Bio-Medical Informatics

&

Emergency Physician

Jae-Ho Lee, M.D. , PhD. Assistant Professor,

Depart. of Emergency Medicine/Depart. of Biomedical Informatics

University of Ulsan College of medicine

• Megatrends: Health Care & Health IT

• What is Bio-Medical Informatics (BMI) ?

• BMI & Clinician

• Emergency Medicine, Emergency Medical

Informatics, and Emergency Physician

Contents

Megatrends:

Healthcare & Health IT

• Predictive

• Personalized

• Preventive

• Participatory

-데일리메디 2010-06-30

http://www.dailymedi.com/news/opdb/index.php?cmd=view&code=106532&page=1&dbt=article&sel=&key=&cate=class2&term=

Next-G Healthcare: 4P Medicine

Predictive & Personalized

Preventive

건강검진 +

건강검진 -

보험지급+

보험지급-

• 병원에 오지 않게 하는 진료에 대한 수가 책정?

• 예방적 만성질환 관리

Participatory

• Patient-Centeredness

Individual patient preferences, needs, and value…

Patient engagement: self-care, communication…

Patient empowerment: information sharing…

Health2.0

Healthcare SNS

PHR

Personal Genome

Home Healthcare

Oct. 2009: Tim O'Reilly and John Battelle answer the question of "What's next for Web 2.0?" in Web Squared: Web 2.0 Five Years On.

Health2.0

Health2.0

Health2.0

Era of Smart

Smart Health

Smart Health trends

1) Era of Smart

국내 스마트폰 판매량 > PC 판매량

PC: One of Computer or One of Smart Device?

2) Mobile Healthcare & Hospital

세계 Tablet 출하량 5년 뒤 5배 수준

http://media.daum.net/digital/view.html?cateid=100031&newsid=20120131143707966&p=inews24

"iPad"…애플, PC시장서 HP 제쳤다

http://media.daum.net/digital/others/clusterview?newsId=20120131154318021&clusterId=505040

Smart Hospital Survey

2009

스마트폰과 병원정보시스템 연동: > 60%

2011

smart hospital: > 85%

smart clinical service

암센터, 간호부, 가정간호사, 임상약사 등

Say Bye to The Stethoscope

And "Hello" to Your Smartphone

http://ghbn-blog.blogspot.com/2010/03/say-bye-to-stethoscope.html

Say Bye to The Pocket Stethoscope

And "Hello" to Smartphone Ultrasound

http://www.imedicalapps.com/2011/05/phone-oximeter-peripheral-pulse-ox-respiratory-rate-iphone/

Cancer diagnosis in the palm of your

hand: MRI smartphone

http://holykaw.alltop.com/cancer-diagnosis-in-the-palm-of-your-hand-mri

2011

http://www.bbc.co.uk/news/health-14489208

Electronic skin

Smart

SNS

Health

Game

Emerging Health IT: Smart Health

What is

Bio-Medical Informatics?

Bio

Edward H. Shortliffe, MD, PhD, MACP, FACMI

Biomedical Informatics

Biomedical informatics (BMI) is the interdisciplinary

field that studies and pursues

the effective uses of biomedical data, information,

and knowledge

for scientific inquiry, problem solving, and decision

making, motivated by efforts to

improve human health.

Biomedical Informatics in Perspective

Basic Research

Applied Research

And Practice

Biomedical Informatics Methods,

Techniques, and Theories

Bioinformatics Clinical

Informatics

Imaging

Informatics

Public Health

Informatics

Biomedical Informatics ≠ Bioinformatics

© AMIA 2011

Interdisciplinary Nature of

Biomedical Informatics

Biomedical

Informatics

Cognitive Science

& Decision Making

Management

Sciences

Clinical

Sciences Basic Biomedical

Sciences

Epidemiology

And Statistics

Bioengineering

Computer

Science

(hardware)

Computer

Science

(software)

