Daniel R. Masys, MD Professor and Chair Department of Biomedical Informatics Professor of Medicine

Biomedical Informatics Biomedical Informatics Year in ReviewYear in Review

Notable publications and events in Informatics Notable publications and events in Informatics since the 2007 AMIA Symposiumsince the 2007 AMIA Symposium

Daniel R. Masys, MDDaniel R. Masys, MD

Professor and ChairProfessor and Chair

Department of Biomedical InformaticsDepartment of Biomedical Informatics

Professor of MedicineProfessor of Medicine

Vanderbilt University School of MedicineVanderbilt University School of Medicine

Content for this session is Content for this session is at:at:

http://dbmichair.mc.vanderbilt.edu/amia2http://dbmichair.mc.vanderbilt.edu/amia2008/008/

including citation lists and linksincluding citation lists and linksand this PowerPointand this PowerPoint

Design for this SessionDesign for this Session

• Modeled on American College of Modeled on American College of Physician “Update” sessionsPhysician “Update” sessions

• Emphasis on ‘what it is’ and ‘why it Emphasis on ‘what it is’ and ‘why it is important’is important’

• 1-2 examples of each in detail and 1-2 examples of each in detail and others in synopsisothers in synopsis

• Audience interaction for each Audience interaction for each category of item discussedcategory of item discussed

Source of Content for Source of Content for SessionSession

• Literature review of RCTs indexed by Literature review of RCTs indexed by MeSH term “Medical Informatics”, MeSH term “Medical Informatics”, “Telemedicine” & descendents or main “Telemedicine” & descendents or main MeSH term “Bioinformatics”, and Entrez MeSH term “Bioinformatics”, and Entrez date between November 2007 and date between November 2007 and October 2008 further qualified by October 2008 further qualified by involvement of >100 providers or involvement of >100 providers or patients (n=31)patients (n=31)

• Poll of American College of Medical Poll of American College of Medical Informatics fellows listInformatics fellows list

Thanks toThanks to

• Rebecca JeromeRebecca Jerome• Russ AltmanRuss Altman• David BatesDavid Bates• Don DetmerDon Detmer• Parvati DevParvati Dev• Robert DolinRobert Dolin• Peter ElkinPeter Elkin• Charles FriedmanCharles Friedman• Robert FriedmanRobert Friedman• Betsy HumphreysBetsy Humphreys

• George HripcsakGeorge Hripcsak• Isaac KohaneIsaac Kohane• Nancy LorenziNancy Lorenzi• Randy MillerRandy Miller• Meryl RosenbloomMeryl Rosenbloom• Dean SittigDean Sittig• David StatesDavid States• Justin StarrenJustin Starren• Mark TuttleMark Tuttle

It takes a village…It takes a village…

TopicsTopics

• Representative New Literature Representative New Literature • Notable Events – the ‘Top Ten’ Notable Events – the ‘Top Ten’

listlist

New Literature Highlights: New Literature Highlights: Clinical InformaticsClinical Informatics

• Clinical Decision SupportClinical Decision Support• Personal Health RecordsPersonal Health Records• TelemedicineTelemedicine• The practice of informaticsThe practice of informatics

New Literature Highlights: New Literature Highlights: Bioinformatics and Bioinformatics and

Computational BiologyComputational Biology

• Human Health and DiseaseHuman Health and Disease• The practice of The practice of

bioinformaticsbioinformatics

Clinical Decision SupportClinical Decision Support

Clinical Decision Support for Clinical Decision Support for ProvidersProviders

• ReferenceReference– Stevens J et al. Pediatrics. 2008 Jun;121(6):1099-105. [Childrens Stevens J et al. Pediatrics. 2008 Jun;121(6):1099-105. [Childrens

Hospital, Columbus, OH]Hospital, Columbus, OH]

• TitleTitle– Trial of computerized screening for adolescent Trial of computerized screening for adolescent

behavioral concerns.behavioral concerns.• AimAim

– to determine whether computerized screening with to determine whether computerized screening with real-time printing of results for pediatricians real-time printing of results for pediatricians increased the identification of injury risk, depressive increased the identification of injury risk, depressive symptoms, and substance use among adolescents.symptoms, and substance use among adolescents.

• MethodsMethods– 878 primary care pts 11-20 yrs old from low income 878 primary care pts 11-20 yrs old from low income

populationspopulations

• ReferenceReference– Stevens J et al. Pediatrics. 2008 Jun;121(6):1099-105. Stevens J et al. Pediatrics. 2008 Jun;121(6):1099-105.

• Methods, cont’dMethods, cont’d– Clinics randomly assigned to have pediatricians Clinics randomly assigned to have pediatricians

receive screening results either just before face-to-receive screening results either just before face-to-face encounters with patients (immediate-results face encounters with patients (immediate-results condition) or 2 to 3 business days later (delayed-condition) or 2 to 3 business days later (delayed-results condition)results condition)

– Measures: numbers of conditions identified and Measures: numbers of conditions identified and recognition rate by clinical providers.recognition rate by clinical providers.

• ResultsResults– 59% of respondents had 1 or more behavioral issues59% of respondents had 1 or more behavioral issues– Of those screen positive, 68% were identified and Of those screen positive, 68% were identified and

documented by clinicians vs. 52% in delayed results documented by clinicians vs. 52% in delayed results groupgroup


• ReferenceReference– Stevens J et al. Pediatrics. 2008 Jun;121(6):1099-Stevens J et al. Pediatrics. 2008 Jun;121(6):1099-

105. 105.

• ImportanceImportance– Adds to an extensive literature that patient Adds to an extensive literature that patient

provided information via a variety of care provided information via a variety of care setting input methods (portals, waiting setting input methods (portals, waiting room kiosks and workstations, tablet PCs) room kiosks and workstations, tablet PCs) can influence identification and care can influence identification and care planning for health conditionsplanning for health conditions



• ReferenceReference– Poller et al. J Thromb Haemost. 2008 Jun;6(6):935-43. [Univ. Poller et al. J Thromb Haemost. 2008 Jun;6(6):935-43. [Univ.

Manchester, UK]Manchester, UK]

• TitleTitle– An international multicenter randomized study of computer-An international multicenter randomized study of computer-

assisted oral anticoagulant dosage vs. medical staff dosage.assisted oral anticoagulant dosage vs. medical staff dosage.• AimAim

– To compare the safety and effectiveness of computer-To compare the safety and effectiveness of computer-assisted dosage with dosage by experienced medical staff assisted dosage with dosage by experienced medical staff at the same centers.at the same centers.

• MethodsMethods– A randomized study of dosage of two commercial A randomized study of dosage of two commercial

computer-assisted dosage programs (PARMA 5 and DAWN computer-assisted dosage programs (PARMA 5 and DAWN AC) vs. manual dosage at 32 centers in 13 countries. AC) vs. manual dosage at 32 centers in 13 countries.


• ReferenceReference– Poller et al. J Thromb Haemost. 2008 Jun;6(6):935-43. Poller et al. J Thromb Haemost. 2008 Jun;6(6):935-43.

• Methods, cont’dMethods, cont’d– Safety and effectiveness of computer-assisted dosage Safety and effectiveness of computer-assisted dosage

were compared with those of medical staff dosage.were compared with those of medical staff dosage.• ResultsResults

– 13,219 patients participated, 6503 patients being 13,219 patients participated, 6503 patients being randomized to medical staff and 6716 to computer-randomized to medical staff and 6716 to computer-assisted dosage. assisted dosage.

– International Normalized Ratio (INR) tests numbered International Normalized Ratio (INR) tests numbered 193,890 with manual dosage and 193,424 with computer-193,890 with manual dosage and 193,424 with computer-assisted dosage.assisted dosage.

– In the 3209 patients with deep vein thrombosis/ In the 3209 patients with deep vein thrombosis/ pulmonary embolism, 37 fewer clinical events (24%, P = pulmonary embolism, 37 fewer clinical events (24%, P = 0.001) for computer assisted dosage.0.001) for computer assisted dosage.


• ReferenceReference– Poller et al. J Thromb Haemost. 2008 Jun;6(6):935-43. Poller et al. J Thromb Haemost. 2008 Jun;6(6):935-43.

• Results, cont’dResults, cont’d– Time in target INR range improved with Time in target INR range improved with

computer assisted dosage (P<.0001)computer assisted dosage (P<.0001)• ImportanceImportance

– Adds to an extensive literature on anticoagulant Adds to an extensive literature on anticoagulant dosage clinical decision support that has dosage clinical decision support that has consistently shown outcomes improvement vs. consistently shown outcomes improvement vs. unaided clinician judgment. unaided clinician judgment.

– First international multicenter study (32 sites) to First international multicenter study (32 sites) to show that effects are robust across a large show that effects are robust across a large number of care settings worldwide number of care settings worldwide

Clinical Decision Support for Clinical Decision Support for ProvidersProviders• ReferenceReference

– Weber V, White A, McIlvried R. J Gen Intern Med. 2008 Apr;23(4):399-404. Weber V, White A, McIlvried R. J Gen Intern Med. 2008 Apr;23(4):399-404. [Geisinger Health Sys, Danville PA][Geisinger Health Sys, Danville PA]

• TitleTitle– An electronic medical record (EMR)-based intervention to An electronic medical record (EMR)-based intervention to

reduce polypharmacy and falls in an ambulatory rural elderly reduce polypharmacy and falls in an ambulatory rural elderly population.population.

• AimAim– To evaluate an EMR-based intervention to reduce overall To evaluate an EMR-based intervention to reduce overall

medication use, psychoactive medication use, and occurrence medication use, psychoactive medication use, and occurrence of falls in an ambulatory elderly population at risk for falls.of falls in an ambulatory elderly population at risk for falls.

