The Internet - How Will It Transform the Practice of Medicine?

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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

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Practice of Medicine Pre-Internet
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Practice of Medicine Post-Internet
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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?

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Agenda for the Panel

• Jim Cimino - Medical informatics
• Dan Nutkis - Privacy and security
• Harry Jacobson Evidence-based medicine

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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

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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

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Televaluation of PatCIS
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Average Monthly Log-Ons
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Average Session Time by User
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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

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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)

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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
  whats going on, what we can do, change meds or
  whatever

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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

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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