1. Don E. Detmer, MD, MA President & CEO, AMIA; Prof. Med. Education, UVA __________________________ University of Michigan September 2008 Organizing Informatics at Michigan for Health, Care, Education, & Research

2. Last here for the University of Michigan Informatics Grand Rounds –November 3, 2006 Then: Current Issues in Improving Clinical Practice through Informatics Today: Clinical Practice & beyond…

3. Informatics Informatics is the study of information & the ways information is used by & affects people & social systems. Experts in this field design information technology tools for scientific, business, & cultural needs, & study how such tools are used. - School of Information, University of Michigan

4. What is Biomedical/Health Informatics? “An integrative scientific field that draws upon the information sciences & related technology to enhance the use of the knowledge base of the health sciences to improve health care, biomedical & clinical research, education, management, & policy.” - D.E. Detmer

5. Informatics is a Means to Ends. –"It is the pervading law of all things organic and inorganic, –Of all things physical and metaphysical, –Of all things human and all things super-human, –Of all true manifestations of the head, –Of the heart, of the soul, –That the life is recognizable in its expression, –That form ever follows function. This is the law.” - Louis Sullivan (1896)

6. Biomedical/Health Informatics* Clinical Informatics, including –Clinical Research Hypothesis Generation, Phase 3, etc. –EHRs / PHRs - Consumer Health Public Health Informatics Translational Bioinformatics VISION (Visualization, Imaging, & Simulation in Organs & Networks) * Overlap among domains is appropriate

7. We are tracking a moving target. - Gil Omenn 2006

8. What ends will you pursue? Where are you headed? Better Health of Citizens Better Care for Patients Economic Development of Michigan Research Grants Winning Teams

9. Population & Annual Costs Estimates Population & Annual Costs Estimates Healthy Lynn et al., 2007 Acutely ill Living with chronic illness/ disability Coping with illness at the end of life 170 million  12 million  117 million  9 million  $1,118 /  /yr $25,000 /  /yr $9,316 /  /yr $46,667 /  /yr … $190 billion/yr $300 billion $1090 billion $420 billion

10. Paying for care instead of improving health America spends 15% of GDP on health care by far more than anyone yet ranks 22nd for men & 25th for women for life expectancy, and 25th for both infant mortality & low birth weight. WHY? Poor continuity of care plus disproportionate costs at end of life Better predictors of health are socio-economic status, average per capita income, income inequality & woman’s education status. 17% of Americans live in poverty, when developed country average is 10.2%. Only 2.3% of U.S. GDP is spent on efforts to reduce poverty v. 5.8 Canada & 9.6 Netherlands.

11. Prescription for AHC Leaders - Claire Pomeroy, MD, PhD (Blue Ridge Group meeting 2008) The further we distance new policies from the reality of social determinants, the more health care costs will rise while U.S. health declines over time. Reach beyond traditional medical care delivery mechanisms Coordinate closely with a broad range of government & community leaders Create integrated, multi-sector policies & structures to improve societal health & reduce disparities in a cost- effective manner

12. Distribution of Determinants of Health Source: Sowada, 2003

13. Continuum of Care Mechanisms Healthy Acutely ill Living with chronic illness/ disability Frail/ Coping with illness at the end of life Population tracking/ “health home” / “personalized” care Transitional Care Chronic Care Management PACE*/ Hospice Care Courtesy of Mary Naylor, RN, PhD *Program for All-inclusive Care of the Elderly

14. Care Continuum: Portfolio of EHRs Needed Healthy Acutely ill Living with chronic illness/ disability Frail/ Coping with illness at the end of life Population tracking/ “health home” Transitional Care Chronic Care Management PACE*/ Hospice Care Adapted from Mary Naylor, RN, PhD *Program for All-inclusive Care of the Elderly

15. A Comprehensive Integrated University-wide Strategy for the University of Michigan Biomedical and Health Informatics Components – Health – Care – Education – Research

16. Work in Parallel with AMIA’s Strategic Vision Through informatics, transform health & health care for individuals & populations –Care that is Equitable, Efficient, Effective, Patient- centered, Timely, Safe – Healthy populations in healthy environments Transform informatics from a serious avocation to a formally recognized health profession

17. Finish the Foundational Informatics Infrastructure Semantic Grid –Data computational layer Data stored, transferred & analyzed –Information layer Data associated with meaning –Knowledge layer Use of information for a purpose See University of Minnesota CTSA Strategy

