Transcript Purpose

Biomedical Informatics
Year in Review
Notable publications and events in Informatics
since the 2008 AMIA Symposium
Daniel R. Masys, MD
Professor and Chair
Department of Biomedical Informatics
Professor of Medicine
Vanderbilt University School of Medicine
Content for this session is at:
http://dbmichair.mc.vanderbilt.edu/amia2009/
including citation lists and links
and this PowerPoint
Design for this Session




Modeled on American College of Physician
“Update” sessions
Emphasis on ‘what it is’ and ‘why it is
important’
1-2 examples of each in detail and others
in synopsis
Audience interaction for each category of
item discussed
Source of Content for Session


Literature review of RCTs indexed by MeSH
term “Medical Informatics”, “Telemedicine” &
descendents or main MeSH term
“Bioinformatics”, and Entrez date between
November 2008 and October 2009 further
qualified by involvement of >100 providers or
patients
Poll of American College of Medical
Informatics fellows list
It takes a (global) village…
Thanks to:







Rebecca Jerome
David Bates
Don Detmer
Ken Goodman
Bill Hersh
George Hripcsak
Betsy Humphreys






Kevin Johnson
Bonnie Kaplan
Nancy Lorenzi
Dean Sittig
Bill Stead
Jan Talmon
Session components
Representative New Literature
 Notable Events – the ‘Top Ten’ list

New Literature Highlights:
Clinical Informatics
Clinical Decision Support
 Telemedicine
 The practice of informatics

New Literature Highlights:
Bioinformatics and
Computational Biology
Human Health and Disease
 The practice of bioinformatics

Clinical Decision
Support
25 new RCTs published
meeting search criteria
November 2008 – October 2009
Clinical Decision Support for Providers




Reference
 Med. 2009 Apr 27;169(8):771-80.[Brigham & Women’s, Boston MA]
Schnipper JL et. al.. Arch Intern
Title
 Effect of an electronic medication reconciliation application and
process redesign on potential adverse drug events: a clusterrandomized trial.
Aim
 To measure the impact of an information technology-based medication
reconciliation intervention on medication discrepancies with potential
for harm (potential adverse drug events [PADEs])
Methods
 Controlled trial, randomized by medical team, on general medical
inpatient units at 2 academic hospitals from May to June 2006.
 322 patients admitted to 14 medical teams, for whom a medication
history could be obtained before discharge.
 Intervention was a computerized medication reconciliation tool and
process redesign involving physicians, nurses, and pharmacists.
Clinical Decision Support for Providers



Reference
 Schnipper JL et. al.. Arch Intern Med. 2009 Apr 27;169(8):771-80.
Methods, cont’d
 The main outcome was unintentional discrepancies between
preadmission medications and admission or discharge medications
that had potential for harm (PADEs).
Results
 Among 160 control patients, there were 230 PADEs (1.44 per patient),
while among 162 intervention patients there were 170 PADEs (1.05
per patient) (adjusted relative risk [ARR], 0.72; 95% confidence
interval [CI], 0.52-0.99).
 A significant benefit was found at hospital 1 (ARR, 0.60; 95% CI, 0.380.97) but not at hospital 2 (ARR, 0.87; 95% CI, 0.57-1.32) (P = .32 for
test of effect modification).
 Hospitals differed in the extent of integration of the medication
reconciliation tool into computerized provider order entry applications
at discharge.
Clinical Decision Support for Providers



Reference
 Schnipper JL et. al.. Arch Intern Med. 2009 Apr 27;169(8):771-80.
Conclusions
 A computerized medication reconciliation tool and process redesign
were associated with a decrease in unintentional medication
discrepancies with potential for patient harm.
 Software integration issues are important for successful
implementation of computerized medication reconciliation tools.
Importance
 Contributes to literature on ‘people, process and technology’ that
confirms Reed Gardner’s classic observation that technology is only
(10-15-20) percent of success, the rest is sociology.
Clinical Decision Support for Providers

Reference




Terrell KM, et al. J Am Geriatr Soc. 2009 Aug;57(8):1388-94. Epub
2009 Jun 22. [Indiana University, Indianapolis, Indiana]
Title
 Computerized decision support to reduce potentially
inappropriate prescribing to older emergency department
patients: a randomized, controlled trial.
Aim
 To evaluate the effectiveness of computer-assisted decision
support in reducing potentially inappropriate prescribing to
older adults.
Setting:
 Academic emergency department where computerized
physician order entry was used to write all medication
prescriptions
Clinical Decision Support for Providers

Reference


Terrell KM, et al. J Am Geriatr Soc. 2009 Aug;57(8):1388-94. Epub
2009 Jun 22.
Methods
 63 emergency physicians randomized to the intervention (32
physicians) or control (31 physicians) group.
 Decision support advised against use of nine potentially
inappropriate medications and recommended safer substitute
therapies.
 Primary outcome was the proportion of ED visits by seniors that
resulted in one or more prescriptions for an inappropriate
medication.
 Secondary outcomes were the proportions of medications
prescribed that were inappropriate and intervention physicians'
reasons for rejecting the decision support.
Clinical Decision Support for Providers

Reference


Terrell KM, et al. J Am Geriatr Soc. 2009 Aug;57(8):1388-94. Epub
2009 Jun 22.
Results
 Average age of the patients = 74, two-thirds were female, and
just over half were African American.
 Decision support was provided 114 times to intervention
physicians, who accepted 49 (43%) of the recommendations.
 Intervention physicians prescribed one or more inappropriate
medications during 2.6% of ED visits by seniors, compared with
3.9% of visits managed by control physicians (P=.02).
 The proportion of all prescribed medications that were
inappropriate significantly decreased from 5.4% to 3.4%.
 The most common reason for rejecting decision support was
that the patient had no prior problems with the medication.
Clinical Decision Support for Providers

Reference


Conclusions



Terrell KM, et al. J Am Geriatr Soc. 2009 Aug;57(8):1388-94.
Epub 2009 Jun 22.
Computerized physician order entry with decision support
significantly reduced prescribing of potentially inappropriate
medications for seniors.
Approach might be used in other efforts to improve ED care.
Importance


Overrides of clinical decision support guidance occur
because of data not captured in the EMR but elicited by
providers
An installed CPOE system with CDSS is an essential
infrastructure for such interventions
Clinical Decision Support for Providers

Reference


Title



Smith DH et al. Am J Manag Care. 2009 May;15(5):281-9. [Kaiser
Permanente, Portland, OR]
Improving laboratory monitoring of medications: an economic
analysis alongside a clinical trial.
Aim
 To test the efficiency and cost-effectiveness of interventions
aimed at enhancing laboratory monitoring of medication.
Methods:
 A cost-effectiveness analysis.
 Patients of a not-for-profit, group-model HMO were
randomized to 1 of 4 interventions: an electronic medical
record reminder to the clinician, an automated voice
message to patients, pharmacy-led outreach, or usual care.
Clinical Decision Support for Providers

Reference

Smith DH et al. Am J Manag Care. 2009 May;15(5):281-9

Methods, cont’d:
 Patients followed for 25 days to determine completion of all
recommended baseline laboratory monitoring tests.
 Measured the rate of laboratory test completion and the
cost-effectiveness of each intervention.
 Direct medical care costs to the HMO (repeated testing,
extra visits, and intervention costs) were determined using
trial data and a mix of other data sources.