Biomedical Science & Medical Practice

Clinical Knowledge Management with BMI

From Research Into Practice with BMI

Era of Data/Information Tsunami

• Clinical Knowledge-Base (2000)

> 8,000 new articles/week (NLM)

→ 40% of all articles published worldwide

• Maintaining Current Clinical Knowledge (2000)

A General Internist

- 20 articles/day, 365 days of the year

“Pneumonia”

• Google search (2012.06.10.22:05)

In English: 39,600,000

Scholar: 1,180,000

Books: 7,740,000

• Google search (2012.06.10.22:10)

In English: 1,670, Scholar: 42, Books: not found

“Community-Acquired Pneumonia” “guideline” “H2-blocker”

Medicine is Fundamentally

an Information Science!!!

• Patient / Disease Information

Acquisition → Analysis → Decision → Practice

• Being Optimally Used?

• How to Use Clinical Information Better?

BioMedical Informatics

&

Clinicians

✴ How can IT improve patient safety?*

Improving communication

Making knowledge more readily accessible

Prompting for key pieces of information

Assisting with calculation

Monitoring & checking in real time

Providing decision support

HIT vs. Healthcare Quality

* NEJM 2003;348:2526-34

Promises of EMR*

• Optimizing the documentation of patient encounters

• Improving communication of information to physicians

• Improving access to patient medical information

• Error reduction

• Optimizing billing & improving reimbursement

• Data repository; research & quality improvement

• Reduction of paper

* Ped Emerg Care 2006;22:184-194

✤ “Life After a Disastrous EMR Implementation

: One Clinic’s Experience”*

High cost; direct, indirect

Inability to handle graphics effectively

Inadequate computer support

Ineffective user manual

Excessive Downtime

Difficulty in learning & Using the system

Confidentiality

* Idea Group Inc (IGI). Pitfalls and Triumphs of Information Technology Management, 2001

Electronic Medical Records

Computerized Provider Order Entry

22 new error types: commercial CPOE system*

Long gaps in medication delivery; fragmented CPOE display

Failure to discontinue medications or renew antibiotics

Mortality X3↑ after new CPOE (critically ill-pediatrics)#

Insufficient order entry

Too much time spent at the computer screen

* JAMA 2005;293:1197-12-3

# Pediatrics 2005;116:1506-12

Why is Health IT hard?

• Doesn’t solve the physician’s problem

• Little attention to workflow

• Introducing technology is disruptive

• Benefits accrue to others

• Incentives are misaligned

• Lack physicians & nurses with informatics training

Clinical Informatics

Disruptive Technology

• Clinical IT Systems are designed to be: Objective

Rational

Linear

Solitary

Single minded

• Clinical Work is fundamentally: Interpretative

Multitasking

Collaborative

Distributed

Opportunistic

Reactive

Interrupted frequently

Document & Bill

Clinical Informatics

•Medical knowledge

•The field of informatics

•Leadership

•Role of Life-long Learner

•Role of Clinician

•Role of Educator/Communicator

•Role of Researcher

•Role of Manager

BioMedical Informatics (BMI) for Doctors

Contemporary Issues In Medicine: Medical Informatics and Population Health. AAMC, 1998

BMI is Fundamentally

a kind of Medicine!!!

• IT Medicine

IT 를 의료서비스(practice)와 의료의 질 향상

• 진단검사 의학, 영상 의학, 핵 의학, 예방 의학

Emergency Medicine,

Emergency Medical Informatics,

and Emergency Physician

Characteristics or Risk of ED*

• Unbounded demand

• Multiplicity of patients & inherent variability

• Uncertainty of diagnosis

• Narrow time windows

• Decision density & cognitive load

• Poor feedback

• Interruptions & distractions

• Fatigue & shift work

* P Croskerry, KS Cosby, S Schenkel, R Wears. Patient Safety in Emergency Medicine. 2008:p19

