The Internet - How Will It Transform The Internet - How Will It Transform the Practice of Medicine?the Practice of Medicine?

James J. Cimino - Columbia UniversityJames J. Cimino - Columbia University

Daniel Nutkis - MedtegrityDaniel Nutkis - Medtegrity

Harry Jacobson - Web EBM and Harry Jacobson - Web EBM and Vanderbilt University Medical CenterVanderbilt University Medical Center

Practice of Medicine: Pre-InternetPractice of Medicine: Pre-Internet

Patient

Payor

Services

Provider

Practice of Medicine: Post-InternetPractice of Medicine: Post-Internet

OtherRoles?

InformationResources

ExpertSystems

More Questions than AnswersMore Questions than Answers

How will the consumer (aka How will the consumer (aka "patient") make informed decisions?"patient") make informed decisions?

How will care be coordinated?How will care be coordinated? How will it be reimbursed?How will it be reimbursed? How will we know when we are How will we know when we are

improving care?improving care? What new roles will there be?What new roles will there be?

Agenda for the PanelAgenda for the Panel

Jim Cimino - Medical informatics Jim Cimino - Medical informatics

Dan Nutkis - Privacy and securityDan Nutkis - Privacy and security

Harry Jacobson: Evidence-based medicineHarry Jacobson: Evidence-based medicine

AMIA 2000 Symposium ReportAMIA 2000 Symposium Report

Rating health information on the NetRating health information on the Net Coordinating diverse data sourcesCoordinating diverse data sources Multimedia data capture and displayMultimedia data capture and display Remote biomonitoringRemote biomonitoring Usability of Web-based systemsUsability of Web-based systems The Web and legacy systemsThe Web and legacy systems Peer reviewPeer review Education at a distanceEducation at a distance

Patient Clinical Information System Patient Clinical Information System (PatCIS)(PatCIS)

New York Presbyterian Hospital clinical data New York Presbyterian Hospital clinical data repositoryrepository

Web-based Clinical Information System Web-based Clinical Information System (WebCIS)(WebCIS)

National Information Infrastructure contract National Information Infrastructure contract from NLM:from NLM:– give patients WebCISgive patients WebCIS– see what happenssee what happens

Pilot study conductedPilot study conducted

“Televaluation” of PatCIS

Patient

1. Video BasedUsability Testing - in laboratory

Interact via WWW Patient Information System (PatCIS)

2. Telephone Interviews (audiotape)

5. On-line Questionnaire Data (sequenced forms)

4. Tracking User Actions - System Usage Database (log files)

3. E-mail(to evaluators)

Average Monthly Log-OnsAverage Monthly Log-Ons

0

2

4

6

8

10

12

14

16

U1 U2 U3 U4 U5 U6 U7 U8 U9 U10 U11 U12 U13

0

10

20

30

40

50

60

70User 1

User 2

User 3

User 4

User 5

User 6

User 7

User 8

User 9

User 10

User 11

User 12

User 13

Average Session Time by UserAverage Session Time by User

Function UsageFunction Usage Data entry: 73 totalData entry: 73 total Data review: 1831 totalData review: 1831 total

– 1518 laboratory1518 laboratory– 36 vital signs36 vital signs– 35 diabetes flow sheets35 diabetes flow sheets– 212 reports (81 radiology, 35 pathology)212 reports (81 radiology, 35 pathology)– 30 Microbiology30 Microbiology

Education: 53 totalEducation: 53 total Advice: 6 totalAdvice: 6 total

Patients and Physicians InterviewsPatients and Physicians Interviews

Subjects felt that use of PatCIS had a direct Subjects felt that use of PatCIS had a direct impact on doctor-patient communicationimpact on doctor-patient communication

For patients For patients – Improved communication resulting from following their Improved communication resulting from following their

own lab results (review of data function) prior to meeting own lab results (review of data function) prior to meeting with their physicianwith their physician

For physiciansFor physicians– Allows for focus on issues of decision making and patient Allows for focus on issues of decision making and patient

compliance during during doctor-patient interviews compliance during during doctor-patient interviews (rather than review of data)(rather than review of data)

Excerpts from Patient InterviewsExcerpts from Patient Interviews

“ “ Communication is less in the way of getting Communication is less in the way of getting information now, and more in the way of information now, and more in the way of discussing treatment options and agreeing on discussing treatment options and agreeing on a course of action, so to me its more efficient a course of action, so to me its more efficient than the old way”than the old way”

“ “ I look for trends in my medical data and if I see I look for trends in my medical data and if I see something I can contact the doctor to see something I can contact the doctor to see what’s going on, what we can do, change what’s going on, what we can do, change meds or whatever” meds or whatever”

Excerpts Physician InterviewsExcerpts Physician Interviews

“ “ Right now most of the communication takes Right now most of the communication takes place during the ten or fifteen minute visit and place during the ten or fifteen minute visit and if I throw a lot of information at the patient if I throw a lot of information at the patient about their condition or what I want them to about their condition or what I want them to do, its very hard for them to absorb all that. do, its very hard for them to absorb all that.

It (PatCIS) gives them a chance to go back and It (PatCIS) gives them a chance to go back and look at things about their health record that look at things about their health record that they can then ask better questions about in they can then ask better questions about in the limited time that we have during the visit. the limited time that we have during the visit. Its another channel of communication”Its another channel of communication”

The Role of Medical InformaticsThe Role of Medical Informatics

Understanding information needsUnderstanding information needs Providing educational and information Providing educational and information

resourcesresources Integration of clinical, educational, Integration of clinical, educational,

administrative, financial and research administrative, financial and research resourcesresources

New forms of decision supportNew forms of decision support Facilitation through the InternetFacilitation through the Internet