Results

Average cost of patient contact was $5.45 in the pharmacyled intervention, $7.00 in the electronic reminder
intervention, and $4.64 in the automated voice message
reminder intervention.
Clinical Decision Support for Providers

Reference


Results, cont’d



Smith DH et al. Am J Manag Care. 2009 May;15(5):281-9
The electronic medical record intervention was more costly
and less effective than other methods.
The automated voice message intervention had an
incremental cost-effectiveness ratio (ICER) of $47 per
additional completed case, and the pharmacy intervention
had an ICER of $64 per additional completed case.
Conclusions:

Using the data available to compare strategies to enhance
baseline monitoring, direct clinician messaging was not an
efficient use of resources.
Clinical Decision Support for Providers

Reference


Conclusions, cont’d:



Smith DH et al. Am J Manag Care. 2009 May;15(5):281-9
Depending on a decision maker's willingness to pay,
automated voice messaging and pharmacy-led efforts can
be efficient choices to prompt therapeutic baseline
monitoring.
Direct clinician messaging is a less efficient use of
resources.
Importance

Adds to a growing literature that when implementing clinical
decision support, members of the care team other than
physicians appear to be better targets for automated alerts
and reminders
Clinical Decision Support for Providers

Reference


Title


An electronic health record-based intervention to improve tobacco
treatment in primary care: a cluster-randomized controlled trial.
Aim


Linder JA et. al. Arch Intern Med. 2009 Apr 27;169(8):781-7 [Brigham &
Womens, Boston MA].
To assess impact of intervention design to improve the documentation
and treatment of tobacco use in primary care
Methods

Developed and implemented a 3-part electronic health record
enhancement: (1)smoking status icons, (2) tobacco treatment reminders,
and (3) a Tobacco Smart Form that facilitated the ordering of medication
and fax and e-mail counseling referrals.
Clinical Decision Support for Providers

Reference


Methods, cont’d




Linder JA et. al. Arch Intern Med. 2009 Apr 27;169(8):781-7 [Brigham
& Womens, Boston MA].
A cluster-randomized controlled trial of the enhancement in 26
primary care practices between December 19, 2006, and September
30, 2007.
Primary outcome was the proportion of documented smokers who
made contact with a smoking cessation counselor.
Secondary outcomes included coded smoking status documentation
and medication prescribing.
Results

During the 9-month study period, 132,630 patients made 315,962
visits to study practices.
Clinical Decision Support for Providers

Reference


Linder JA et. al. Arch Intern Med. 2009 Apr 27;169(8):781-7
Results, cont’d



Coded documentation of smoking status increased from 37% of
patients to 54% (+17%) in intervention practices and from 35% of
patients to 46% (+11%) in control practices (P < .001 for the
difference in differences).
Among the 9589 patients who were documented smokers at the start
of the study, more patients in the intervention practices were recorded
as nonsmokers by the end of the study (5.3% vs 1.9% in control
practices; P < .001).
Among 12,207 documented smokers, more patients in the
intervention practices made contact with a cessation counselor (3.9%
vs 0.3% in control practices; P < .001).
Clinical Decision Support for Providers

Reference


Results, cont’d


Smokers in the intervention practices were no more likely to be
prescribed smoking cessation medication (2% vs 2% in control
practices; P = .40).
Conclusions


Linder JA et. al. Arch Intern Med. 2009 Apr 27;169(8):781-7
The EHR-based intervention improved smoking status documentation
and increased counseling assistance to smokers but not the
prescription of cessation medication.
Importance

CDSS literature on smoking has shown it to be a remarkably difficult
condition to modify through interventions. Gratifying positive results.
Clinical Decision Support for Providers




Reference
 Schriefer SP et al. Fam Med. 2009 Jul-Aug;41(7):502-7.
[MAHEC Family Health Center, Asheville, NC]
Title
 Effect of a computerized body mass index prompt on
diagnosis and treatment of adult obesity.
Aim
 To determine whether a computerized body mass index (BMI)
chart prompt would increase the likelihood that patients of
family physicians would be diagnosed with obesity and
referred for obesity treatment.
Methods
 A total of 846 obese patients of 37 family physicians were
randomly assigned to either have a patient's BMI chart prompt
placed in their electronic medical record (intervention group)
or not have a BMI prompt (comparison group) placed in the
record.
Clinical Decision Support for Providers

Reference


Methods, cont’d



Schriefer SP et al. Fam Med. 2009 Jul-Aug;41(7):502-7.
Patient medical records examined for evidence of an obesity
diagnosis and referral for specific obesity treatments.
Also measured whether the presence of comorbidities in
obese patients influenced the likelihood of diagnoses and
treatments by the physicians.
Results

Obese patients of physicians who had a BMI chart prompt in
their medical records were significantly more likely than
obese patients of physicians who did not receive a BMI chart
prompt to receive a diagnosis of obesity (16.6% versus
10.7%; P=.016).
Clinical Decision Support for Providers

Reference


Results



Schriefer SP et al. Fam Med. 2009 Jul-Aug;41(7):502-7.
Patients of physicians who were provided with a BMI chart
prompt were also more likely than patients of physicians who
did not get a chart prompt to receive a referral for diet
treatment (14.0% versus 7.3%, P=.002) and exercise (12.1%
versus 7.1%, P=.016).
Of the obesity comorbidities, only obstructive sleep apnea
(OSA) was a predictor of a patient being diagnosed with
obesity (P=.014).
Conclusion:

Inclusion of a computerized BMI chart prompt increased the
likelihood that physicians would diagnose obesity in obese
patients and refer them for treatment.
Clinical Decision Support for Providers

Reference


Schriefer SP et al. Fam Med. 2009 Jul-Aug;41(7):502-7.
Importance

Consistent with well established literature on physician alerts
and prompts that shows both a modest increase in
compliance with best practices and disappointing overall
effect on care processes.
Clinical Decision Support for Providers

Reference




Ahmad F et al. Ann Intern Med. 2009 Jul 21;151(2):93-102. Epub
2009 Jun 1. [University of Toronto, Ontario, Canada]
Title
 Computer-assisted screening for intimate partner violence
and control: a randomized trial.
Aim
 To assess whether computer-assisted screening can
improve detection of women at risk for intimate partner
violence and control (IPVC) in a family practice setting.
Setting:
 An urban, academic, hospital-affiliated family practice clinic
in Toronto.
Clinical Decision Support for Providers

Reference


Ahmad F et al. Ann Intern Med. 2009 Jul 21;151(2):93-102. Epub
2009 Jun 1.
Methods




