Informatics

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Informatics Nephrology How Can We Integrate
the Computer in Our Daily Practice?

• YOUSEF A. BOOBES, M.D.
• Head Renal Division
• Tawam Hospital, Al Ain

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Science is built up with facts as a house with
stones.

• But a collection of facts is no more a science
  than a heap of stones is a house.

• Jules Henri Poincaré, 1908

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Introduction

• The volume and complexity of medical knowledge
  and data today have far outstripped any
  physicians ability to function optimally without
  the support of information management tools.
• Yet many physicians are uncertain how to
  implement these tools in their daily medical
  activities.

J. Osheroff, Computer in Clinical Practice
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Transcribed Dictation
Dialysis TRT Data
BP Values
Pre Tx Evaluation
V A Pressures
Infectious Disease
Nursing Charting
Knowledge Database
Presc. Drugs
BV Changes
B. pump
ECG
Decision Making Processor, Data And Time Driver
Intradialytic Complications
INTEGRATED CLINICAL DATA BASE
Dialysis Schedule
X-Rays
Data Review Alerts Computations Interpretations Pr
otocols
Laboratory
Diet
Others
Dialysis Kt/V
Blood TX
Admission
Medical Records
Vascular Access
Social Rehab
OUTCOME
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What is Medical Informatics?

• Simple definition
• Computer applications in medical care
• Complicated definition
• The systematic processing of data, information
  and knowledge in medicine and health care.

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Fields of Medical Informatics

• Information (knowledge data) management and
  decision making
• Communication tasks of medical practice
• Basic science and clinical research
• Medical education
• Planning and policy issues

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Fields of Medical Informatics

• Information (knowledge data) management and
  decision making
• Communication tasks of medical practice
• Basic science and clinical research
• Medical education
• Planning and policy issues

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Knowledge
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Traditional Sources of Knowledge

• Print-based textbooks and journals
• Personal or through health science library
• Colleagues
• Consultation
• Informal questions
• Referrals to Academic health care centers
• CME
• Conferences
• Courses

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Computerized Sources of Knowledge

• Printed textbooks journals
• Colleagues
• Consultation
• Referrals to Academic health care centers
• Informal questions
• CME
• Conferences
• Courses

• Clinical computer software applications
• Web sites
• Colleagues
• Telemedicine
• Internet Group of discussion
• The Web
• cyberConferences
• Online Courses

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Clinical Computer Software

• Electronic medical textbook and encyclopedia
• Bibliographic and full-text information retrieval
  systems
• Clinical decision-support systems (CDSS)

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Clinical Textbooks in Electronic (CD-ROM) Format

• Examples of electronic textbooks
• UpToDate
• The Kidney Brenner and Rector
• Oxfords Textbook of Clinical Nephrology
• Reference (PDR)
• Some are accessible via the internet

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Bibliographic Information Retrieval Software

• The National Library of Medicine has developed
  MEDLINE-based resources such as
• PubMed
• Grateful Med
• LOANSOME DOC
• Bibliographic search software, such as
• Ovid
• Aries Knowledge Finder
• SilverPlatter
• PaperChase

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The World Wide Web

• Clinically useful information can be found on the
  Web
• Many of Web information unsuitable for direct
  clinical application
• Known High Quality Web Sites
• Government agencies (in U.S. and other)
• Academic health care centers
• Professional specialty organizations
• Peer-reviewed journals
• Others

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gt Drinking Water From a Fire Hose

• Internet can be helpful for
• Answering clinical questions
• Providing the latest relevant information
• It could be time - consuming
• Retrieve huge number of sites
• Then, retrieve large set of relevant publications

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E-mail Based Discussion Groups (Listservs)

• NEPHROL
• General nephrology, including renal pathology
  Tx.
• NEPHJNL
• Nephrology/transplantation journal club.
• NEPJHIST
• history of renal medicine, ISN Video Legacy
  Project interview transcripts.
• NEPHCNPT
• discussions of individual clinical nephrology
  cases.
• NEPHNPPT
• discussions of individual renal biopsy cases.

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Clinical Decision-Support Systems (CDSS)

• Examples
• Dxplain, ILIAD, Meditel
• Given a set of patient findings
• Explain differential diagnoses
• Show relevant laboratory tests
• Suggest possible workup protocols
• Provide links to relevant biomedical literature

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Patients Data
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Categories of Clinical Computer Software

• Electronic medical record systems (EMRSs)
• Haemodialysis Data Management software

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Electronic Medical Record Systems

• Very efficient for storing and retrieving
• Patient data
• Clinician's orders
• Clinical textual reports (e.g., history and P.E.,
  progress notes, nursing notes, X-R reports,..)
• Laboratory results,
• Pharmacy information,
• Billing information,
• Census data,
• Outcome data.

