Winter 2008
Up to data
Training programs, utilization of medical informatics continue rapid growth
Classes represented in this story: ’83, ’88, ’89, ’99
Why is it that a Milwaukeean who banks around the corner from her house can access information about her accounts from an ATM across the country in Tucson; however, neither she nor health care providers at the Tucson Medical Center can access her medical history when she is rushed to their emergency room?
The inability to share medical records nationwide is but one of the complex health care issues that medical informatics professionals are currently trying to resolve.
Abel N. Kho, MD ’99, MS |
“There’s so much more information available to health care providers today than ever,” said Abel N. Kho, MD ’99, MS, who completed the National Library of Medicine Training Program in Medical Informatics at the Regenstrief Institute in Indiana. “The ability to hone quickly in on the critical data elements will determine the quality and safety of the health care we deliver. That’s why medical informatics is important.”
Just over 10 years ago, the Medical College of Wisconsin and Milwaukee School of Engineering joined together to offer a masters of science degree program in medical informatics. Those enrolled in the joint program benefit from the strength of the Medical College’s expertise in medical care, education and research while drawing on the Milwaukee School of Engineering’s expertise in business and information technology.
One characteristic of the MCW-MSOE program that sets it apart from other informatics programs is that students come from various backgrounds. They are working professionals who immediately understand the implications and applications of what they are learning. Some have information technology backgrounds, but many are clinicians.
John S. Traxler, MD ’89, GME ’95, MS ’00, MBA |
“It makes for dynamic classroom discussions,” said
John S. Traxler, MD ’89, GME ’95, MS ’00, MBA, Co-director of the MCW-MSOE medical informatics program with Gary P. Barnas, MD, Associate Professor of Medicine (Internal) at the Medical College.
Raymond J. Zastrow, MD ’83, implements and uses medical informatics as President of QuadMed Clinics. |
“We’ve got nurses and doctors and lab techs and the like,” said Raymond J. Zastrow, MD ’83, an instructor for the program. “A lot of times they’ve been bitten by the computer bug. In the case of nursing staff, they’re just kind of getting burnt out on hands-on patient care in the hospital. So this gives them an opportunity to take a step back and look at the big picture of health care.”
Another unique characteristic of the program is that each of the classes in the core curriculum was designed specifically for the program. They are not just a mixture of classes from the disciplines of medicine, information technology and business. Separate core classes were designed to emphasize the applied nature of medical informatics. One of the main foci of the program is implementing electronic medical records (EMRs).
“That’s what’s happening right now. It’s where the market is,” Dr. Zastrow said. “And as fast as people come through the program, they’re being picked up by large institutions that are implementing EMRs or by EMR vendors.”
Dr. Zastrow was recently named President of QuadMed Clinics. The clinics include on-site medical, dental and vision centers, pharmacies and rehab centers for employees of Quad Graphics in the suburbs of Milwaukee.
“Frankly, in the mid-90s, I was in a role where I would have loved to have a program like the one with MCW and MSOE. But it didn’t exist, and I was already thrown into it. So I learned by doing,” Dr. Zastrow said.
While EMRs are considered the most basic level of health care data, computerized provider order entry (CPOE) systems for reducing medication errors, and clinical decision support (CDS) systems that alert physicians to best practices at the point of care are other popular medical informatics tools.
“Any solution that decreases costs, while at the same time maintaining or improving quality, will have a positive impact on access to health care,” said Dr. Traxler an Assistant Professor at MSOE.
One of the medical informatics tools Dr. Zastrow is using at QuadMed is data warehousing software that allows his staff to compare pharmacy benefits data with employee eligibility information. They use the results to generate financial reports on how they are performing for their sponsor, Quad Graphics. It is a database on which they are able to perform clinical queries as well.
“Our use of this database is different because being an on-site clinic that’s employer sponsored, self-funded, we’re looking at the data from all angles,” Dr. Zastrow said.
But until recently, most medical informatics work had been done in a vacuum. That is to say the benefits were confined to individual organizations and the patients they serve, not health care as a whole. However, two graduates of the MCW-MSOE program, Edward Barthell, MD, GME ’88, MS’ 02, and Amy L. Helwig, MD ’83, GME ’96, MS ’00, are working on a grander scale.
John S. Traxler, MD ’89, GME ’95, MS ’00, MBA |
Dr. Barthell is Executive Vice President of Strategy and Clinical Affairs at Infinity HealthCare in Mequon, Wis. He is an emergency room physician and co-founder of the Wisconsin Health Information Exchange (WHIE). WHIE is a non-profit organization dedicated to research and development of health care information networking.
In April 2007, WHIE, through collaboration with the Milwaukee Health Care Partnership, the State of Wisconsin and Microsoft, implemented the first phase of a regional health information exchange system called the ED Linking Project. This system provides quick access to patients’ medical history when they arrive at health care facilities. While the first two phases of the project are taking place in Milwaukee County emergency departments and in the clinics of safety-net caregivers, such as Medicaid providers, the goal is to eventually make the system available to all patients statewide.
“The first step in this process is just getting the regional information shared,” Dr. Barthell said. “Then there are emerging national standards that we’ll be able to use to ultimately share data from one region of the country to another.”
At the national level, Dr. Helwig is working for the U.S. Agency for Healthcare Research and Quality. She is building a network of patient safety databases that allows for analysis of national trends in patient safety. Researchers of quality improvement and patient safety programs at local, regional and national levels will use the interactive network of data. The goal of the program is to build an infrastructure that aids in the reporting of patient safety events from all settings in a confidential, non-punitive manner throughout the entire nation.
“The most important things I learned through the MCW-MSOE medical informatics program,” said Dr. Helwig, “were systems analysis, project management and a solid understanding of the components necessary for local, regional and national health care information exchange.”
“One of the appeals of [medical informatics] for me,” said Dr. Kho, “is you can use these principals and tools to make system changes that really influence and improve the care for, not just your patients, but for the whole system’s patients.”
The Journal of American Medical Informatics Association is publishing a paper on Dr. Kho’s research with Methicillin-Resistant Staphylococcus Aureus (MRSA) infections. Dr. Kho and his collaborators used standardized information to detect patients with MRSA between hospitals in Indianapolis. They not only identified the problem by sharing information, they are now fixing it. Their work also successfully demonstrated the ability to share real time information about MRSA status.
“I still go to work in a hospital, and I still see patients in a clinic,” Dr. Kho said, “But if you do straight, everyday, 100 percent clinical care, you’ll get frustrated eventually, because there’s a lot about health care that you wish you could change and make better for everyone. This is the way you do it.”