• MethodsMethods– Standardized medication review conducted and Standardized medication review conducted and

recommendations made to the primary physician via the recommendations made to the primary physician via the EMR. Randomized by clinic to intervention vs. normal careEMR. Randomized by clinic to intervention vs. normal care

• ReferenceReference– Weber V, White A, McIlvried R. J Gen Intern Med. 2008 Apr;23(4):399-404.Weber V, White A, McIlvried R. J Gen Intern Med. 2008 Apr;23(4):399-404.

• Methods, cont’dMethods, cont’d– Patients contacted to obtain self reports of falls at 3-month Patients contacted to obtain self reports of falls at 3-month

intervals over the 15-month period of study. intervals over the 15-month period of study. – Fall-related diagnoses and medication data were collected Fall-related diagnoses and medication data were collected

through the EMR.through the EMR.• ResultsResults

– 620 Pts over age 70 enrolled.620 Pts over age 70 enrolled.– Intervention did not reduce the total number of medications, Intervention did not reduce the total number of medications,

but reduced prescribing of psychoactive meds (P < .01)but reduced prescribing of psychoactive meds (P < .01)– Intervention group had 0.38 risk of falls vs. controls as Intervention group had 0.38 risk of falls vs. controls as

documented by EMR (P < .01) but no difference when self documented by EMR (P < .01) but no difference when self report data added. report data added.


• ReferenceReference– Weber V, White A, McIlvried R. J Gen Intern Med. Weber V, White A, McIlvried R. J Gen Intern Med.

2008 Apr;23(4):399-404.2008 Apr;23(4):399-404.

• ConclusionConclusion– EMR to assess medication use in the elderly may EMR to assess medication use in the elderly may

reduce the use of psychoactive medications and reduce the use of psychoactive medications and falls in a community-dwelling elderly population.falls in a community-dwelling elderly population.

• ImpactImpact– Looking only inside the EMR may miss real world Looking only inside the EMR may miss real world

health events. Best to gather independent health events. Best to gather independent observations if possible in interventional studies. observations if possible in interventional studies.



– van Wyk et al. Circulation. 2008 Jan 22;117(3):371-8. [Erasmus van Wyk et al. Circulation. 2008 Jan 22;117(3):371-8. [Erasmus Univ, Rotterdam, Netherlands].Univ, Rotterdam, Netherlands].

• TitleTitle– Electronic alerts versus on-demand decision support to improve Electronic alerts versus on-demand decision support to improve

dyslipidemia treatment: a cluster randomized controlled trial.dyslipidemia treatment: a cluster randomized controlled trial.• AimAim

– To study the effect of both alerting and on-demand decision To study the effect of both alerting and on-demand decision support with respect to screening and treatment of dyslipidemia support with respect to screening and treatment of dyslipidemia based on guidelines of the Dutch College of General based on guidelines of the Dutch College of General Practitioners. Practitioners.

• MethodsMethods– Cluster randomized trial 38 Dutch general practices (77 Cluster randomized trial 38 Dutch general practices (77

physicians) who used the ELIAS electronic health record, and physicians) who used the ELIAS electronic health record, and 87,886 of their patients87,886 of their patients


– van Wyk et al. Circulation. 2008 Jan 22;117(3):371-8. [Erasmus van Wyk et al. Circulation. 2008 Jan 22;117(3):371-8. [Erasmus Univ, Rotterdam, Netherlands].Univ, Rotterdam, Netherlands].

• Methods, cont’dMethods, cont’d– Each practice assigned to receive alerts, on-demand support, or Each practice assigned to receive alerts, on-demand support, or

no intervention. no intervention. – Outcome: percentage of patients screened and treated after 12 Outcome: percentage of patients screened and treated after 12

months of follow-up.months of follow-up.• ResultsResults

– In alerting group, 65% of Pts requiring screening were screened In alerting group, 65% of Pts requiring screening were screened vs. 35% of Pts in the on-demand group and 25% of Pts in control vs. 35% of Pts in the on-demand group and 25% of Pts in control group. group.

– In alerting group, 66% of patients requiring Rx were treated vs. In alerting group, 66% of patients requiring Rx were treated vs. 40% of Pts in on-demand group and 36% of Pts in the control 40% of Pts in on-demand group and 36% of Pts in the control group. group.


• ReferenceReference– van Wyk et al. Circulation. 2008 Jan 22;117(3):371-8. van Wyk et al. Circulation. 2008 Jan 22;117(3):371-8.

[Erasmus Univ, Rotterdam, Netherlands].[Erasmus Univ, Rotterdam, Netherlands].• ConclusionsConclusions

– Alerting version of the clinical decision support systems Alerting version of the clinical decision support systems significantly improved screening and treatment significantly improved screening and treatment performance for dyslipidemia by general practitioners.performance for dyslipidemia by general practitioners.

• ImpactImpact– Magnitude of improvements in guideline adherence Magnitude of improvements in guideline adherence

historically associated with inpatient settings can be historically associated with inpatient settings can be observed in primary care outpatient settings for common observed in primary care outpatient settings for common disorders, using a practice-based EMR (in the Netherlands). disorders, using a practice-based EMR (in the Netherlands).

– More evidence of Northern Europe leading in ambulatory More evidence of Northern Europe leading in ambulatory practice innovations vs. USpractice innovations vs. US


– Mulvaney SA et al. J Am Med Inform Assoc. 2008 Mar-Apr;15(2):203-11. [Vanderbilt, Mulvaney SA et al. J Am Med Inform Assoc. 2008 Mar-Apr;15(2):203-11. [Vanderbilt, Nashville, TN]Nashville, TN]

• TitleTitle– A randomized effectiveness trial of a clinical informatics consult A randomized effectiveness trial of a clinical informatics consult

service: impact on evidence-based decision-making and knowledge service: impact on evidence-based decision-making and knowledge implementation. implementation.

• AimAim– To determine the effectiveness of providing synthesized research To determine the effectiveness of providing synthesized research

evidence to inform patient care practices via an evidence based evidence to inform patient care practices via an evidence based informatics program, the Clinical Informatics Consult Service (CICS). informatics program, the Clinical Informatics Consult Service (CICS).

• MethodsMethods– Consults randomly assigned to CICS Provided, where clinicians Consults randomly assigned to CICS Provided, where clinicians

received synthesized information from literature addressing the received synthesized information from literature addressing the consult question or No CICS Provided, in which no information was consult question or No CICS Provided, in which no information was provided.provided.


– Mulvaney SA et al. J Am Med Inform Assoc. 2008 Mar-Apr;15(2):203-11.Mulvaney SA et al. J Am Med Inform Assoc. 2008 Mar-Apr;15(2):203-11. • Methods, cont’dMethods, cont’d

– Outcomes measured via online post-consult forms that assessed Outcomes measured via online post-consult forms that assessed consult purpose, actual and potential impact, satisfaction, time consult purpose, actual and potential impact, satisfaction, time spent searching, and other variables. spent searching, and other variables.

• ResultsResults– 226 consults made during 19-month study period. 226 consults made during 19-month study period. – Clinicians primarily made requests in order to update Clinicians primarily made requests in order to update

themselves (65.0%, 147/226) and were satisfied with the service themselves (65.0%, 147/226) and were satisfied with the service results (Mean 4.52 of possible 5.0, SD 0.94).results (Mean 4.52 of possible 5.0, SD 0.94).

– Intention to treat (ITT) analyses showed that consults in the CICS Intention to treat (ITT) analyses showed that consults in the CICS Provided condition had a greater actual and potential impact on Provided condition had a greater actual and potential impact on clinical actions and clinician satisfaction than No CICS consults. clinical actions and clinician satisfaction than No CICS consults.


– Mulvaney SA et al. J Am Med Inform Assoc. 2008 Mar-Apr;15(2):203-11.Mulvaney SA et al. J Am Med Inform Assoc. 2008 Mar-Apr;15(2):203-11. • ResultsResults

– Evidence provided primarily impacted the use of a new or different Evidence provided primarily impacted the use of a new or different treatment (OR 8.19 95% CI 1.04-64.00). treatment (OR 8.19 95% CI 1.04-64.00).

– Reasons for no or little impact included a lack of evidence addressing Reasons for no or little impact included a lack of evidence addressing the issue or that the clinician was already implementing the the issue or that the clinician was already implementing the practices indicated by the evidence.practices indicated by the evidence.

• ConclusionsConclusions – Clinical decision-making, particularly regarding treatment issues, Clinical decision-making, particularly regarding treatment issues,

was impacted by the service. was impacted by the service. • ImpactImpact

– Programs such as the CICS may provide an effective tool for Programs such as the CICS may provide an effective tool for facilitating integration of research evidence into management of facilitating integration of research evidence into management of patient care and may foster clinicians' engagement with the patient care and may foster clinicians' engagement with the biomedical literature. biomedical literature.

Clinical Decision Support for Clinical Decision Support for PatientsPatients• ReferenceReference

– Persell et al. Jt Comm J Qual Patient Saf. 2008 Feb;34(2):98-Persell et al. Jt Comm J Qual Patient Saf. 2008 Feb;34(2):98-105. [Northwestern Univ, Chicago] 105. [Northwestern Univ, Chicago]

• TitleTitle– Patient-directed intervention versus clinician reminders alone Patient-directed intervention versus clinician reminders alone

to improve aspirin use in diabetes: a cluster randomized trial.to improve aspirin use in diabetes: a cluster randomized trial.• AimAim

– To determine whether mailing to Pts plus nurse telephone To determine whether mailing to Pts plus nurse telephone call more effective than standard CDSS reminders to call more effective than standard CDSS reminders to physicians for prescribing ASA to diabetics. physicians for prescribing ASA to diabetics.

• MethodsMethods– Cluster-randomized design, 19 physicians caring for 334 eligible Cluster-randomized design, 19 physicians caring for 334 eligible

patients at least 40 years of age randomized. patients at least 40 years of age randomized. – All clinicians received computerized reminders at office visits. All clinicians received computerized reminders at office visits.


– Persell et al. Jt Comm J Qual Patient Saf. 2008 Feb;34(2):98-105. Persell et al. Jt Comm J Qual Patient Saf. 2008 Feb;34(2):98-105.