293 adult women in a current or recent relationship randomized to
computer-based multi-risk assessment report attached to the
medical chart.
The report was generated from information provided by
participants before the physician visit (n = 144).
Control participants received standard medical care (n = 149).
Measured frequency of initiation of discussion about risk for IPVC
(discussion opportunity) and detection of women at risk based on
review of audiotaped medical visits.
Clinical Decision Support for Providers

Reference


Results




Ahmad F et al. Ann Intern Med. 2009 Jul 21;151(2):93-102. Epub
2009 Jun 1.
The overall prevalence of any type of violence or control was 22%
(95% CI, 17% to 27%).
In adjusted analyses based on complete cases (n = 282), the
intervention increased opportunities to discuss IPVC (adjusted
relative risk, 1.4 [CI, 1.1 to 1.9]) and increased detection of IPVC
(adjusted relative risk, 2.0 [CI, 0.9 to 4.1]).
Participants recognized the benefits of computer screening but had
some concerns about privacy and interference with physician
interactions.
Conclusion

Computer screening effectively detected IPVC in a busy family
medicine practice, and it was acceptable to patients.
Clinical Decision Support for Providers

Reference


Ahmad F et al. Ann Intern Med. 2009 Jul 21;151(2):93102. Epub 2009 Jun 1.
Importance


Extends literature on patients’ willingness to use
computerized interviewing methods to report sensitive
and potentially stigmatizing conditions.
Additional evidence that tailored reports inserted into
outpatient setting can reduce barriers to initiation of
difficult conversations between providers and patients
Clinical Decision Support for Providers and Patients




Reference
 Holbrook A. et al. CMAJ. 2009 Jul 7;181(1-2):37-44. [McMaster
University, Hamilton ON]
Title
 Individualized electronic decision support and reminders to
improve diabetes care in the community: COMPETE II
randomized trial.
Aim
 To determine whether electronic decision support, providing
information that is shared by both patient and physician,
encourages timely interventions and improves the management
of this chronic disease.
Methods
 Randomly assigned adult primary care patients with type 2 diabetes
to receive the intervention or usual care.
Clinical Decision Support for Providers and Patients


Reference
 Holbrook A. et al. CMAJ. 2009 Jul 7;181(1-2):37-44. [McMaster
University, Hamilton ON]
Methods
 Intervention involved shared access by the primary care provider
and the patient to a Web-based, color-coded diabetes tracker.
 Intervention provided sequential monitoring values for 13 diabetes
risk factors, their respective targets, and brief, prioritized messages
of advice.
 Primary outcome measure was a process composite score.
 Secondary outcomes included clinical composite scores, quality of
life, continuity of care and usability.
 Outcome assessors were blinded to each patient's intervention
status.
Diabetes tracker: Physician view
Diabetes tracker: Patient view
Clinical Decision Support for Providers and Patients

Reference


Holbrook A. et al. CMAJ. 2009 Jul 7;181(1-2):37-44. [McMaster
University, Hamilton ON]
Results, cont’d




Recruited 46 primary care providers and 511 of their patients,
mean age 60.7.
Mean follow-up was 5.9 months.
Process composite score was significantly better for patients in the
intervention group than for control patients (difference 1.27, p <
0.001);
61.7% (156/253) of patients in the intervention group, compared
with 42.6% (110/258) of control patients, showed improvement
(difference 19.1%, p < 0.001).
Clinical Decision Support for Providers and Patients

Reference


Results, cont’d



The clinical composite score also had significantly more variables
with improvement for the intervention group (0.59, 95% CI 0.091.10, p = 0.02), including significantly greater declines in blood
pressure (-3.95 mm Hg systolic and -2.38 mm Hg diastolic) and
glycated hemoglobin (-0.2%).
Patients in the intervention group reported greater satisfaction with
their diabetes care.
Conclusions


Holbrook A. et al. CMAJ. 2009 Jul 7;181(1-2):37-44. [McMaster
University, Hamilton ON]
A shared electronic decision-support system improved the process
of care and some clinical markers of the quality of diabetes care.
Importance

New models of shared decision support are succeeding
Clinical Decision Support for Providers and Patients




Reference
 Sequist TD. Arch Intern Med. 2009 Feb 23;169(4):364-71[Dept Health
Care Policy, Harvard, Boston MA]
Title
 Patient and physician reminders to promote colorectal cancer screening:
a randomized controlled trial.
Aim
 To determine whether systematic reminders to patients and physicians
could increase cancer screening rates .
Methods
 A randomized controlled trial in 11 ambulatory health care centers.
 Participants included 21 860 patients aged 50 to 80 years who were
overdue for colorectal cancer screening and 110 primary care
physicians.
 Patients were randomly assigned to receive mailings containing an
educational pamphlet, fecal occult blood test kit, and instructions for
direct scheduling of flexible sigmoidoscopy or colonoscopy.
 Physicians were randomly assigned to receive electronic reminders
during office visits with patients overdue for screening.
Clinical Decision Support for Providers and Patients



Reference
 Sequist TD. Arch Intern Med. 2009 Feb 23;169(4):364-71[Dept Health
Care Policy, Harvard, Boston MA]
Methods, cont’d
 Primary outcome was receipt of fecal occult blood testing, flexible
sigmoidoscopy, or colonoscopy over 15 months
 Secondary outcome was detection of colorectal adenomas.
Results
 Screening rates were higher for patients who received mailings
compared with those who did not (44.0% vs 38.1%; P < .001).
 Effect increased with age: +3.7% for ages 50 to 59 years; +7.3% for ages
60 to 69 years; and +10.1% for ages 70 to 80 years (P = .01 for trend).
 Screening rates were similar among patients of physicians receiving
electronic reminders and the control group (41.9% vs 40.2%; P = .47).
 However, electronic reminders tended to increase screening rates
among patients with 3 or more primary care visits (59.5% vs 52.7%; P =
.07).
 Detection of adenomas tended to increase with patient mailings (5.7% vs
5.2%; P = .10) and physician reminders (6.0% vs 4.9%; P = .09).
Clinical Decision Support for Providers and Patients



Reference
 Sequist TD. Arch Intern Med. 2009 Feb 23;169(4):364-71[Dept Health
Care Policy, Harvard, Boston MA]
Conclusions
 Mailed reminders to patients are an effective tool to promote colorectal
cancer screening
 Electronic reminders to physicians may increase screening among
adults who have more frequent primary care visits.
Importance

Adds to CDSS literature that shows larger effect size when best
practice guidance sent to patients compared to same message sent to
physicians
Clinical Decision Support for Patients




Reference
 Volandes AE et al. BMJ. 2009 May 28;338:b2159. doi:
10.1136/bmj.b2159. [Massachusetts General Hospital, Boston, MA]
Title
 Video decision support tool for advance care planning in dementia:
randomised controlled trial.
Aim
 To evaluate the effect of a video decision support tool on the preferences
for future medical care in older people if they develop advanced
dementia, and the stability of those preferences after six weeks.
Setting
 Four primary care clinics (two geriatric and two adult medicine) affiliated
with three academic medical centers in Boston.
Clinical Decision Support for Patients