18. Informatics Planning Matrix Clinical Informatics Public HealthTranslational Bioinformatics VISION Health Who, what, when, how, where, $s Care Education Research

19. Genetics Cardiovascular Center CS Mott Children’s & Women’s Hospital/Peds Kellogg Eye Center Brehm Center for Type 1 Diabetes* Global goals ( AMIA Gate’s twinning program ) ‘Informatics for Excellence’ programs tied to Michigan’s strengths

20. Biomedical & Health Informatics Departmental Issues Institutional Service Linkages/Responsibilities Divisions –Clinical Informatics –Translational Bioinformatics Faculty issues –Total slots/ Core Fulltime/Joint Appointments/Salary /Criteria for Promotion Agreements on Overhead Educational focus Research

21. University-wide Strategic Governance Group (7-12 people) Biomedical Informatics Strategic Policy Group Biomedical Informatics Operations Subgroup –Academic Department for Education & Research Components –Service Unit(s) with Active Clinical Components Health Informatics Strategic Policy Group Health Informatics Operations Subgroup –Academic Unit to lead Education & Research Components –Service Unit identified heads up Policy Component with outside representation

22. University-wide Strategy & Governance Group (7-12 people) Planning –Components –Players –Programs –Initiatives Governance –Services –Business agreements –Data sharing and networks –Community building

23. Build from current Informatics strengths at Michigan Health Sciences –MICHR/CTSA Biomedical Informatics Program –Clinical Research Informatics Core –Health Disparities Component School of Information –Informatics Others Approved this past spring, informatics is a joint program of the College of Literature, Science, & the Arts; the College of Engineering; and the School of Information. (Sept. 2008)

24. Biomedical Informatics Partnering Schools/Colleges at University of Michigan Business Dentistry Engineering LSA (parts) Medicine Nursing Pharmacy Public Health

25. Example of Clinical Informatics Agenda - Assuring Value in Clinical Settings Complete Infrastructure from “Got EHR?” to “Got EHR! Now what?!” –Instill Learning Care Culture –Institute EHR/Work Redesign Program Electronic Health Records –Secure Portal for Patients –Enhance Clinical Decision Support Best Practices & Scale for General Users –Esp. Chronic Illness Management, Population tracking/ “health home” / “personalized” care

26. Example of Clinical Informatics Agenda - Assuring Value in Clinical Settings Complete Infrastructure –Instill Learning Care Culture –Institute EHR/Work Redesign Program Electronic Health Records –Secure Portal for Patients –Enhance Clinical Decision Support Best Practices & Scale for General Users –Esp. Chronic Illness Management, Population tracking/ “health home” / “personalized” care

27. Develop Specific Plans/Programs for Care, Education, & Research 5-7 yr. goals; 2 yr. work plans Ex: Biomedical (Care)- Engineering & Medicine Systems Engineering Work flow Complex Adaptive Systems *see http://www.sys.virginia.edu/healthcare/

28. The Future of Care: Manage Change supported by Information Technology & Informatics Build Knowledgeable Teams Reinvent Workflow Integrate Innovations* Remove ‘ Outdated ’ Practices Reduce Variation Improve Safety/Quality while Reducing Costs Manage the Base of Knowledge *Innovation student teams w/ Business School National Academies: “ Building a Better Delivery System ” National Academy Press, 2005

29. Also, Business School & Biomedical Care Dimensions Complex adaptive systems Organizational behavior Marketing Supply Chain Management Strategic planning

30. Health Informatics – Schools/Colleges at University of Michigan Education Information Law LSA (parts) Medicine Nursing Public Health Public Policy Social Work

31. The time lag which exists between the fact of change & the social & political understanding of what has happened. - Henry Adams Law of Acceleration of Changing Times

32. Some Disruptive Technologies: Telegraph, Telephone, Television, Internet - Web 1.0 & Web 2.0 “If you study politics, military events & things like that, you’re studying how history gets made from the top down.” “But you can also study the common people, history from the bottom up, because they’re making history, as well.” - Daniel Walker Howe

33. Disruptive Technology Web 1.0 Web 2.0 Biomedical Informatics (science-based) Top down “Controlled from on high” –HIPAA rules Privacy #1* Health & Freedom #3 Health Informatics (narrative-based) Bottom up “Power to the People” –Personal Choice rules: Ex. PatientsLikeMe Freedom & Health #1; Privacy #3 *www.sciencexpress.org /4 September 2008 / Page 1/ 10.1126/science.1165490