• Methods, cont’dMethods, cont’d– Intervention physicians received e-mails asking whether Intervention physicians received e-mails asking whether

aspirin was indicated for each patient. aspirin was indicated for each patient. – If so, patients received a mailing and nurse telephone call If so, patients received a mailing and nurse telephone call

addressing aspirin. addressing aspirin. – Primary outcome was self-reported regular aspirin use. Primary outcome was self-reported regular aspirin use.

• ResultsResults– Outcome assessment telephone interviews completed for Outcome assessment telephone interviews completed for

242 (72.5%) patients. 242 (72.5%) patients. – At follow-up, aspirin use was reported by 60 (46%) of the 130 At follow-up, aspirin use was reported by 60 (46%) of the 130

intervention patients and 44 (39%) of the 112 reminder-only intervention patients and 44 (39%) of the 112 reminder-only patients, a nonsignificant difference. patients, a nonsignificant difference.

Clinical Decision Support for Clinical Decision Support for PatientsPatients

• ReferenceReference– Persell et al. Jt Comm J Qual Patient Saf. 2008 Feb;34(2):98-105. Persell et al. Jt Comm J Qual Patient Saf. 2008 Feb;34(2):98-105.

• Results, cont’dResults, cont’d– In subgroup reporting no aspirin use at baseline and no In subgroup reporting no aspirin use at baseline and no

contraindications, 33 (43%) of the 76 intervention and 22 contraindications, 33 (43%) of the 76 intervention and 22 (30%) of the 74 reminder-only patients began using aspirin, (30%) of the 74 reminder-only patients began using aspirin, a 10% difference accounting for clustering (P = .013).a 10% difference accounting for clustering (P = .013).

• ConclusionsConclusions– A patient-directed intervention modestly increased aspirin A patient-directed intervention modestly increased aspirin

use among diabetes patients beyond that achieved using use among diabetes patients beyond that achieved using computerized clinician reminders for ideal candidates. computerized clinician reminders for ideal candidates.

– Obstacles included difficulty contacting patients, real or Obstacles included difficulty contacting patients, real or perceived contraindications, and failure to follow the nurse's perceived contraindications, and failure to follow the nurse's advice.advice.


• ReferenceReference– Persell et al. Jt Comm J Qual Patient Saf. 2008 Persell et al. Jt Comm J Qual Patient Saf. 2008

Feb;34(2):98-105. Feb;34(2):98-105.

• ImpactImpact– Person-intensive best practice strategies, like Person-intensive best practice strategies, like

automated CDSS’s, encounter diminishing automated CDSS’s, encounter diminishing returns vs. ideal guidelines and outcomesreturns vs. ideal guidelines and outcomes


– Ten Wolde GB et al. Addiction. 2008 Apr;103(4):662-70. [Leiden Univ, Ten Wolde GB et al. Addiction. 2008 Apr;103(4):662-70. [Leiden Univ, Netherlands]Netherlands]

• TitleTitle– Long-term effectiveness of computer-generated tailored patient Long-term effectiveness of computer-generated tailored patient

education on benzodiazepines: a randomized controlled trial.education on benzodiazepines: a randomized controlled trial.• AimAim

– To examined the long-term effectiveness of a tailored patient To examined the long-term effectiveness of a tailored patient education intervention on benzodiazepine use. education intervention on benzodiazepine use.

• MethodsMethods– Controlled trial with three arms, comparing (i) a single tailored letter; Controlled trial with three arms, comparing (i) a single tailored letter;

(ii) a multiple tailored letters and (iii) a general practitioner letter. More (ii) a multiple tailored letters and (iii) a general practitioner letter. More info in tailored letters.info in tailored letters.

– 508 Pts using benzodiazepines recruited by their general practitioners 508 Pts using benzodiazepines recruited by their general practitioners and assigned randomly to one of the three groups. and assigned randomly to one of the three groups.

– Post-test took place after 12 months. Post-test took place after 12 months.


– Ten Wolde GB et al. Addiction. 2008 Apr;103(4):662-70.Ten Wolde GB et al. Addiction. 2008 Apr;103(4):662-70. • ResultsResults

– Participants receiving tailored interventions were twice as Participants receiving tailored interventions were twice as likely to have quit benzodiazepine use compared to the likely to have quit benzodiazepine use compared to the general practitioner letter. general practitioner letter.

– Among participants with the intention to discontinue usage at Among participants with the intention to discontinue usage at baseline, both tailored interventions led to high percentages baseline, both tailored interventions led to high percentages of those who actually discontinued usage (single tailored of those who actually discontinued usage (single tailored intervention 51.7%; multiple tailored intervention 35.6%; intervention 51.7%; multiple tailored intervention 35.6%; general practitioner letter 14.5%). general practitioner letter 14.5%).

• ConclusionsConclusions – Tailored patient education can be an effective tool for Tailored patient education can be an effective tool for

reducing benzodiazepine use, and can be implemented easily.reducing benzodiazepine use, and can be implemented easily.


• ReferenceReference– Ten Wolde GB et al. Addiction. 2008 Apr;103(4):662-Ten Wolde GB et al. Addiction. 2008 Apr;103(4):662-

70.70.

• ImpactImpact– Adds to literature on CDS for Pts that Adds to literature on CDS for Pts that

suggests it is easier to get Pts to stop than suggests it is easier to get Pts to stop than start medications.start medications.


– Kypri K et al. Arch Intern Med. 2008 Mar 10;168(5):530-6. Kypri K et al. Arch Intern Med. 2008 Mar 10;168(5):530-6. [Univ. Newcastle, New South Wales, Australia][Univ. Newcastle, New South Wales, Australia]

• TitleTitle– Randomized controlled trial of web-based alcohol screening Randomized controlled trial of web-based alcohol screening

and brief intervention in primary care.and brief intervention in primary care.• AimAim

– To determine whether an electronic Screening and Brief To determine whether an electronic Screening and Brief Intervention (e-SBI) reduces hazardous drinking. Intervention (e-SBI) reduces hazardous drinking.

• MethodsMethods– RCT in a university primary health care service. RCT in a university primary health care service. – 975 students (age range, 17-29 years) screened using the Alcohol 975 students (age range, 17-29 years) screened using the Alcohol

Use Disorders Identification Test (AUDIT). Use Disorders Identification Test (AUDIT). – 599 students (61%) scored in hazardous or harmful range599 students (61%) scored in hazardous or harmful range


– Kypri K et al. Arch Intern Med. 2008 Mar 10;168(5):530-6. [Univ. Kypri K et al. Arch Intern Med. 2008 Mar 10;168(5):530-6. [Univ. Newcastle, New South Wales, Australia]Newcastle, New South Wales, Australia]

• MethodsMethods– 576 (300 women) in high risk group consented and were randomized to 576 (300 women) in high risk group consented and were randomized to

receive an information pamphlet (control group), a Web-based receive an information pamphlet (control group), a Web-based motivational intervention (single-dose e-SBI group), or a Web-based motivational intervention (single-dose e-SBI group), or a Web-based motivational intervention with further interventions 1 and 6 months later motivational intervention with further interventions 1 and 6 months later (multidose e-SBI group). (multidose e-SBI group).

– Measures: self-reported alcohol consumption at 12 monthsMeasures: self-reported alcohol consumption at 12 months

• ResultsResults– Single-dose e-SBI group at 6 months reported a lower frequency of Single-dose e-SBI group at 6 months reported a lower frequency of

drinking, less total consumption, and fewer academic problems that drinking, less total consumption, and fewer academic problems that were sustained at 12 months. were sustained at 12 months.

– Multidose e-SBI group at 6 months reported same plus modestly reduced Multidose e-SBI group at 6 months reported same plus modestly reduced episodic heavy drinking (NS), sustained at 12 months.episodic heavy drinking (NS), sustained at 12 months.


• ReferenceReference– Kypri K et al. Arch Intern Med. 2008 Mar Kypri K et al. Arch Intern Med. 2008 Mar

10;168(5):530-6.10;168(5):530-6. • ConclusionsConclusions

– Single-dose e-SBI reduces hazardous drinking, and Single-dose e-SBI reduces hazardous drinking, and the effect lasts 12 months. the effect lasts 12 months.

– Additional sessions seem not to enhance the effect. Additional sessions seem not to enhance the effect.

• ImpactImpact – Adds to literature that college students are a unique Adds to literature that college students are a unique

population willing to report hazardous behaviors and population willing to report hazardous behaviors and respond to information interventions directed at respond to information interventions directed at reducing those behaviors.reducing those behaviors.


– Matheny ME et al. Arch Intern Med. 2007 Nov 12;167(20):2233-9. Matheny ME et al. Arch Intern Med. 2007 Nov 12;167(20):2233-9. [Brigham & Women’s Hospital, Boston][Brigham & Women’s Hospital, Boston]

• TitleTitle– Impact of an automated test results management system on Impact of an automated test results management system on

patients' satisfaction about test result communication.patients' satisfaction about test result communication.• AimAim

– To assess the impact of physicians' use of a test results To assess the impact of physicians' use of a test results management tool embedded in an electronic health record on management tool embedded in an electronic health record on patient satisfaction with test result communication. patient satisfaction with test result communication.

• MethodsMethods– Cluster-randomized, trial of 570 patient encounters in 26 outpatient Cluster-randomized, trial of 570 patient encounters in 26 outpatient

primary care practicesprimary care practices– Physicians in intervention practices were trained, given access to test Physicians in intervention practices were trained, given access to test

results management tool with imbedded patient notification functions. results management tool with imbedded patient notification functions.


– Matheny ME et al. Arch Intern Med. 2007 Nov 12;167(20): 2233-9.Matheny ME et al. Arch Intern Med. 2007 Nov 12;167(20): 2233-9.• Methods, cont’dMethods, cont’d

– Patient satisfaction surveys conducted by telephone after the patient Patient satisfaction surveys conducted by telephone after the patient underwent the test and were administered before and after the underwent the test and were administered before and after the intervention in both arms. intervention in both arms.

