Lecture given for the Capiz-Aklan PCP Chapter 1st postgraduate course last August 2010 in Roxas City.

1. Medical Informatics
Who’s afraid of
new technology?
Iris Thiele Isip Tan MD, FPCP, FPSEM
MS Health Informatics (cand.)
Clinical Assoc. Professor, UP College of Medicine
Section of Endocrinology, Diabetes & Metabolism
Philippine General Hospital

2. No
conflict
of interest

3. Outline
Electronic
medical
record
Mobile
technology
Web 2.0

4. Outline
Electronic
medical
record
Mobile
technology
Web 2.0

5. Smartphone
SMS
MMS No industry
Voice calls standard
Phonebook definition
More than
Miniature basic cell
computer with phone
phone capability capabilities
Wikipedia

6. Smartphone Platform Market Share
Palm
Google
6%
9%
Microsoft 16% 43% RIM
Apple 26%
comScore Feb 2010 (US)

7. US Physicians Using a Smartphone
No
smartphone
36%
36% 27% iPhone
64%
37% Blackberry
2009 Manhattan Research Survey “Taking the Pulse”

8. “Mobile technology has the
potential to revolutionize how
physicians practice medicine.”
Burdette et al Clin Inf Dis 2008;47:117-22

9. 40% of Sma!
adverse Phone
drug events
(ADE) Point of care
lack of at time of
critical prescribing,
patient and dispensing,
drug administering
information medicines
Leape et al JAMA 1995

10. “Information is often not
available to those who need
it when they need it.
As a result, patients often do
not get care they need or do
get care they don’t need.”
Kohn et al. To Err is Human:
Building a Safer Health System (2000)

11. Epocrates Free
Prescription
medication
OTC drugs
Pill ID
Drug
interactions
Medical
iPhone/iPod touch Android calculator
BlackBerry Windows Mobile
Palm

12. Medscape Free
Internet access
not required
6000+ drugs
1000+ OTC
1000+ Herbal
supplements
Interactions
between drugs,
iPhone/iPod touch herbals & supplements
BlackBerry

13. ABXGuide $24.95
Johns Hopkins
Organized by
diagnosis, drugs,
pathogens,
management and
vaccines
Renal dosing guide
Diagnostic criteria
Treatment
iPhone/iPod touch Android
BlackBerry Windows Mobile regimens/algorithm
Palm Symbian

14. Free
Information on
many traditional
herbs & botanicals
Medicinal used in
Herbs complementary &
alternative
medicine (CAM)
Not
evidence-based
iPhone/ iPod touch

15. Today’s experienced physician
needs close to 2 million pieces
of information to practice
medicine.
Denekamp Y. IMAJ 2007;9:771-6
“Good information is
the best medicine.”
Michael E. DeBakey, MD

16. $59.95
Harrison’s Manual of Medicine
Derived from
Harrison’s
Principles of
Internal Medicine
Diagnosis & therapy
(emphasis on
patient care)
Free 1-year access
to Harrison’s
iPhone/ iPod touch
on the Web

17. $79.99
5-minute Clinical Consult
Diagnosis &
management of
over 900 medical
conditions
New in 2011: 22
topics & 14
treatment
algorithms
Offered by SkyScape,
Unbound Medicine &
iPhone/ iPod touch Lexi-Comp

18. Diagnosaurus DDx $0.99
More than 1,000
differential
diagnoses
Disease, symptom
or organ system
searching
Personalized
favorites
Extensive links to
iPhone/ iPod touch related entries

19. ACC Pocket Guidelines
Free
American College
of Cardiology
Adapted from ACC/
AHA Practice
Guidelines
Installs into
Skyscape Medical
Resources
Environment
iPhone/ iPod touch

20. STAT Asthma
Free
NHLBI Guidelines
Expert Panel Report 3
(EPR3): Guidelines
for the Diagnosis and
Management of
Asthma
Interactive tool
Check off data -
symptoms, nighttime
awakenings, SABA
use, lung function
results etc.
iPhone/ iPod touch

21. STAT Adult Immunization
Free
Full updated
2009 CDC
Recommended Adult
Immunization
Schedule
Includes all adult
age groups &
vaccine schedule
based on medical
& other indications
iPhone/ iPod touch

22. Free
STAT Framingham Heart Age
Based on
Framingham Risk
Score
Estimate a person’s
‘Heart Age’ which
could be higher
than their
chronological age
iPhone/ iPod touch

