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History of Health Information Technology in The U.S

The Health IT Workforce Curriculum was developed for U.S. community colleges to enhance workforce training programmes in health information technology. The curriculum consist of 20 courses of 3 credits each. Each course includes instructor manuals, learning objectives, syllabi, video lectures with accompanying transcripts and slides, exercises, and assessments. The materials were authored by Columbia University, Duke University, Johns Hopkins University, Oregon Health & Science University, and University of Alabama at Birmingham. The project was funded by the U.S. Office of the National Coordinator for Health Information Technology. All of the course materials are available under a Creative Commons Attribution Noncommercial ShareAlike (CC BY NC SA) License (http://creativecommons.org/licenses/by-nc-sa/3.0/). The course description, learning objectives, author information, and other details may be found at http://archive.org/details/HealthITWorkforce-Comp05Unit07. The full collection may be browsed at http://knowledge.amia.org/onc-ntdc or at http://www.merlot.org/merlot/viewPortfolio.htm?id=842513.

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Health IT Workforce Curriculum - 2012
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23 views

History of Health Information Technology in The U.S

The Health IT Workforce Curriculum was developed for U.S. community colleges to enhance workforce training programmes in health information technology. The curriculum consist of 20 courses of 3 credits each. Each course includes instructor manuals, learning objectives, syllabi, video lectures with accompanying transcripts and slides, exercises, and assessments. The materials were authored by Columbia University, Duke University, Johns Hopkins University, Oregon Health & Science University, and University of Alabama at Birmingham. The project was funded by the U.S. Office of the National Coordinator for Health Information Technology. All of the course materials are available under a Creative Commons Attribution Noncommercial ShareAlike (CC BY NC SA) License (http://creativecommons.org/licenses/by-nc-sa/3.0/). The course description, learning objectives, author information, and other details may be found at http://archive.org/details/HealthITWorkforce-Comp05Unit07. The full collection may be browsed at http://knowledge.amia.org/onc-ntdc or at http://www.merlot.org/merlot/viewPortfolio.htm?id=842513.

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Health IT Workforce Curriculum - 2012
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Download as PPT, PDF, TXT or read online on Scribd
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History of Health Information

Technology in the U.S.


History of Clinical Decision
Support Systems
Lecture b Examples of Early CDS Systems

This material Comp5_Unit7 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
History of Clinical Decision
Support Systems
Learning Objectives
Describe various types and structures of clinical decision support (CDS)
systems
Discuss the evolution of clinical decision support from expert system
research
Discuss the changes in focus of clinical decision support from the 1980s to
the present
Discuss the change in architecture and mode of access of clinical decision
support systems from the 1980s to the present
Describe some of the early clinical decision support systems
Discuss the historical challenges in implementing CDS
2
Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the US
History of Clinical Decision Support Systems
Lecture b
Examples of Early CDS
MYCIN
INTERNIST-1/QMR
DXplain
Antibiotic Assistant
Regenstrief CDS






Sources: (Buchanan & Shortliffe, 1984)
(Clancey & Shortliffe, 1984)
3
Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the U.S.
History of Health IT Organizations
Lecture b
MYCIN
Expert system developed at Stanford
Provided diagnostic and therapeutic advice like an expert
consultant

4
Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the U.S.
History of Health IT Organizations
Lecture b
MYCIN
Expert system developed at Stanford
Provided diagnostic and therapeutic advice like an expert
consultant
Infectious diseases
Diagnosed causal organism
Suggested drug to treat infection

5
Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the U.S.
History of Health IT Organizations
Lecture b
MYCIN
Certainty factors
Performed well compared to experts
Model expanded to oncology and other areas


6
Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the U.S.
History of Health IT Organizations
Lecture b
MYCIN
Certainty factors
Performed well compared to experts
Model expanded to oncology and other areas
Stand-alone system
Never used in practice





Source: (Wyatt, 1999)
7
Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the U.S.
History of Health IT Organizations
Lecture b
INTERNIST-1
Expert system developed at University of Pittsburgh
Diagnosis in Internal Medicine
Captured experts knowledge







Source: (Miller, et al., 1982)

8
Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the U.S.
History of Health IT Organizations
Lecture b
INTERNIST-1
Expert system developed at University of Pittsburgh
Diagnosis in Internal Medicine
Captured experts knowledge
User entered findings and system produced diagnosis
Controlled vocabulary
Weighted positive and negative findings evoking
strength, frequency and importance
9
Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the U.S.
History of Health IT Organizations
Lecture b
Quick Medical Reference (QMR)
Decision support, not an expert system
Demise of the Greek Oracle model






Source: (Miller & Masarie, 1990)


10
Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the U.S.
History of Health IT Organizations
Lecture b
Quick Medical Reference (QMR)
Decision support, not an expert system
Demise of the Greek Oracle model
Used the INTERNIST-1 knowledge base
Stand-alone commercial system no longer available
Integrated with Vanderbilts EHR
Part of McKessons Horizon Expert Orders