Reference


Volandes AE et al. BMJ. 2009 May 28;338:b2159. doi:
10.1136/bmj.b2159. [Massachusetts General Hospital, Boston, MA]
Methods.
 Convenience sample of 200 older people (>or=65 years) living in
the community with previously scheduled appointments at one of
the clinics. Mean age was 75 and 58% were women.
 Intervention was verbal narrative alone (n=106) or with a video
decision support tool (n=94).
 Main outcome measure was preferred goal of care: life prolonging
care (cardiopulmonary resuscitation, mechanical ventilation),
limited care (admission to hospital, antibiotics, but not
cardiopulmonary resuscitation), or comfort care (treatment only to
relieve symptoms). Checked again six weeks later.
 Analyzed difference in proportions of participants in each group
who preferred comfort care.
Clinical Decision Support for Patients

Reference


Volandes AE et al. BMJ. 2009 May 28;338:b2159. doi:
10.1136/bmj.b2159. [Massachusetts General Hospital, Boston, MA]
Results.
 Among participants receiving the verbal narrative alone, 68 (64%)
chose comfort care, 20 (19%) chose limited care, 15 (14%) chose
life prolonging care, and three (3%) were uncertain.
 In the video group, 81 (86%) chose comfort care, eight (9%)
chose limited care, four (4%) chose life prolonging care, and one
(1%) was uncertain (P=0.003).
 Among all participants the factors associated with a greater
likelihood of opting for comfort care were being a college graduate
or higher, good or better health status, greater health literacy,
white race, and randomization to the video arm.
Clinical Decision Support for Patients

Reference



Volandes AE et al. BMJ. 2009 May 28;338:b2159. doi:
10.1136/bmj.b2159. [Massachusetts General Hospital, Boston, MA]
Results
 Participants were re-interviewed after six weeks. Among the
94/106 (89%) participants re-interviewed in the verbal group, 27
(29%) changed their preferences (kappa=0.35).
 Among the 84/94 (89%) participants re-interviewed in the video
group, five (6%) changed their preferences (kappa=0.79)
(P<0.001 for difference).
Conclusions
 Older people who view a video depiction of a patient with
advanced dementia after hearing a verbal description of the
condition are more likely to opt for comfort as their goal of care
compared with those who solely listen to a verbal description.
 They also have more stable preferences over time.
Clinical Decision Support for Patients


Reference
 Volandes AE et al. BMJ. 2009 May 28;338:b2159. doi:
10.1136/bmj.b2159. [Massachusetts General Hospital, Boston,
MA]
Importance
 Multimedia technologies can assist patients in understanding
future health states.
 To understand dementia, a movie is worth a thousand words…
10 New CDSS RCTs showing no difference
for intervention vs. control
1.
Piazza G. Physician alerts to prevent symptomatic venous
thromboembolism in hospitalized patients. Circulation. 2009 Apr
28;119(16):2196-201. Epub 2009 Apr 13. [Brigham & Woman’s
Hospital, Boston MA]
2.
Bosworth HB et al. Patient education and provider decision
support to control blood pressure in primary care: a cluster
randomized trial. Am Heart J. 2009 Mar;157(3):450-6. Epub 2009 Jan
10. [Center for Health Svcs Research, Durham NC]
3.
Kline JA et al. Randomized trial of computerized quantitative
pretest probability in low-risk chest pain patients: effect on safety
and resource use. Ann Emerg Med. 2009 Jun;53(6):727-35.e1. Epub
2009 Jan 9. [Carolinas Medical Ctr, Charlotte NC]
4.
Leveille SG et al. Health coaching via an internet portal for primary
care patients with chronic conditions: a randomized controlled
trial. Med Care. 2009 Jan;47(1):41-7. [Beth Israel Deaconnes Med Ctr,
Boston MA]
10 New CDSS RCTs showing no difference
for intervention vs. control, cont’d
5.
Stoddard JL et al. Effect of adding a virtual community (bulletin
board) to smokefree.gov: randomized controlled trial. J Med Internet
Res. 2008 Dec 19;10(5):e53. [SAIC -NCI Frederick, MD]
6.
Gurwitz JH et al. Effect of computerized provider order entry with
clinical decision support on adverse drug events in the long-term
care setting. J Am Geriatr Soc. 2008 Dec;56(12):2225-33. [U. Mass,
Worcester, MA]
7.
Askins MA et al. Report from a multi-institutional randomized clinical
trial examining computer-assisted problem-solving skills training
for English- and Spanish-speaking mothers of children with newly
diagnosed cancer. J Pediatr Psychol. 2009 Jun;34(5):551-63. Epub
2008 Dec 17. [MD Anderson, Houston, TX]
8.
Kasper J et al. Informed shared decision making about
immunotherapy for patients with multiple sclerosis (ISDIMS): a
randomized controlled trial. Eur J Neurol. 2008 Dec;15(12):1345-52.
[Univ. Hamburg, Germany]
10 New CDSS RCTs showing no difference
for intervention vs. control, cont’d
9.
Hung CS et al. Using paper chart based clinical reminders to
improve guideline adherence to lipid management. J Eval
Clin Pract. 2008 Oct;14(5):861-6. [National Taiwan University
Hospital, Taiwan]
10.
Lo HG et al. Impact of non-interruptive medication laboratory
monitoring alerts in ambulatory care. J Am Med Inform Assoc.
2009 Jan-Feb;16(1):66-71. Epub 2008 Oct 24. [Univ. Penn.,
Philadelphia, PA]
Clinical Decision
Support
Questions and Comments
Telemedicine
12 new RCTs published
November 2008 – October 2009
•4 diabetes
•2 each psychiatric care, hypertension and
smoking cessation
•1 chronic conditions coaching
•1 insomnia
Telemedicine - diabetes




Reference
 Shea S et. al. J Am Med Inform Assoc. 2009 Jul-Aug;16(4):446-56.
Epub 2009 Apr 23. [Columbia Univ., New York NY]
Title
 A randomized trial comparing telemedicine case management with
usual care in older, ethnically diverse, medically underserved
patients with diabetes mellitus: 5 year results of the IDEATel study.
Aim
 To examine the effectiveness of a telemedicine intervention to
achieve clinical management goals in older, ethnically diverse,
medically underserved patients with diabetes.
Methods
 A randomized controlled trial was conducted, comparing
telemedicine case management to usual care, with blinded outcome
evaluation, in 1,665 Medicare recipients with diabetes, aged >/= 55
years, residing in federally designated medically underserved areas
of New York State.
Telemedicine - diabetes



Reference
 Shea S et. al. J Am Med Inform Assoc. 2009 Jul-Aug;16(4):446-56.
Epub 2009 Apr 23. [Columbia Univ., New York NY]
Methods, cont’d
 Intervention was home telemedicine unit with nurse case
management versus usual care.
 Main outcome measures were hemoglobin A1c (HgbA1c), low
density lipoprotein (LDL) cholesterol, and blood pressure levels.
Results


