comp5 unit1b lecture slides
TRANSCRIPT
History of Health Information Technology in the U.S.Evolution of Health IT: The
Early YearsLecture b – The 1970s
This material Comp5_Unit1 was developed by The University of Alabama Birmingham, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology
under Award Number 1U24OC000023
Evolution of Health IT: The Early Years
Learning Objectives
2
• Discuss how the problem-oriented medical record changed the structure of medical records
• Discuss the impact that increased access to healthcare had on the use of computers in healthcare in the 1970s
• Describe how key informatics innovations such as the problem-oriented medical record, MEDLINE, early EMRs and CDSS relate to the general healthcare environment of the 1970s
• Describe some of the early forerunners of today’s EHR including COSTAR, TMR, and the Regenstrief CPRS
• Describe early clinical decision support systems including INTERNIST-1, MYCIN and the HELP system
Health IT Workforce Curriculum Version 3.0/Spring 2012
History of Health Information Technology in the U.S. Evolution of Health IT: The
Early Years Lecture 1b
General Environment – 1970s
• Access to higher education• Increase in science funding
3Health IT Workforce Curriculum Version 3.0/Spring 2012
History of Health Information Technology in the U.S. Evolution of Health IT: The
Early Years Lecture b
General Environment – 1970s
• Access to higher education• Increase in science funding• Science applied to education
4Health IT Workforce Curriculum Version 3.0/Spring 2012
History of Health Information Technology in the U.S. Evolution of Health IT: The
Early Years Lecture b
General Environment – 1970s
• Access to higher education• Increase in science funding• Science applied to education• Mainframe computers• Computer specialists in industry
5Health IT Workforce Curriculum Version 3.0/Spring 2012
History of Health Information Technology in the U.S. Evolution of Health IT: The
Early Years Lecture b
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History of Health Information Technology in the U.S. Evolution of Health IT: The
Early Years Lecture b
(Courtesy: Lawrence Livermore National Laboratory)
Healthcare Environment – 1970s
• Increase in medical students
7Health IT Workforce Curriculum Version 3.0/Spring 2012
History of Health Information Technology in the U.S. Evolution of Health IT: The
Early Years Lecture b
Healthcare Environment – 1970s
• Increase in medical students• Increase in NIH funding
Source: (Kalberer and Newell, 1979)
8Health IT Workforce Curriculum Version 3.0/Spring 2012
History of Health Information Technology in the U.S. Evolution of Health IT: The
Early Years Lecture b
Healthcare Environment – 1970s
• Increase in medical students• Increase in NIH funding• Fee-for-service practice model• Few controls on physicians
9Health IT Workforce Curriculum Version 3.0/Spring 2012
History of Health Information Technology in the U.S. Evolution of Health IT: The
Early Years Lecture b
Healthcare Environment – 1970s
• Increase in medical students• Increase in NIH funding• Fee-for-service practice model• Few controls on physicians• Escalating healthcare costs
10Health IT Workforce Curriculum Version 3.0/Spring 2012
History of Health Information Technology in the U.S. Evolution of Health IT: The
Early Years Lecture b
Healthcare Environment – 1970s
• Increase in medical students• Increase in NIH funding• Fee-for-service practice model• Few controls on physicians• Escalating healthcare costs• Mainframe computers (fiscal)• Computer specialists
11Health IT Workforce Curriculum Version 3.0/Spring 2012
History of Health Information Technology in the U.S. Evolution of Health IT: The
Early Years Lecture b
Healthcare Organizations
• Increase revenue– Increase number of physicians
• Increase in procedures, hospitalizations
12Health IT Workforce Curriculum Version 3.0/Spring 2012
History of Health Information Technology in the U.S. Evolution of Health IT: The
Early Years Lecture b
Healthcare Organizations
• Increase revenue– Increase number of physicians
• Increase in procedures, hospitalizations
• Fiscal, data processing automation– Administrative Data Processing– Billing and Collections– Director of Data Processing
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History of Health Information Technology in the U.S. Evolution of Health IT: The
Early Years Lecture b
Physicians
• Solo, group private practice• Artful application of science • Increase in use of technology• Increase in income
Source: (Berg, 1997)
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History of Health Information Technology in the U.S. Evolution of Health IT: The
Early Years Lecture b
Physicians
• Solo, group private practice• Artful application of science • Increase in use of technology• Increase in income• Physician dominance• No direct use of computers
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History of Health Information Technology in the U.S. Evolution of Health IT: The
Early Years Lecture b
Academic Physicians
• Scientific practice of medicine
Source: (Berg, 1997, p. 22)
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History of Health Information Technology in the U.S. Evolution of Health IT: The
Early Years Lecture b
Academic Physicians
• Scientific practice of medicine– Technology– “Objective” data
• Emphasis on laboratory medicine
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History of Health Information Technology in the U.S. Evolution of Health IT: The
Early Years Lecture b
Academic Physicians
• Scientific practice of medicine– Technology– “Objective” data
• Emphasis on laboratory medicine– Systematic data collection/recording
• Problem-oriented medical record (Weed)
Source: (Weed, 1968)
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History of Health Information Technology in the U.S. Evolution of Health IT: The