• ResultsResults– The survey response rate after successful patient contact was 74.2% The survey response rate after successful patient contact was 74.2%

(570/768). (570/768). – After adjusting for patient age, sex, race, socioeconomic status, and After adjusting for patient age, sex, race, socioeconomic status, and

insurance type, the intervention significantly increased patient insurance type, the intervention significantly increased patient satisfaction with test results communication (odds ratio, 2.35; 95% satisfaction with test results communication (odds ratio, 2.35; 95% confidence interval, 1.05-5.25; P = .03) and more satisfied with confidence interval, 1.05-5.25; P = .03) and more satisfied with information given them for medical treatments and conditions information given them for medical treatments and conditions regarding their results (odds ratio, 3.45; 95% confidence interval, 1.30-regarding their results (odds ratio, 3.45; 95% confidence interval, 1.30-9.17; P = .02). 9.17; P = .02).


• ReferenceReference– Matheny ME et al. Arch Intern Med. 2007 Nov Matheny ME et al. Arch Intern Med. 2007 Nov

12;167(20): 2233-9.12;167(20): 2233-9. • ConclusionsConclusions

– Automated test results management system can Automated test results management system can improve patient satisfaction with communication of improve patient satisfaction with communication of test results ordered by their primary care provider test results ordered by their primary care provider and and

– can improve patient satisfaction with the can improve patient satisfaction with the communication of information regarding their communication of information regarding their condition and treatment plans. condition and treatment plans.

• ImpactImpact – Knowledge is power and contributes to customer Knowledge is power and contributes to customer

satisfaction in healthcare.satisfaction in healthcare.


– Preibe et al. Br J Psychiatry. 2007 Nov;191:420-6. [University of Preibe et al. Br J Psychiatry. 2007 Nov;191:420-6. [University of London, London, UK]London, London, UK]

• TitleTitle– Structured patient-clinician communication and 1-year outcome in Structured patient-clinician communication and 1-year outcome in

community mental healthcare: cluster randomised controlled trial.community mental healthcare: cluster randomised controlled trial.• AimAim

– To test a computer-mediated intervention structuring patient-To test a computer-mediated intervention structuring patient-clinician dialogue (DIALOG) focusing on patients' quality of life clinician dialogue (DIALOG) focusing on patients' quality of life and needs for care. and needs for care.

• MethodsMethods– Cluster-randomized, trial of 134 providers in six countries were Cluster-randomized, trial of 134 providers in six countries were

allocated to DIALOG or treatment as usual; 507 people with allocated to DIALOG or treatment as usual; 507 people with schizophrenia or related disorders included.schizophrenia or related disorders included.


– Preibe et al. Br J Psychiatry. 2007 Nov;191:420-6. Preibe et al. Br J Psychiatry. 2007 Nov;191:420-6. • Methods, cont’dMethods, cont’d

– Every 2 months for 1 year, clinicians asked patients to rate satisfaction Every 2 months for 1 year, clinicians asked patients to rate satisfaction with quality of life and treatment, and request additional or different with quality of life and treatment, and request additional or different support. support.

– Responses fed back immediately in screen displays, compared with Responses fed back immediately in screen displays, compared with previous ratings and discussed. previous ratings and discussed.

– Primary outcome was subjective quality of life, secondary outcomes Primary outcome was subjective quality of life, secondary outcomes were unmet needs and treatment satisfaction. were unmet needs and treatment satisfaction.

• ResultsResults– Of 507 patients, 56 lost to follow-up and 451 were included in Of 507 patients, 56 lost to follow-up and 451 were included in

intention-to-treat analyses. intention-to-treat analyses. – Patients receiving the DIALOG intervention had better subjective Patients receiving the DIALOG intervention had better subjective

quality of life, fewer unmet needs and higher treatment satisfaction quality of life, fewer unmet needs and higher treatment satisfaction after 12 months. after 12 months.


• ReferenceReference– Preibe et al. Br J Psychiatry. 2007 Nov;191:420-Preibe et al. Br J Psychiatry. 2007 Nov;191:420-

6.6. • ConclusionsConclusions

– Structuring patient-clinician dialogue to focus on Structuring patient-clinician dialogue to focus on patients' views positively influenced quality of patients' views positively influenced quality of life, needs for care and treatment satisfaction. life, needs for care and treatment satisfaction.

• ImpactImpact – CDSS tools that facilitate communication CDSS tools that facilitate communication

complement those that provide information from complement those that provide information from data/knowledge sources.data/knowledge sources.

New CDSS RCTs showing no New CDSS RCTs showing no difference for intervention vs. difference for intervention vs.

controlcontrol1.1. Matheny ME et al. Matheny ME et al. A randomized trial of electronic A randomized trial of electronic

clinical reminders to improve medication laboratory clinical reminders to improve medication laboratory monitoring.monitoring. J Am Med Inform Assoc. 2008 Jul- J Am Med Inform Assoc. 2008 Jul-Aug;15(4):424-9. [Brigham & Women’s, Boston]Aug;15(4):424-9. [Brigham & Women’s, Boston]

2.2. Hicks LS. Hicks LS. Impact of computerized decision support on Impact of computerized decision support on blood pressure management and control: a randomized blood pressure management and control: a randomized controlled trial.controlled trial. J Gen Intern Med. 2008 Apr;23(4):429- J Gen Intern Med. 2008 Apr;23(4):429-41. [Brigham & Women’s, Boston]41. [Brigham & Women’s, Boston]

3.3. Tamblyn R et al. Tamblyn R et al. A randomized trial of the effectiveness A randomized trial of the effectiveness of on-demand versus computer-triggered drug decision of on-demand versus computer-triggered drug decision support in primary care.support in primary care. J Am Med Inform Assoc. 2008 J Am Med Inform Assoc. 2008 Jul-Aug;15(4):430-8. [McGill University, Montreal, Jul-Aug;15(4):430-8. [McGill University, Montreal, Canada]Canada]

New CDSS RCTs showing no New CDSS RCTs showing no difference for intervention vs. difference for intervention vs.

controlcontrol4.4. Thomas KG et al. Thomas KG et al. Use of a registry-generated audit, Use of a registry-generated audit, feedback, and patient reminder intervention in an feedback, and patient reminder intervention in an internal medicine resident clinic--a randomized trial.internal medicine resident clinic--a randomized trial. J Gen Intern Med. 2007 Dec;22(12):1740-4. [Mayo J Gen Intern Med. 2007 Dec;22(12):1740-4. [Mayo Clinic]Clinic]

5.5. Harari D et al. Harari D et al. Promotion of health in older people: a Promotion of health in older people: a randomised controlled trial of health risk appraisal in randomised controlled trial of health risk appraisal in British general practice.British general practice. Age Ageing. 2008 Age Ageing. 2008 Sep;37(5):565-71 [St Thomas Hospital, London, UK]Sep;37(5):565-71 [St Thomas Hospital, London, UK] - computerized health risk appraisal & action plan - computerized health risk appraisal & action plan

6.6. Hansagi H et al. Hansagi H et al. Is information sharing between the Is information sharing between the emergency department and primary care useful to emergency department and primary care useful to the care of frequent emergency department users?the care of frequent emergency department users? Eur J Emerg Med. 2008 Feb;15(1):34-9. [Karolinska Eur J Emerg Med. 2008 Feb;15(1):34-9. [Karolinska Univ, Sweden] – case notes of ED forwarded to PMDsUniv, Sweden] – case notes of ED forwarded to PMDs

Clinical Decision SupportClinical Decision Support

Questions and CommentsQuestions and Comments

Personal Health RecordsPersonal Health Records

Personal Health RecordsPersonal Health Records• ReferenceReference

– Grant RW et al. Arch Intern Med. 2008 Sep 8;168(16):1776-82. Grant RW et al. Arch Intern Med. 2008 Sep 8;168(16):1776-82. [Mass General/Partners, Boston][Mass General/Partners, Boston]

• TitleTitle– Practice-linked online personal health records for type 2 diabetes Practice-linked online personal health records for type 2 diabetes

mellitus: a randomized controlled trial.mellitus: a randomized controlled trial.• AimAim

– To evaluate effects of web-based PHR linked to EMR on Type 2 To evaluate effects of web-based PHR linked to EMR on Type 2 diabetes care. diabetes care.

• MethodsMethods– randomized 11 primary care practices. randomized 11 primary care practices. – Intervention practices received access to a DM-specific PHR that Intervention practices received access to a DM-specific PHR that

imported clinical and medications data, provided patient-tailored imported clinical and medications data, provided patient-tailored decision support, and enabled the patient to author a "Diabetes Care decision support, and enabled the patient to author a "Diabetes Care Plan" for electronic submission to their physician prior to upcoming Plan" for electronic submission to their physician prior to upcoming appointments. appointments.


– Grant RW et al. Arch Intern Med. 2008 Sep 8;168(16):1776-82. Grant RW et al. Arch Intern Med. 2008 Sep 8;168(16):1776-82. [Mass General/Partners, Boston][Mass General/Partners, Boston]

• Methods, cont’dMethods, cont’d– Active control practices received a PHR to update and submit family Active control practices received a PHR to update and submit family

history and health maintenance information. All patients attending history and health maintenance information. All patients attending these practices were encouraged to sign up for online access.these practices were encouraged to sign up for online access.

• ResultsResults– 244 patients with DM enrolled (37% of the eligible population with 244 patients with DM enrolled (37% of the eligible population with

registered online access, 4% of the overall population of patients with registered online access, 4% of the overall population of patients with DM). DM).

– Study participants were younger (mean age, 56.1 years vs 60.3 years; Study participants were younger (mean age, 56.1 years vs 60.3 years; P < .001) and lived in higher-income neighborhoods (median income, P < .001) and lived in higher-income neighborhoods (median income, $53,784 vs $49,713; P < .001) but had similar baseline glycemic $53,784 vs $49,713; P < .001) but had similar baseline glycemic control compared with nonparticipants.control compared with nonparticipants.