Intention-to-treat mixed models showed that telemedicine achieved
net overall reductions over five years of follow-up in the primary
endpoints (HgbA1c, p = 0.001; LDL, p < 0.001; systolic and diastolic
blood pressure, p = 0.024; p < 0.001).
Estimated differences (95% CI) in year 5 were 0.29 (0.12, 0.46)%
for HgbA1c, 3.84 (-0.08, 7.77) mg/dL for LDL cholesterol, and 4.32
(1.93, 6.72) mm Hg for systolic and 2.64 (1.53, 3.74) mm Hg for
diastolic blood pressure.
Telemedicine - diabetes



Reference
 Shea S et. al. J Am Med Inform Assoc. 2009 JulAug;16(4):446-56. Epub 2009 Apr 23. [Columbia Univ.,
New York NY]
Conclusions
 Telemedicine case management resulted in net
improvements in HgbA1c, LDL-cholesterol and blood
pressure levels over 5 years in medically underserved
Medicare beneficiaries.
Importance
 Effectiveness of telemedicine technologies is not
restricted to well educated and affluent individuals
Telemedicine – smoking cessation

Reference


Title


Rabius V et al. J Med Internet Res. 2008 Nov 21;10(5):e45.
[National Cancer Information Center, American Cancer Society,
Austin, Texas]
Comparing internet assistance for smoking cessation: 13-month
follow-up of a six-arm randomized controlled trial.
Aims



To describe long-term smoking cessation rates associated with 6
different Internet-based cessation services and the variation among
them,
To test the hypothesis that interactive and tailored Internet services
yield higher long-term quit rates than more static Web-posted
assistance
To explore the possible effects of level of site utilization and a selfreported indicator of depression on long-term cessation rates.
Telemedicine – smoking cessation



Reference
 Rabius V et al. J Med Internet Res. 2008 Nov 21;10(5):e45. [National
Cancer Information Center, American Cancer Society, Austin, Texas]
Methods
 In 2004-05, a link was placed on the American Cancer Society (ACS)
website for smokers who wanted help in quitting via the Internet. The
link led smokers to the QuitLink study website, where they could
answer eligibility questions, provide informed consent, and complete
the baseline survey.
 Enrolled participants were randomly assigned to receive emailed
access to one of five tailored interactive sites provided by cooperating
research partners or to a targeted, minimally interactive ACS site with
text, photographs, and graphics providing stage-based quitting advice
and peer modeling.
Results
 6451 of the visitors met eligibility requirements and completed
consent procedures and the baseline survey. All of these smokers
were randomly assigned to one of the six experimental groups.
Telemedicine – smoking cessation


Reference
 Rabius V et al. J Med Internet Res. 2008 Nov 21;10(5):e45. [National
Cancer Information Center, American Cancer Society, Austin, Texas]
Results, cont’d
 Follow-up surveys done online and via telephone interviews at
approximately 13 months after randomization yielded 2468
respondents (38%) and found no significant overall quit rate
differences among those assigned to the different websites (P = .15).
 At baseline, 1961 participants (30%) reported an indicator of
depression. Post hoc analyses found that this group had significantly
lower 13-month quit rates than those who did not report the indicator
(all enrolled, 8% vs 12%, P < .001; followed only, 25% vs 31%, P =
.003).
 When the 4490 participants (70%) who did not report an indicator of
depression at baseline were separated for analysis, the more
interactive, tailored sites, as a whole, were associated with higher
quitting rates than the less interactive ACS site: 13% vs 10% (P = .04)
among 4490 enrolled and 32% vs 26% (P = .06) among 1798
followed.
Telemedicine – smoking cessation



Reference
 Rabius V et al. J Med Internet Res. 2008 Nov 21;10(5):e45.
[National Cancer Information Center, American Cancer Society,
Austin, Texas]
Conclusions
 Internet assistance is attractive and potentially cost-effective and
suggest that tailored, interactive websites may help cigarette
smokers who do not report an indicator of depression at baseline
to quit and maintain cessation.
Importance
 Specific features of telemedicine technology (eg., website
content and functionality) may be less important that patient
characteristics when measuring health outcomes.
Telemedicine - depression




Reference
 Kessler D, et al. Lancet. 2009 Aug 22;374(9690):628-34. [University of
Bristol, Bristol, UK]
Title
 Therapist-delivered Internet psychotherapy for depression in primary
care: a randomised controlled trial.
Aim
 To investigate the effectiveness of CBT delivered online in real time by
a therapist for patients with depression in primary care.
Methods
 297 individuals with a score of 14 or more on the Beck depression
inventory (BDI) and a confirmed diagnosis of depression recruited from
55 general practices in Bristol, London, and Warwickshire, UK.
 Participants were randomly assigned, by a computer-generated code,
to online CBT in addition to usual care (intervention; n=149) or to usual
care from their general practitioner while on an 8-month waiting list for
online CBT (control; n=148).
Telemedicine - depression




Reference
 Kessler D, et al. Lancet. 2009 Aug 22;374(9690):628-34.
Methods
 The primary outcome was recovery from depression (BDI score <10) at
4 months. Analysis by intention to treat.
Results
 113 participants in the intervention group and 97 in the control group
completed 4-month follow-up.
 43 (38%) patients recovered from depression (BDI score <10) in the
intervention group versus 23 (24%) in the control group at 4 months
(p=0.011), and 46 (42%) versus 26 (26%) at 8 months (2.07, 1.11-3.87;
p=0.023).
Conclusion
 CBT effective when delivered online in real time by a therapist, with
benefits maintained over 8 months.
Telemedicine - depression


Reference
 Kessler D, et al. Lancet. 2009 Aug 22;374(9690):628-34.
Importance
 Extends 35+ year literature showing effectiveness of telemedicinemediated psychiatry services.
 Observed effects also consistent with more therapy better than less
therapy.
Telemedicine - insomnia




Reference
 Vincent N, Lewycky S., Sleep. 2009 Jun 1;32(6):807-15. [University of
Manitoba, Canada]
Title
 Logging on for better sleep: RCT of the effectiveness of online
treatment for insomnia.
Aim
 To evaluate the impact of a 5-week, online treatment for insomnia.
Methods
 Randomization of 118 adults with chronic insomnia to either online
treatment or waiting list control.
 Participants received online treatment in their homes.
 Online treatment consisted of psychoeducation, sleep hygiene, and
stimulus control instruction, sleep restriction treatment, relaxation
training, cognitive therapy, and help with medication tapering.
Telemedicine - insomnia