34. The Driver’s License Solution Add 3 more ‘opt out’ icons to the Organ Donor option –Do not use my driver’s license # for electronic healthcare record authentication purposes Suggested symbol – EHR# or EHR# –Do not allow my healthcare record information to be sent to me & my healthcare professionals Suggested symbol or * –Do not allow my healthcare record information to be used for medical research (IRB approved research) & to contact me for relevant research Suggested symbol or * * Does not preclude my being asked at care sites © DEDetmer 2006

35. Public Health/Population Informatics; Consumer Health Informatics Consumer oriented Education & Support (Citizen/Patient/Informal Caregivers) Integrated Personal Health Record* *See Detmer DE, Bloomrosen M, Raymond B, Tang P: Integrated personal health records: Transformative tools for consumer-centric care. 2008 BMC Medical Informatics and Decision Making (in press)

36. Education Strategy Participate in AMIA’s 10x10 Program –Translational Bioinformatics –Clinical Informatics –Public Health Informatics –(Consumer Informatics) Consider collaboration in AMIA International Developments –20/20 Bits/Bytes Courses

37. National Readiness Assessment Instrument; other tool kits PhD; Masters Informatics __________________________ Clinician/Public Health 10x10 Champions ______________________________ 20/20 “Bits &Bytes” Knowledge & Skills Offerings Executive Seminars; Leadership ID, Training & Advocacy Global ‘South’ Components of Needs & 20/20 Vision for Assuring eHealth Capacity Policy & Leadership Human Capital (eHealth Workforce Capacity) State of ICT Technology Infrastructure ComponentsVision for eHealth Workforce

38. Education Strategy Participate in AMIA’s Academic Forum –Develop Clinical Informatics Training Program for MD sub-certification –Develop parallel Nursing/Pharmacy/Dentistry Informatics Training Programs –Engage issues such as salary structure & promotion criteria –Require Common Core ICT/Informatics Education for all health professional students (AMIA’s Academic Strategic Leadership Council initiative)

39. Informatics Tracks ( Now & Future*) Doctoral Level –Academic/Research Career – PhD Medicine: Translational Bioinformatics /Clinical Informatics Nursing/Public Health Informatics/Other NLM’s Training Programs plus other university programs Master’s –Clinical Informatics –Public Health/Population Informatics CDC –Health Information Management Certificates * –Fellowships & Medical Sub-certification –10x10 – AMIA Graduate Level Course work –20/20 Bits/Bytes – Global Informatics Education

40. University-wide Informatics R&D Template Use Informatics Toolkits/ EHRs to Assess Environment & Evaluation of Interventions Easing life transitions –Healthy to acutely ill –Acutely ill to chronically ill –Chronically ill to End-of-life Personal health assessment / support Population – community health assessment Public Health

41. Measuring Excellence in 2015 It’s not human memory & technology (IT) per se that will matter. It’s integrating carbon & silicon- based intelligence (Informatics) across disciplines to create needed change.

42. Well done is better than well said. - Benjamin Franklin

43. Upcoming AMIA Events Grand Hyatt San Francisco San Francisco, California March 15-17, 2009 2 nd Annual Summit on Translational Bioinformatics Yves Lussier, Program Chair Jaap Suermondt, Program Chair AMIA 2008 Annual Symposium Hilton Washington Hotel and Towers Washington, DC November 8-12, 2008 Hyatt Reston, Reston VA September 15, 2008 AMIA Health Policy Forum Doug Fridsma, Suzanne Markel-Fox 2009 AMIA Spring Congress Walt Disney World Swan Orlando, Florida May 28-30, 2009 Patti Abbott, Program Chair

44. Personal reflections on this topic 1. Warner HR, Detmer DE, Peay WJ. IAIMS implementation and administration at the University of Utah. Proc Fifth Conf Med Informatics 1986; p. 1-6. 2. Detmer DE. The Future of IAIMS in a Managed Care Environment: A Call for Private Action and Public Investment. JAMIA 1997; 4, S65-S72. 3. Detmer DE, Steen EB: Information & Communications Technology & the Future Health Workforce: Transformative Opportunities & Critical Challenges. In Holmes DE: From Education to Regulation: Dynamic Challenges for the Health Workforce. Assoc. Acad. Health Centers, 2008, Washington, DC, pp.21-46.

45. detmer@amia.org http://www.amia.org Thank you & Best Wishes.