1. Technology and the Future of Medicine James J. Cimino, M.D. ‘81

3. Technology and the Future of Medicine Future of technology Impact on the modern hospital Impact on the operating suite Impact on physician practice

4. Technology Future of Medicine Informatics

6. What I’ll Really Talk About What is medical informatics? What we’re doing at Columbia Medical informatics training Medical informatics career paths Impact on future physicians

7. What is Medical Informatics? “Computers in medicine” The study the role of information in the biomedical sciences and the application of techniques for improving its management

8. Domains of Medical Informatics Bioinformatics Imaging and signal processing Public health informatics Clinical informatics

9. Clinical Informatics Clinical Information Systems Educational Resources Decision support systems Standards

10. Electronic Medical Records Billing systems Laboratory reporting systems Central repositories Decision support Communication and coordination

11. Educational Resources Medline Pubmed On-line textbooks Web resources Palm-based resources

12. Expert Systems Greek oracle model Reminders and alerts Guidelines Integration into process of care

13. New York Presbyterian Hospital Clinical Information Systems Architecture Medical Entities Dictionary Database Monitor Medical Logic Modules Alerts & Reminders Research Administrative Results Review... Radiology Laboratory Discharge Summaries Reformatter Clinical Database Database Interface

21. Linking to Expert Systems

25. Medical Entities Dictionary Medical Entity Laboratory Procedure CHEM-7 Plasma Glucose Test Laboratory Specimen Plasma Specimen Substance Sampled Part of Has Specimen Event Laboratory Test Diagnostic Procedure Substance Measured Glucose Plasma Anatomic Substance Bioactive Substance Chemical Carbo- hydrate

26. Medical Entities Dictionary

27. Translations with the MED Gentamicin Injectable Gentamicin Gentamicn Sensitivity Test Serum Gentamicin Level Gentamicin Toxicity Etiology Measures Sensitivity Substance Measured Has ingredient Decision Rule Expert System Drug Information

28. Chest X ray Congestive Heart Failure Intravascular CK Test Creatine Kinase Chest X ray 2 View Cardiac Enzyme Angina Lab :1/1/99 Cardiac Enzyme Test Radiology :2/23/99 Chest X Ray Radiology :2/28/96 Head CT Lab :12/28/96 Sickle Cell Test Admission :3/14/96 Stroke Admission :2/14/98 Angina Lab :1/1/99 Blood Type Test Radiology :2/1/97 Knee X Ray Concept-Oriented View: Heart Disease Chest Discharge :1/15/99 CHF CHF Discharge :1/15/99 CHF CHF Admission :2/14/98 Angina Lab :1/1/99 Cardiac Enzyme Test Radiology :2/23/99 Chest X Ray

36. Active Log-Ons by User

37. Telehealth Evolution 3 Months Glucose Lipids Smoking Weight BP

38. Home telemedicine unit (HTU) IDEATel Informatics for Diabetes Education And Telemedicine

39. HTU Launchpad

41. PalmCIS Errors: slips and mistakes Proximal causes of errors: –Inadequate access to information –Ineffective communication.coordination Measure proximal causes Interventions: –Virtual white board –Infobuttons –Extension to palm-based wireless medium Controlled clinical trial

42. Medical Informatics Training Self-teaching Computer classes Externships (NLM) Degrees (Masters, Ph.D.) Fellowships

43. Medical Informatics Career Paths User Power user/advisor Provider organizations Vendors/developer Government/Standards Consultant Academic

44. Impact on Future Physicians Length of stay Case management Evidence-based Medicine Error reduction Genomics