– Grant RW et al. Arch Intern Med. 2008 Sep 8;168(16):1776-82. Grant RW et al. Arch Intern Med. 2008 Sep 8;168(16):1776-82. • ResultsResults

– More patients in the intervention arm had their DM treatment More patients in the intervention arm had their DM treatment regimens adjusted (53% vs 15%; P < .001) compared with active regimens adjusted (53% vs 15%; P < .001) compared with active controls. controls.

– No significant differences in risk factor control between study arms No significant differences in risk factor control between study arms after 1 year (P = .53). after 1 year (P = .53).

• ConclusionsConclusions– Pre-visit use of online PHR linked to the EMR increased rates of DM-Pre-visit use of online PHR linked to the EMR increased rates of DM-

related medication adjustment. related medication adjustment. – Low rates of online patient account registration and good baseline Low rates of online patient account registration and good baseline

control among participants limited the intervention's impact on control among participants limited the intervention's impact on overall risk factor control. overall risk factor control.


• ReferenceReference– Grant RW et al. Arch Intern Med. 2008 Sep Grant RW et al. Arch Intern Med. 2008 Sep

8;168(16):1776-82. [Mass 8;168(16):1776-82. [Mass General/Partners, Boston]General/Partners, Boston]

• ImpactImpact– Motivated, engaged patients with personal Motivated, engaged patients with personal

resources constitute the majority of PHR and resources constitute the majority of PHR and portal users. These well-educated ‘good portal users. These well-educated ‘good patients’ can make it difficult to detect patients’ can make it difficult to detect outcomes differences due to high baseline outcomes differences due to high baseline compliance.compliance.

TelemedicineTelemedicine


10 new RCTs published 10 new RCTs published

November 2007 – October November 2007 – October 20082008

•3 hypertension

•1 each diabetes care, stroke, coronary disease, heart failure, transplantation follow-up, implantable cardioverter, robotic telerounding

• 3 RCTs on hypertensiom 3 RCTs on hypertensiom

– Green BB, et al. Green BB, et al. Effectiveness of home blood pressure Effectiveness of home blood pressure monitoring, Web communication, and pharmacist care on monitoring, Web communication, and pharmacist care on hypertension control: a randomized controlled trial.hypertension control: a randomized controlled trial. JAMA. JAMA. 2008 Jun 25;299(24):2857-67. [Group Health, Seattle]2008 Jun 25;299(24):2857-67. [Group Health, Seattle]

– Santamore WP et al. Santamore WP et al. Accuracy of blood pressure Accuracy of blood pressure measurements transmitted through a telemedicine measurements transmitted through a telemedicine system in underserved populations.system in underserved populations. Telemed J E Health. Telemed J E Health. 2008 May;14(4):333-8. [Temple Univ, Philadelphia]2008 May;14(4):333-8. [Temple Univ, Philadelphia]

– Madsen LB et al. Madsen LB et al. Blood pressure control during Blood pressure control during telemonitoring of home blood pressure. A randomized telemonitoring of home blood pressure. A randomized controlled trial during 6 months.controlled trial during 6 months. Blood Press. Blood Press. 2008;17(2):78-86. [Aarhus Univ, Denmark]2008;17(2):78-86. [Aarhus Univ, Denmark]


• MethodsMethods– Group Health Study: 778 hypertensive Pts in 3 Group Health Study: 778 hypertensive Pts in 3

grps : use secure website +/- pharmacist web grps : use secure website +/- pharmacist web communication vs. usual care. Outcome communication vs. usual care. Outcome variable: Percent of Pts with controlled BP at 12 variable: Percent of Pts with controlled BP at 12 months months

– Temple study: 464 hypertensive pts given Temple study: 464 hypertensive pts given recording sphygmomanometer. Entered BP recording sphygmomanometer. Entered BP reading on website, compared to downloaded reading on website, compared to downloaded BP values at clinic visits.BP values at clinic visits.

– Denmark study: 236 hypertensive pts Denmark study: 236 hypertensive pts randomized to entering BP into PDA randomized to entering BP into PDA synchronized over net, with web provider-pt synchronized over net, with web provider-pt feedback. Outcome variable: mean systolic BP feedback. Outcome variable: mean systolic BP change over 6 months.change over 6 months.


• ResultsResults– Group Health Study found web + pharmacist Group Health Study found web + pharmacist

care increased numbers of Pts with controlled care increased numbers of Pts with controlled BP but not web alone vs. standard care.BP but not web alone vs. standard care.

– Temple study found Pt entered accurate BP Temple study found Pt entered accurate BP readings, including underserved and low readings, including underserved and low literacy patientsliteracy patients

– Denmark study found both groups had BP fall Denmark study found both groups had BP fall during study, telemonitoring ‘as good as’ during study, telemonitoring ‘as good as’ office visit monitoring office visit monitoring

• ImpactImpact– Adds to substantial literature showing Adds to substantial literature showing

therapeutic equivalency of telemedicine vs. in therapeutic equivalency of telemedicine vs. in person monitoring of chronic conditions.person monitoring of chronic conditions.


TelemedicineTelemedicine• ReferenceReference

– Meyer BC et al. Lancet Neurol. 2008 Sep;7(9):787-95. [UC San Meyer BC et al. Lancet Neurol. 2008 Sep;7(9):787-95. [UC San Diego]Diego]

• TitleTitle– Efficacy of site-independent telemedicine in the STRokE DOC trial: Efficacy of site-independent telemedicine in the STRokE DOC trial:

a randomised, blinded, prospective study. a randomised, blinded, prospective study. • AimAim

– To assessed whether telemedicine (real-time, two-way audio and To assessed whether telemedicine (real-time, two-way audio and video) or telephone was superior for decision making regarding video) or telephone was superior for decision making regarding use of thrombolytics in acute stroke. use of thrombolytics in acute stroke.

• MethodsMethods– Stroke patients at four remote sites in California randomized to video and Stroke patients at four remote sites in California randomized to video and

DICOM image telemedicine vs. telephone consultation with neurologists DICOM image telemedicine vs. telephone consultation with neurologists at academic center. at academic center.

– Cases reviewed for correctness of decision regarding use of Cases reviewed for correctness of decision regarding use of thrombolytics and incidence of intracerebral hemorrhagethrombolytics and incidence of intracerebral hemorrhage


– Meyer BC et al. Lancet Neurol. 2008 Sep;7(9):787-95. Meyer BC et al. Lancet Neurol. 2008 Sep;7(9):787-95. • ResultsResults

– 234 patients assessed Jan 2004 – Aug 2007. 111 randomized to each 234 patients assessed Jan 2004 – Aug 2007. 111 randomized to each arm, 207 completed study. arm, 207 completed study.

– Correct treatment decisions were made more often in the telemedicine Correct treatment decisions were made more often in the telemedicine group than telephone grp 98% vs 82%, p=0.0009).group than telephone grp 98% vs 82%, p=0.0009).

– Intravenous thrombolytics were used at an overall rate of 25% (31 Intravenous thrombolytics were used at an overall rate of 25% (31 [28%] telemedicine vs 25 [23%] telephone, 1.3, 0.7-2.5; p=0.43). [28%] telemedicine vs 25 [23%] telephone, 1.3, 0.7-2.5; p=0.43).

– No difference in mortality (1.6, 0.8-3.4; p=0.27) or rates of intracerebral No difference in mortality (1.6, 0.8-3.4; p=0.27) or rates of intracerebral hemorrhage.hemorrhage.

• ConclusionsConclusions– Telemedicine results in more accurate stroke decision makingTelemedicine results in more accurate stroke decision making

• ImpactImpact– Telemedicine useful way to project specialized neurology svcsTelemedicine useful way to project specialized neurology svcs

TelemedicineTelemedicine• ReferenceReference– Shea S, IDEATel Consortium. Trans Am Clin Climatol Assoc. Shea S, IDEATel Consortium. Trans Am Clin Climatol Assoc.

2007;118:289-304. [Columbia Univ, NYC]2007;118:289-304. [Columbia Univ, NYC]• TitleTitle

– The Informatics for Diabetes and Education Telemedicine (IDEATel) The Informatics for Diabetes and Education Telemedicine (IDEATel) project. project.

• AimAim– To comparing telemedicine case management to usual care for To comparing telemedicine case management to usual care for

diabetes in low socioeconomic status patients. diabetes in low socioeconomic status patients. • MethodsMethods

– 1,665 Medicare recipients with diabetes, aged 55 years or greater, living 1,665 Medicare recipients with diabetes, aged 55 years or greater, living in federally designated medically underserved areas of New York State. in federally designated medically underserved areas of New York State.

– Specialized home telemedicine unit with web-enabled computer, video, Specialized home telemedicine unit with web-enabled computer, video, glucose and BP monitoring, upload to Columbia EMRglucose and BP monitoring, upload to Columbia EMR

– Primary endpoints were HgbA1c, blood pressure, and low density Primary endpoints were HgbA1c, blood pressure, and low density lipoprotein (LDL) cholesterol levels. lipoprotein (LDL) cholesterol levels.


– Shea S, IDEATel Consortium. Trans Am Clin Climatol Assoc. Shea S, IDEATel Consortium. Trans Am Clin Climatol Assoc. 2007;118:289-304. 2007;118:289-304.

• ResultsResults– In New York City, 98% of participants were black or Hispanic, In New York City, 98% of participants were black or Hispanic,

69% were Medicaid-eligible, and 93% reported annual household 69% were Medicaid-eligible, and 93% reported annual household income < or =$20,000. income < or =$20,000.

– In upstate New York, 91% were white, 14% Medicaid eligible, In upstate New York, 91% were white, 14% Medicaid eligible, and 50% reported annual household income < or =$20,000. and 50% reported annual household income < or =$20,000.