Reference
 Vincent N, Lewycky S., Sleep. 2009 Jun 1;32(6):807-15.
Results
 From pre- to post-treatment, there was a 33% attrition rate, and attrition
was related to referral status (i.e., dropouts were more likely to have
been referred for treatment rather than recruited from the community).
 Using a mixed model analysis of variance procedure (ANOVA), results
showed that online treatment produced statistically significant
improvements in the primary end points of sleep quality, insomnia
severity, and daytime fatigue.
 Online treatment also produced significant changes in process
variables of pre-sleep cognitive arousal and dysfunctional beliefs about
sleep.
Conclusion
 “Implications of these findings are that identification of who most
benefits from online treatment is a worthy area of future study.”
Telemedicine - insomnia


Reference
 Vincent N, Lewycky S., Sleep. 2009 Jun 1;32(6):807-15.
Importance
 An appealing Telemedicine application (“As long as I’m up, I
might as well…”)
 Beware cohort effects in technology evaluation studies
Telemedicine
Questions and Comments
Practice of Informatics
Practice of Informatics




Reference
 Simon SR et al. J Am Med Inform Assoc. 2009 Jul-Aug;16(4):465-70.
Epub 2009 Apr 23.[HMS and Harvard Pilgrim Healthcare, Boston,
MA]
Title
 Physicians' use of key functions in electronic health records from
2005 to 2007: a statewide survey.
Aim
 To determine physicians’ lack of use of EHR functionality is
decreasing over time.
Methods
 Follow-up mail survey of 1,144 physicians in Massachusetts who
completed a 2005 survey.
Practice of Informatics


Reference
 Simon SR et al. J Am Med Inform Assoc. 2009 Jul-Aug;16(4):46570. Epub 2009 Apr 23.[HMS and Harvard Pilgrim Healthcare,
Boston, MA]
Results
 Response rate was 79.4%.
 In 2007, 35% of practices had EHRs, up from 23% in 2005.
 Among practices with EHRs, there was little change between 2005
and 2007 in the availability of nine of ten EHR features; the notable
exception was electronic prescribing, reported as available in 44.7%
of practices with EHRs in 2005 and 70.8% in 2007.
 Use of EHR functions changed inconsequentially, with more than
one out of five physicians not using each available function regularly
in both 2005 and 2007.
 Only electronic prescribing increased substantially: in 2005, 19.9%
of physicians with this function available used it most or all the time,
compared with 42.6% in 2007 (p < 0.001)..
Practice of Informatics



Reference
 Simon SR et al. J Am Med Inform Assoc. 2009 Jul-Aug;16(4):465-70.
Epub 2009 Apr 23.[HMS and Harvard Pilgrim Healthcare, Boston, MA]
Conclusions
 By 2007, more than one third of practices in Massachusetts reported
having EHRs
 The availability and use of electronic prescribing within these systems
increased vs. 2005.
 In contrast, physicians reported little change in the availability and use
of other EHR functions.
 System refinements, certification efforts, and health policies, including
standards development, should address the gaps in both EHR
adoption and the use of key functions.
Importance
 Even the best applications won’t show outcomes differences if not
used
 Data for the national debate on ‘meaningful use’ of EHRs
Practice of Informatics



Reference
 Jha AK et al (Sr. author Blumenthal, D). N Engl J Med. 2009 Apr
16;360(16):1628-38. Epub 2009 Mar 25. [Dept of Health Policy &
Management, Harvard, Boston, MA]
Title
 Use of electronic health records in U.S. hospitals.
Aim
 To determine the presence of specific electronic-record
functionalities.
 To examine the relationship of adoption of electronic health records
to specific hospital characteristics and factors that were reported to
be barriers to or facilitators of adoption.
Practice of Informatics



Reference
 Jha AK et al (Sr. author Blumenthal, D). N Engl J Med. 2009 Apr
16;360(16):1628-38. Epub 2009 Mar 25. [Dept of Health Policy &
Management, Harvard, Boston, MA]
Methods
 Survey of all AHA member hospitals
Results
 63% response rate
 Of hospitals surveyed, only 1.5% have a comprehensive electronicrecords system (i.e., present in all clinical units), and an additional 7.6%
have a basic system (i.e., present in at least one clinical unit).
 Computerized provider-order entry for medications has been
implemented in only 17% of hospitals.
 Larger hospitals, those located in urban areas, and teaching hospitals
were more likely to have electronic-records systems.
 Respondents cited capital requirements and high maintenance costs as
the primary barriers to implementation, although hospitals with
electronic-records systems were less likely to cite these barriers than
hospitals without such systems.
Practice of Informatics


Reference
 Jha AK et al (Sr. author Blumenthal, D). N Engl J Med. 2009 Apr
16;360(16):1628-38. Epub 2009 Mar 25. [Dept of Health Policy &
Management, Harvard, Boston, MA]
Conclusions
 The very low levels of adoption of electronic health records in U.S.
hospitals suggest that policymakers face substantial obstacles to the
achievement of health care performance goals that depend on health
information technology.
 A policy strategy focused on financial support, interoperability, and
training of technical support staff may be necessary to spur adoption of
electronic-records systems in U.S. hospitals.
Practice of Informatics



Reference
 Stead, W.W. & Lin, H.S. (Eds.). (2009) Computer Science
and Telecommunications Board, National Research
Council. Washington, D.C.: National Academies Press.
Title
 Computational technology for effective health care:
immediate steps and strategic directions. Committee on
Engaging the Computer Science Research Community in
Health Care Informatics.
Aim
 National Academies report on ways to make progress in
EHR technologies and their broad scale implementation.
Practice of Informatics
Questions and Comments
New Literature Highlights:
Bioinformatics and
Computational Biology
Human Health and Disease
 The practice of bioinformatics

Bioinformatics: Human Health & Disease




Reference
 Treutlein J et al. Arch Gen Psychiatry. 2009 Jul;66(7):773-84
[Central Institute of Mental Health, Mannheim, Germany]
Title
 Genome-wide association study of alcohol dependence.
Aim
 To identify susceptibility genes for alcohol dependence through a
genome-wide association study (GWAS) and a follow-up study in a
population of German male inpatients with an early age at onset.
Methods
 Five university hospitals in southern and central Germany.
 GWAS included 487 male inpatients with alcohol dependence as
defined by the DSM-IV and an age at onset younger than 28 years
and 1358 population-based control individuals.
 Follow-up study included 1024 male inpatients and 996 agematched male controls.
 Outcome measures: significant association findings in the GWAS
and follow-up study with the same alleles.
Bioinformatics: Human Health & Disease




Reference
 Treutlein J et al. Arch Gen Psychiatry. 2009 Jul;66(7):773-84
[Central Institute of Mental Health, Mannheim, Germany]
Results
 In the combined analysis, 2 closely linked intergenic SNPs met
genome-wide significance (rs7590720, P = 9.72 x 10(-9);
rs1344694, P = 1.69 x 10(-8)). They are located on chromosome
region 2q35, which has been implicated in linkage studies for
alcohol phenotypes.
 Nine SNPs were located in genes, including the CDH13 and
ADH1C genes, that have been reported to be associated with
alcohol dependence.
Conclusion
 The first GWAS and follow-up study to identify a genome-wide
significant association in alcohol dependence.
Significance
 GWAS studies now venturing into behavioral disorders that may be
considered stigmatizing
Published Genome-Wide Associations through 6/2009, 439
published GWA at p < 5 x 10-8
NHGRI GWA Catalog
www.genome.gov/GWAStudies
Bioinformatics:
Human Health & Disease




