What is Medical Informatics?

Agus Widiyatmoko

Health (Medical) Informatics

Simplistic definition: Medical informatics is the application of computers, communications and information technology and systems to all fields of medicine - medical care, medical education and medical research.
MF Collen, MEDINFO '80, Tokyo
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Health (Medical) Informatics

Medical informatics is the rapidly developing scientific field that deals with resources, devices and formalized methods for optimizing the storage, retrieval and management of biomedical information for problem solving and decision making.
Edward Shortliffe, M.D., Ph.D. What is medical informatics? Stanford University, 1995.
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Health (Medical) Informatics

Medical Informatics is the branch of science concerned with the use of computers and communication technology to acquire, store, analyze, communicate, and display medical information and knowledge to facilitate understanding and improve the accuracy, timeliness, and reliability of decision-making.
Warner, Sorenson and Bouhaddou, Knowledge Engineering in Health Informatics, 1997
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Health Informatics Defined

Information Technology

Health care Research Education Communication Knowledge Management Decision support Clinical Information Management
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Fundamentals

Medical Informatics
Knowledge Management Clinical Information Management

Communication

Decision Support

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Informatics Use in Health Care

Communication

Decision Support

Telemedicine Tele-radiology Patient e-mail Presentations Journals Consumer Health information Evidence-based medical information

Reminder systems Diagnostic Expert Systems Drug Interaction Electronic Medical Records Billing transactions Ordering Systems

Knowledge management

Information Management

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Informatics Curriculum
Computer Literacy

Research

Word processing Graphics

Data analysis E-mail, web, presentation

Communication skills

Life-long learning Medical Reference Clinical Information management

Evidence Based Medicine

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Knowledge Management

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Knowledge Management
20th Century Medical Library

Bricks and morter Print journals, books, quick reference manuals Interlibrary loans Microfiche, Microfilm, dimes

21st Century Medical Library

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Books, Journals and Manuals

StatRef Pubmed PDxMD MDConsult Dynamed

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Consumer Health Information

Health Finder Familydoctor.org More consumer health websites

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Evidence Anyway You Want It

Cochrane Collaboration InfoRetriever

Web Desktop PDA

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The Evidence Based Medicine Database

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Introduction
The most current and widely accepted definition of evidence-based medicine is the integration of the best research evidence with clinical expertise and patient values This reflects a systematic approach to clinical problem solving.

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Major Authoritative Web Sites

www.CDC.gov www.Guidelines.gov www.nlm.nih.gov http://epss.ahrq.gov/ http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubm ed Professional medical organizations, associations and academies Avoid Wikipedia
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systematic process for implementing evidence based medicine into clinical practice
Start with the patient -- a clinical problem or question arises out of the care of the patient Construct a well built (PICO) clinical question Select the appropriate resource Appraise that evidence Return to the patient Evaluate your performance

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Select the appropriate resource

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Major EBM Databases

A high-quality foraging tool employs a transparent process that:
1. Systematically surveys or reviews the literature 2. filters out disease-oriented research and presents only patientoriented research outcomes 3. demonstrates that a validity assessment has been performed using appropriate criteria 4. assigns levels of evidence, based on appropriate validity criteria, to individual studies 5. provides specific recommendations, when feasible, on how to apply the information, placing it into clinical context 6. comprehensively reviews the literature for a specific specialty or discipline 7. coordinates with a high-quality hunting tool
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Cochrane Database of Systematic Reviews

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Cochrane Database
Highest level of rigor, systematically reviews the entire English publications on a topic. Abstracts are free at their website. Full text is available through WileyInterscience. Cochrane Systematic Reviews on therapy topics only contain randomized clinical trials It produces and disseminates systematic reviews of healthcare interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions.

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ACP Journal Club

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ACP Journal Club

Critical appraisals of studies from two journals, the ACP Journal Club and Evidence Based Medicine. ACP Journal Club's general purpose is to select from the biomedical literature articles that report original studies and systematic reviews that warrant immediate attention by physicians attempting to keep pace with important advances in internal medicine. These articles are summarized in value-added abstracts and commented on by clinical experts.

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Daily POEMS

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Daily POEMS
Patient Oriented Evidence that Matters. Published daily, and ongoing since 1996, editors review more than 1,200 studies monthly from 100+ medical journals, presenting only the best as InfoPOEMs. The acclaimed POEMs process applies specific criteria for validity and relevance to clinical practice. About 1 in 40 studies qualifies.
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Database of Abstracts of Reviews of Effectiveness

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Database of Abstracts of Reviews of Effectiveness (DARE)

DARE contains summaries of systematic reviews which have met strict quality criteria. Included reviews have to be about the effects of interventions. Each summary also provides a critical commentary on the quality of the review. The database covers a broad range of health and social care topics and can be used for answering questions about the effects of interventions, as well as for developing guidelines and policy making. (DARE) is currently available through Ovid.
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National Guideline Clearinghouse

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National Guideline Clearinghouse

A public resource for evidence-based clinical practice guidelines. NGC is an initiative of the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services. NGC was originally created by AHRQ in partnership with the American Medical Association and the American Association of Health Plans

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US Preventative Services Task Force (USPSTF)

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US Preventative Services Task Force (USPSTF)

The USPSTF is the leading independent panel of privatesector experts in prevention and primary care. The USPSTF conducts rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling, and preventive medications. Its recommendations are considered the "gold standard" for clinical preventive services.

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ACP PIER

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ACP PIER
PIER (Physicians' Information and Education Resource) is an evidence based, decision-support tool designed for rapid point-of-care delivery of up-to-date guidance for clinicians. PIER is an evidence-based "System" of actionable information about health conditions and interventions. Information in PIER is presented in a "drill down" format, in which the user clicks from an opening guidance statement through to more specific information.

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Clinical Evidence

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Clinical Evidence Clinical Evidence -- Web Version

Evidence-based evaluations of interventions for common clinical conditions developed in collaboration with the American College of Physicians, the American Society of Internal Medicine and BMJ. Summaries of evidence Specific clinical questions: treatment and prevention Makes specific recommen-dations States when there is a lack of evidence
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Essential Evidence Plus

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Essential Evidence Plus

104 journals surveyed for Evidence-Based Practice Newsletter Over 1300 article synopses/ POEMS Cochrane abstracts Selected evidence-based guidelines (USPSTF, CDC, JNC7,others) Basic drug info ICD-9 codes Clinical calculators/prediction rules
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DynaMed

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DynaMed
DynaMed is a huge, evidence based reference designed to pro-vide the most useful and current disease information at the point-of-care for health care profes-sionals. Where available, links are provided to full-text elec-tronic resources, including all FSU-available ejournals via a PubMed reference and patient education handouts.

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Decision Support

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Handheld Applications
ePocrates 5 Minute Clinical Consult Medical Calculators Immunization schedule

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Communications

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E-mail
Private, secure e-mail between Doctor and Patient http://www.medocs.net

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Clinical Information Systems

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Clinical Information Systems

Practice Partner Electronic Medical Record System

Drug Interaction Allergy checks Internal e-mail Integrated with billing and appointments Links to knowledge base Patient Education handouts
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Medical Search Engine

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