– 95% of NYC participants did not know how to use a computer95% of NYC participants did not know how to use a computer– BP, LDL, and HBA1C all decreased in intervention grp relative to BP, LDL, and HBA1C all decreased in intervention grp relative to

usual care grp at 1 year of follow-up.usual care grp at 1 year of follow-up.– Same effects observed in urban and rural populationsSame effects observed in urban and rural populations– User satisfaction high.User satisfaction high.


– Shea S, IDEATel Consortium. Trans Am Clin Shea S, IDEATel Consortium. Trans Am Clin Climatol Assoc. 2007;118:289-304. Climatol Assoc. 2007;118:289-304.

• ConclusionsConclusions– Telemedicine is an effective method for translating Telemedicine is an effective method for translating

modern approaches to disease management into modern approaches to disease management into effective care for underserved populations.effective care for underserved populations.

• ImpactImpact– Telemedicine effects seen in low income, non-Telemedicine effects seen in low income, non-

computer literate populationcomputer literate population– No analysis of cost-effectiveness providedNo analysis of cost-effectiveness provided

TelemedicineTelemedicine• ReferenceReference– Ellison LM et al. Arch Surg. 2007 Dec;142(12):1177-81 Ellison LM et al. Arch Surg. 2007 Dec;142(12):1177-81

[Penobscot Bay Medical Center, Rockport, ME][Penobscot Bay Medical Center, Rockport, ME]• TitleTitle

– Postoperative robotic telerounding: a multicenter randomized Postoperative robotic telerounding: a multicenter randomized assessment of patient outcomes and satisfaction. assessment of patient outcomes and satisfaction.

• AimAim– To assess patient safety and satisfaction when robotic To assess patient safety and satisfaction when robotic

videoconferencing (telerounding) is used in the postoperative videoconferencing (telerounding) is used in the postoperative setting. setting.

• MethodsMethods– 270 adults undergoing a urologic procedure requiring a 270 adults undergoing a urologic procedure requiring a

hospital stay of 24 to 72 hours were randomized to receive hospital stay of 24 to 72 hours were randomized to receive either traditional bedside rounds or robotic telerounds.either traditional bedside rounds or robotic telerounds.


– Ellison LM et al. Arch Surg. 2007 Dec;142(12):1177-81 [Penobscot Bay Ellison LM et al. Arch Surg. 2007 Dec;142(12):1177-81 [Penobscot Bay Medical Center, Rockport, ME]Medical Center, Rockport, ME]

• Methods, cont’dMethods, cont’d– The primary outcome measure was postoperative patient morbidity. The primary outcome measure was postoperative patient morbidity. – Secondary outcomes were patient-reported satisfaction and hospital Secondary outcomes were patient-reported satisfaction and hospital

length of stay. length of stay. – Other variables assessed included demographics, procedure, operative Other variables assessed included demographics, procedure, operative

time, estimated blood loss, and mortality. time, estimated blood loss, and mortality. – Patients also completed a validated satisfaction instrument 2 weeks Patients also completed a validated satisfaction instrument 2 weeks

after hospital discharge.after hospital discharge.

• ResultsResults– Morbidity rates and length of stay were similar between the study arms Morbidity rates and length of stay were similar between the study arms

(standard rounds vs telerounds: 16% vs 13%; P = .64, 2.8 days LOS (standard rounds vs telerounds: 16% vs 13%; P = .64, 2.8 days LOS both groups, P=.94). both groups, P=.94).

– Patient satisfaction was equivalently high in both groups. Patient satisfaction was equivalently high in both groups.


– Ellison LM et al. Arch Surg. 2007 Ellison LM et al. Arch Surg. 2007 Dec;142(12):1177-81 [Penobscot Bay Medical Dec;142(12):1177-81 [Penobscot Bay Medical Center, Rockport, ME] Center, Rockport, ME]

• ConclusionsConclusions– Robotic telerounds matched the performance of Robotic telerounds matched the performance of

standard bedside rounds after urologic surgical standard bedside rounds after urologic surgical procedures. procedures.

• ImpactImpact– Provocative in-hospital telemedicine reportProvocative in-hospital telemedicine report– Telemedicine provider skills somewhat different Telemedicine provider skills somewhat different

than in person skills; some clinicians natural ‘TV than in person skills; some clinicians natural ‘TV doctors’, some notdoctors’, some not

Telemedicine RCTs with no Telemedicine RCTs with no difference between intervention difference between intervention

and controland control• Dansky et al. Dansky et al. Impact of telehealth on clinical Impact of telehealth on clinical

outcomes in patients with heart failure.outcomes in patients with heart failure. Clin Nurs Res. Clin Nurs Res. 2008 Aug;17(3):182-99. [Penn State] – Home 2008 Aug;17(3):182-99. [Penn State] – Home monitoring vs. F2F care, no sig diff in symptoms or ED monitoring vs. F2F care, no sig diff in symptoms or ED visits/hospitalizations.visits/hospitalizations.

• Leimig R et al. Leimig R et al. Infection, rejection, and Infection, rejection, and hospitalizations in transplant recipients using hospitalizations in transplant recipients using telehealth.telehealth. Prog Transplant. 2008 Jun;18(2):97-102. Prog Transplant. 2008 Jun;18(2):97-102. [Univ Tenn.] – Live interactive sessions w/ specialized [Univ Tenn.] – Live interactive sessions w/ specialized telemedicine equip including physical exam vs. nurse telemedicine equip including physical exam vs. nurse visits. No diff in infections, rejection, hospitalizations.visits. No diff in infections, rejection, hospitalizations.



Practice of InformaticsPractice of Informatics

Practice of InformaticsPractice of Informatics• ReferenceReference

– Love TE et al. J Gen Intern Med. 2008 Apr;23(4):383-91. [Case Love TE et al. J Gen Intern Med. 2008 Apr;23(4):383-91. [Case Western, Cleveland]Western, Cleveland]

• TitleTitle– Electronic medical record-assisted design of a cluster-randomized Electronic medical record-assisted design of a cluster-randomized

trial to improve diabetes care and outcomes.trial to improve diabetes care and outcomes.• AimAim

– To describe the design of a CRT of clinical decision support to To describe the design of a CRT of clinical decision support to improve diabetes care and outcomes. improve diabetes care and outcomes.

• MethodsMethods– EMR-derived Pt characteristics used to partition Pts into groups with EMR-derived Pt characteristics used to partition Pts into groups with

comparable baseline characteristics for two different cluster-comparable baseline characteristics for two different cluster-randomized interventional trials of diabetes care using two different randomized interventional trials of diabetes care using two different EMRs (Systems A and B).EMRs (Systems A and B).

– Measures: distributions of important eligibility and covariates Measures: distributions of important eligibility and covariates compared to traditional means of identifying groupscompared to traditional means of identifying groups

• ReferenceReference– Love TE et al. J Gen Intern Med. 2008 Apr;23(4):383-91.Love TE et al. J Gen Intern Med. 2008 Apr;23(4):383-91.

• ResultsResults– In System A, 4,306 patients assigned to 2 groups of practices; In System A, 4,306 patients assigned to 2 groups of practices;

8,369 patients in system B assigned to 3 groups of practices.8,369 patients in system B assigned to 3 groups of practices.– Nearly all baseline outcome variables and covariates were well-Nearly all baseline outcome variables and covariates were well-

balanced, including several not included in the initial design. balanced, including several not included in the initial design. – Study design balance was superior to alternative partitions Study design balance was superior to alternative partitions

based on volume, geography or demographics alone. based on volume, geography or demographics alone.

• ConclusionConclusion– EMRs facilitated rigorous CRT design by identifying large EMRs facilitated rigorous CRT design by identifying large

numbers of patients with diabetes and enabling fair numbers of patients with diabetes and enabling fair comparisons through preassignment balancing of practice sites.comparisons through preassignment balancing of practice sites.


• ReferenceReference– Love TE et al. J Gen Intern Med. 2008 Love TE et al. J Gen Intern Med. 2008

Apr;23(4):383-91.Apr;23(4):383-91.• ImpactImpact

– In the era of Clinical and Translational In the era of Clinical and Translational Science Awards (CTSAs) increasingly Science Awards (CTSAs) increasingly sophisticated methods are being sophisticated methods are being developed to data mine EMRs for developed to data mine EMRs for observational studies, eligibility and design observational studies, eligibility and design for interventional studies.for interventional studies.


• ReferenceReference– Bereznicki BJ et al. Med J Aust. 2008 Jul 7;189(1):21-5.. [Univ of Bereznicki BJ et al. Med J Aust. 2008 Jul 7;189(1):21-5.. [Univ of

Tasmania, Australia]Tasmania, Australia]• TitleTitle

– Data-mining of medication records to improve asthma Data-mining of medication records to improve asthma management. management.

• AimAim– To use community pharmacy medication records to identify To use community pharmacy medication records to identify

patients whose asthma not well managed, implement and patients whose asthma not well managed, implement and evaluate a multidisciplinary educational intervention to evaluate a multidisciplinary educational intervention to improve asthma management.improve asthma management.

• MethodsMethods– 42 pharmacies ran software application to "data-mine" med 42 pharmacies ran software application to "data-mine" med

records, generating a list of patients w/ >= 3 canisters of records, generating a list of patients w/ >= 3 canisters of inhaled short-acting beta(2)-agonists in the preceding 6 inhaled short-acting beta(2)-agonists in the preceding 6 months. months.


• ReferenceReference– Bereznicki BJ et al. Med J Aust. 2008 Jul 7;189(1):21-Bereznicki BJ et al. Med J Aust. 2008 Jul 7;189(1):21-

55..• Methods, cont’dMethods, cont’d

– Pts randomized to be contacted by the community Pts randomized to be contacted by the community pharmacist via mail, and sent educational material & pharmacist via mail, and sent educational material & letter encouraging them to see their general letter encouraging them to see their general practitioner for an asthma management review.practitioner for an asthma management review.

