Don E. Detmer, MD, MAPresident & CEO, AMIA;

Prof. Med. Education, UVA__________________________

University of MichiganSeptember 2008

Organizing Informatics at Michigan for Health, Care, Education, &

Research  

• Last here for the University of Michigan Informatics Grand Rounds – November 3, 2006

Then: Current Issues in Improving Clinical Practice through Informatics

Today: Clinical Practice & beyond…

Informatics

Informatics is the study of information & the ways information is used by & affects people & social systems.

Experts in this field design information technology tools for scientific, business, & cultural needs, & study how such tools are used.

- School of Information, University of Michigan

What is Biomedical/Health Informatics?

“An integrative scientific field that draws upon the information sciences & related technology to enhance the use of the knowledge base of the health sciences to improve health care, biomedical & clinical research, education, management, & policy.”

- D.E. Detmer

Informatics is a Means to Ends.

– "It is the pervading law of all things organic and inorganic,

– Of all things physical and metaphysical, – Of all things human and all things super-human, – Of all true manifestations of the head, – Of the heart, of the soul, – That the life is recognizable in its expression, – That form ever follows function. This is the

law.”

- Louis Sullivan (1896)

Biomedical/Health Informatics*

• Clinical Informatics, including– Clinical Research

• Hypothesis Generation, Phase 3, etc. – EHRs / PHRs - Consumer Health

• Public Health Informatics• Translational Bioinformatics• VISION (Visualization, Imaging, & Simulation

in Organs & Networks)

* Overlap among domains is appropriate

We are tracking a moving target.

- Gil Omenn 2006

What ends will you pursue? Where are you headed?

• Better Health of Citizens• Better Care for Patients• Economic Development of Michigan• Research Grants• Winning Teams

Population & Annual Costs EstimatesPopulation & Annual Costs Estimates

Healthy

Lynn et al., 2007

Acutely ill

Living with chronic illness/ disability

Coping with illness at the end of life

170 million

12 million

117 million

9 million

$1,118//yr

$25,000 //yr

$9,316 //yr

$46,667 //yr …

$190 billion/yr

$300 billion

$1090 billion

$420 billion

Paying for care instead of improving health

America spends 15% of GDP on health care by far more than anyone yet ranks 22nd for men & 25th for women for life expectancy, and 25th for both infant mortality & low birth weight. WHY?

Poor continuity of care plus disproportionate costs at end of life

Better predictors of health are socio-economic status, average per capita income, income inequality & woman’s education status.

17% of Americans live in poverty, when developed country average is 10.2%. Only 2.3% of U.S. GDP is spent on efforts to reduce poverty v. 5.8 Canada & 9.6 Netherlands.

Prescription for AHC Leaders- Claire Pomeroy, MD, PhD

(Blue Ridge Group meeting 2008)

• The further we distance new policies from the reality of social determinants, the more health care costs will rise while U.S. health declines over time.

• Reach beyond traditional medical care delivery mechanisms• Coordinate closely with a broad range of government &

community leaders• Create integrated, multi-sector policies & structures to

improve societal health & reduce disparities in a cost-effective manner

Distribution of Distribution of Determinants of HealthDeterminants of Health

Medical Care 20%

Behavioral Factors 20%

Environmental &Societal Factors 55%

Genetics 5%

Source: Sowada, 2003

Continuum of Care MechanismsContinuum of Care Mechanisms

Healthy

Acutely ill

Living with chronic illness/ disability

Frail/ Coping with illness at the end of life

Population tracking/ “health home” / “personalized” care

Transitional Care

Chronic Care Management

PACE*/ Hospice

Care

Courtesy of

Mary Naylor, RN, PhD

*Program for All-inclusive Care of the Elderly

Care Continuum: Portfolio of EHRs Care Continuum: Portfolio of EHRs Needed Needed

Healthy

Acutely ill

Living with chronic illness/ disability

Frail/ Coping with illness at the end of life

Population tracking/ “health home”

Transitional Care

Chronic Care Management

PACE*/ Hospice

Care

Adapted from

Mary Naylor, RN, PhD

*Program for All-inclusive Care of the Elderly

A Comprehensive Integrated University-wide Strategy for the

University of Michigan

Biomedical and Health Informatics• Components

– Health– Care– Education– Research

Work in Parallel with AMIA’s Strategic Vision

• Through informatics, transform health & health care for individuals & populations– Care that is Equitable, Efficient, Effective,

Patient-centered, Timely, Safe– Healthy populations in healthy environments

• Transform informatics from a serious avocation to a formally recognized health profession

