Don E. Detmer, MD, MAPresident & CEO, AMIA;
Prof. Med. Education, UVA__________________________
University of MichiganSeptember 2008
Organizing Informatics at Michigan for Health, Care, Education, &
Research
• Last here for the University of Michigan Informatics Grand Rounds – November 3, 2006
Then: Current Issues in Improving Clinical Practice through Informatics
Today: Clinical Practice & beyond…
Informatics
Informatics is the study of information & the ways information is used by & affects people & social systems.
Experts in this field design information technology tools for scientific, business, & cultural needs, & study how such tools are used.
- School of Information, University of Michigan
What is Biomedical/Health Informatics?
“An integrative scientific field that draws upon the information sciences & related technology to enhance the use of the knowledge base of the health sciences to improve health care, biomedical & clinical research, education, management, & policy.”
- D.E. Detmer
Informatics is a Means to Ends.
– "It is the pervading law of all things organic and inorganic,
– Of all things physical and metaphysical, – Of all things human and all things super-human, – Of all true manifestations of the head, – Of the heart, of the soul, – That the life is recognizable in its expression, – That form ever follows function. This is the
law.”
- Louis Sullivan (1896)
Biomedical/Health Informatics*
• Clinical Informatics, including– Clinical Research
• Hypothesis Generation, Phase 3, etc. – EHRs / PHRs - Consumer Health
• Public Health Informatics• Translational Bioinformatics• VISION (Visualization, Imaging, & Simulation
in Organs & Networks)
* Overlap among domains is appropriate
We are tracking a moving target.
- Gil Omenn 2006
What ends will you pursue? Where are you headed?
• Better Health of Citizens• Better Care for Patients• Economic Development of Michigan• Research Grants• Winning Teams
Population & Annual Costs EstimatesPopulation & Annual Costs Estimates
Healthy
Lynn et al., 2007
Acutely ill
Living with chronic illness/ disability
Coping with illness at the end of life
170 million
12 million
117 million
9 million
$1,118//yr
$25,000 //yr
$9,316 //yr
$46,667 //yr …
$190 billion/yr
$300 billion
$1090 billion
$420 billion
Paying for care instead of improving health
America spends 15% of GDP on health care by far more than anyone yet ranks 22nd for men & 25th for women for life expectancy, and 25th for both infant mortality & low birth weight. WHY?
Poor continuity of care plus disproportionate costs at end of life
Better predictors of health are socio-economic status, average per capita income, income inequality & woman’s education status.
17% of Americans live in poverty, when developed country average is 10.2%. Only 2.3% of U.S. GDP is spent on efforts to reduce poverty v. 5.8 Canada & 9.6 Netherlands.
Prescription for AHC Leaders- Claire Pomeroy, MD, PhD
(Blue Ridge Group meeting 2008)
• The further we distance new policies from the reality of social determinants, the more health care costs will rise while U.S. health declines over time.
• Reach beyond traditional medical care delivery mechanisms• Coordinate closely with a broad range of government &
community leaders• Create integrated, multi-sector policies & structures to
improve societal health & reduce disparities in a cost-effective manner
Distribution of Distribution of Determinants of HealthDeterminants of Health
Medical Care 20%
Behavioral Factors 20%
Environmental &Societal Factors 55%
Genetics 5%
Source: Sowada, 2003
Continuum of Care MechanismsContinuum of Care Mechanisms
Healthy
Acutely ill
Living with chronic illness/ disability
Frail/ Coping with illness at the end of life
Population tracking/ “health home” / “personalized” care
Transitional Care
Chronic Care Management
PACE*/ Hospice
Care
Courtesy of
Mary Naylor, RN, PhD
*Program for All-inclusive Care of the Elderly
Care Continuum: Portfolio of EHRs Care Continuum: Portfolio of EHRs Needed Needed
Healthy
Acutely ill
Living with chronic illness/ disability
Frail/ Coping with illness at the end of life
Population tracking/ “health home”
Transitional Care
Chronic Care Management
PACE*/ Hospice
Care
Adapted from
Mary Naylor, RN, PhD
*Program for All-inclusive Care of the Elderly
A Comprehensive Integrated University-wide Strategy for the
University of Michigan
Biomedical and Health Informatics• Components
– Health– Care– Education– Research
Work in Parallel with AMIA’s Strategic Vision
• Through informatics, transform health & health care for individuals & populations– Care that is Equitable, Efficient, Effective,
Patient-centered, Timely, Safe– Healthy populations in healthy environments
