introduction to biomedical informatics
Post on 26-Jan-2015
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DESCRIPTIONLecture given to University of Iowa College of Medicine first year medical students
- 1. Introduction To Biomedical Informatics! Michael P. D'Alessandro, M.D.! University of Iowa College of Medicine / University of Iowa Children's Hospital! firstname.lastname@example.org! www.educationalinformatics.org! www.slideshare.net/michaeldalessandro!
2. Welcome to the Medical Profession The Greatest Adventure in the World! Stay connected to world ~ Stay connected to family ~ Golden Rule ~ Read about your patients! 3. About Me! Started programming in 1977! B.S. in Computer Science in 1985! Educational Informatics Lab's vision since 1989! To improve patients' care, outcomes and lives;! By changing physician's knowledge, attitudes, and behaviors;! Through the creation and evaluation of tools, techniques, and procedures that shift learning from the classroom and lecture hall to the point-of-care and document + preserve this learning to create a personalized learning environment / knowledge management / e-memory system for every physician! Strong record of innovation in medical education! Resulting in grants, peer-reviewed publications, awards! Currently serve 2 million learners / year ~ highest impact factors on Internet! 4. What is Biomedical Informatics?! The application of computers in medicine, specically in ! Patient care (clinical informatics) ! Education (educational informatics) ! Research (bioinformatics)! 5. Why is Biomedical Informatics Important?! As medicine becomes digital in the 21st century, a working knowledge of informatics is a medical core competency, with its own place in physicians toolkits alongside anatomy + physiology, pathology, the physical exam and diagnostic reasoning ! 6. Overview! Biomedical Informatics! Past - Clinical Informatics! Electronic medical record! Present - Educational Informatics! Providers! Patients! Future - Bioinformatics! Data mining! Personalized Medicine! Tricorders! Articial intelligence! Singularity! Assignment - Hands on Biomedical Informatics! To Learn More! 7. What is Powering Informatics? Moore's Law! Gordon Moore - 1965! Number of components that can be put on a computer chip doubles every 18 months while price remains same! Means computer power doubles every 18 months! 8. What is Powering Informatics? Moore's Law! Technology in ! 1963 - Born! Mainframe computers! 1985 - Start medical school! Personal computers + Internet + social networking! 2013 - Today! Ubiquitous computing! This is what happened computationally in my half century! What will happen in your half century?! 9. The Past! Clinical Informatics! 10. Electronic Medical Record! History! 1960's-1990's - Rare, institution-specic, handmade (HELP)! Medicine been the last industry to go digital - Why?! 2000's-today - Universal, institution-independent, commercial! Components / Plumbing! Laboratory system! Documentation system! Communications system! User interface (requires training)! Patient portal! Moving towards standards compliance + interoperability! @UIHealthCare! Good news - you have the best EPIC! Bad news - it is universally disliked! 11. Electronic Medical Record Enables! Billing! Disease correction - Consistency of care / improved patient outcomes ! Disease prevention - health promotion! Answer to the question - what do you gain from going paperless?! 12. Electronic Medical Record Supports! Provider-centric model of health care! Current paradigm of medical practice for providers and patients - disease correction! 13. The Present! Educational Informatics for Providers! 14. The Learning Continuum! Data -> Information -> Knowledge - > Wisdom / Mastery! [acquired + organized] [reected] [shared] ! Personal learning environment -> Social learning network! [focus on individual] [focus on group]! 15. Learning is an Apprenticeship! "In what my be called the natural method of teaching, the student begins with the patient, continues with the patient, and ends his studies with the patient using books and lectures as tools, as means to an end." ! ! ! ! ! !- Sir William Osler! 16. How the Medical Apprentice Learns! Diagnosis! Clinical skills related to experience! When seeing a new case you encapsulate it in an "illness script" which you pattern match to previous cases "illness scripts" in order to diagnose! Case-based reasoning / Storytelling! Expert is the person who can best capture, organize, and retrieve their experience (cases)! Treatment! Work up driven by medical knowledge! - Schmidt HG, Norman GR, Boshuizen HPA. A Cognitive Perspective on Medical Expertise: Theory and Implications. Acad Med 1990 Oct;65 (10):611-21.! 