Finish the Foundational Informatics Infrastructure

• Semantic Grid – Data computational layer

• Data stored, transferred & analyzed

– Information layer• Data associated with meaning

– Knowledge layer • Use of information for a purpose

See University of Minnesota CTSA Strategy

Informatics Planning MatrixClinical Informatics

Public Health

Translational Bioinformatics

VISION

Health Who, what, when, how, where, $s

Care

Education

Research

• Genetics• Cardiovascular Center• CS Mott Children’s & Women’s Hospital/Peds• Kellogg Eye Center• Brehm Center for Type 1 Diabetes*• Global goals (AMIA Gate’s twinning program)

‘Informatics for Excellence’ programs tied to Michigan’s strengths

Biomedical & Health Informatics Departmental Issues

• Institutional Service Linkages/Responsibilities• Divisions

– Clinical Informatics– Translational Bioinformatics

• Faculty issues– Total slots/ Core Fulltime/Joint

Appointments/Salary /Criteria for Promotion • Agreements on Overhead• Educational focus• Research

University-wide Strategic Governance Group (7-12 people)

• Biomedical Informatics Strategic Policy Group

• Biomedical Informatics Operations Subgroup– Academic Department for Education & Research

Components– Service Unit(s) with Active Clinical Components

• Health Informatics Strategic Policy Group• Health Informatics Operations Subgroup

– Academic Unit to lead Education & Research Components

– Service Unit identified heads up Policy Componentwith outside representation

University-wide Strategy & Governance Group (7-12 people)

• Planning

– Components– Players– Programs– Initiatives

• Governance– Services– Business agreements– Data sharing and networks

– Community building

Build from current Informatics strengths at Michigan

• Health Sciences– MICHR/CTSA Biomedical Informatics

Program– Clinical Research Informatics Core– Health Disparities Component

• School of Information– Informatics

• Others

Approved this past spring, informatics is a joint program of the College of Literature, Science, & the Arts; the College of Engineering; and the School of Information. (Sept. 2008)

Biomedical Informatics Partnering Schools/Colleges at University of

Michigan• Business• Dentistry• Engineering • LSA (parts)• Medicine• Nursing• Pharmacy• Public Health

Example of Clinical Informatics Agenda -

Assuring Value in Clinical Settings• Complete Infrastructure

• from “Got EHR?” to “Got EHR! Now what?!”– Instill Learning Care Culture– Institute EHR/Work Redesign Program

• Electronic Health Records– Secure Portal for Patients– Enhance Clinical Decision Support

• Best Practices & Scale for General Users– Esp. Chronic Illness Management, Population tracking/

“health home” / “personalized” care

Example of Clinical Informatics Agenda -

Assuring Value in Clinical Settings• Complete Infrastructure

– Instill Learning Care Culture– Institute EHR/Work Redesign Program

• Electronic Health Records– Secure Portal for Patients– Enhance Clinical Decision Support

• Best Practices & Scale for General Users– Esp. Chronic Illness Management, Population

tracking/ “health home” / “personalized” care

Develop Specific Plans/Programs for Care, Education, & Research5-7 yr. goals; 2 yr. work plans

Ex: Biomedical (Care)- Engineering & Medicine

• Systems Engineering• Work flow• Complex Adaptive Systems

*see http://www.sys.virginia.edu/healthcare/

The Future of Care: Manage Change supported by

Information Technology & Informatics

• Build Knowledgeable Teams• Reinvent Workflow • Integrate Innovations*• Remove ‘Outdated’ Practices• Reduce Variation• Improve Safety/Quality while Reducing Costs• Manage the Base of Knowledge

*Innovation student teams w/ Business School National Academies: “Building a Better Delivery System”

National Academy Press, 2005

Also, Business School & Biomedical Care Dimensions

• Complex adaptive systems• Organizational behavior• Marketing• Supply Chain Management• Strategic planning

Health Informatics –Schools/Colleges at University of

Michigan

• Education• Information • Law• LSA (parts)• Medicine• Nursing• Public Health• Public Policy• Social Work

 

The time lag which exists between the fact of change & the social & political understanding of what has happened.

- Henry Adams

Law of Acceleration of Changing Times

Some Disruptive Technologies:Telegraph, Telephone, Television,

Internet - Web 1.0 & Web 2.0

“If you study politics, military events & things like that , you’re studying how history gets made from the top down.”

“But you can also study the common people, history from the bottom up, because they’re making history, as well.”