• Transform informatics from a serious avocation to a formally recognized health profession
Finish the Foundational Informatics Infrastructure
• Semantic Grid – Data computational layer
• Data stored, transferred & analyzed
– Information layer• Data associated with meaning
– Knowledge layer • Use of information for a purpose
See University of Minnesota CTSA Strategy
Informatics Planning MatrixClinical Informatics
Public Health
Translational Bioinformatics
VISION
Health Who, what, when, how, where, $s
Care
Education
Research
• Genetics• Cardiovascular Center• CS Mott Children’s & Women’s Hospital/Peds• Kellogg Eye Center• Brehm Center for Type 1 Diabetes*• Global goals (AMIA Gate’s twinning program)
‘Informatics for Excellence’ programs tied to Michigan’s strengths
Biomedical & Health Informatics Departmental Issues
• Institutional Service Linkages/Responsibilities• Divisions
– Clinical Informatics– Translational Bioinformatics
• Faculty issues– Total slots/ Core Fulltime/Joint
Appointments/Salary /Criteria for Promotion • Agreements on Overhead• Educational focus• Research
University-wide Strategic Governance Group (7-12 people)
• Biomedical Informatics Strategic Policy Group
• Biomedical Informatics Operations Subgroup– Academic Department for Education & Research
Components– Service Unit(s) with Active Clinical Components
• Health Informatics Strategic Policy Group• Health Informatics Operations Subgroup
– Academic Unit to lead Education & Research Components
– Service Unit identified heads up Policy Componentwith outside representation
University-wide Strategy & Governance Group (7-12 people)
• Planning
– Components– Players– Programs– Initiatives
• Governance– Services– Business agreements– Data sharing and networks
– Community building
Build from current Informatics strengths at Michigan
• Health Sciences– MICHR/CTSA Biomedical Informatics
Program– Clinical Research Informatics Core– Health Disparities Component
• School of Information– Informatics
• Others
Approved this past spring, informatics is a joint program of the College of Literature, Science, & the Arts; the College of Engineering; and the School of Information. (Sept. 2008)
Biomedical Informatics Partnering Schools/Colleges at University of
Michigan• Business• Dentistry• Engineering • LSA (parts)• Medicine• Nursing• Pharmacy• Public Health
Example of Clinical Informatics Agenda -
Assuring Value in Clinical Settings• Complete Infrastructure
• from “Got EHR?” to “Got EHR! Now what?!”– Instill Learning Care Culture– Institute EHR/Work Redesign Program
• Electronic Health Records– Secure Portal for Patients– Enhance Clinical Decision Support
• Best Practices & Scale for General Users– Esp. Chronic Illness Management, Population tracking/
“health home” / “personalized” care
Example of Clinical Informatics Agenda -
Assuring Value in Clinical Settings• Complete Infrastructure
– Instill Learning Care Culture– Institute EHR/Work Redesign Program
• Electronic Health Records– Secure Portal for Patients– Enhance Clinical Decision Support
• Best Practices & Scale for General Users– Esp. Chronic Illness Management, Population
tracking/ “health home” / “personalized” care
Develop Specific Plans/Programs for Care, Education, & Research5-7 yr. goals; 2 yr. work plans
Ex: Biomedical (Care)- Engineering & Medicine
• Systems Engineering• Work flow• Complex Adaptive Systems
*see http://www.sys.virginia.edu/healthcare/
The Future of Care: Manage Change supported by
Information Technology & Informatics
• Build Knowledgeable Teams• Reinvent Workflow • Integrate Innovations*• Remove ‘Outdated’ Practices• Reduce Variation• Improve Safety/Quality while Reducing Costs• Manage the Base of Knowledge
*Innovation student teams w/ Business School National Academies: “Building a Better Delivery System”
National Academy Press, 2005
Also, Business School & Biomedical Care Dimensions
• Complex adaptive systems• Organizational behavior• Marketing• Supply Chain Management• Strategic planning
Health Informatics –Schools/Colleges at University of
Michigan
• Education• Information • Law• LSA (parts)• Medicine• Nursing• Public Health• Public Policy• Social Work
The time lag which exists between the fact of change & the social & political understanding of what has happened.
- Henry Adams
Law of Acceleration of Changing Times
Some Disruptive Technologies:Telegraph, Telephone, Television,
Internet - Web 1.0 & Web 2.0
“If you study politics, military events & things like that , you’re studying how history gets made from the top down.”
“But you can also study the common people, history from the bottom up, because they’re making history, as well.”