– Outcome variable: ratio of preventer meds (steroids) Outcome variable: ratio of preventer meds (steroids) to reliever meds (beta2 agonists) to reliever meds (beta2 agonists)

• ResultsResults– 702 intervention and 849 control Pts. 702 intervention and 849 control Pts. – Threefold increase in preventer-reliever ratio in Threefold increase in preventer-reliever ratio in

intervention vs. control groupintervention vs. control group


• ReferenceReference– Bereznicki BJ et al. Med J Aust. 2008 Jul Bereznicki BJ et al. Med J Aust. 2008 Jul

7;189(1):21-57;189(1):21-5..• ConclusionConclusion

– Community pharmacy medication records can Community pharmacy medication records can be effectively used to identify patients with be effectively used to identify patients with suboptimal asthma management, who can suboptimal asthma management, who can then be referred to their GP for reviewthen be referred to their GP for review

• ImpactImpact– Similar to post-Katrina experience in US, Similar to post-Katrina experience in US,

commercial pharmacy records can be merged commercial pharmacy records can be merged and data mined to improve careand data mined to improve care


• ReferenceReference– Meystre SM, Huag PJ. Int J Med Inform. 2008 Sep;77(9):602-Meystre SM, Huag PJ. Int J Med Inform. 2008 Sep;77(9):602-

12. [Univ of Utah]12. [Univ of Utah]• TitleTitle

– Randomized controlled trial of an automated problem list Randomized controlled trial of an automated problem list with improved sensitivity. with improved sensitivity.

• AimAim– To improve the completeness and timeliness of an To improve the completeness and timeliness of an

electronic problem list.electronic problem list.• MethodsMethods

– Authors developed a system using Natural Language Authors developed a system using Natural Language Processing (NLP) to automatically extract potential medical Processing (NLP) to automatically extract potential medical problems from clinical, free-text documentsproblems from clinical, free-text documents

– Problems then proposed for inclusion in an electronic Problems then proposed for inclusion in an electronic problem list management application. problem list management application.


• ReferenceReference– Meystre SM, Huag PJ. Int J Med Inform. 2008 Sep;77(9):602-12.Meystre SM, Huag PJ. Int J Med Inform. 2008 Sep;77(9):602-12.

• Methods, cont’dMethods, cont’d– 247 patients enrolled intensive care unit and IN 247 patients enrolled intensive care unit and IN

cardiovascular surgery unit)cardiovascular surgery unit)– All patients had their documents analyzed by the All patients had their documents analyzed by the

system, but the medical problems discovered were system, but the medical problems discovered were only proposed in the problem list for intervention only proposed in the problem list for intervention patients. patients.

– Measured the sensitivity, specificity, positive and Measured the sensitivity, specificity, positive and negative predictive values, likelihood ratios and the negative predictive values, likelihood ratios and the timeliness of the problem lists. timeliness of the problem lists.

• ResultsResults– System increased sensitivity of problem lists in ICU, System increased sensitivity of problem lists in ICU,

from 9% to 41%, and to 77% if problems automatically from 9% to 41%, and to 77% if problems automatically proposed but not acknowledged also considered. proposed but not acknowledged also considered.


• ReferenceReference– Meystre SM, Huag PJ. Int J Med Inform. 2008 Meystre SM, Huag PJ. Int J Med Inform. 2008

Sep;77(9):602-12.Sep;77(9):602-12.

• Results, cont’dResults, cont’d– Timeliness of addition of problems to the Timeliness of addition of problems to the

list was greatly improved, with a time list was greatly improved, with a time between a problem's first mention in a between a problem's first mention in a clinical document and its addition to the clinical document and its addition to the problem list reduced from about 6 days to problem list reduced from about 6 days to less than 2 days. less than 2 days.

– No significant effect was observed in the No significant effect was observed in the cardiovascular surgery unit.cardiovascular surgery unit.

• ImpactImpact– NLP is coming of age for extraction of NLP is coming of age for extraction of

structured content from unstructured clinical structured content from unstructured clinical documents.documents.




New Literature Highlights: New Literature Highlights: Bioinformatics and Bioinformatics and

Computational BiologyComputational Biology

• Human Health and DiseaseHuman Health and Disease• The practice of The practice of

bioinformaticsbioinformatics

Bioinformatics: Bioinformatics: Human Health & DiseaseHuman Health & Disease

• ReferenceReference– Cooper GM et al. Blood. 2008 Aug 15;112(4):1022-7.) [Univ Cooper GM et al. Blood. 2008 Aug 15;112(4):1022-7.) [Univ

Washington, Seattle]Washington, Seattle]

• TitleTitle– A genome-wide scan for common genetic variants A genome-wide scan for common genetic variants

with a large influence on warfarin maintenance dose. with a large influence on warfarin maintenance dose. • AimAim

– To determine whether common single nucleotide To determine whether common single nucleotide polymorphisms (SNPs) other than VKORC1 and CYP2C9 have a polymorphisms (SNPs) other than VKORC1 and CYP2C9 have a large effect on warfarin dosing.large effect on warfarin dosing.

• MethodsMethods– Index population of 181 warfarin-using Pts and two independent Index population of 181 warfarin-using Pts and two independent

verification populations (total 374) were studied for 550,000 verification populations (total 374) were studied for 550,000 SNPs.SNPs.

• ReferenceReference– Cooper GM et al. Blood. 2008 Aug 15;112(4):1022-7.)Cooper GM et al. Blood. 2008 Aug 15;112(4):1022-7.)

• ResultsResults– Most significant independent effect was Most significant independent effect was

associated with VKORC1 polymorphisms (P = 6.2 associated with VKORC1 polymorphisms (P = 6.2 x 10(-13)) in the index patients. x 10(-13)) in the index patients.

– CYP2C9 (rs1057910 CYP2C9*3) and rs4917639) CYP2C9 (rs1057910 CYP2C9*3) and rs4917639) was associated with dose at moderate was associated with dose at moderate significance levels (P approximately 10(-4).significance levels (P approximately 10(-4).

– 355 candidate SNPs in index population did not 355 candidate SNPs in index population did not replicate in other populations.replicate in other populations.

• ConclusionConclusion– Two SNPs named in FDA labeling information for Two SNPs named in FDA labeling information for

Coumadin are likely to be the only clinically Coumadin are likely to be the only clinically significant ones.significant ones.


• ReferenceReference– Cooper GM et al. Blood. 2008 Aug Cooper GM et al. Blood. 2008 Aug

15;112(4):1022-7.)15;112(4):1022-7.)

• ImportanceImportance– Model of independent verification of Model of independent verification of

Genome Wide Association Studies (GWAS) Genome Wide Association Studies (GWAS) is essential due to noisy, high is essential due to noisy, high dimensionality nature of SNP data.dimensionality nature of SNP data.



• ReferenceReference– Uhl GR et al. Arch Gen Psychiatry. 2008 Jun;65(6):683-Uhl GR et al. Arch Gen Psychiatry. 2008 Jun;65(6):683-

93. [NIDA intramural program, NIH]93. [NIDA intramural program, NIH]

• TitleTitle– Molecular genetics of successful smoking cessation: Molecular genetics of successful smoking cessation:

convergent genome-wide association study results.convergent genome-wide association study results.

• AimsAims– To identify replicated genes that facilitate smokers' To identify replicated genes that facilitate smokers'

abilities to achieve and sustain abstinence from abilities to achieve and sustain abstinence from smoking (referred to as quit-success genes) found in smoking (referred to as quit-success genes) found in more than 2 genome-wide association (GWA) studies of more than 2 genome-wide association (GWA) studies of successful vs unsuccessful abstainers,successful vs unsuccessful abstainers,

– Secondarily, to nominate genes for selective Secondarily, to nominate genes for selective involvement in smoking cessation success with involvement in smoking cessation success with bupropion hydrochloride vs nicotine replacement bupropion hydrochloride vs nicotine replacement therapy (NRT). therapy (NRT).

• ReferenceReference– Uhl GR et al. Arch Gen Psychiatry. 2008 Jun;65(6):683-Uhl GR et al. Arch Gen Psychiatry. 2008 Jun;65(6):683-

93.93.

• MethodsMethods– GWA study in 550 subjects from 3 centers, with GWA study in 550 subjects from 3 centers, with

secondary analyses of Nicotine Replacement Tx vs secondary analyses of Nicotine Replacement Tx vs bupropion responders.bupropion responders.

• ResultsResults– SNPs associated with successful smoking cessation SNPs associated with successful smoking cessation

were identified and found to participate in alteration of were identified and found to participate in alteration of cell adhesion, enzymatic, transcriptional, structural, cell adhesion, enzymatic, transcriptional, structural, and DNA, RNA, and/or protein-handling functionsand DNA, RNA, and/or protein-handling functions

– Partial overlap with gene variants associated with Partial overlap with gene variants associated with dependence on addictive substances, and memory.dependence on addictive substances, and memory.

Bioinformatics: Bioinformatics: Human Health & Disease Human Health & Disease

• ReferenceReference– Uhl GR et al. Arch Gen Psychiatry. 2008 Uhl GR et al. Arch Gen Psychiatry. 2008

Jun;65(6):683-93.Jun;65(6):683-93.

• ImportanceImportance– Molecular genetics can be used to match Molecular genetics can be used to match

types and intensity of anti-smoking types and intensity of anti-smoking treatments with the smokers most likely to treatments with the smokers most likely to benefit from them.benefit from them.

– Pathway interpretation of SNP functionality Pathway interpretation of SNP functionality is early evidence of systems biology is early evidence of systems biology approach to understanding mechanisms of approach to understanding mechanisms of complex traitscomplex traits

Bioinformatics: Bioinformatics: Human Health & Disease Human Health & Disease


• ReferenceReference– Castellanos-Rubio A et al. Gastroenterology. 2008 Castellanos-Rubio A et al. Gastroenterology. 2008

Mar;134(3):738-46.Mar;134(3):738-46.

• TitleTitle– Combined functional and positional gene Combined functional and positional gene

information for the identification of susceptibility information for the identification of susceptibility variants in celiac disease.variants in celiac disease.

