Informatika_Kedokteran 2009

8/3/2019 Informatika_Kedokteran 2009

1/75

1

What is Medical Informatics?

Agus Widiyatmoko


2/75

2

Health (Medical) Informatics

Simplistic definition:

Medical informatics is the application ofcomputers, communications and information

technology and systems to all fields of

medicine - medical care, medical education

and medical research.

MF Collen, MEDINFO '80, Tokyo


3/75

3


Medical informatics is the rapidly developing

scientific field that deals with resources,devices and formalized methods for

optimizing the storage, retrieval and

management of biomedical information for

problem solving and decision making.Edward Shortliffe, M.D., Ph.D. What is medical

informatics? Stanford University, 1995.


4/75

4


Medical Informatics is the branch of science

concerned with the use of computers and

communication technology to acquire, store,

analyze, communicate, and display medical

information and knowledge to facilitate

understanding and improve the accuracy,

timeliness, and reliability of decision-making.Warner, Sorenson and Bouhaddou, Knowledge Engineering

in Health Informatics, 1997


5/75

5

Health Informatics Defined

Information Technology

Health care

Research

Education

Fundamentals

Communication

Knowledge Management

Decision support

Clinical Information Management


6/75

6


7/757

Medical Informatics

Knowledge

Management

Clinical Information

Management

Communication Decision Support


8/758


9/759


10/7510


11/7511


12/7512


13/7513

Informatics Use in Health Care

Communication Telemedicine

Tele-radiology

Patient e-mail

Presentations

Knowledge management Journals

Consumer Health information Evidence-based medical

information

Decision Support

Reminder systems

Diagnostic Expert Systems Drug Interaction

Information Management

Electronic Medical Records

Billing transactions

Ordering Systems


14/7514

Informatics Curriculum

Computer Literacy

Word processing

Graphics

Life-long learning

Medical Reference

Clinical Informationmanagement

Research

Data analysis

Communication skills

E-mail, web,

presentation

Evidence BasedMedicine
http://med.fsu.edu/informatics/Curriculum.asphttp://med.fsu.edu/informatics/Curriculum.asp


15/7515



16/7516


20th Century Medical Library Bricks and morter

Print journals, books, quick reference manuals Interlibrary loans

Microfiche, Microfilm, dimes

21

st

Century Medical Library
http://med.fsu.edu/library/default.asphttp://med.fsu.edu/library/default.asphttp://med.fsu.edu/library/default.asphttp://med.fsu.edu/library/default.asphttp://med.fsu.edu/library/default.asphttp://med.fsu.edu/library/default.asphttp://med.fsu.edu/library/default.asp


17/7517

Books, Journals and Manuals

StatRef

Pubmed

PDxMD

MDConsult

Dynamed
http://med.fsu.edu/library/default.asp


18/7518

Consumer Health Information

Health Finder

Familydoctor.org

More consumer health websites
http://www.healthfinder.gov/http://familydoctor.org/http://med.fsu.edu/library/PatientEd.asphttp://med.fsu.edu/library/PatientEd.asphttp://familydoctor.org/http://www.healthfinder.gov/


19/75

19

Evidence Anyway You Want It

Cochrane Collaboration

InfoRetriever Web

Desktop

PDA


20/75

20

The Evidence Based MedicineDatabase


21/75

21

Introduction

The most current and widely accepted

definition of evidence-based medicine is the

integration of the best research evidence with

clinical expertise and patient values This

reflects a systematic approach to clinical

problem solving.


22/75

22

Major Authoritative Web Sites

www.CDC.gov

www.Guidelines.gov

www.nlm.nih.gov

http://epss.ahrq.gov/

http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubm

ed Professional medical organizations, associations

and academies

Avoid Wikipedia
http://www.cdc.gov/http://www.guidelines.gov/http://www.nlm.nih.gov/http://epss.ahrq.gov/http://epss.ahrq.gov/http://www.nlm.nih.gov/http://www.guidelines.gov/http://www.cdc.gov/


23/75

23

systematic process for implementing evidencebased medicine into clinical practice

Start with the patient -- a clinical problem orquestion arises out of the care of the patient

Construct a well built (PICO) clinical question Select the appropriate resource

Appraise that evidence

Return to the patient

Evaluate your performance


24/75

24

Select the appropriate resource


25/75

25

Major EBM Databases

A high-quality foraging tool employs a transparent processthat:1. Systematically surveys or reviews the literature

2. filters out disease-oriented research and presents only patient-oriented research outcomes

3. demonstrates that a validity assessment has been performed usingappropriate criteria

4. assigns levels of evidence, based on appropriate validity criteria, toindividual studies

5. provides specific recommendations, when feasible, on how to applythe information, placing it into clinical context

6. comprehensively reviews the literature for a specific specialty ordiscipline

7. coordinates with a high-quality hunting tool


26/75

26

Cochrane Database of SystematicReviews


27/75

27

Cochrane Database

Highest level of rigor, systematically reviews the entireEnglish publications on a topic.

