Clinical Information Systems (Part 1) - Health IT: The Big Picture
121213 bmi and emergency physician
1. 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
2. Contents
• Megatrends: Health Care & Health IT
• What is Bio-Medical Informatics (BMI) ?
• BMI & Clinician
• Emergency Medicine, Emergency Medical
Informatics, and Emergency Physician
26. 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.
28. Interdisciplinary Nature of
Biomedical Informatics
Computer Computer
Science Science
(hardware) (software)
Cognitive Science
Bioengineering
& Decision Making
Biomedical
Informatics
Management Epidemiology
Sciences And Statistics
Clinical Basic Biomedical
Sciences Sciences
29. Biomedical Science & Medical Practice
Clinical Knowledge Management with BMI
From Research Into Practice with BMI
30. 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
31. “Pneumonia”
• Google search (2012.06.10.22:05)
In English: 39,600,000
Scholar: 1,180,000
Books: 7,740,000
“Community-Acquired Pneumonia” “guideline” “H2-blocker”
• Google search (2012.06.10.22:10)
In English: 1,670, Scholar: 42, Books: not found
32. Medicine is Fundamentally
an Information Science!!!
• Patient / Disease Information
Acquisition → Analysis → Decision → Practice
• Being Optimally Used?
• How to Use Clinical Information Better?
34. HIT vs. Healthcare Quality
✴ 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
* NEJM 2003;348:2526-34
35. 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
36. Electronic Medical Records
✤ “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
37. 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
38. Clinical Informatics
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
39. Disruptive Technology
• Clinical IT Systems are designed to be:
Objective
Rational Document & Bill
Linear
Solitary
Single minded
• Clinical Work is fundamentally:
Interpretative
Multitasking
Collaborative
Distributed
Opportunistic
Reactive
Interrupted frequently
40. Clinical Informatics
• Medical knowledge
• The field of informatics
• Leadership
41. BioMedical Informatics (BMI) for Doctors
• Role of Life-long Learner
• Role of Clinician
• Role of Educator/Communicator
• Role of Researcher
• Role of Manager
Contemporary Issues In Medicine: Medical Informatics and Population Health. AAMC, 1998
42. 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
44. Challenges of Emergency Medicine
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
45. 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)
46. Challenges of Emergency Medicine
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 Poor feedback
conditions Inexperience
Patient factors Inadequate supervision
(e.g., language, delirium) Sleep deprivation/sleep debt
Fatigue
Multiple transitions of care
Poorly designed procedures
Marx: Rosen’s Emergency Medicine: Concepts & Clinical Practice, 6th ed(2006)
48. EDIS: ACEP TF white paper (2009)
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.
49. 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.
51. 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
52. Patient Entry
Anonymous pre-hospital identification
“temporary” unique identification
- before triage, during triage
“무명남”, “무명녀”, “사전접수?”, “접취?”
56. Emergency Medical Informatics (EMI)
• 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
57. 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)
58. BMI for Emergency Physicians
• 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?
59. Role of
Korean Society of
Emergency Medical Informatics
(KSEMI)
