医学信息学的发展前景

淋附附賺附臟肪按"船附耐腿腿腿一unttt問呱取w恥UnJVLRSJTY(/fTliXASIttALYH^CPEM(tClWIIIIA・lloiMQH>rit<»i>crf11r«mmNfctau•擊i^wif^cviBiomedicalInformatics:CurrentChallengesJiajieZhang,PhDDr.DorisL.RossProfessor&AssociateDeanforResearchUofTexasSchoolofHealthInformationSciencesatHoustonOutline■BiomedicalInformatics:ATexasStyle■Whatisit?■StructureandProcess■Scope■Challenges■NationalInfrastructure■Ontology■TranslationalInformatics■Human-CenteredComputing■Conclusion識_l:owbiuly丄;il,:ncLliu/',;u:l1

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libraries•Supporiiugpr；Ldiccaladistance•Buildingspeciflc1:AIRc<Hnp<nicnls)J，:'decisionsiipporl:,etc.)•(；i_eatnigpcrsoihilhealthrecordCopyrightCZhang2(MNApplicationDomains•HealthCare(emphasizingCiire()tindividuals)•PublicHealth(emphasizinghealthofpopulations)•BiomedicalResearch(b^isicresearchandclinicalresearch)•EducationofHealthProtession^lsandConsumers•Administration/KLin^gementofHe^lth-reLittdorganizations•HealthLibrariesCopyrightCZhang2(KWhyCodedTerminologies?■Dataorganization■Dataexchange■Dataintegration■Semanticconsistency■Structureddataentry■DecisionsupportCopyright◎ZhangCodedTerminologies■TerminologicTerms(ISOStandard1087)■Object:anypartoftheperceivableorconceivableworld■Name:designationofanobjectbylinguisticexpression■Concept:aunitofthoughtconstitutedthroughabstractiononthebasisofpropertiescommontoasetofobjects■Term:designationofadefinedconceptinaspeciallanguagebyalinguisticexpression■Terminology:setoftermsrepresentingthesystemofconceptsofaparticularsubjectfield.■Nomenclature:systemoftermsthatiselaboratedaccordingtopreestablishednamingrules■Dictionary:Structuredcollectionoflexicalunitswithlinguisticinformationabouteachofthem.■Vocabulary:dictionarycontainingtheterminologyofasubjectfieldCopyright◎ZhangNOCNANDACPTRcatXDCGalenCopyrightCZhang2(XTranslationalInformatics■OneofthenewdirectionsatNIH■Translationfrombasicresearchfindingstoclinicalpractice■Vision:■Individualizedprevention,diagnosis,andtreatmentthroughtheintegrationofinformationfromthelevelsofmolecules,throughgenesandproteins,tothelevelsofindividualsandpopulationsCopyright◎Zhiing2(.HNMolecT.kC^LLiLdrjim:DUl..3\nLCnrtJ:llLd;?]ProTsinISiib-zelhtazTurnsEH?:fc:TmIOreanCoreJ:'cse-：7：Cgt^1:Siaidiamjic:;ZoLDlLT'/JOaillCare2:BizD^diciilJ^qiK.i3Cored:Ijfd-miavreCart?:zdue?.nonandT^icdoz蠹pyright©Zh^iig2(MUSHealthCareSpending(fromPatrickKennedy’sAMIAKeynoteinApril，2005)U.S.HealthCareSpendingHeflleretal.,HealthAffairs,2005Copyrigjn◎ZhangMWhyishealthcaresocostly?■Wasteofresources■Asmanyas20%ofalltestsand1in7hospitaladmissionsmaybetheresultofinadequateaccesstoinformation■Inefficiency■30%timeforrecordkeeping■MedicalerrorsCopyright◎ZhangAnnualDeathRatesinUSdeathsaccidentsCopyright◎Zhang200(CostofMedicalError■$17-29Billiontotalnationalcost■Lostincome■Losthouseholdproduction■Disability■Healthcare(halfofthetotalcost)■Example:LengthofStayup4,6days,+$4,700peradmissionCopyright◎Zhang200(HumanErrorsinHospitalization(Brennanetal，，1991)-7Copyright◎ZhangComputerizedphysicianorder-entry(CPOE)systems■NowphysicianshavetoentertheordersthemselvesCopyright◎ZhangJAMAArticle,March9,2005nRoleofComputerizedPhysicianOrderEntrySystemsinFacilitating

