Information (knowledge & data)
management and decision making
• Communication tasks of medical
practice
• Basic science and clinical research
• Medical education
• Planning and policy issues
Knowledge
Traditional Sources of
Knowledge
• Print-based textbooks and journals
– Personal or through health science library
• Colleagues:
– Consultation
– Informal questions
– Referrals to Academic health care centers
• CME
– Conferences
– Courses
Computerized Sources of
Knowledge
• Printed textbooks &
journals
• Clinical computer
software applications
• Colleagues:
• Web sites
– Consultation
– Referrals to Academic
health care centers
– Informal questions
• CME
– Conferences
– Courses
• Colleagues:
– Telemedicine
– Internet Group of
discussion
• The Web
– cyberConferences
– Online Courses
Clinical Computer Software
• Electronic medical textbook and
encyclopedia
• Bibliographic and full-text
information retrieval systems
• Clinical decision-support systems
(CDSS)
Clinical Textbooks in
Electronic (CD-ROM) Format
• Examples of electronic textbooks:
– UpToDate
– The Kidney “Brenner and Rector”
– Oxfords Textbook of Clinical Nephrology
– Reference (PDR)
• Some are accessible via the internet
Bibliographic & Information
Retrieval Software
• The National Library of Medicine has
developed MEDLINE-based resources
such as:
– PubMed
– Grateful Med
– LOANSOME DOC
• Bibliographic search software, such as
–
–
–
–
Ovid
Aries Knowledge Finder
SilverPlatter
PaperChase
The World Wide Web
• Clinically useful information can be found
on the Web
• Many of Web information unsuitable for
direct clinical application
• Known High Quality Web Sites
–
–
–
–
–
Government agencies (in U.S. and other)
Academic health care centers
Professional specialty organizations
Peer-reviewed journals
Others
• Internet can be helpful for:
– Answering clinical questions
– Providing the latest relevant information
• It could be time - consuming
– Retrieve huge number of sites
– Then, retrieve large set of relevant
publications
=> Drinking Water From a Fire Hose
E-mail Based Discussion
Groups (Listservs)
• NEPHROL:
– General nephrology, including renal pathology & Tx.
• NEPHJNL:
– Nephrology/transplantation journal club.
• NEPJHIST:
– history of renal medicine, ISN Video Legacy Project
interview transcripts.
• NEPHCNPT:
– discussions of individual clinical nephrology cases.
• NEPHNPPT:
– discussions of individual renal biopsy cases.
Clinical Decision-Support
Systems (CDSS)
• Examples
– Dxplain, ILIAD, Meditel
• Given a set of patient findings
– Explain differential diagnoses
– Show relevant laboratory tests
– Suggest possible workup protocols
– Provide links to relevant biomedical
literature
Patient’s Data
Categories of Clinical
Computer Software
• Electronic medical record systems
(EMRSs)
• Haemodialysis Data Management
software
Electronic Medical Record
Systems
• Very efficient for storing and retrieving:
– Patient data
– Clinician's orders
– Clinical textual reports (e.g., history and P.E.,
progress notes, nursing notes, X-R reports,..)
–
–
–
–
–
Laboratory results,
Pharmacy information,
Billing information,
Census data,
Outcome data.
Haemodialysis Data
Management software
• Fresenius: Finesse System
• Hospal: Communication System
Others Uses of Computer
• Telemedicine
• Dialysis Kinetics and Modeling
• Education:
– Resources
– Slide Presentation
• Research
– Basic science and clinical research
• Planning and policy issues
How Can We Integrate the
Computer in Our Daily
Practice?