Challenges of Emergency Medicine

Challenges of Emergency Medicine

• Overcrowded

• “Boarding” of patients

• Waiting for inpatient beds

• Ambulance diversion

• Patients who leave without being seen

* Hospital-based Emergency Care: At the Breaking Point (IOM, 2007)

Intrinsic Extrinsic

Human cognitive properties High communication load

High levels of uncertainty Poor teamwork

High decision density Overcrowding

High cognitive load Production pressures

Narrow windows of opportunity High ambient noise levels

Multiple interruptions/distractions Information gaps

Low signal-to-noise ratio Report delays

Surge phenomena Inadequate staffing

Novel or infrequently occurring

conditions

Poor feedback

Inexperience

Patient factors

(e.g., language, delirium)

Inadequate supervision

Sleep deprivation/sleep debt

Fatigue

Multiple transitions of care

Poorly designed procedures

Marx: Rosen’s Emergency Medicine: Concepts & Clinical Practice, 6th ed(2006)

Challenges of Emergency Medicine

EDIS EDIS

Health IT presents ongoing opportunities

• to improve the quality of emergency care,

• promote patient safety,

• reduce medical errors,

• and enhance the efficiency of emergency departments.

EDIS: ACEP TF white paper (2009)

Emergency Department Information System (EDIS)

is Electronic health record systems designed specifically

to manage data and workflow in support of Emergency

department patient care and operations.

Fundamentally, an EDIS should

• facilitate the delivery of patient care,

• conform to relevant data interoperability standards,

• and comply with applicable privacy and security

constructs to ensure the secure availability of relevant

healthcare information.

EDIS: ACEP TF white paper (2009)

EDIS Functions

Clinical Functionality

• Patient entry

• Patient tracking

Patient-centered tracking, Clinical course tracking, Patient

location tracking, Department-centered tracking

• Department dashboards

• Clinical Documentation: EMR

• Computer Provider Order Entry (CPOE)

• Result Reporting

• Discharge Management

ACEP TF white paper, 2009

EDIS Functions

Other Considerations

• System Interfaces

• The User Interface (UI)

• Clinical Decision Support (CDS)

• A Consolidated Digitized Environment

• Picture Archiving and Communication System (PACS)

• Patient Safety

• Coordination of Care

• Automated Alerts

• Medical Content and Domain Knowledge

• Reference Material

• Authentication & Authorization Processes

• Using Patient-Centered Automation

• Risk Management

• Remote EDIS Access

ACEP TF white paper, 2009

Patient Entry

Anonymous pre-hospital identification

“temporary” unique identification

- before triage, during triage

“무명남”, “무명녀”, “사전접수?”, “접취?”

Patient Tracking

Patient-centered tracking

Clinical course tracking

Patient location tracking

Department-centered tracking

Department Dashboard

Discharge Management

• Prescription

• Discharge & instructions

• Follow-up information

• Detailed visit information

• The collection, management, processing, and application of

emergency patient care & operational data*

• A domain of Clinical Informatics

• Emergency Medicine + BioMedical Informatics

• HIT → Emergency medicine Quality Improvement

• Prehospital, ED, Public surveillance

* EMERGENCY MEDICINE INFORMATICS: INFORMATION MANAGEMENT

AND APPLICATIONS IN THE 21ST CENTURY, Emergencias 2009; 21: 354-361

Emergency Medical Informatics (EMI)

Healthcare IT & Emergency care: 6 key areas*

• Management & coordination of patient flow and care

• Linkage of the ED to the wider health care community

• Clinical decision support

• Clinical documentation

• Training and knowledge enhancement

• Population health monitoring

* Hospital-based Emergency Care: At the Breaking Point (IOM, 2007)

Emergency Medical Informatics (EMI)

• Is ED IT system safe, effective, and patient-centered?

• How can we measure/evaluate that?

• How can we make it more valuable?

• How to use HIT in practice & research?

• How to practice Emergency IT Medicine?

BMI for Emergency Physicians

Role of

Korean Society of

Emergency Medical Informatics

(KSEMI)