1	Health of the Population: Medical Informatics Applications David R. Little, MD MS February 16, 2007
2	Objectives To understand the role of information technology in improving the health of the population To identify the complexities of information management in the US health care system
3	Objectives To recognize important applications for health information management To develop a personal strategy for acquiring skills in information technology
4	Health of the Population A variety of issues A variety of settings A variety of providers A variety of data types A variety of third-party stakeholders
5	Case Report Mr. Kennedy is 75-year-old diabetic man who presents to the office for evaluation of an injured ankle. The injury occurred one week ago when he fell on ice outside the community senior center.
6	A Variety of Issues Acute Disease Management Does Mr. Kennedy need an x-ray of his ankle? Chronic Disease Management Is the blood sugar controlled? Preventive Care Services Should he get a flu shot? Community Health Concerns Is the community center safe?
7	A Variety of Settings Office Hospital Emergency Room Urgent Care Nursing Home, ancillary care facility Home School Work
8	A Variety of Providers Primary care physician Specialty physician Advance Practice Clinicians Nursing Ancillary care providers Alternative therapies Family Caregivers Do-it-yourself
9	A Variety of Data Types Office Notes Hospital Records Lab, x-ray results Consultant notes Pharmacy data Patient-generated data Research reports
10	A Variety of Stakeholders Patient Physician Hospital Health Care Agencies Pharmacies Third-Party Payers Employers Outside Interests
11	The “Dis-integrated” Health Care System “The nation’s health care delivery system has fallen far short in its ability to translate knowledge into practice and to apply new technology appropriately and safely.” -Institute of Medicine, 2001
12	The Consequences Health Disparities Data Management (or the lack thereof)
13	The Consequences Medical Errors A physician seeing 25 patients per day will generate approximately 15 clinical questions Approximately 2/3 of these questions go unanswered One half of these answers directly impact patient care
14	Six aims for improvement Safe – avoid patient injury Effective – provide state-of-the-art quality care Patient-centered Timely – reduce harmful delays Efficient – avoid waste of resources Equitable – universal standard of quality
15	How Technology Can Help To reduce errors and improve care delivery To understand the community To empower the patient To inform the clinician
16	To reduce errors and improve care delivery Electronic Health Records Electronic Prescribing Decision Support
17	Electronic Health Records Penetration Approximately 20% of private physician offices employ some form of electronic health record Higher percentages in larger practices Financially-motivated applications far exceed safety- and quality-motivated applications US has called for universal EHR adaptation by 2014 At current pace, this will happen by 2024 Interoperability
18	Continuity of Care Record (CCR)
19	Electronic Health Records Data Standards 845.00 unspecified site of ankle sprain 845.01 deltoid (ligament), ankle sprain 845.02 calcaneofibular (ligament) ankle sprain 845.03 tibiofibular (ligament) sprain, distal 845.09 other ankle sprain
20	To understand the community Clinical Data Repository How well are my patients’ blood sugars controlled? Disease Registries How many new cases of lymphoma were diagnosed in Greene County last year? Regional Health Information Network Who lives in Montgomery County and what are their health care needs? Population-based health policies How should we distribute flu shots?
21	To empower the patient Patient health information Internet Doctor-patient communication Patient portal to health records To examine To upload Personal health records Remote Care Delivery
22	To inform the clinician Medical decision-making Formulating questions Information retrieval point-of-care primary / secondary Analyzing evidence Medical decision support Pharmacologic info Clinical Alert systems
23	What the First-Year Medical Student Needs to Know Information management is a vital need for medical education Clinical Problem solving EBM resources, Medline, textbooks, Ddx tools Pharmacology databases More on information retrieval and clinical decision making in Year II
24	What the First-Year Medical Student Needs to Know Information technology is a vital need for quality patient care Electronic Health Records Universal access Interoperability Patient Health Information Decision Support Patient Safety
25	What the First-Year Medical Student Needs to Know Information management is vital to the health of the public Public health surveillance and detection Clinical data repositories Dissemination of information Clinical outcomes assessment Public Health Policy
26	What the Medical Student Needs to Do: Year I Acquire and refine basic computer skills Become familiar with Medline searching Develop an understanding of population health and systems-based practice
27	What the Medical Student Needs to Do: Year II Develop a thorough understanding of Evidence-Based Medicine (EBM) How to formulate a clinical question How to search the literature for evidence How to critically appraise the quality of the literature How to interpret and apply the evidence
28	What the Medical Student Needs to Do: Year III Acquire and refine the skills of handheld computing Refine the skills of identifying and formulating clinical questions based upon real-life clinical situations Utilize point-of-care information resources to access: Clinical information Pharmacology information Evidence-based information
29	What the Medical Student Needs to Do: Year IV Refine the skills of applying clinical evidence to medical decision-making at the point of care using information technology Develop specialty-specific skills in the use of information technology Consider additional training opportunities