Handheld Computers
Categories
• Palm-size:
– Small enough to fit in
one hand
• Handheld PC
(H/PC):
– Two-handed size with
keyboard and bigger
display
PROS and CONS:
Palm-size
• PROS
– Lighter and smaller
– Longer battery life
• CONS:
– Not practical for extensive data input
without a keyboard attachment
– Less likely to have internal modems
PROS and CONS:
H/PC
• PROS
– Much better for data entry or writing than
palm-size
– Larger screen
– More PC-like interface
• CONS:
– Costs more than Palm-size
– Not practical for extensive typing
Classification of Handhelds
According OS
• Palm OS: palm-size
– Palm, HandSpring: Visor,
Sony Clie
• Windows CE: H/PC,
palm-size
– Compaq iPaq 3630
– HP Jornada 545
– Casio Cassiopeia E-115
• Psion, (Symbian): H/CP
Palm-Size:
Palm OS vs. Windows CE
• Both have pluses and minuses
• Windows CE devices
– Have more memory and faster processor
• But practically => same
– Special version of the most popular PC app (Word,
Excel, ..) => synchronizing the information with PC is
easier
• Palm OS devices dominate the market (>80%)
– Have > 70,000 third-party developers creating tons of
applications
– Cheaper & longer battery Life
Applications
• Medical Records • Specialty
Applications
• Personal
Organization
• Reference tools
• Fax
• Beeper
• Calculation tools • Cell phone
• Internet Access
Tasks Best Suited for Palmsize Devices
• Access existing data
• Access reference
material
• Personal information
manager
• Access information
networks via modem
or wireless
• Cellular phone
material
• Beeper Access
• Fax - send and
receive
• Calculator
Things Can be Done with
Palm-Size Devices,1
• Personal information manager
– Ideal for keeping track of small pieces of
information such as
• Telephone numbers, addresses and appointments.
• To take short notes,
• Read documents and manage your email all while away
from the desktop.
• Take your personal notes with you
– Download abstracts or other text to read them
latter, lunch, etc.
– Download web pages, email,… to read them latter
Things Can be Done with
Palm-Size Devices, 2
• Electronic Medical Records/Patient Tracking
– Storing:
• Personal and demographic information of patients
• Lab data, medical history, clinical data and prescriptions.
– Using:
• Patient data is downloaded at the start of each ward round
• Modifications done during rounds are synchronized at the
end
• With a radio network card => mobile access to main hospital
server
– Palm devices are more useful than the desktop PC:
• All charts & records are easily viewed at the bedside
• Notes or prescriptions can be added easily at the bedside.
Things Can be Done with
Palm-Size Devices, 3
• Store reference material in your pocket
– Text books:
• NephroToGo, Harrison
– Drug guides:
• ePocrate
• Medical calculators
– Perform almost any complex calculation:
• Quickly receive the results of a number of preloaded
equations (i.e., kt/v, Creat. clearance, anion gap, etc.)
Things Can be Done with
Palm-Size Devices, 4
• Internet access
– ability to access and store a tremendous amount
of information from online archives, newsgroups
and others
– Software:
• AvantGo:
– They are not ideal for simple browsing of the web,
but for quick trips to find relevant information they
can prove pretty convenient.
• Because these devices are extremely
customizable, the functionality is only
limited by your imagination
Palm Devices & Renal Fellowship
Program - University of Minnesota
• Palm provides "just-in-time information"
for both fellows and faculty
– A web page that allows fellows to download
schedules, announcements, forms, and lecture
notes to their Palm
– "NephroToGo": a handbook of nephrology that can
be downloaded for free
• Diagnostic and technical info as well as renal calculators
• WWW.nephrotogo.com
Where to Get More
Information?
• The 2000 Guide to Handheld and Palmtop
Computing Resources for Health Care
Professionals.
– http://themedicalguide.hypermart.net/
• Medical Software Reviews 2000 Index
– http://www.crihealthcarepubs.com/indx00c.html
• WWW Sites
– www.acponline.org, www.palm.com,
www.pilotgear.com
– www.palmcentral.com,
– http://palmtops.about.com/gadgets/palmtops/cs/re
viewresources/index.htm?terms=palmtop