1. Computers in the Medical Profession

2.  This is the intersection of information science, computer science, and health care  It began in the 1950’s with the rise of microchips and computers  Two examples: ICD and EHR  For the future? Medical Informatics

3. ICD-Implantable Cardioverter-Defibrillator  Put in patients who have ventricular fibrillation  Generates an impulse when a program detects a cardiac arrhythmia  First developed in 1969, but tested 11 years later

4. How Difficult Is It?

5. Story of Joshua Oukrop  Had a genetic disease called hypertrophic cardiomyopathy  In 2001, an ICD was implanted  Life was back to normal until 2005, when the ICD short-circuited  He was 21 years old

6.  In 2005, Guidant Corp recalled almost 50,000 ICD’s  Magnetic switches got stuck in the off position, causing the product to not send shocks and for the battery life to decrease  Caused at least two deaths  They waited 3 years to put out the recall  To go along with this, defibrillator recalls are on the rise Guidant Corp

7. Electronic Health Records  A person’s medical record in digital format  Accessed on computers  Has been in existence for 30 years, but less than 10% of hospitals have them (2006)  Must make sure that the software can work on older technology  Advantages?  Physical vs. Digital  Location  Disadvantages?  Viruses  Older records  Software updates

8.  Many countries have started to implement E.H.R. systems, including the UK and Alberta  Can customize the system  However, in 2002, Cedars Sinai found that their system had many problems  30% of E.H.R. attempts have failed for various reasons

9.  Scientists are working on a computer program that could predict what patients in comas would want to do medically  16 studies have been done with surrogates, with a 68% accuracy  Program began by surveying people what they would want  Found that most people would want more medical treatment if there is a 1% chance of having the ability to reason, remember, and communicate  David Wendler is pursuing to collect data from various groups to refine a “formula” for the program  David Wendler thinks the accuracy could get to 90% one day Future of Medical Informatics

10.  Critics say that no machine can determine what is right or wrong for a human  Commenter W. Brown--“Would remove emotional judgments and be in the best interest for patients.” Is it Ethical?

11.  Can the ICD be trusted? What if a shock gets sent to the heart when it is unnecessary?  Do you think that the electronic health record will continue to be integrated into hospitals?  Would you trust a computer’s diagnosis more than a doctor’s?  Would it be ethical to have a computer make a life or death decision? Questions