• AimAim– Characterize genetic contributions to celiac disease Characterize genetic contributions to celiac disease

susceptibility using a novel approachsusceptibility using a novel approach

• MethodsMethods– Intestinal biopsy specimens subjected to gene Intestinal biopsy specimens subjected to gene

expression analysisexpression analysis


• ReferenceReference– Castellanos-Rubio A et al. Gastroenterology. Castellanos-Rubio A et al. Gastroenterology.

2008 Mar;134(3):738-46.2008 Mar;134(3):738-46.• Methods, cont’dMethods, cont’d

– Intestinal biopsy specimens subjected to Intestinal biopsy specimens subjected to gene expression analysis to identify gene expression analysis to identify overexpressed genes relative to normal overexpressed genes relative to normal mucosamucosa

– 71 genes found via differential expression 71 genes found via differential expression analysis had 361 previously described SNPs.analysis had 361 previously described SNPs.

– Genotyping panels for these 361 SNPs used Genotyping panels for these 361 SNPs used to characterize 262 celiac disease Pts vs. to characterize 262 celiac disease Pts vs. 214 controls214 controls


• ReferenceReference– Castellanos-Rubio A et al. Gastroenterology. 2008 Castellanos-Rubio A et al. Gastroenterology. 2008

Mar;134(3):738-46.Mar;134(3):738-46.

• ResultsResults– Strong evidence of association present for three Strong evidence of association present for three

SNPs that pinpoint novel candidate determinants of SNPs that pinpoint novel candidate determinants of predisposition to the disease in previously predisposition to the disease in previously identified linkage regions (eg, SERPINE2 in 2q33, identified linkage regions (eg, SERPINE2 in 2q33, and PBX3 or PPP6C in 9q34). and PBX3 or PPP6C in 9q34).

• ImportanceImportance– Use of complementary functional and structural Use of complementary functional and structural

approaches to finding disease–related genesapproaches to finding disease–related genes

The Practice of BioinformaticsThe Practice of Bioinformatics• ReferenceReference

– Chaussabel D et al. Immunity. 2008 Jul;29(1):150-64. Chaussabel D et al. Immunity. 2008 Jul;29(1):150-64. [Baylor, Houston, TX][Baylor, Houston, TX]

• TitleTitle– A modular analysis framework for blood genomics A modular analysis framework for blood genomics

studies: application to systemic lupus erythematosus.studies: application to systemic lupus erythematosus.

• AimAim– Create strategy for microarray analysis that is based Create strategy for microarray analysis that is based

on the identification of transcriptional modules formed on the identification of transcriptional modules formed by genes coordinately expressed in multiple disease by genes coordinately expressed in multiple disease data sets. data sets.

• MethodsMethods– Genes coordinately over-expressed in cells from SLE Genes coordinately over-expressed in cells from SLE

Pts organized into ‘transcriptional modules’ Pts organized into ‘transcriptional modules’ representing common metabolic pathwaysrepresenting common metabolic pathways

The Practice of BioinformaticsThe Practice of Bioinformatics• ReferenceReference

– Chaussabel D et al. Immunity. 2008 Chaussabel D et al. Immunity. 2008 Jul;29(1):150-64. [Baylor, Houston, TX]Jul;29(1):150-64. [Baylor, Houston, TX]

• ResultsResults– Modules used to select biomarkers that Modules used to select biomarkers that

were more robust in predicting disease were more robust in predicting disease progression in SLE patients than progression in SLE patients than individually overexpressed genes.individually overexpressed genes.

• ImportanceImportance– An example of ‘systems scale’ analysis An example of ‘systems scale’ analysis

combining quantitative assessment of combining quantitative assessment of individual genes with knowledge of control individual genes with knowledge of control pathways and metabolic circuits, to predict pathways and metabolic circuits, to predict clinically meaningful eventsclinically meaningful events

Computational Biology Computational Biology and Bioinformaticsand Bioinformatics


Top Ten List of Top Ten List of Notable Events Notable Events

in the Past 12 monthsin the Past 12 months

““Top Ten” EventsTop Ten” Events

#10 – Personal Genome Project data available #10 – Personal Genome Project data available 10/20/0810/20/08


#10 – Personal Genome Project data available #10 – Personal Genome Project data available

#9 – ONC Strategic Plan published, 6/3/2008#9 – ONC Strategic Plan published, 6/3/2008


#10 – Personal Genome Project data available#10 – Personal Genome Project data available

#9 – ONC Strategic Plan published#9 – ONC Strategic Plan published

#8 – Massachusetts and Nevada pass laws requiring#8 – Massachusetts and Nevada pass laws requiring encryption of portable devices. September encryption of portable devices. September 20082008

Even organizations that have no facilities or personnel in Massachusetts should anticipate that they will be subject to the regulations if they maintain personal information of any Massachusetts residents. Personal information is defined as: first name and last name or first initial and last name in combination with Social Security number; driver’s license number or state-issued identification card number; and financial account or credit or debit card number with or without any required security code, access code, personal identification number or password that would permit access to an individual’s financial account.

Besides the new encryption obligation, the regulations require entities that maintain personal information of Massachusetts residents to:

•designate an employee to maintain security program;

•identify paper, electronic and other storage media (including laptops) that contain personal information;

•conduct risk assessments;

•develop and implement, according to the results of those risk assessments, a program that ensures the security of all records – whether maintained in paper or electronic form – that contain personal information of Massachusetts residents;

•document the security program;

•include in the security program:

•processes for granting and withdrawing access privileges,

•ensuring proper authentication of users,

•appropriate access controls,

•methods of assigning passwords,

•maintaining up to date firewalls and malware protections,

•training all affected employees and

•disciplining employees for violations of the security program;

•implement physical access controls and develop a written procedure;

•limit the amount of personal information to that which is reasonably necessary to accomplish the purpose for which the personal information was collected;

•limit the amount of time that personal information can be retained to only the time necessary to accomplish the purpose for which personal information was collected;

•limit access to only those individuals who need access in order to accomplish their job duties;

•regularly monitor compliance with the security program;

•conduct at least annual reviews of the security program and measures; and

•document response taken in connection with any security breach.

•Also, a Nevada statute, scheduled to take effect on October 1, 2008, will require encryption by entities doing business in that state of all personal information leaving an organization’s system and transmitted over electronic networks. Taken together, the Nevada and Massachusetts enactments go a long way toward moving encryption from a best practice to a nationwide legal obligation. Moreover, the Massachusetts regulations go significantly further than any other state law or regulation by codifying many additional elements which have been best practice with respect to data security up until now.




#8 – Massachusetts, Nevada require encryption#8 – Massachusetts, Nevada require encryption

#7 – Exchange of clinical data using HITSP #7 – Exchange of clinical data using HITSP standardsstandards orchestrated by ONC, 9/23/2008 orchestrated by ONC, 9/23/2008





#7 – Exchange of clinical data using HITSP standards#7 – Exchange of clinical data using HITSP standards orchestrated by ONC orchestrated by ONC

#6 – AMIA organizes Rockefeller Global eHealth #6 – AMIA organizes Rockefeller Global eHealth conference, conference, Bellagio, Italy, July 2008 Bellagio, Italy, July 2008

The Rockefeller Foundation Bellagio

Center20-25 July, 2008

““Top Ten” EventsTop Ten” Events#10 – Personal Genome Project data available#10 – Personal Genome Project data available




#6 – AMIA organizes Rockefeller Global eHealth #6 – AMIA organizes Rockefeller Global eHealth conferenceconference

#5 - CMS Medicare Improvements Act of 2008 pays more #5 - CMS Medicare Improvements Act of 2008 pays more

for e-prescribing for e-prescribing






#5 - CMS Medicare Improvements Act of 2008 pays more #5 - CMS Medicare Improvements Act of 2008 pays more

for e-prescribing for e-prescribing

#4 – Explosion of molecular data#4 – Explosion of molecular data

• 22ndnd, 3, 3rdrd, and 4, and 4thth full full human genomes online human genomes online in past yearin past year

• $500 personal $500 personal genome expected in 3 genome expected in 3 yearsyears

• Proteomic labs Proteomic labs generating a terabyte of generating a terabyte of mass spec data per mass spec data per experimentexperiment

• Straining Straining communication, communication, archiving and analysis archiving and analysis infrastructureinfrastructure






#5 - CMS Medicare Improvements Act of 2008 pays more #5 - CMS Medicare Improvements Act of 2008 pays more for e-prescribing for e-prescribing


#3 - FDA Sentinel Initiative launched, May 2008#3 - FDA Sentinel Initiative launched, May 2008





#6 – AMIA organizes Rockefeller Global eHealth conference#6 – AMIA organizes Rockefeller Global eHealth conference



#3 - FDA Sentinel Initiative launched#3 - FDA Sentinel Initiative launched

#2 – NIH Public Access policy becomes mandatory 12/2007#2 – NIH Public Access policy becomes mandatory 12/2007

And the #1 top event of And the #1 top event of 2008 is…2008 is…





#6 – AMIA organizes Rockefeller Global eHealth conference#6 – AMIA organizes Rockefeller Global eHealth conference



#3 - FDA Sentinel Initiative launched#3 - FDA Sentinel Initiative launched

#2 – NIH Public Access policy becomes mandatory#2 – NIH Public Access policy becomes mandatory

#1 – Obama wins Presidency on platform including $50B for#1 – Obama wins Presidency on platform including $50B for EMR infrastructure EMR infrastructure

The only thing we The only thing we know about the know about the future is that it future is that it will be different.will be different.

Peter Drucker

The Village Inn

The Year in The Year in Review Review Summary…Summary…

Content for this session is Content for this session is at:at:

http://dbmichair.mc.vanderbilt.edu/amia2http://dbmichair.mc.vanderbilt.edu/amia2008/008/

including citation lists and linksincluding citation lists and linksand this PowerPointand this PowerPoint

Documents

Daniel R. Masys, MD Professor and Chair Department of Biomedical Informatics Professor of Medicine