Technology and the Future of Medicine

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Technology and the Future of Medicine

• James J. Cimino, M.D. 81

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Technology and the Future of Medicine

• Future of technology
• Impact on the modern hospital
• Impact on the operating suite
• Impact on physician practice

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Technology
Future of Medicine
Informatics
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What Ill Really Talk About

• What is medical informatics?
• What were doing at Columbia
• Medical informatics training
• Medical informatics career paths
• Impact on future physicians

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What is Medical Informatics?

• Computers in medicine
• The study the role of information in the
  biomedical sciences and the application of
  techniques for improving its management

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Domains of Medical Informatics

• Bioinformatics
• Imaging and signal processing
• Public health informatics
• Clinical informatics

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Clinical Informatics

• Clinical Information Systems
• Educational Resources
• Decision support systems
• Standards

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Electronic Medical Records

• Billing systems
• Laboratory reporting systems
• Central repositories
• Decision support
• Communication and coordination

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Educational Resources

• Medline
• Pubmed
• On-line textbooks
• Web resources
• Palm-based resources

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Expert Systems

• Greek oracle model
• Reminders and alerts
• Guidelines
• Integration into process of care

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New York Presbyterian HospitalClinical
Information Systems Architecture
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Linking to Expert Systems
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Linking to Expert Systems
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Linking to Expert Systems
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Linking to Expert Systems
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Medical Entities Dictionary
Medical Entity
CHEM-7
Plasma Glucose Test
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Medical Entities Dictionary
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Translations with the MED
Injectable Gentamicin
Serum Gentamicin Level
Gentamicin
Gentamicn Sensitivity Test
Gentamicin Toxicity
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Concept-Oriented View Heart
Radiology 2/28/96 Head CT
Lab 12/28/96 Sickle Cell Test
Admission 3/14/96 Stroke
Lab 1/1/99 Blood Type Test
Radiology 2/1/97 Knee X Ray
Admission 2/14/98 Angina
Discharge 1/15/99 CHF
Radiology 2/23/99 Chest X Ray
Lab 1/1/99 Cardiac Enzyme Test
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Active Log-Ons by User
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Telehealth Evolution
3 Months
Glucose Lipids Smoking Weight BP
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IDEATelInformatics for Diabetes Education And
Telemedicine

• Home telemedicine unit (HTU)

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HTU Launchpad
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PalmCIS

• Errors slips and mistakes
• Proximal causes of errors
• Inadequate access to information
• Ineffective communication.coordination
• Measure proximal causes
• Interventions
• Virtual white board
• Infobuttons
• Extension to palm-based wireless medium
• Controlled clinical trial

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Medical Informatics Training

• Self-teaching
• Computer classes
• Externships (NLM)
• Degrees (Masters, Ph.D.)
• Fellowships

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Medical Informatics Career Paths

• User
• Power user/advisor
• Provider organizations
• Vendors/developer
• Government/Standards
• Consultant
• Academic

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Impact on Future Physicians

• Length of stay
• Case management
• Evidence-based Medicine
• Error reduction
• Genomics