Fixing the Electronic Health Record: What's Wrong, What Needs to be Done, and How Do We Do It?

Abstract: 
Today's electronic health records (EHRs) are built on the legacy of paper-based medical records combined with electronic billing systems.  The result is a database that resembles a diary, filled with transactions and events, and a set of applications that record and use the data for specific tasks (billing, order entry, result reporting, note writing, to name a few).  When patient information is represented in a structured, formal way using controlled terminologies (such as medications, problems, allergies and laboratory results), computer applications can provide active support for patient care, such as automated alerts and reminders.  However, the messages these applications generate are often deemed irrelevant and annoying, and they are often ignored.  An key component of the patient care process is the clinical reasoning that underlies decision making.  Although this is (or is supposed to be) made explicit in the clinical notes, the narrative form makes it largely inaccessible to the logic of EHRs.    What is lacking is a comprehensive, computable model of what is going on with the patient and the health care process.  Dr. Cimino will provide examples of how such information can be represented in EHRs and describe a plan for incorporating the capture and use of the information to directly improve the care of the patient and, through improved reusability of EHR data, advance the ultimate goal of a learning health system.

Speaker Bio:
Dr. James Cimino is a board certified internist who completed a National Library of Medicine informatics fellowship at the Massachusetts General Hospital and Harvard University and then went on to an academic position at Columbia University College of Physicians and Surgeons and the Presbyterian Hospital in New York.  He spent 20 years at Columbia, carrying out clinical informatics research, building clinical information systems, teaching medical informatics and medicine, and caring for patients, rising to the rank of full professor in both Biomedical Informatics and Medicine.  His principle research areas there included desiderata for controlled terminologies, mobile and Web-based clinical information systems for clinicians and patients, and a context-aware form of clinical decision support called “infobuttons”. 

In 2008, he moved to the National Institutes of Health, where he was the Chief of the Laboratory for Informatics Development and a Tenured Investigator at the NIH Clinical Center and the National Library of Medicine.  His principle project involved the development of the Biomedical Translational Research Information System (BTRIS), an NIH-wide clinical research data resource.

In 2015, he left NIH to be the inaugural Director of the Informatics Institute at the University of Alabama at Birmingham.  The Institute is charged with improving informatics research, education, and service across the University, supporting the Personalized Medicine Institute, the Center for Genomic Medicine, and the University Health System Foundation, including improvement of and access to electronic health records. He holds the rank of Tenured Professor in Medicine, and is the Chief for the Informatics Section in the Division of General Internal Medicine.

He continues to conduct research in clinical informatics and clinical research informatics, he has been director of the NLM's week-long Biomedical Informatics course (currently hosted by Georgia Regents University) for 16 years, and teaches at Columbia University and Georgetown University as an Adjunct Professor.  He is co-editor (with Edward Shortliffe) of a leading textbook on Biomedical Informatics and is an Associate Editor of the Journal of Biomedical Informatics.

His honors include Fellowships of the American College of Physicians, the New York Academy of Medicine and the American College of Medical Informatics (Past President), the Priscilla Mayden Award from the University of Utah, the Donald A.B. Lindberg Award for Innovation in Informatics and the President’s Award, both from the American Medical Informatics Association, the Medal of Honor from New York Medical College, the NIH Clinical Center Director’s Award (twice), and induction into the National Academy of Medicine (formerly the Institute of Medicine).


Host: Dr. Eva Lee

Event Details

Date/Time:

  • Thursday, September 28, 2017
    11:55 am