elegation’s posterous

el·e·ga·tion: being highly effective, yet simple  
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November 13, 2009

Visual Thinking, Metaphors, and Inspiration to Improve Electronic Medical Records (EMRs)

I would like to share with you one of the most inspiring books for me.


Perhaps you have heard of it?  Its by Colin Ware, "Visual Thinking for
Design", a free preview can be found on google books:

http://books.google.com/books?id=WBlUgKhMbdsC&lpg=PP1&dq=visual%20thinking%20for%20design&pg=PP1#v=onepage&q=&f=false

I draw inspiration from the book.  One is the idea that most humans are at a basic level fundamentally designed to receive and interpret visual information in the same manner.  The steps higher up in cognition, such as "what" is that object, what to "do" with the object can be different for different people.  Due to these similarites, products and interfaces can be designed and optimized for human use.  Elegant design by an engineer can help decrease mental workload and make a task actually more enjoyable & effortless.  The current hospital environment and design of EMRs have loads of room for optimizing workflow, visualization of data, and for distributing workload between humans as well as human-computer.  Specifically, the tasks for which the computers are able to accomplish (data storage, continuous monitoring, information retrieval, and communication) can be interfaced with the human's strength (prioritization, problem solving, decision making, interpretation and adding meaning to data).  The interface can provide a powerful end product (see computer/device alerts in the critical care setting for when a patient is getting ill, the amount of data
the cllinician is able to review on a daily basis during "rounds", or the human maintaining a medical problem list for a patient).

Clinicans, when combined with elegant design of computerized systems is safer and more effective than the clinician without any tools.  Dr. Friedman's "Fundamental Theorem" of informatics elegantly describes this idea:
http://www.jamia.org/cgi/content/full/16/2/169/FIG1

A current problem in health care that much of the electronic medical record (EMR) is not objectified.  Humans evolved and succeeded in their environment due to the ability to manipulate objects.  It can even be an enjoyable experience (see the iPhone).  The difficult to use interface and navigation of clinical data that is commonplace in the currently availabe EMRs has much room for improvement.  Coln Ware's book offers a reference to my other academic hero, Dr. George Lakoff.  page 62-63, "Even when we talk about abstract, inherently non-spatial ideas, phrases such as connected to, built on, contained within, are so common that we do not even think of them as metaphoric.  According to Lakoff, these kinds of spatial analogies are fundamental to human reasoning, which is ultimately grounded in human experience gained by interacting with the environment."  In other words the lower levels of visual processing are fundamental and fixed, but the higher levels offer for a much more malleable situation.  The human is "programmed" via narratives and metaphors.

One feeling I get in engineering these days is that conceptual models can be very complex, and I wonder if they could be simplified a bit.  One possibility would be if these models could actually be tied more directly to some of the fundamental metaphors and narratives for which many of us are familiar.  Perhaps these ideas and concepts which are written on papers and journals are essentially in "the cloud".  I wonder if there is an opportunity to bring it back to earth, to the world in which we live, to be more applicable to our everyday lives.

Filed under  //   clinical informatics   Colin Ware   emr   fundamental theorum   informatics   medical records   metaphor   visual thinking   visualization  

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April 9, 2009

MD training in Clinical Informatics.

I have been on the hunt for a strong, distance clinical informatics program for physicians (MDs).  

The below information culled from AMIAs website, I specifically looked at those with online options.  Many of the links were outdated and others more were mainly nursing.

Harvard-Mit Health Sciences and Technology appears to be a top-tier program.  Not a lot in terms of distance learning.  Can't go wrong combining MIT + Harvard I suppose.

Indiana CTSI : Combining Purdue, Nortre Dame, and IU, 
"Health care professionals committed to a career in clinical research are ideal candidates for the CITE program. Over the past several decades, it has been increasingly recognized that a cadre of clinician-scientists committed to and trained in patient-centered research is essential to complement the numerous advances emanating from the basic biomedical and laboratory sciences. There are substantial needs as well as funding opportunities for investigators interested in conducting clinical trials, epidemiological studies, translational research, health services and outcomes research, studies involving large databases, and other types of clinical studies. Employment possibilities for trained clinical investigators include research positions in academics, industry, and government.

