Not for MDs only

Mining Data, Minding Patients

Holly Brugge Jimison

Holly Brügge Jimison

Make medical care more personal through the power of computers

By Eric Weissman
Photograph by Anne Rybak

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. It’s 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 clinician’s 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.

“It’s 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 Buddy’s small screen. The heart failure patient can respond, for instance, by indicating that she’s feeling more fatigued than usual. Electronic scales in the home can alert offsite caregivers to a jump in weight, perhaps indicating that a diuretic isn’t 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.”

Jimison’s involvement in using technology to manage health at home isn’t 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, she’s 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.

Jimison’s 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, Jimison’s 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. It’s electronic. It’s online. It’s data-driven. But it’s personal. SMD

Comments? Contact Stanford Medicine at

 Back To Contents