Medical Informatics and Computer Applications

This document has been endorsed by the American Academy of Family Physicians and was developed in cooperation with the Association of Departments of Family Medicine, the Association of Family Practice Residency Directors and the Society of Teachers of Family Medicine.

Caregivers must be increasingly competent in their ability to access and process a growing body of information in a manner that meets the urgent needs of day-to-day patient care and ongoing patient management. The ability to evaluate and improve one's clinical performance is an essential element of quality improvement.

Medical Information Management comprises the effective acquisition, distillation, interpretation, application and communication of medical information including patient and practice specific data. In addition to the more traditional sources of information, computers now represent one increasingly important tool in managing information. Therefore, some basic familiarity with this medium is critical for the family physician.

Attitudes

The resident should:

Appreciate the importance of the need to deal effectively with the growing body of information.
Accept the increasing role of computer-based technology in the management of patients.
Commit to self-directed learning principles and practice.
Maintain an open attitude to new sources of learning and information.
Value access to information at the point of service in the management of patients.

Knowledge

The resident should critically evaluate the variety of resources available for information access:
1. Print sources
  1. Journals
  2. Textbooks
  3. Monographs
  4. Newspapers/Newsletters
  5. Subscription services
2. Computer-based sources
  1. CD-ROM
  2. Literature search sources
  3. Internet communications
  4. CME technologies
  5. Awareness of Internet and electronic information resources
    1. On-line textbooks
    2. Bibliographic databases (e.g., Medline)
    3. Evidenced-based databases (e.g., Cochrane Library)
    4. On-line journals and CME
    5. Clinical simulations
    6. Experimental technologies, such as virtual reality systems
  6. Practice-based computer systems including practice management, Electronic Medical Records (EMR) and patient education systems
3. Communication and information system technologies
  1. Telecommunications including digital papers and cellular phones
  2. Voice mail
  3. E-mail
  4. Electronic networking between hospitals/practice and practice/practice
  5. Personal digital assistant (PDA)
  6. Telemedicine
  7. Medico-legal implications of these new technologies including compliance
4. Interpersonal interactions
  1. Other family physicians
  2. Consultants
  3. Other health-care personnel
5. Practice experience
  1. Drug information databases - Personal Digital Assistant (PDA) and computer based
  2. Drug interaction programs - Personal Digital Assistant (PDA) and computer based
  3. Practice guidelines
  4. Disease management protocols
  5. Practice-based outcomes data including Health Plan Employment Data and Information Set (HEDIS) criteria
  6. Patient education materials
The resident should learn which source is best for the information being sought:
1. Answering a specific patient-related question
2. Update of personal knowledge base, not patient-directed
3. Balance the cost of the process used vs. the need for information
The resident should be able to prioritize information.
The resident should understand how to form an appropriate clinical question:
1. Identify outcomes or interest
2. Determine pertinence

Skills

The resident should demonstrate skills to:

Establish a method of ongoing self-assessment of learning needs
Identify one's best learning style
Use a variety of learning methodologies, depending on information being sought
Evaluate the usefulness of medical information being presented
1. Determination of validity
2. Relevance to need of physician or patient
3. Application of experimental vs. clinically tested information
4. Relevance to patient population and practice setting
Develop basic computer skills to enhance access to timely information
1. Keyboard competency
2. Competence with commonly used operating systems (e.g., Windows)
3. Telecommunication
  1. E-mail
  2. Internet
    1. Discussion forums
    2. Video conferencing
4. Use of electronic learning systems, such as examinations, and self-directed clinical scenarios
5. Use of drug-data and interaction programs
6. Use of Internet
  1. On-line databases - perform literature searches
  2. Organizational information (e.g., AAFP Web site)
  3. Medical information sites such as MDconsult, NIH, CDC Web pages
Use of basic business and communications software
1. Word processing such as Word or Word Perfect
2. Database and financial software such as Excel, Lotus, Access
3. Presentation software such as PowerPoint
Use of electronic medical records available for the practice setting including advantages, costs, key features and limitations
Enhance clinical decision-making and could be mastered by those interested in furthering their individual goals.
1. The ability to distill data into useful information (e.g., use of Statistical Package for the Social Sciences (SPSS)
2. Application of artificial intelligence programs
3. Use and limitations of decision support systems
Obtain and evaluate information efficiently in a clinical context.

Implementation

The Practice Management Curriculum is an ideal location to place many of these curricular issues.

Many of the basics of these guidelines need to be taught directly through didactics with clinicians experienced in these skills and through faculty role-modeling. However, for maximal benefit, they must also be woven into the day-to-day patient care activities of the resident. Additional individualized guidance of each resident is necessary to help develop the insight necessary to grow in this area. The program should attempt to allow every resident multiple opportunities to work with computers and utilize various information services.

Resources*

Shaughnessy AF, Slawson DC, Bennett JH. Teaching information mastery: evaluating information provided by pharmaceutical representatives. Fam Med 1995;27(9):581-5.
Guyatt GH, Sackett DL, Cook DJ. Users' guides to the medical literature. II. How to use an article about therapy or prevention. B. What were the results and will they help me in caring for my patients? The Evidence-Based Medicine Working Group. JAMA 1994;271:59-63.
Longlett SK. Community-oriented primary care: critical assessment and implications for resident. J AM Board Fam Pract 2001 Mar-Apr; 14(2): 141-7
McKenna MK Worth while Web: 50 useful sites for family physicians. Fam Pract Manag 01 Apr-2001; 8(4): 23-8
Rehm S Electronic medical records: the FPM vendor survey. Fam Pract Manag 01-Jan-2001; 8(1):45-54
Becker L Helping physicians make evidence-based decisions. Am Fam Physician 2-Jun-2001; 63(11): 2130, 2133, 2136
Jerant AF Applied medical informatics and computing skills of students, residents and faculty Fam Med 01-Apr-2000; 32(4): 367-72
Miser WF Critical appraisal of the literature. J Am Board Fam Pract 1999 Jul-Aug; 12(4): 315-33
Alper BS Answering family physicians' clinical questions using electronic medical databases. J Fam Pract 01-Nov-2001; 50 (11): 960-5

*This list is intended to provide residencies with some basic information to begin the informatics process. With the constant evolution of computerized medical resources, the information in these resources is only current as of the date of the development of these guidelines.

Published 2/96
Revised 6/02