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Setting a New Standard in Health I/T

UAB’s new Informatics Institute works to put the power of big data into patients’ medical records.

Dr. James Cimino, director of UAB’s new Informatics Institute, hopes to make health care records deliver information to the point of care.

 

Dr. James Cimino grew up with computers, using them through high school, college and medical school. So imagine the exasperation when he started his medical residency at a New York hospital and discovered he had no computer at hand.

“I didn’t have a computer when I was doing my residency, and there were a lot of times when I thought I could do so much better if I had one.”

The 62-year-old Cimino got his wish and then some. He is now both a physician and a leading figure in computer applications in the health care field. As such, he is the inaugural director of UAB’s Informatics Institute, part of the university’s medical school. 

At its core, the Informatics Institute is working to find better ways of organizing data — lots of data — in a way that is beneficial to patients, caregivers, researchers and other health industry professionals. It is also involved with teaching informatics and training the next generation of informatics experts.

“My definition of informatics is the art and science of capturing, representing, storing and reusing information,” Cimino says. “There is an art to it, maybe not an art as much as an instinctive application of domain knowledge.”

A major goal of UAB’s Informatics Institute is to improve the electronic health care record at UAB and, ultimately, everywhere. It’s a record that Cimino says is “a big commercial system, a multimillion-dollar system, very complex, and one that does a lot of good.” 

But it isn’t perfect. “The electronic health record we have is really just the electronic form of the old paper record we had before,” Cimino says. “We’ve made some things better. The electronic record is easier to read than paper, and it’s easier to find the record than it was with paper.

“But as we’ve developed these electronic systems, we’ve seen this huge influx of data from all these different sources, and we’re trying to make sense of that. We mostly have put it in folders like we did with the paper record and then give it to a doctor or nurse and say, ‘OK, here’s everything we know about the patient. Make sure you read everything and don’t miss anything important.’”

From his UAB office, located inside a former bank vault, Dr. Cimino plans to unlock for physicians solutions now stashed in impenetrable stacks of data files. 

 

So, electronic paper records often give a physician tons of information but might not point out what the doctor or nurse really needs to know. That can be especially frustrating.

“If the computer knows what the physicians are trying to do, it can bring knowledge to the point of care,” Cimino says. “It can say, ‘Oh, I see where you think this fever is due to pneumonia and you are ordering this antibiotic. Well, here is the latest literature on the best antibiotic to use for community-acquired pneumonia.’ Computers can do that. They just don’t know when they’re supposed to.

“If we can tell them enough about what we’re thinking, they’ll go, ‘Oh, you must want this.’ We can do this in medicine. People have built programs to do this, but electronic health records just don’t know how to invoke this.”

The Informatics Institute is partnering with several other groups and universities. That includes Dr. Lucio Miele, a professor and head of the Department of Genetics at Louisiana State University’s School of Medicine, who points out that there are different kinds of electronic health records. 

“They don’t talk well with each other,” Miele says, “so if you have multiple hospitals each using a different system, it is not straightforward to compare notes between hospitals.”

Together with different partners, UAB’s Informatics Institute is striving, in effect, to standardize data sets among different institutions and research groups to better pinpoint possible solutions.

Says Miele: “Once you identify, for example, how many cases of a certain type of cancer you have for a given region, you can then run clinical tests, both large cooperative clinical trials that include multiple academic institutions, as well as industry clinical trials.

“The pharmaceutical industry wants to know before a clinical trial at a given site or groups of sites how many people (cases) are out there that could be potentially enrolled in that trial to determine if it’s feasible. The only way to find that out with reasonable speed is to mine data in this manner. The data have to be collected, validated and stored in a standardized format, and Dr. Cimino is leading that effort.”

Prior to coming to UAB, Cimino was the chief of the Laboratory for Informatics Development at the National Institutes of Health’s Clinical Center and a senior scientist at the National Library of Medicine. He co-edited an influential textbook on informatics, Biomedical Informatics: Computer Applications in Health Care and Biomedicine.

That he wears two hats is a good thing. “When you put a physician with an understanding of how computers work in a position of trying to solve some of these problems, they solve in a different way than a physician with no computer background or a computer scientist would,” Cimino says. 

“You have Information Technology people, and they can write computer programs, but if they don’t understand what’s happening in the real medical world, it’s going to be hard for them.”

Cimino and Miele agree that informatics bodes well for business. “There will be a lot of business opportunities to work with UAB in general and the Informatics Institute in particular as we develop new ideas that can be developed into new technologies,” he says.

Says Miele: “There are several business possibilities. One, it attracts industry-sponsored clinical trials. Second, it improves the effects of medicine, so it attracts higher-quality medical professionals to the region.

“And, of course, developing better electronic health records is something that can eventually and possibly produce a template that can be used for electronic health records of the future, and that’s a very large business possibility,” says Miele. “So there are large implications for clinical research, clinical practice and for the informatics industry.”

Charlie Ingram is a freelance writer for Business Alabama. He is based in Birmingham.

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