MedicationErrorsnJournalofAmericanMedicalAssociation,293(10)，

1197-1203,2005Butseeourresponse:Hotsky,J.,Zhang,J,，&Patel,V.L.(2005).Toisnotentirelyhuman:Complextechnologyandusercognition.JournalofBiotnedicalInformatics,38,

264-266.Worse!PediatricsArticle,December,2006nUnexpected[ncreased

MortalityAfterImplementationofaCommerciallySoldComputerisedPhysicianOrderEntrySystem”Pediatrics，166(6),1506-1512,2006Seeourresponseagain:Sittig,I).R,Ash,J.S-’Zhang,JOsheroff,J.A.,&Shabot,M.M.(inpress).Responseto"'UnexpectedincreasedmortalityafterimplementationofacommerciallysoldComputerizedPhysicianOrderEntrySystem,J.Pediatrics,()0,000-000.Copyright◎ZhangNationalHealthInformationTechnologyInitiative■PresidentBush’sgoal■Electronichealthrecords(EHR)foreveryindividualby2014■Reducecost■Reducemedicalerror■Improvecarer8,■AtaltimesGoodFeaturesBadFeaturesXGoodFeatures%fBadFeatures2,3,ElectronicMedium6,7,Paper-basedRecords•Atallpointsofcare■Complete■Accurate■TimelyHealthinformationanddataResultsinanagementOrdereiitry/iiiaiiagemeiitDecisionsupportElectronicconiinunkatioiiandconnectivityPatientsupportAdministrativeprocessesReporting&.populationhealthmanagement■Foralheathcareprofesslonas&patientsCopyrightCZhang2(XStatusofEHRAdoption■1991IOMreportcalledforimplementationofEMRin10years■12yearslater,only7%inUS■50-90%inEuropeStatusofEHRAdoption■AmbulatoryEHRpenetrationlevel(fromMarkLeavitt,CCHIT^:■OverallEHRpenetration1:17%■Smalloffices(i.e.mostdoctors)2:7%■Groupsof50doctorsormore2:20%■8%ofphysiciansorderbycomputer.(ci)(“2oo5)1nationalAmbulatoryMedicalCareSurveyreport,March20051Center

咖St_ngHealthSystemChange'Sept2004，。：⑽EHREffects:Positive■Computerizedorderingreducesmedicationerrorsby88%.(Bates,1999)■Reducingcostscreieh,2000)■Nationally,fullimplementationofITcouldsave$77.8billionannually.(CenterforITLeadership)■ROIforbothinpatientandoutpatientsettings.(Schmitt,2002;Wang,2003)Copyright◎Zhang2(MNEHREffects:Positive8%oftotalhealthcarecost1.2%ofGPD$162Billions/yearcouldbesavedbyHITinUSIncreasedefficienciesReducedadversedrugeventsPrevention&ManagementRAND2005repo^^|ltQ/.hailg2llr([81467oooooo987654ooo321scoms的ProblemswithEHR■AnoutpatientCPOEincreasedencountertimeperpatientby2,2minutes■from9.8to12.(C)vcrhagc.1997)■AninpatientCPOEincreasedthetimespentonpatientorderentry■from2.1%to9%workday.(shU，2_ProblemswithEHR■TheCedars-SinaiHospitalStory■Fall,2002:■534millionEHRsystemwasimplemented■January2003:■severalhundreddoctorsdemandedanendtothehospitafsshortlivedexperiment.■Examples:■3minusingpaper;30-40minusingEHR■Absoluatclynomisspellings■CountlessautomaticalertsfortrivialproblemsCopyrighr◎ZhangkIndustry-WideITFailure34%□success51%15%Source:CHAOSReport.TheStandishGroup,2004ISProjectSuccessRate□failure□"challenged"・Ratesshownareaverageof13,522projectsacrossindustry・TheriskoffailureisevengreaterforlargerprojectsFromKeithButleratBoeingCopyright©ZhangkEHRismorethananITproject■Morethan50%HITprojectsfail■MostofthesefailuresareNOTduetoflawedtechnology■Butduetothelackofsystematicconsiderationsofnontechnologyissues■Human-ccntcrcdcomputing■workflow■organizationalchange■medicalerror■processreengineeringCopyright◎Zhang200(HowtoAddressHITFailur