17. E-Memory System - Digitization Of Your Life! A digital archive of your life! "Lifelogging"! Made possible / inevitable by! Most memories are digital! Near-innite space to store them! Every improving technology to recall them! Captures, stores, organizes and makes retrievable your experience + reected wisdom! You become the librarian, archivist, cartographer and curator of your life! Early example: www.evernote.com! 18. Learning Portfolio! A digital archive of your medical educational life = learning diary! Document + store clinical questions + answers ! For each case! Question ~ Story ~ Answer ~ Impact on Practice ~ Resources Used! Educational construct! Case-Based Learning! Constructionism ~ Learning by doing / Creating learning artifacts! 19. Personal Learning Environment! Composed of mobile devices, apps, and Web sites that will allow medical apprentice learners to capture, store, organize and make retrievable their medical experience! Help support medical education's increasing emphasis on problem-based and case-based learning in undergraduate, graduate, and continuing medical education! Help to focus medical learning and allow individuals to better enjoy their voyage towards medical mastery! Can be used at all levels of medical education by all learners and should facilitate communication amongst and between learners at all levels! This usage can begin the rst day of medical school and continue throughout their career! 20. Personal Learning Environment! System that help learners take control of and manage their own learning including providing support for learners to! Set their own learning goals! Manage their own learning - both content and process ! Communicate with others in the process of learning! = summation of software programs / apps / Web sites you use ! Learner-centric ~ "This is what I will learn today"! Decentralized ~ Standards are the glue that hold it together! 21. Medical Student Personal Learning Environment! Custom search engine Apps / Web sites Learning Portfolio! Librarians indirectly play a key role in this! 22. The Present! Educational Informatics for Patients! 23. Health is Not Dependent on Physicians! 90% of variance in illness and premature death is related to factors other than access to medical treatment! 50% = Behavioral - Diet / Nutrition / Exercise! 25% = Environmental - Presence or absence of war, sanitation, toxins! 15% = Genetic! 10% = Access to medical treatment! Immunization mainly! Your physician is almost inconsequential ! Unless you live in the western world and are susceptible to ills of afuence / lifestyle! - MHS 2025 - Toward a New Enterprise, Section 4 page 2! 24. Dose of Reality Regarding Compliance! Four good health rules! Don't smoke, maintain normal weight, eat fruit + vegetables, exercise! Only 3% of Americans follow all 4 rules! - Archives of Internal Medicine 2005;165:854-7! [Two more rules - Don't drink to excess + Practice safe sex]! 40% of seniors don't take all the meds their physicians prescribe for them! - Health Affairs 2005 April 19! 25. Patient's Information Seeking Behaviors! There can be no more motivated learner than the patient! 81% of U.S. adults use the Internet! 59% of U.S. adults say they have looked online for health information in the past year! 35% of U.S. adults say they have gone online specically to try to gure out what medical condition they or someone else might have! - Pew Internet & American Life Project, Health Online 2013! You should use Information Prescriptions to partner with them! Doctor means teacher - you must teach your patients! www.medlineplus.gov! 26. Quantied Self! Goal - to Stay Healthy! Step 1 - Sequence your genome! "23andMe can help you manage risk and make informed decisions" - (for $99)! 23andMe is creating vast database of genetic information of its customers + cross referencing it against the health history they provide! Is Big Data, CEO is spouse of Larry Brin of Google! www.23andme.com! Step 2 - Engineering approach to life ! Quantify it with biosensors, analyze it, act on it! www.quantiedself.com! Result - Empowered patients who will present with data driven chief complaint! Gordon Bell - www.totalrecallbook.com! Larry Smarr - hacking his own body! 27. Personal Health Record! www.healthvault.com! 28. Patients Taking Control of Their Care! Internet was designed to route around obstructions! Now patients are using the Internet to route around obstructions like you! They are running their own clinical trials! www.patientslikeme.com - "Share your experiences with treatments. Find patients just like you. Learn from others who know."! Social network for sick people! 29. The Future! Research Informatics! Paradigm of medical practice will change from disease correction to disease prevention! Informatics tools will allow super empowered patients to live healthy lives! When patients become ill, informatics tools will help them take control of and guide their treatment and the role physicians will play! 30. The Next Step: Big Data + Data Mining! Denition! Big Data - Huge data sets (exabytes = 1 billion gigabytes)! Data Mining - Algorithms extract and synthesize knowledge from analyzing large numbers of individual cases!