23. STAT Cardiac Clearance Free
ACC/AHA 2007
guideline on
perioperative CV
evaluation and
care for non-
cardiac surgery
Step-by-step
cardiac evaluation
& care algorithm
iPhone/ iPod touch

24. Free
AF Guide:
The Atrial Fibrillation Reference
Management of
acute & chronic
atrial fibrillation
Estimate stroke &
bleeding risk
Warfarin dose
calculator
Quick access to
drugs & dosing in
iPhone/ iPod touch acute setting

25. Nearly impossible
to stay up-to-date!
Medical knowledge
doubles every 19 years
Body of knowledge
increases by
at least 400% in a
38-year career
Smith, Richard. BMJ 1996, www.bmj.com/
cgi/content/full/313/7064/1062

26. DocGuide Free
Articles & abstracts
from 2000+ peer-
reviewed journals
Dispatches from
top national &
international
conferences
Forum
Multiple specialties
iPhone/ iPod touch & interests covered

27. Free
PLoS Medicine
Created by Center for
Biomedical Informatics
(Harvard Medical
School) with Public
Library of Science
PLoS is a leading
open-access
medical journal
View online or get pdf
Favorite & share
iPhone/ iPod touch

28. Free
Pri-Med Mobile
Watch concise
expert presentations
Solve real cases
from real doctors
Compete in
compelling medical
challenges
Earn free CME
credits
iPhone/ iPod touch
Android

29. Free
Joslin CME
Diabetes-
focused
certified CME
Audio and slides
Alerts for new
programs
Keyword searches
to find CME
you want
iPhone/ iPod touch

30. Free
PandoraBox
App Store has
10,000+ apps
100+ apps on sale &
300+ free apps
everyday
Receive the latest
information about
new apps
Find about free or
discounted apps
iPhone/ iPod touch Track your favorites

31. iTunes U
Learn anything,
anytime, anywhere.
A powerful distribution system for
everything from lectures to language
lessons, films to labs, audiobooks to tours
http://www.apple.com/education/itunes-u/

37. Outline
Electronic
medical
record
Mobile
technology
Web 2.0

38. Problematic Paper-based Record
Illegible
Incomplete
Difficult to
access in
more than
Insecure
one place
from
unauthorized
uses/users
Hersh WR. JAMA 2002; 288(16):1955-7

39. Problematic Paper-based Record
11% of
laboratory
tests lost and
30% of
reordered
treatment 50% either
orders not missing or
documented Physicians incomplete
spend 35%
of time doing
paperwork
http://www.veranda.com.ph/hermant/cbpr.htm; Accessed 12 Jan 2006

40. Poor presentation
of clinical data
can lead to
Poorly informed clinical practice
Inappropriate repeat investigation
Unnecessary referrals
Wastes clinical time
and other resources

41. Electronic Medical Record (EMR)
Low adoption rate

42. Usability
Checklist
Scanning (built-in)
http://www.emrusability.org/Usability_Checklist.htm

43. Usability
Checklist
Dictation
http://www.emrusability.org/Usability_Checklist.htm

44. Usability
Checklist
Vital Signs
http://www.emrusability.org/Usability_Checklist.htm

45. Usability
Checklist
Prescriptions
http://www.emrusability.org/Usability_Checklist.htm

46. Usability
Checklist
Interface design
Unique to my role?
Partially customizable?
Unique to device?
Simple and task-specific?
Minimal training?
http://www.emrusability.org/Usability_Checklist.htm

47. Usability
Checklist
Incoming fax reports
http://www.emrusability.org/Usability_Checklist.htm

48. Usability
Checklist
Appointments/
Scheduling
http://www.emrusability.org/Usability_Checklist.htm

49. Usability
Checklist
Office workflow
Analyze, Adjust, Automate
http://www.emrusability.org/Usability_Checklist.htm

50. Usability
Checklist
Application
Performance
http://www.emrusability.org/Usability_Checklist.htm

51. http://openmrs.org/
Free and open source program
National Telehealth Center

52. “... application which enables design of a customized
medical records system with no programming knowledge
(although medical and systems analysis knowledge is
required).”

53. Outline
Electronic
medical
record
Mobile
technology
Web 2.0

54. Web 2.0
Dynamic
“push”
Collaborative
Participative
“Two-way” Web

55. Google Health

56. AskDrWiki

60. RSS (Really Simple Syndication)

61. twitter

65. facebook

68. slideshare.net

70. Outline
Electronic
medical
record
Mobile
technology
Web 2.0

71. "ank Y#
http://www.endocrine-witch.info
isiptan@gmail.com