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Not for MDs onlyMining Data, Minding Patients
Make medical care more personal through the power of computersBy Eric Weissman We may be living large in the Information Age but many health-care providers
still rely upon Stone-Age tools when it comes to managing patient information
and providing patient education. Holly Brügge Jimison, PhD, a 1990
alum in medical informatics is working to change that. Jimison is a medical informatics specialist at the Kaiser Permanente
Center for Health Research in Portland, Ore. Asked to define the field,
she hesitates before giving a simple response, Computer applications
in medical care. But with a big caveat. Medical informatics is not merely about creating electronic databases,
she says. Its also about finding the intersection between information
technology and clinical care the point at which medical information
can be applied meaningfully in order to get a cardiac patient who smokes
a pack and a half a day to take her medication, exercise regularly and
kick the habit. From a clinicians perspective, medical informatics not only provides
sophisticated tools to assist with patient care but also workflow aids,
reducing paperwork and enabling clinicians to focus on human interactions
with patients, Jimison says. In addition, medical informatics can provide
patients with knowledge critical to enabling them to become better partners
with their health-care providers, ultimately leading to sound decision-making
about their own treatment. Its all about how technology can be used to augment medical
care, Jimison says. The underlying idea is to use the data to make
the most appropriate health-care decisions, decreasing the lag-time between
data collection and clinical action and improving information exchange
between health-care providers, plan administrators and patients. In addition to developing methods that improve workflow in a health-care
setting, Jimison is also creating ways to use communication technology
to help people deal with chronic disease, specifically heart failure.
Home-based technology such as the Health Buddy, a small device that sits
by the phone and relays information between patients and clinicians,
is part of the picture. Each day a series of automated health-related
questions appear on Health Buddys small screen. The heart failure
patient can respond, for instance, by indicating that shes feeling
more fatigued than usual. Electronic scales in the home can alert offsite
caregivers to a jump in weight, perhaps indicating that a diuretic isnt
working properly. This is especially helpful, says Jimison, because many heart failure patients are confused or depressed and may not notice trends. Anything we can do to aid frequent monitoring is extremely valuable to them. Jimisons involvement in using technology to manage health at home isnt new. In the late 1990s, as the Internet became increasingly prevalent in ordinary peoples lives, she worked with WebMD to help shape online Internet-based communities. These communities, which took the form of chat rooms, message boards
and live broadcasts featuring health-care experts, were intended to trigger
behavioral change in people who have chronic illnesses. They were also
designed to bring patients together, providing support and resources
through peer groups. Now through Kaiser, Jimison is working on new online interventions and
high-tech tools specifically geared toward seniors. Big Brotherish at
first glance, electronic devices would keep an eye on elders health.
She is collaborating with a high-tech assisted-living facility in
Oregon called EliteCare, developing digital tools to monitor, collect
and transmit residents health data electronically in real time.
Weight sensors under the bed, location sensors and light sensors placed
in the homes of the residents relay data to both local and remote caregivers. Jimison notes that some of the healthier elders are initially concerned
about monitoring, but as more care is needed over time, everyone, including
the residents, comes to appreciate the value of these tools that ultimately
prolong independence. The efforts applying medical informatics to elder care go beyond changing
unhealthy behaviors and monitoring physical health. In a project with
Oregon Health Science University, where Jimison serves as adjunct associate
professor of medical informatics, shes working on Web-based computer
games that will help measure cognitive performance of patients at home,
anticipating declines along with providing electronic mental exercises
and games to keep them sharp. Similar to the hardware used at EliteCare, devices such as location
sensors would be installed into the homes of at-risk seniors to sense their
behavior and patterns. In her research to develop and implement such
tools, Jimison hopes to learn how electronic monitoring could be used
to enhance independence and health care for elders in their homes, potentially
delaying the need for assisted living or nursing homes. Jimisons research showed that computer users over age 80 particularly
enjoy the computer solitaire game Freecell. She and her colleagues adapted
the game to measure cognitive performance. Additionally, a pressure-sensitive
mouse can monitor confusion as a senior is using the computer. In conjunction
with other sensors and the more traditional gait analysis, Jimison hopes
to detect trends in cognitive function. A cognitive decline could indicate
anything from a bad reaction to medication to the need for an early intervention,
she says. The goal of this work, explains Jimison, is to improve screening methods
for dementia. She hopes pilot data from the research will convince granting
agencies to fund a larger clinical trial. Jimison also teaches a course at OHSU on the ethical and legal issues
related to medical informatics. The last class had 35 students, many
of whom were physicians with patients of their own. Occasionally drawing
on these cases, the students muscled through ethical dilemmas and situations
they would likely face in the real world. The course aimed to instruct
students not just in the application of medical informatics but also
on exploring the quality of the health-care system and understanding
the ethical issues related to information technology in patient care. Despite the reliance on leading-edge technology and the endless streams of impersonal data requiring analysis, at the bottom of it all, Jimisons work remains focused on people. Never does she lose sight of the patient who needs to get better or the physician who needs improved workflow. That kind of wrestling with real-world problems is so valuable, she says. The same is the case for medical informatics at large. Its electronic. Its online. Its data-driven. But its personal. SMD Comments? Contact Stanford Medicine at ![]() |
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