Early Years Lecture b
Old-Fashioned Progress Note
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History of Health Information Technology in the U.S. Evolution of Health IT: The
Early Years Lecture b
Problem List
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History of Health Information Technology in the U.S. Evolution of Health IT: The
Early Years Lecture b
SOAP Note
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History of Health Information Technology in the U.S. Evolution of Health IT: The
Early Years Lecture b
Academic Physicians
• Scientific medical education
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History of Health Information Technology in the U.S. Evolution of Health IT: The
Early Years Lecture b
Academic Physicians
• Scientific medical education– Behavioral objectives– Objective evaluation
• Multiple choice tests
23Health IT Workforce Curriculum Version 3.0/Spring 2012
History of Health Information Technology in the U.S. Evolution of Health IT: The
Early Years Lecture b
Academic Physicians
• Scientific medical education– Behavioral objectives– Objective evaluation
• Multiple choice tests– Problem-based learning– Teach medical problem solving
Source: (Neufeld and Barrows, 1974)
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History of Health Information Technology in the U.S. Evolution of Health IT: The
Early Years Lecture b
Medical Informaticians
• Automated clinical systems
Source: (Collen et al., 1971)
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History of Health Information Technology in the U.S. Evolution of Health IT: The
Early Years Lecture b
Medical Informaticians
• Automated clinical systems• Computers to promote the scientific practice
of medicine
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History of Health Information Technology in the U.S. Evolution of Health IT: The
Early Years Lecture b
Medical Informaticians
• Automated clinical systems• Computers to promote the scientific practice
of medicine– Access to knowledge and patient databases– MEDLINE
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History of Health Information Technology in the U.S. Evolution of Health IT: The
Early Years Lecture b
Medical Informaticians• Computers to systematize practice
– Computer-based Patient Record
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History of Health Information Technology in the U.S. Evolution of Health IT: The
Early Years Lecture b
Medical Informaticians• Computers to systematize practice
– Computer-based Patient Record• COSTAR – Mass General Hospital• TMR – Duke University Medical Center• RMRS – Regenstrief Institute
Sources: (Barnett et al., 1979) (Hammond, 2001)(McDonald et al., 1977)
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History of Health Information Technology in the U.S. Evolution of Health IT: The
Early Years Lecture b
Medical Informaticians• Computers to systematize practice
– Computer-based Patient Record• COSTAR – Mass General Hospital• TMR – Duke University Medical Center• RMRS – Regenstrief Institute
• Expert systems research– Clinical decision support, reminders, alerts
• MYCIN – Stanford • INTERNIST-1 – Pittsburgh • HELP – LDS Hospital
Sources: (Shortliffe and Buchanan, 1976)(Miller et al., 1982)(Warner et al., 1972)
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History of Health Information Technology in the U.S. Evolution of Health IT: The
Early Years Lecture b
Evolution of Health IT: The Early Years
Summary — Lecture 1b• Fee-for-service medicine• Artful application of science• Teaching medical students the “scientific practice of
medicine”• Automation of billing processes in hospitals• Research on clinical computer applications to make
clinical practice more scientific and to systematize practice.
Source: (Schwartz, 1970)
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History of Health Information Technology in the U.S. Evolution of Health IT: The
Early Years Lecture b
Evolution of Health IT: The Early YearsReferences – Lecture b
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History of Health Information Technology in the U.S. Evolution of Health IT: The
Early Years Lecture b
a
References
• Barnett GO, Justice NS, Somand ME et al. COSTAR – A computer-based medical information system for ambulatory care. Proc IEEE. 1979;67:1226-37.
• Berg M. Rationalizing medical work. decision-support techniques and medical practices. Cambridge, MA:MIT Press; 1997. • Collen MF, Davis LS, van Brunt EE. The computer medical record in health screening. Methods Inf Med. 1971;10(3):138-
42.• Hammond WE. How the past teaches the future: ACMI distinguished lecture. J Am Med Inform Assoc. 2001;8(30):222-34.• Kalberer JT Jr, Newell GR Jr. Funding impact of the National Cancer Act and beyond. Cancer Res. 1979;4274-84.• McDonald CJ, Murray R, Jeris D, Bhargava B, Seeger J, Blevins L. A computer-based record and clinical monitoring system
for ambulatory care. Am J Public Health.1977;67(3):240-5.• Miller RA, Pople HE, Myers JD. INTERNIST-1: An experimental computer-based diagnostic consultant for general internal
medicine. N Engl J Med.1982;307:468-76.• Neufeld VR , Barrows HS. The “McMaster Philosophy”: an approach to medical education. J Med Educ. 1974;49(11):1040-
50.• Schwartz WB. Medicine and the computer: the promise and problems of change. N Engl J Med. 1970;283(3):1257-64.• Shortliffe EH, Buchanan BG. A model of inexact reasoning in medicine. Math Biosci. 1976;23:351-79.• Warner HR, Olmsted CM, Rutherford BD. HELP, a program for medical decision-making. Comp Biomed Res. 1972;5:65-74.• Weed LL. Medical records that guide and teach. N Engl J Med. 1968 Mar 14;278(11):593-600.• Weed LL. Medical records that guide and teach. N Engl J Med. 1968 Mar 21;278(12):652-7 concl.