Bio-Medical Informatics              &     Emergency Physician           Jae-Ho Lee, M.D. , PhD. Assistant Professor,Depar...
Contents• Megatrends: Health Care & Health IT• What is Bio-Medical Informatics (BMI) ?• BMI & Clinician• Emergency Medicin...
Megatrends:Healthcare & Health IT
Next-G Healthcare: 4P Medicine• Predictive• Personalized• Preventive                                -데일리메디 2010-06-30     ...
Predictive & Personalized
Preventive                건강검진   +       보험지급+                건강검진   -       보험지급-• 병원에 오지 않게 하는 진료에 대한 수가 책정?• 예방적 만성질환 관리
Participatory• Patient-Centeredness Individual patient preferences, needs, and value… Patient engagement: self-care, commu...
Health2.0Healthcare SNSPHRPersonal GenomeHome Healthcare
Health2.0Oct. 2009: Tim OReilly and John Battelle answer the question of "Whats next for Web2.0?" in Web Squared: Web 2.0 ...
Health2.0
Health2.0
Era of SmartSmart Health
Smart Health trends1) Era of Smart  국내 스마트폰 판매량 > PC 판매량  PC: One of Computer or One of Smart Device?2) Mobile Healthcare ...
세계 Tablet 출하량 5년 뒤 5배 수준http://media.daum.net/digital/view.html?cateid=100031&newsid=20120131143707966&p=inews24
"iPad"…애플, PC시장서 HP 제쳤다http://media.daum.net/digital/others/clusterview?newsId=20120131154318021&clusterId=505040
Smart Hospital Survey 2009  스마트폰과 병원정보시스템 연동: > 60% 2011  smart hospital: > 85% smart clinical service  암센터, 간호부, 가정간호사...
Say Bye to The Stethoscope  And "Hello" to Your Smartphonehttp://ghbn-blog.blogspot.com/2010/03/say-bye-to-stethoscope.html
Say Bye to The Pocket StethoscopeAnd "Hello" to Smartphone Ultrasound
http://www.imedicalapps.com/2011/05/phone-oximeter-peripheral-pulse-ox-respiratory-rate-iphone/
Cancer diagnosis in the palm of your      hand: MRI smartphone                                                            ...
Electronic skin      http://www.bbc.co.uk/news/health-14489208
Emerging Health IT: Smart HealthSmartSNSHealthGame
What isBio-Medical Informatics?
BioEdward H. Shortliffe, MD, PhD, MACP, FACMI
Biomedical InformaticsBiomedical informatics (BMI) is the interdisciplinaryfield that studies and pursuesthe effective use...
Biomedical Informatics in PerspectiveBasic Research             Biomedical Informatics Methods,                           ...
Interdisciplinary Nature of                      Biomedical Informatics                       Computer                   C...
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 pub...
“Pneumonia”• Google search (2012.06.10.22:05) In English: 39,600,000 Scholar:     1,180,000 Books:       7,740,000 “Commun...
Medicine is Fundamentally      an Information Science!!!• Patient / Disease Information Acquisition → Analysis → Decision ...
BioMedical Informatics          &      Clinicians
HIT vs. Healthcare Quality✴ How can IT improve patient safety?*  Improving communication  Making knowledge more readily ac...
Promises of EMR*• Optimizing the documentation of patient encounters• Improving communication of information to physicians...
Electronic Medical Records✤ “Life After a Disastrous EMR Implementation   : One Clinic’s Experience”*    High cost; direct...
Computerized Provider Order Entry 22 new error types: commercial CPOE system*  Long gaps in medication delivery; fragment...
Clinical Informatics Why is Health IT hard? • Doesn’t solve the physician’s problem • Little attention to workflow • Intr...
Disruptive Technology• Clinical IT Systems are designed to be:   Objective   Rational                      Document & Bill...
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/Communicato...
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 & inher...
Challenges of Emergency Medicine• Overcrowded• “Boarding” of patients• Waiting for inpatient beds• Ambulance diversion• Pa...
Challenges of Emergency Medicine                Intrinsic                                ExtrinsicHuman cognitive properti...
EDIS   EDIS
EDIS: ACEP TF white paper (2009) Health IT presents ongoing opportunities • to improve the quality of emergency care, • p...
EDIS: ACEP TF white paper (2009) Emergency Department Information System (EDIS) is Electronic health record systems desig...
EDIS Functions Clinical Functionality • Patient entry • Patient tracking   Patient-centered tracking, Clinical course tra...
EDIS Functions Other Considerations •   System Interfaces •   The User Interface (UI) •   Clinical Decision Support (CDS)...
Patient Entry Anonymous pre-hospital identification  “temporary” unique identification  - before triage, during triage “...
Patient Tracking Patient-centered tracking  Clinical course tracking  Patient location tracking Department-centered trac...
Department Dashboard
Discharge Management• Prescription• Discharge & instructions• Follow-up information• Detailed visit information
Emergency Medical Informatics (EMI)• The collection, management, processing, and application of emergency patient care & o...
Emergency Medical Informatics (EMI) Healthcare IT & Emergency care: 6 key areas* • Management & coordination of patient f...
BMI for Emergency Physicians• Is ED IT system safe, effective, and patient-centered?• How can we measure/evaluate that?• H...