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Haemodialysis Data Management software

• Fresenius Finesse System
• Hospal Communication System

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Others Uses of Computer

• Telemedicine
• Dialysis Kinetics and Modeling
• Education
• Resources
• Slide Presentation
• Research
• Basic science and clinical research
• Planning and policy issues

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How Can We Integrate the Computer in Our Daily
Practice?

• Handheld Computers

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Categories

• Palm-size
• Small enough to fit in one hand
• Handheld PC (H/PC)
• Two-handed size with keyboard and bigger display

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PROS and CONS Palm-size

• PROS
• Lighter and smaller
• Longer battery life
• CONS
• Not practical for extensive data input without a
  keyboard attachment
• Less likely to have internal modems

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PROS and CONS H/PC

• PROS
• Much better for data entry or writing than
  palm-size
• Larger screen
• More PC-like interface
• CONS
• Costs more than Palm-size
• Not practical for extensive typing

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Classification of Handhelds According OS

• Palm OS palm-size
• Palm, HandSpring Visor, Sony Clie
• Windows CE H/PC, palm-size
• Compaq iPaq 3630
• HP Jornada 545
• Casio Cassiopeia E-115
• Psion, (Symbian) H/CP

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Palm-SizePalm OS vs. Windows CE

• Both have pluses and minuses
• Windows CE devices
• Have more memory and faster processor
• But practically gt same
• Special version of the most popular PC app (Word,
  Excel, ..) gt synchronizing the information
  with PC is easier
• Palm OS devices dominate the market (gt80)
• Have gt 70,000 third-party developers creating
  tons of applications
• Cheaper longer battery Life

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Applications

• Medical Records
• Personal Organization
• Reference tools
• Calculation tools

• Specialty Applications
• Fax
• Beeper
• Cell phone
• Internet Access

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Tasks Best Suited for Palm-size Devices

• Access existing data
• Access reference material
• Personal information manager
• Access information networks via modem or wireless

• Cellular phone material
• Beeper Access
• Fax - send and receive
• Calculator

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Things Can be Done with Palm-Size Devices,1

• Personal information manager
• Ideal for keeping track of small pieces of
  information such as
• Telephone numbers, addresses and appointments.
• To take short notes,
• Read documents and manage your email all while
  away from the desktop.
• Take your personal notes with you
• Download abstracts or other text to read them
  latter, lunch, etc.
• Download web pages, email, to read them latter

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Things Can be Done with Palm-Size Devices, 2

• Electronic Medical Records/Patient Tracking
• Storing
• Personal and demographic information of patients
• Lab data, medical history, clinical data and
  prescriptions.
• Using
• Patient data is downloaded at the start of each
  ward round
• Modifications done during rounds are synchronized
  at the end
• With a radio network card gt mobile access to
  main hospital server
• Palm devices are more useful than the desktop PC
• All charts records are easily viewed at the
  bedside
• Notes or prescriptions can be added easily at the
  bedside.

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Things Can be Done with Palm-Size Devices, 3

• Store reference material in your pocket
• Text books
• NephroToGo, Harrison
• Drug guides
• ePocrate
• Medical calculators
• Perform almost any complex calculation
• Quickly receive the results of a number of
  preloaded equations (i.e., kt/v, Creat.
  clearance, anion gap, etc.)

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Things Can be Done with Palm-Size Devices, 4

• Internet access
• ability to access and store a tremendous amount
  of information from online archives, newsgroups
  and others
• Software
• AvantGo
• They are not ideal for simple browsing of the
  web, but for quick trips to find relevant
  information they can prove pretty convenient.
• Because these devices are extremely customizable,
  the functionality is only limited by your
  imagination

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Palm Devices Renal Fellowship Program -
University of Minnesota

• Palm provides "just-in-time information" for both
  fellows and faculty
• A web page that allows fellows to download
  schedules, announcements, forms, and lecture
  notes to their Palm
• "NephroToGo" a handbook of nephrology that can
  be downloaded for free
• Diagnostic and technical info as well as renal
  calculators
• WWW.nephrotogo.com

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Where to Get More Information?

• The 2000 Guide to Handheld and Palmtop Computing
  Resources for Health CareProfessionals.
• http//themedicalguide.hypermart.net/ 
• Medical Software Reviews 2000 Index
• http//www.crihealthcarepubs.com/indx00c.html 
• WWW Sites
• www.acponline.org, www.palm.com,
  www.pilotgear.com
• www.palmcentral.com,
• http//palmtops.about.com/gadgets/palmtops/cs/revi
  ewresources/index.htm?termspalmtop

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