Most participants will already have a doctoral degree (e.g., MD, PhD, DNS, DDS, or DPT) or be in training for a doctoral degree. Potential applicants include, but are not limited to, the following:

  • Fellows or other health care professional trainees who have substantial protected time for clinical research
  • Junior faculty who have career awards or support from their division or department head for participation in the CITE program
  • Other faculty who previously have focused on basic research or other academic activities but now are committed to pursuing a career in clinical research"

Stanford Biomedical Informatics has a complete Professional Masters Course online

UIC's Masters in health informatics is fully online.  However not really geared for MDs.  They also have an MPH coursework that may be closer.  They are the upcoming site for the AMIA's next 10x10 .

Nebraska seems interesting as well, but programs of study and research not as aligned with mine.

University of Texas at Houston seems like an up and coming program, not clear if they offer much in the way of distance coursework.

Utah has a strong history and appears flexible (1-3 year fellowship + sabbatical leaves).  Some distance learning opportunities including podcasts.  Also has a fellowship.

University of Virginia seems very interesting, however their fellowships appear only open to phd's.  Their area of focus is very aligned with my interests:

Example Research Topics

Fellows will focus their research in healthcare information systems. Example research topics:

  • Intelligent clinical user interfaces and decision support systems.
  • Analysis and design of handoffs of care.
  • The design, construction and testing of computerized and physical simulators for training clinical palpation and surgical skills.
  • Use of mathematical and statistical approaches to aid in the evaluation and clinical interpretation of laboratory tests
  • Analysis of medical longitudinal data using multivariate and nonlinear time series analysis
  • Spatiotemporal analysis of medical images such as from MRI or digital x-rays
  • Clinical laboratory automation, embedded sensors, and remote patient monitoring using the Internet and wide area communications.
  • Consumer health informatics and evaluation of informatics tools and resources.
  • The role of standards in support of data integration, data repositories, physician order entry, decision support, and the optimal use of clinical data for patient safety and clinical research.
  • Design, structure, function, and utility of large patient data repositories for clinical and research purposes.
  • Patient safety and the application of systems engineering techniques to prospectively study practices or retrospectively use chart review and data mining methods.
  • Visualization of medical and biological data sets.
Columbia University in NY has been near the top of my list since the beginning, but its unclear if the program is growing or shrinking.

And still, the MD training for clinical informatics powerhouses still include the Regenstrief Institute in Indianapolis , and The Oregon Health and Science University .

Filed under  //   AMIA   clinical informatics   Clinical support systems   design   Harvard   informatics   Masters   MD   MIT   Nebraska   NIH   NLM   OHSU   post-doc   Regenstrief   Stanford   UIC   user interface   Utah  

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July 13, 2008

ePocrates and post MI care

I have had ePocrates on my iPhone for about 24 hrs.  It has been a dream so far.  I havent had any patient interactions, as it is my day of the week off.

However, I have been quite impressed with the formulary function.  I have been able to quickly see which of the frequently prescribed medications are on the Madison formulary.

I will run in to this clinical situation many times in the next month on the cardiology ward:

A patient with no known history enters the hospital emergently due to an acute myocardial infarction (heart attack).  They have previously not taken any medication.  If all goes well, they will be discharged in 3-4 days on multiple new medicaitons, including:

Aspirin (generic, over the counter)
B-blocker (metoprolol tartrate or carvedilol are both covered on the Target 4$ Program)
Ace-inhibitor (lisinopril is covered)
Statin (simvastatin and atorvastatin are most commonly used, but quite expensive).  Pravastatin and Lovastatin are covered, but not as well studied.
Plavix, or clopidogrel: very expensive still.  There was a lawsuit back in 2007 to keep it under patent.
Fish Oil, or omega 3 fatty acids

If on-patent drugs are prescribed, this can be quite expensive quite quickly.

Filed under  //   cardiology   clinical   clinical informatics   Clinical support systems   ePocrates   iphone   medical   Medicine  

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