Role of      Korean Society ofEmergency Medical Informatics          (KSEMI)
121213 bmi and emergency physician
121213 bmi and emergency physician
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121213 bmi and emergency physician

  1. 1. Bio-Medical Informatics & Emergency Physician Jae-Ho Lee, M.D. , PhD. Assistant Professor,Depart. of Emergency Medicine/Depart. of Biomedical Informatics University of Ulsan College of medicine
  2. 2. Contents• Megatrends: Health Care & Health IT• What is Bio-Medical Informatics (BMI) ?• BMI & Clinician• Emergency Medicine, Emergency Medical Informatics, and Emergency Physician
  3. 3. Megatrends:Healthcare & Health IT
  4. 4. Next-G Healthcare: 4P Medicine• Predictive• Personalized• Preventive -데일리메디 2010-06-30 http://www.dailymedi.com/news/opdb/index.php?cmd• Participatory =view&code=106532&page=1&dbt=article&sel=&key=& cate=class2&term=
  5. 5. Predictive & Personalized
  6. 6. Preventive 건강검진 + 보험지급+ 건강검진 - 보험지급-• 병원에 오지 않게 하는 진료에 대한 수가 책정?• 예방적 만성질환 관리
  7. 7. Participatory• Patient-Centeredness Individual patient preferences, needs, and value… Patient engagement: self-care, communication… Patient empowerment: information sharing…
  8. 8. Health2.0Healthcare SNSPHRPersonal GenomeHome Healthcare
  9. 9. Health2.0Oct. 2009: Tim OReilly and John Battelle answer the question of "Whats next for Web2.0?" in Web Squared: Web 2.0 Five Years On.
  10. 10. Health2.0
  11. 11. Health2.0
  12. 12. Era of SmartSmart Health
  13. 13. Smart Health trends1) Era of Smart 국내 스마트폰 판매량 > PC 판매량 PC: One of Computer or One of Smart Device?2) Mobile Healthcare & Hospital
  14. 14. 세계 Tablet 출하량 5년 뒤 5배 수준http://media.daum.net/digital/view.html?cateid=100031&newsid=20120131143707966&p=inews24
  15. 15. "iPad"…애플, PC시장서 HP 제쳤다http://media.daum.net/digital/others/clusterview?newsId=20120131154318021&clusterId=505040
  16. 16. Smart Hospital Survey 2009 스마트폰과 병원정보시스템 연동: > 60% 2011 smart hospital: > 85% smart clinical service 암센터, 간호부, 가정간호사, 임상약사 등
  17. 17. Say Bye to The Stethoscope And "Hello" to Your Smartphonehttp://ghbn-blog.blogspot.com/2010/03/say-bye-to-stethoscope.html
  18. 18. Say Bye to The Pocket StethoscopeAnd "Hello" to Smartphone Ultrasound
  19. 19. http://www.imedicalapps.com/2011/05/phone-oximeter-peripheral-pulse-ox-respiratory-rate-iphone/
  20. 20. Cancer diagnosis in the palm of your hand: MRI smartphone 2011 http://holykaw.alltop.com/cancer-diagnosis-in-the-palm-of-your-hand-mri
  21. 21. Electronic skin http://www.bbc.co.uk/news/health-14489208
  22. 22. Emerging Health IT: Smart HealthSmartSNSHealthGame
  23. 23. What isBio-Medical Informatics?
  24. 24. BioEdward H. Shortliffe, MD, PhD, MACP, FACMI
  25. 25. 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.
  26. 26. Biomedical Informatics in PerspectiveBasic Research Biomedical Informatics Methods, Techniques, and Theories Biomedical Informatics ≠ Bioinformatics Imaging Clinical Public Health BioinformaticsApplied Research Informatics Informatics Informatics And Practice © AMIA 2011
  27. 27. 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
  28. 28. Biomedical Science & Medical Practice Clinical Knowledge Management with BMI From Research Into Practice with BMI
  29. 29. 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
  30. 30. “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
  31. 31. Medicine is Fundamentally an Information Science!!!• Patient / Disease Information Acquisition → Analysis → Decision → Practice• Being Optimally Used?• How to Use Clinical Information Better?
  32. 32. BioMedical Informatics & Clinicians
  33. 33. 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
  34. 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
  35. 35. 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
  36. 36. 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
  37. 37. 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
  38. 38. 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
  39. 39. Clinical Informatics • Medical knowledge • The field of informatics • Leadership
  40. 40. 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
  41. 41. 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
  42. 42. Emergency Medicine,Emergency Medical Informatics, and Emergency Physician
  43. 43. 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
  44. 44. 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)
  45. 45. 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)
  46. 46. EDIS EDIS
  47. 47. 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.
  48. 48. 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.
  49. 49. EDIS Functions Clinical Functionality • Patient entry • Patient tracking Patient-centered tracking, Clinical course tracking, Patient location tracking, Department-centered tracking • Department dashboards • Clinical Documentation: EMR • Computer Provider Order Entry (CPOE) • Result Reporting • Discharge Management ACEP TF white paper, 2009
  50. 50. 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
  51. 51. Patient Entry Anonymous pre-hospital identification “temporary” unique identification - before triage, during triage “무명남”, “무명녀”, “사전접수?”, “접취?”
  52. 52. Patient Tracking Patient-centered tracking Clinical course tracking Patient location tracking Department-centered tracking
  53. 53. Department Dashboard
  54. 54. Discharge Management• Prescription• Discharge & instructions• Follow-up information• Detailed visit information
  55. 55. 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
  56. 56. 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)
  57. 57. 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?
  58. 58. Role of Korean Society ofEmergency Medical Informatics (KSEMI)

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