Biomedical InformaticsBiomedical informatics (BMI) is the interdisciplinaryfield that studies and pursuesthe effective uses of biomedical data, information,and knowledgefor scientific inquiry, problem solving, and decisionmaking, motivated by efforts toimprove human health.
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
Biomedical Science & Medical Practice Clinical Knowledge Management with BMI From Research Into Practice with BMI
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
“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
Medicine is Fundamentally an Information Science!!!• Patient / Disease Information Acquisition → Analysis → Decision → Practice• Being Optimally Used?• How to Use Clinical Information Better?
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
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
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
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
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
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
Clinical Informatics • Medical knowledge • The field of informatics • Leadership
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
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
Emergency Medicine,Emergency Medical Informatics, and Emergency Physician
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
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)
Challenges of Emergency Medicine Intrinsic ExtrinsicHuman cognitive properties High communication loadHigh levels of uncertainty Poor teamworkHigh decision density OvercrowdingHigh cognitive load Production pressuresNarrow windows of opportunity High ambient noise levelsMultiple interruptions/distractions Information gapsLow signal-to-noise ratio Report delaysSurge phenomena Inadequate staffingNovel or infrequently occurring Poor feedback conditions InexperiencePatient 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)
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.
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.
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
Patient Entry Anonymous pre-hospital identification “temporary” unique identification - before triage, during triage “무명남”, “무명녀”, “사전접수?”, “접취?”
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
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)
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?
Role of Korean Society ofEmergency Medical Informatics (KSEMI)