Abstracts are free at their website. Full text is availablethrough WileyInterscience.

Cochrane Systematic Reviews on therapy topics onlycontain randomized clinical trials

It produces and disseminates systematic reviews of

healthcare interventions and promotes the search forevidence in the form of clinical trials and other studies ofinterventions.


28/75

28

ACP Journal Club


29/75

29

ACP Journal Club

Critical appraisals of studies from two journals, the ACPJournal Club and Evidence Based Medicine.

ACP Journal Club's general purpose is to select from thebiomedical literature articles that report original studies andsystematic reviews that warrant immediate attention byphysicians attempting to keep pace with important advancesin internal medicine.

These articles are summarized in value-added abstracts andcommented on by clinical experts.


30/75

30

Daily POEMS


31/75

31

Daily POEMS

Patient Oriented Evidence that Matters.

Published daily, and ongoing since 1996, editors

review more than 1,200 studies monthly from 100+medical journals, presenting only the best asInfoPOEMs.

The acclaimed POEMs process applies specific

criteria for validity and relevance to clinicalpractice.

About 1 in 40 studies qualifies.


32/75

32

Database of Abstracts of

Reviews of Effectiveness


33/75

33

Database of Abstracts of Reviews ofEffectiveness (DARE)

DARE contains summaries of systematic reviews whichhave met strict quality criteria.

Included reviews have to be about the effects ofinterventions.

Each summary also provides a critical commentary on thequality of the review.

The database covers a broad range of health and social care

topics and can be used for answering questions about theeffects of interventions, as well as for developing guidelinesand policy making.

(DARE) is currently available through Ovid.


34/75

34

National Guideline Clearinghouse


35/75

35

National Guideline

Clearinghouse A public resource for evidence-based clinical

practice guidelines.

NGC is an initiative of the Agency for HealthcareResearch and Quality (AHRQ), U.S. Department ofHealth and Human Services.

NGC was originally created by AHRQ in

partnership with the American Medical Associationand the American Association of Health Plans


36/75

36

US Preventative Services Task Force (USPSTF)


37/75

37

US Preventative Services Task Force(USPSTF)

The USPSTF is the leading independent panel of private-sector experts in prevention and primary care.

The USPSTF conducts rigorous, impartial assessments ofthe scientific evidence for the effectiveness of a broad rangeof clinical preventive services, including screening,counseling, and preventive medications.

Its recommendations are considered the "gold standard" for

clinical preventive services.


38/75

38

ACP PIER


39/75

39

ACP PIER

PIER (Physicians' Information and Education Resource) isan evidence based, decision-support tool designed for rapidpoint-of-care delivery of up-to-date guidance for clinicians.

PIER is an evidence-based "System" of actionableinformation about health conditions and interventions.

Information in PIER is presented in a "drill down" format, inwhich the user clicks from an opening guidance statement

through to more specific information.


40/75


41/75

41

Clinical Evidence Clinical

Evidence -- Web Version Evidence-based evaluations of interventions for

common clinical conditions developed incollaboration with the American College ofPhysicians, the American Society of InternalMedicine and BMJ.

Summaries of evidence

Specific clinical questions: treatment and preven-

tion Makes specific recommen-dations

States when there is a lack of evidence


42/75

42

Essential Evidence Plus


43/75

43

Essential Evidence Plus

104 journals surveyed for Evidence-Based PracticeNewsletter

Over 1300 article synopses/ POEMS Cochrane abstracts

Selected evidence-based guidelines (USPSTF,CDC, JNC7,others)

Basic drug info

ICD-9 codes

Clinical calculators/prediction rules


44/75

44

DynaMed


45/75

45

DynaMed

DynaMed is a huge, evidence based referencedesigned to pro-vide the most useful and current

disease information at the point-of-care for healthcare profes-sionals.

Where available, links are provided to full-textelec-tronic resources, including all FSU-available e-

journals via a PubMed reference and patienteducation handouts.


46/75

46

Decision Support


47/75

47

Handheld Applications

ePocrates

5 Minute Clinical

Consult

Medical Calculators

Immunization schedule


48/75

48

Communications


49/75

49

E-mail

Private, secure e-mail between Doctor and

Patient

http://www.medocs.net
http://www.medocs.net/http://www.medocs.net/


50/75

50

Clinical Information Systems
http://www.wtdd.net/images/medical%20records.jpg


51/75

51

Clinical Information Systems

Practice Partner Electronic Medical RecordSystem

Drug Interaction

Allergy checks

Internal e-mail

Integrated with billing and appointments Links to knowledge base

Patient Education handouts


52/75

52

Medical Search Engine


53/75

53


54/75

54


55/75

55


56/75

56


57/75

57


58/75

58


59/75

59


60/75

60


61/75

61


62/75

62


63/75

63


64/75

64


65/75

65


66/75

66


67/75

67


68/75

68


69/75

69


70/75

70


71/75

71


72/75

72


73/75

73


74/75

74


75/75

Informatika_Kedokteran 2009

Documents

Transcript of Informatika_Kedokteran 2009