Reference
 Mardis ER et al. N Engl J Med. 2009 Sep 10;361(11):1058-66. Epub 2009
Aug 5. [Dept. Genetics, Washington Univ, St. Louis, MO]
Title
 Recurring mutations found by sequencing an acute myeloid leukemia
genome.
Methods
 Massively parallel DNA sequencing use to obtain a very high level of
coverage (approximately 98%) of a primary, cytogenetically normal, de
novo genome for AML with minimal maturation (AML-M1) and a matched
normal skin genome.
Results




12 acquired (somatic) mutations identified within the coding sequences of
genes
52 somatic point mutations in conserved or regulatory portions of the
genome.
All mutations appeared to be heterozygous and present in nearly all cells in
the tumor sample.
The AML genome contained approximately 750 point mutations, of which
only a small fraction are likely to be relevant to pathogenesis.
Bioinformatics:
Human Health & Disease

Reference
 Mardis ER et al. N Engl J Med. 2009 Sep 10;361(11):1058-66. Epub
2009 Aug 5. [Dept. Genetics, Washington Univ, St. Louis, MO]

Conclusion


By comparing the sequences of tumor and skin genomes of a
patient with AML-M1, it is possible to identify recurring mutations
that may be relevant for pathogenesis.
Importance


Current GWAS studies involving SNPs still provide only a ‘picket
fence’ view of the genome for studies of disease mechanism.
Full genome sequencing will be the preferred technology for
many diseases when it becomes cost-effective.
Bioinformatics:
Human Health & Disease




Reference
 Turer AT et al. Circulation. 2009 Apr 7;119(13):1736-46. Epub 2009
Mar 23. [Duke Univ. Med Ctr., Durham, NC]
Title
 Metabolomic profiling reveals distinct patterns of myocardial
substrate use in humans with coronary artery disease or left
ventricular dysfunction during surgical ischemia/reperfusion.
Aim
 To characterize human myocardial metabolism in the setting of
surgical cardioplegic arrest and ischemia/reperfusion.
Methods
 Mass spectrometry-based platform used to profile 63 intermediary
metabolites in serial paired peripheral arterial and coronary sinus
blood effluents obtained from 37 patients undergoing cardiac
surgery, stratified by presence of coronary artery disease and left
ventricular dysfunction.
Bioinformatics:
Human Health & Disease



Reference
 Turer AT et al. Circulation. 2009 Apr 7;119(13):1736-46. Epub 2009
Mar 23. [Duke Univ. Med Ctr., Durham, NC]
Title
 Metabolomic profiling reveals distinct patterns of myocardial
substrate use in humans with coronary artery disease or left
ventricular dysfunction during surgical ischemia/reperfusion.
Results
 The myocardium was a net user of a number of fuel substrates
before ischemia, with significant differences between patients with
and without coronary artery disease.
 After reperfusion, significantly lower extraction ratios of most
substrates were found, as well as significant release of 2 specific
acylcarnitine species. These changes were especially evident in
patients with impaired ventricular function, who exhibited profound
limitations in extraction of all forms of metabolic fuels.
 Principal component analysis highlighted several metabolic
groupings as potentially important in the postoperative clinical
course.
Bioinformatics:
Human Health & Disease



Reference
 Turer AT et al. Circulation. 2009 Apr 7;119(13):1736-46. Epub 2009
Mar 23. [Duke Univ. Med Ctr., Durham, NC]
Conclusions
 The preexisting ventricular state is associated with significant
differences in myocardial fuel uptake at baseline and after
ischemia/reperfusion.
 The dysfunctional ventricle is characterized by global suppression
of metabolic fuel uptake and limited myocardial metabolic reserve
and flexibility after global ischemia/reperfusion stress in the setting
of cardiac surgery.
 Altered metabolic profiles after ischemia/reperfusion are associated
with postoperative hemodynamic course and suggest a role for
perioperative metabolic monitoring and targeted optimization in
cardiac surgical patients.
Importance

Metabolomics is another “high dimensionality” class of data that will
eventually influence clinical decision support.
Bioinformatics:
Human Health & Disease




Reference
 Rello J et al. Chest. 2009 Sep;136(3):832-40. Epub 2009 May
11. [Hospital Universitari, Tarragona, Spain]
Title
 Severity of pneumococcal pneumonia associated with genomic
bacterial load.
Aim
 To develop objective methods of identifying patients at risk for
septic shock and poorer outcomes among those with
community-acquired pneumonia (CAP).
Methods
 Quantification of Streptococcus pneumoniae DNA level by realtime polymerase chain reaction (rt-PCR) was prospectively
conducted on whole-blood samples from a cohort of 353 patients
who were displaying CAP symptoms upon their admission to the
ED.
Bioinformatics:
Human Health & Disease


Reference
 Rello J et al. Chest. 2009 Sep;136(3):832-40. Epub 2009 May
11. [Hospital Universitari, Tarragona, Spain]
Results
 CAP caused by S pneumoniae was documented in 93 patients
(36.5% with positive blood culture findings). A positive S
pneumoniae rt-PCR assay finding was associated with a
statistically significant higher mortality (odds ratio [OR], 7.08),
risk for shock (OR, 6.29), and the need for mechanical
ventilation (MV) [OR, 7.96].
 Logistic regression, adjusted for age, sex, comorbidities, and
pneumonia severity index class, revealed bacterial load as
independently associated with septic shock (adjusted odds ratio
[aOR], 2.42; 95% CI, 1.10 to 5.80) and the need for MV (aOR,
2.71; 95% CI, 1.17 to 6.27).
 An S pneumoniae bacterial load of >or= 10(3) copies per
milliliter occurred in 29.0% of patients (27 of 93 patients; 95% CI,
20.8 to 38.9%) being associated with a statistically significant
higher risk for septic shock (OR, 8.00), the need for MV (OR,
10.50), and hospital mortality (OR, 5.43). .
Bioinformatics:
Human Health & Disease