Source: (Miller, Masarie & Myers, 1986)

11
Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the U.S.
History of Health IT Organizations
Lecture b
DXplain
Diagnostic decision support system developed at
Massachusetts General Hospital
Similar structure to QMR
Stand-alone program





Source: (Barnett, et al., 1987)




12
Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the U.S.
History of Health IT Organizations
Lecture b
DXplain
Diagnostic decision support system developed at
Massachusetts General Hospital
Similar structure to QMR
Stand-alone program
1980s to the present
1980s dial up network (AMA/NET)

13
Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the U.S.
History of Health IT Organizations
Lecture b
1987 Version of Rapid Response
It requires about two minutes to complete
the dial-in sequence to log onto AMA/NET and
to connect to the computer located at
Massachusetts General Hospital.







Source: (Barnett, et al., 1987)

14
Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the U.S.
History of Health IT Organizations
Lecture b
DXplain
Diagnostic Decision Support System developed at
Massachusetts General Hospital
Similar structure to QMR
Stand-alone program
1980s to the present
1980s dial up network (AMA/NET)
1990s floppy disks
2000s Web-based



Source: (Hoffer, et al., 2005)



15
Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the U.S.
History of Health IT Organizations
Lecture b
Antibiotic Assistant
Advising and critiquing system for use of antibiotics
developed at LDS Hospital, Utah
Integrated with the LDS Hospital information systems as part
of HELP system (Health Evaluation through Logical Processing)
Provided advice on orders for antibiotics to prevent infections
Currently in use in LDS Hospital and other hospitals part of the
Intermountain Health Care (IHC)


Source: (Haug, et al., 2007)
16
Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the U.S.
History of Health IT Organizations
Lecture b
Regenstrief CDS
Developed by informatics experts at the Regenstrief Medical
Institute in Indiana and used at multiple hospitals and clinics
Integrated with the Regenstrief Medical Record System
(RMRS)
Reminder type of CDS
Gradual expansion of rules and sites
Still in existence today


Source: (Mamlin, et al., 2007)
17
Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the U.S.
History of Health IT Organizations
Lecture b
History of Clinical Decision
Support Systems
Summary Lecture b
Examples of CDS and how they evolved
18
Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the U.S.
History of Health IT Organizations
Lecture b
History of Clinical Decision
Support Systems
References Lecture b
References
Barnett GO, Cimino JJ, Hupp JA, Hoffer EP. DXplain. An evolving diagnostic decision-support system. JAMA.
1987 Jul 3;258(1):67-74.
Buchanan BG, Shortliffe EH, editors. Rule-based expert systems: the MYCIN experiments of the Stanford
Heuristic Programming Project. Palo Alto (CA): Association for the Advancement of Artificial Intelligence; 1984
Available from: http://www.aaai.org/AITopics/pmwiki/pmwiki.php/AITopics/RuleBasedExpertSystems
Clancey WJ, Shortliffe EH, editors. Readings in medical artificial intelligence: the first decade. Palo Alto (CA):
Association for the Advancement of Artificial Intelligence; 1984. Available from:
http://www.aaai.org/AITopics/pmwiki/pmwiki.php/AITopics/ReadingsInMedicalArtificialIntelligence
Haug PJ, Gardner RM, Evans RS, Rocha BH, Rocha RA. Clinical decision support at Intermountain Healthcare.
In: Berner ES, editor. Clinical Decision Support Systems: Theory and Practice. New York: Springer; 2007. p. 159-
89.



References continued on next slide.

19
Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the U.S.
History of Health IT Organizations
Lecture b
History of Clinical Decision
Support Systems
References Lecture b
20
Health IT Workforce Curriculum
Version 3.0/Spring 2012
History of Health Information Technology in the U.S.
History of Health IT Organizations
Lecture b
References, continued

Hoffer EP, Feldman MJ, Kim RJ, Famiglietti KT, Barnett GO. DXplain: patterns of use of a mature expert
system. AMIA Annu Symp Proc. 2005:321-5.
Mamlin BW, Overahage JM, Tierney W, Dexter P, McDonald CJ. Clinical decision support within the
Regenstrief Medical Record System. In: Berner ES, editor. Clinical Decision Support Systems: Theory and
Practice. New York: Springer, 2007. p. 190-214.
Miller RA, Masarie FE Jr. The demise of the "Greek Oracle" model for medical diagnostic systems. Methods Inf
Med. 1990 Jan;29(1):1-2.
Miller R, Masarie FE, Myers JD. Quick medical reference (QMR) for diagnostic assistance. MD Comput. 1986
Sep-Oct;3(5):34-48.
Miller RA, Pople HE, Myers JD. INTERNIST-1: An experimental computer-based diagnostic consultant. N Engl
J Med. 1982;307:468-76.
Wyatt JC. The promises and perils of modeling medical reasoning. In: van Bemmel JH, McCray AT, editors.
Yearbook of Medical Informatics 1999. Stuttgart: Schattauer Verlag;1999. p. 161-5.

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