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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 Reformatter Reformatter
Clinical Database
Database
Interface

21. Linking to Expert Systems

22. Linking to Expert Systems

23. Linking to Expert Systems

24. Linking to Expert Systems

25. Medical Entities Dictionary
Medical
Entity
Laboratory
Procedure
CHEM-7
Plasma
Glucose
Test
Laboratory
Specimen
Plasma
Specimen
Part of
Event
Laboratory
Test
Diagnostic
Procedure
Glucose
Plasma
Anatomic
Substance
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
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
Heart
Disease
Chest
Discharge :1/15/99
CHF
Discharge :1/15/99
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

40. Syracuse
Intranet
Doctors
Nurse
Supervisor
Router
Intranet
Case
Managers
Doctors
Central Data
Repository
Existing Servers
(WEBCIS, Demographics,
Interface Engine,LDAP,ACE)
Router
Firewall
Existing H.320
Room System for
Project Meetings
Not Shown
Switch
ATI Data Upload
Router/CSU
Evaluation (HHAR)
CM Database
Case Management
Security Policy
CPMC
Harlem Hospital
Verizon
POTS
Public
Internet
Telergy
T1
Referring
Doctors
Home
Telemedicine
Units in Patient
Homes
ADA Web Site
Verizon ISP
Olean General
Arnot-Ogden (Elmira) Samaritan (Watertown)
Other Internet
Resources
ISDN
TBD
IDEATel Proprietary
Information
30 Oct 2000
Justin Starren
Bassett
LAN
Router
Nurse
Evaluator
Existing H.320
Room System for
Project Meetings
Not Shown
Nurse
Evaluator
Existing H.320
Room System for
Project Meetings
Not Shown
Nurse
Evaluator
Existing H.320
Room System for
Project Meetings
Not Shown
Nurse
Evaluator
H.320/128
Video
Existing H.320
Room System for
Project Meetings
Not Shown
Internet 2
Existing H.320
Room System for
Project Meetings
Not Shown
H.320/128
Video
Case
Managers
HHAR
H.320/128
Video
T1
Firewall
Switch
hub
Router
DSL Router
Data
Data & Video
Video
SD
SD
Project Web Server
Baltimore CA

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