Reference
 Rello J et al. Chest. 2009 Sep;136(3):832-40. Epub 2009
May 11. [Hospital Universitari, Tarragona, Spain]
Conclusions
 In patients with pneumococcal pneumonia, bacterial load
is associated with the likelihood of death, the risk of septic
shock, and the need for MV.
 High genomic bacterial load for S pneumoniae may be a
useful tool for severity assessment.
Importance
 Disease diagnosis and prognosis based on pathogen DNA
type and load is an emerging area of clinical bioinformatics
Computational Biology
and Bioinformatics
Questions and Comments
Top Ten List of
Notable Events
in the Past 12 months
“Top Ten” Events
10. Appointment of Francis Collins as NIH Director
“Top Ten” Events
10. Appointment of Francis Collins as NIH Director
9. High throughput sequencing technologies result in hyper-exponential
increases in the genomic data analyzed, stored and distributed.
“Over the past year, 10 trillion base
pairs of high-throughput sequence
data were submitted to NCBI and
placed in a new database
(Sequence Read Archive) designed
specifically for these types of data.
To put that number in perspective,
these data are already 40 times
greater than the 250 billion base
pairs that were deposited over the
last 20 years in NCBI's GenBank
DNA sequence database. “
Betsy Humphreys
“Top Ten” Events
10. Appointment of Francis Collins as NIH Director
9. High throughput sequencing technologies result in exponential increases in
the genomic data analyzed, stored and distributed.
8. AMIA Clinical Informatics sub-certificate being sponsored by American Board
of Preventive Medicine to the American Board of Medical Specialties.
“Top Ten” Events
10. Appointment of Francis Collins as NIH Director
9. High throughput sequencing technologies result in exponential increases in
the genomic data analyzed, stored and distributed.
8. AMIA Clinical Informatics sub-certificate being sponsored by American Board
of Preventive Medicine to the American Board of Medical Specialties.
7. Launch of PMC Canada: the trend toward broader access to research results
“Top Ten” Events
10. Appointment of Francis Collins as NIH Director
9. High throughput sequencing technologies result in exponential increases in
the genomic data analyzed, stored and distributed.
8. AMIA Clinical Informatics sub-certificate being sponsored by American Board
of Preventive Medicine to the American Board of Medical Specialties.
7. Launch of PMC Canada: the trend toward broader access to research results
(July 6, 2009)
6. Senate Finance Committee alleges serious computer flaws from doctors,
patients and engineers unhappy with current systems, demanding to know
what steps vendors have taken to safeguard patients. (October 16)
“Top Ten” Events
10. Appointment of Francis Collins as NIH Director
9. High throughput sequencing technologies result in exponential increases in
the genomic data analyzed, stored and distributed.
8. AMIA Clinical Informatics sub-certificate being sponsored by American Board
of Preventive Medicine to the American Board of Medical Specialties.
7. Launch of PMC Canada: the trend toward broader access to research results
6. Senate Finance Committee alleges serious computer flaws from doctors,
patients and engineers unhappy with current systems, demanding to know
what steps vendors have taken to safeguard patients. (October 16)
5. Passage of ARRA established ONC in law and expands its responsibilities
and budget
“Top Ten” Events
10. Appointment of Francis Collins as NIH Director
9. High throughput sequencing technologies result in exponential increases in
the genomic data analyzed, stored and distributed.
8. AMIA Clinical Informatics sub-certificate being sponsored by American Board
of Preventive Medicine to the American Board of Medical Specialties.
7. Launch of PMC Canada: the trend toward broader access to research results
6. Senate Finance Committee alleges serious computer flaws from doctors,
patients and engineers unhappy with current systems, demanding to know
what steps vendors have taken to safeguard patients. (October 16)
5. Passage of ARRA established ONC in law and expands its responsibilities
and budget
4. Passage of ARRA brings new breach notification and expansion of HIPAA
privacy/security requirements
“Top Ten” Events
10. Appointment of Francis Collins as NIH Director
9. High throughput sequencing technologies result in exponential increases in
the genomic data analyzed, stored and distributed.
8. AMIA Clinical Informatics sub-certificate being sponsored by American Board
of Preventive Medicine to the American Board of Medical Specialties.
7. Launch of PMC Canada: the trend toward broader access to research results
6. Senate Finance Committee alleges serious computer flaws from doctors,
patients and engineers unhappy with current systems, demanding to know
what steps vendors have taken to safeguard patients. (October 16)
5. Passage of ARRA established ONC in law and expands its responsibilities
and budget
4. Passage of ARRA brings new breach notification and expansion of HIPAA
privacy/security requirements
3. Passage of ARRA provides extra $10 billion for NIH ($83 million to NLM)
“Top Ten” Events
10. Appointment of Francis Collins as NIH Director
9. High throughput sequencing technologies result in exponential increases in
the genomic data analyzed, stored and distributed.
8. AMIA Clinical Informatics sub-certificate being sponsored by American Board
of Preventive Medicine to the American Board of Medical Specialties.
7. Launch of PMC Canada: the trend toward broader access to research results
6. Senate Finance Committee alleges serious computer flaws from doctors,
patients and engineers unhappy with current systems, demanding to know
what steps vendors have taken to safeguard patients. (October 16)
5. Passage of ARRA established ONC in law and expands its responsibilities
and budget
4. Passage of ARRA brings new breach notification and expansion of HIPAA
privacy/security requirements
3. Passage of ARRA provides extra $10 billion for NIH ($83 million to NLM)
2. Passage of ARRA requires establishment of first set of "meaningful use"
criteria for EHRs
And the #1 top event of
2009 is…
“Top Ten” Events
10. Appointment of Francis Collins as NIH Director
9. High throughput sequencing technologies result in exponential increases in the
genomic data analyzed, stored and distributed.
8. AMIA Clinical Informatics sub-certificate being sponsored by American Board
of Preventive Medicine to the American Board of Medical Specialties.
7. Launch of PMC Canada: the trend toward broader access to research results
6. Senate Finance Committee alleges serious computer flaws from doctors,
patients and engineers unhappy with current systems, demanding to know
what steps vendors have taken to safeguard patients. (October 16)
5. Passage of ARRA established ONC in law and expands its responsibilities and
budget (March 2009)
4. Passage of ARRA brings new breach notification and expansion of HIPAA
privacy/security requirements
3. Passage of ARRA provides extra $10 billion for NIH ($83 million to NLM)
2. Passage of ARRA requires establishment of first set of "meaningful use"
criteria for EHRs
1. Passage of ARRA provides billions for EHR adoption
“Top Ten” Events
10. Appointment of Francis Collins as NIH Director
9. High throughput sequencing technologies result in exponential increases in
the genomic data analyzed, stored and distributed.
8. AMIA Clinical Informatics sub-certificate being sponsored by American Board
of Preventive Medicine to the American Board of Medical Specialties.
7. Launch of PMC Canada: the trend toward broader access to research results
6. Senate Finance Committee alleges serious computer flaws from doctors,
patients and engineers unhappy with current systems, demanding to know
what steps vendors have taken to safeguard patients. (October 16)
5. Passage of ARRA established ONC in law and expands its responsibilities
and budget
4. Passage of ARRA brings new breach notification and expansion of HIPAA
privacy/security requirements
3. Passage of ARRA provides extra $10 billion for NIH ($83 million to NLM)
2. Passage of ARRA requires establishment of first set of "meaningful use"
criteria for EHRs
1. Passage of ARRA provides billions for EHR adoption
2009: Informatics’ Big Chance Begins
Content for this session is at:
http://dbmichair.mc.vanderbilt.edu/amia2009/
including citation lists and links
and this PowerPoint