- Daniel Walker Howe

Disruptive Technology Web 1.0 Web 2.0

Biomedical Informatics(science-based)• Top down• “Controlled from on

high”– HIPAA rules

• Privacy #1*

• Health & Freedom #3

Health Informatics(narrative-based)• Bottom up• “Power to the People”

– Personal Choice rules: Ex. PatientsLikeMe

• Freedom & Health #1;

• Privacy #3 *www.sciencexpress.org /4 September 2008 / Page 1/ 10.1126/science.1165490

The Driver’s License Solution• Add 3 more ‘opt out’ icons to the Organ Donor option

– Do not use my driver’s license # for electronic healthcare record authentication purposes

• Suggested symbol – EHR# or EHR#

– Do not allow my healthcare record information to be sent to me & my healthcare professionals

• Suggested symbol or *

– Do not allow my healthcare record information to be used for medical research (IRB approved research) & to contact me for relevant research

• Suggested symbol

or *

* Does not preclude my being asked at care sites

© DEDetmer 2006

Public Health/Population Informatics;Consumer Health Informatics

• Consumer oriented Education & Support (Citizen/Patient/Informal Caregivers)• Integrated Personal Health Record*

*See Detmer DE, Bloomrosen M, Raymond B, Tang P: Integrated personal health records:  Transformative tools for consumer-centric care. 2008 BMC Medical Informatics and Decision Making (in press)

Education Strategy

• Participate in AMIA’s 10x10 Program– Translational Bioinformatics– Clinical Informatics– Public Health Informatics– (Consumer Informatics)

• Consider collaboration in AMIA International Developments– 20/20 Bits/Bytes Courses

National Readiness Assessment Instrument; other tool kits

PhD; Masters Informatics__________________________

Clinician/Public Health 10x10 Champions

______________________________20/20 “Bits &Bytes” Knowledge & Skills

Offerings

Executive Seminars;Leadership ID,

Training & Advocacy

Global ‘South’ Components of Needs &20/20 Vision for Assuring eHealth Capacity

Policy &Leadership

Human Capital

(eHealth Workforce Capacity)

State of ICT Technology Infrastructure

Components

Vision for eHealth Workforce

Education Strategy

• Participate in AMIA’s Academic Forum

– Develop Clinical Informatics Training Program for MD sub-certification

– Develop parallel Nursing/Pharmacy/Dentistry Informatics Training Programs

– Engage issues such as salary structure & promotion criteria

– Require Common Core ICT/Informatics Education for all health professional students (AMIA’s Academic Strategic Leadership Council initiative)

Informatics Tracks (Now & Future*)

• Doctoral Level– Academic/Research Career – PhD

• Medicine: Translational Bioinformatics /Clinical Informatics• Nursing/Public Health Informatics/Other• NLM’s Training Programs plus other university programs

• Master’s– Clinical Informatics– Public Health/Population Informatics

• CDC

– Health Information Management

• Certificates *– Fellowships & Medical Sub-certification– 10x10 – AMIA Graduate Level Course work– 20/20 Bits/Bytes – Global Informatics Education

University-wide Informatics R&D Template

Use Informatics Toolkits/ EHRs to Assess Environment & Evaluation of Interventions• Easing life transitions

–Healthy to acutely ill–Acutely ill to chronically ill–Chronically ill to End-of-life

• Personal health assessment / support• Population – community health assessment• Public Health

Measuring Excellence in 2015

It’s not human memory & technology (IT) per se that will matter.

It’s integrating carbon & silicon-based intelligence (Informatics) across disciplines to create needed change.

Well done is better than well said.

- Benjamin Franklin

Upcoming AMIA Events

Grand Hyatt San FranciscoSan Francisco, CaliforniaMarch 15-17, 2009

2nd Annual Summit on Translational Bioinformatics

Yves Lussier, Program Chair

Jaap Suermondt,

Program Chair

AMIA 2008 Annual SymposiumHilton Washington Hotel and TowersWashington, DCNovember 8-12, 2008

Hyatt Reston, Reston VASeptember 15, 2008

AMIA Health Policy Forum

Doug Fridsma,Suzanne Markel-Fox

2009 AMIA Spring Congress Walt Disney World Swan Orlando, Florida May 28-30, 2009

Patti Abbott, Program Chair

Personal reflections on this topic

1. Warner HR, Detmer DE, Peay WJ. IAIMS implementation and administration at the University of Utah. Proc Fifth Conf Med Informatics 1986; p. 1-6.

2. Detmer DE. The Future of IAIMS in a Managed Care Environment: A Call for Private Action and Public Investment. JAMIA 1997; 4, S65-S72.

3. Detmer DE, Steen EB: Information & Communications Technology & the Future Health Workforce: Transformative Opportunities & Critical Challenges. In Holmes DE: From Education to Regulation: Dynamic Challenges for the Health Workforce. Assoc. Acad. Health Centers,

2008, Washington, DC, pp.21-46.

detmer@amia.org

http://www.amia.org

Thank you & Best Wishes.

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