- Daniel Walker Howe
Disruptive Technology Web 1.0 Web 2.0
Biomedical Informatics(science-based)• Top down• “Controlled from on
high”– HIPAA rules
• Privacy #1*
• Health & Freedom #3
Health Informatics(narrative-based)• Bottom up• “Power to the People”
– Personal Choice rules: Ex. PatientsLikeMe
• Freedom & Health #1;
• Privacy #3 *www.sciencexpress.org /4 September 2008 / Page 1/ 10.1126/science.1165490
The Driver’s License Solution• Add 3 more ‘opt out’ icons to the Organ Donor option
– Do not use my driver’s license # for electronic healthcare record authentication purposes
• Suggested symbol – EHR# or EHR#
– Do not allow my healthcare record information to be sent to me & my healthcare professionals
• Suggested symbol or *
– Do not allow my healthcare record information to be used for medical research (IRB approved research) & to contact me for relevant research
• Suggested symbol
or *
* Does not preclude my being asked at care sites
© DEDetmer 2006
Public Health/Population Informatics;Consumer Health Informatics
• Consumer oriented Education & Support (Citizen/Patient/Informal Caregivers)• Integrated Personal Health Record*
*See Detmer DE, Bloomrosen M, Raymond B, Tang P: Integrated personal health records: Transformative tools for consumer-centric care. 2008 BMC Medical Informatics and Decision Making (in press)
Education Strategy
• Participate in AMIA’s 10x10 Program– Translational Bioinformatics– Clinical Informatics– Public Health Informatics– (Consumer Informatics)
• Consider collaboration in AMIA International Developments– 20/20 Bits/Bytes Courses
National Readiness Assessment Instrument; other tool kits
PhD; Masters Informatics__________________________
Clinician/Public Health 10x10 Champions
______________________________20/20 “Bits &Bytes” Knowledge & Skills
Offerings
Executive Seminars;Leadership ID,
Training & Advocacy
Global ‘South’ Components of Needs &20/20 Vision for Assuring eHealth Capacity
Policy &Leadership
Human Capital
(eHealth Workforce Capacity)
State of ICT Technology Infrastructure
Components
Vision for eHealth Workforce
Education Strategy
• Participate in AMIA’s Academic Forum
– Develop Clinical Informatics Training Program for MD sub-certification
– Develop parallel Nursing/Pharmacy/Dentistry Informatics Training Programs
– Engage issues such as salary structure & promotion criteria
– Require Common Core ICT/Informatics Education for all health professional students (AMIA’s Academic Strategic Leadership Council initiative)
Informatics Tracks (Now & Future*)
• Doctoral Level– Academic/Research Career – PhD
• Medicine: Translational Bioinformatics /Clinical Informatics• Nursing/Public Health Informatics/Other• NLM’s Training Programs plus other university programs
• Master’s– Clinical Informatics– Public Health/Population Informatics
• CDC
– Health Information Management
• Certificates *– Fellowships & Medical Sub-certification– 10x10 – AMIA Graduate Level Course work– 20/20 Bits/Bytes – Global Informatics Education
University-wide Informatics R&D Template
Use Informatics Toolkits/ EHRs to Assess Environment & Evaluation of Interventions• Easing life transitions
–Healthy to acutely ill–Acutely ill to chronically ill–Chronically ill to End-of-life
• Personal health assessment / support• Population – community health assessment• Public Health
Measuring Excellence in 2015
It’s not human memory & technology (IT) per se that will matter.
It’s integrating carbon & silicon-based intelligence (Informatics) across disciplines to create needed change.
Well done is better than well said.
- Benjamin Franklin
Upcoming AMIA Events
Grand Hyatt San FranciscoSan Francisco, CaliforniaMarch 15-17, 2009
2nd Annual Summit on Translational Bioinformatics
Yves Lussier, Program Chair
Jaap Suermondt,
Program Chair
AMIA 2008 Annual SymposiumHilton Washington Hotel and TowersWashington, DCNovember 8-12, 2008
Hyatt Reston, Reston VASeptember 15, 2008
AMIA Health Policy Forum
Doug Fridsma,Suzanne Markel-Fox
2009 AMIA Spring Congress Walt Disney World Swan Orlando, Florida May 28-30, 2009
Patti Abbott, Program Chair
Personal reflections on this topic
1. Warner HR, Detmer DE, Peay WJ. IAIMS implementation and administration at the University of Utah. Proc Fifth Conf Med Informatics 1986; p. 1-6.
2. Detmer DE. The Future of IAIMS in a Managed Care Environment: A Call for Private Action and Public Investment. JAMIA 1997; 4, S65-S72.
3. Detmer DE, Steen EB: Information & Communications Technology & the Future Health Workforce: Transformative Opportunities & Critical Challenges. In Holmes DE: From Education to Regulation: Dynamic Challenges for the Health Workforce. Assoc. Acad. Health Centers,
2008, Washington, DC, pp.21-46.
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