Contemporary Issues in Medical Informatics

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Contemporary Issues in Medical Informatics

• James J. Cimino
• Department of Medical Informatics
• Columbia University

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Applications

• Diagnosis
• Treatment
• Training
• Telepresence
• Decision support

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Technologies

• Electronic medical records
• Bioinformatics
• Controlled medical terminologies
• Knowledge bases
• Internet

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Applications Î Technologies

• DX Training Presence Support

EMRs Bioinf. CMTs KBs Internet
Shared Information
Improved Care
Case Based Learning
Automated Integration
Predictive Probability
Prediction/ Prognosis
Effective Planning
Repre- sentation
Linkages
Bridging
Expert Systems
Guidelines
Collaboration
Resources
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History Taking

• New model for medical record
• Granularity of terminology
• Teach patients to give histories

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Summary of Presentations

• James J. Cimino
• Department of Medical Informatics
• Columbia University

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Summary of Presentations

• Presentations
• Issues
• Topics for discussion

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Presentations - David Williams

• Decay of training
• Pharmacology is unknown
• Think about requirements

MD on Board
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Presentations - Sam Pool

• Pharmacodynamics and pharmacokinetics have
  implications for evidence-based medicine
• What medications?
• What equipment?

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Presentations - Jay Sanders

• The 80-20 rule
• Mars to Main Street
• Focus on history-taking

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Presentations -Jeff Sutton

• Smart systems for Rx and monitoring
• Novel sensors
• Novel therapeutic modalities
• Remote fabrication
• Intelligent systems for mentoring/training

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Presentations - Terry Clemmer

• Complex adaptive systems
• Setting the vision is the attractor
• Clockware vs. Swarmware
• The human on a bike (AI-RHEUM)
• Rapid cycle trials - process oriented
• Protocol development

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Presentations - Dan Masys

• How much will we know in the next 25 years?
• Human genome project a parts list
• Task of functional genomics is to map the
  patterns to the clinical picture
• Interrupt command and control mechanisms

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Presentations - Michael Ackerman

• Interactivity is an issue
• Things to pack
• Lessons from submarines
• Risk/benefit analysis

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Presentations - Larry Weed

• Decouple data collection from heuristics
• Stop relying on whats in doctors heads
• New tools are needed
• A new science of medical practice

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Issues

• What do we need to learn?
• What do we need to build?

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Issues - What do we need to learn?

• How to do interviews - but what about psychiatric
  ones?
• Study what gets used in subs, space station,
  islands, Poles - what are the cognitive issues?
• Can we apply informatics to backward chain in
  collecting evidence?

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Issues - What do we need to learn?

• Heuristics and EBM
• Swarmware and chaos theory - its ok to kill a
  few termites
• Genomics - functions vs. markers
• Pattern matching and gestalt - if we can model
  human physicians, why not just model human
  astronauts?

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Issues - What do we need to build?

• My first aid kit
• Lab on a chip - a super dipstick?
• Expert systems - which part is the bicycle and
  which part is the human?

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Topics for Discussion

• How will we practice evidence-based health care?
• What to pack hardware vs. warmware

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