The Medical Informatics Special Interest Group welcomes all APA members with an interest in developing, implementing and evaluating tools that enhance our ability to manage information in medicine. Last year, we had a fun and productive meeting that resulted in a number of new workshops being presented at this year's meeting. In addition, we reviewed some work in progress by our attendees. These presentations catalyzed very informative discussions that all appeared to enjoy!

At the spring meeting in San Francisco, we plan to continue the work we are doing to increase the overall integration of our research efforts and skills with the medical informatics community as a whole and with the needs of PAS participants in particular. We hope to have an invited guest to discuss with us upcoming funding opportunities that we might find of interest. Finally, because last year's abstract presentations were a success, we are planning to allow participants to present research ideas or research in progress, so that we all may contribute to the advancement of our field. Come join us! Any individuals planning to attend should email me if you have an interest in presenting your research ideas to the group.
 

Develop animations with a little imagination and learn how to use it in various settings. Animations are exciting and offer visual enhancement of the learning process. Do animations really help learning? Hear from students and residents on the evaluation of animations as a teaching tool. This interactive workshop will cover an overview of animations as a teaching tool, view an animation entitled, "How does blood clot?" as well as "Understanding von Willebrand disease," and then go through the steps involved in developing animations. We will also teach you how to insert animations in PowerPoint presentations as well as how to further enhance your presentations by other means. On what subject do you spend the most time in your practice explaining to students, residents and patients? Can it be animated? Come with your ideas and we will explore how to develop an animation. A new feature added this year will be some animations of laboratory tests.

By the end of the workshop, the participant will:

1. Learn the various steps involved in making animations,
2. Be able to identify topics that may be presented using animations,
3. Learn about inserting animations into PowerPoint presentations as well as enhancing presentations.
    

This mini course will set the stage for several discussions of particular issues of major importance and interest. What is "preparedness" and what are the real risks of continuing terrorism in the United States? What is the current status of preparedness in the U.S. hospital and public health systems? How do children differ from adults in terms of response to weapons of mass destruction (chemical, biological and radiological)? How do these differences matter in disaster planning? Are the needs of children being incorporated in local, state and federal disaster plans? Smallpox, anthrax and other biological threats: Where do we stand? What do we do? Nuclear power plants, nuclear weapons, dirty bombs and potassium iodide: What do we know? The mental health consequences of terrorism: What have we learned since 9/11, how do we prepare children for an increasingly vulnerable world, building resiliency and sustaining a positive vision. The new pediatric agenda: What do we have to teach students, residents and pediatricians about the pediatric aspects of terrorism planning. Children and exposure to weapons of mass destruction: science and the essential research agenda.

Introduction
Paul H. Saenger, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY

Welcome and Context
Irwin Redlener, National Center for Disaster Preparedness, Columbia University Mailman School of Public Health, New York, NY

Pediatric Preparedness for Terrorism and Disasters
David S. Markenson, Columbia University Mailman School of Public Health, New York, NY

Biological Weapons of Terror: What Pediatricians Need to Know
Theodore J. Cieslak, U.S. Army Research Institute of Infectious Diseases, Ft. Detrick, MD

Helping Children and Families Cope with Terrorism
David J. Schonfeld, Yale University School of Medicine, New Haven, CT

Radiologic Terrorism, Children and the Question of Potassium Iodide
Thomas P. Foley, University of Pittsburgh, Children's Hospital of Pittsburgh, Pittsburgh, PA
 

This workshop will:

1. Review the contents of national public-use databases, such as the National Health Interview Survey, National Ambulatory Medical Care Survey, National Hospital Discharge Survey and vital statistics databases; and
2. Discuss types of questions that can be answered through analysis of these databases.

Examples from recent literature will be examined. Use of administrative and clinical databases for research also will be presented, along with discussion of data validation issues for these. Participants will develop a concept for a research project using a national database, starting with identification of a question of interest and the primary outcome and predictor variables for the question that are contained in a particular database.
 

The Practiced-Based Research Networks SIG has representation from Practice-Based Research Groups (PBRNs) from all geographic regions. PBRNs are networks for practices that do office-based research that generally relates to primary care and day-to-day problems. Our SIG offers the networks a forum to share ideas, brainstorm about solving common problems and the potential to collaborate on research projects. In years past we have had at least a dozen networks present and had outside speakers, as well as original research presented. This year we will have several groups report studies in progress or completed.
 

Children who are victims of violent behavior or merely observers of violence may learn destructive or self-destructive patterns of behavior. Violence is a major public health problem. This symposium will focus on breaking the cycle of violence and will showcase speakers who are working on violence prevention in the pediatric emergency department, school and community. The speakers will demonstrate what can be done by physicians who see the importance of this issue and the ways in which we can make a difference.

Violence Prevention in Primary Care: Moving from Public Health to Private Practice
Robert D. Sege, Tufts-New England Medical Center, Boston, MA

Beyond Treat and Street: Violence Prevention in the Emergency Department
Joel Fein, The Children’s Hospital of Philadelphia, PA

Efforts in the Community
Sheryl A. Ryan, University of Rochester School of Medicine, Rochester, NY

Many new developments in hand-held technology or personal digital assistants (PDA) can positively impact on medical education and medical care. As the technology improves and interfaces with internet-based information and electronic medical records become available, the potential for improving access to information and defining standards of care are clear. Residency programs have utilized PDAs for provision of program information, documentation of procedures/patient panels and access to medical references and information. PDAs have proved useful in a variety of applications in residency program administration. The ability to access medical information from PDA formularies, medical texts and internet sites is now changing the ability of pediatricians to obtain relevant information in a timely manner. Interfaces with electronic medical records offer new opportunities for clinical decision making, documentation and billing.

This workshop will review the trends in the use of the PDA in these areas and demonstrate the use of the PDA in patient tracking, residency program documentation, access to formularies and medical references, searches of medical literature and office and hospital documentation. Participants will be asked to provide feedback and, after discussion in small group settings, will provide a series of recommendations from pediatric faculty regarding the direction of PDA development for pediatric medical education and care and emphasis for PDA applications in the future. We look forward to a stimulating discussion and useful interchange.
 

The National Children’s Study is a national prospective, longitudinal study of environmental effects, including physical, chemical, biological and psychosocial effects, on child health and development. The goal of the study is to improve the health and well-being of children. The study will examine these environmental effects on the health and development of more than 100,000 children across the United States, following them from before birth until age 21. The study is led by a consortium of federal agency partners: the U.S. Department of Health and Human Services, including the National Institute of Child Health and Human Development (NICHD); the National Institute of Environmental Health Sciences (NIEHS); the Centers for Disease Control and Prevention (CDC); and the U.S. Environmental Protection Agency (EPA). For additional information, visit the website at http://www.nationalchildrensstudy.gov/.

The National Children’s Study—An Overview
Duane Alexander, NICHD, National Institutes of Health, Bethesda, MD

The National Children’s Study—Methods
Peter C. Scheidt, National Institutes of Health, Bethesda, MD

Children’s Health and Environmental Exposures: The Most Important Unanswered but Answerable Questions
Michael Weitzman, The AAP Center for Child Health Research at the University of Rochester, Rochester, NY

The application of imaging technologies to solving questions in biology and medicine is revolutionizing medicine by accelerating analyses in situ and in vivo and providing new perspectives on biological processes as diverse as development, neoplasia and injury repair. In this plenary session, three internationally recognized speakers will focus on developmental processes and discuss how these new imaging technologies are providing dynamic insights into the genetic and epigenetic mechanisms that underpin hematopoiesis and vascular development.

Introduction
Lisa M. Guay-Woodford, University of Alabama at Birmingham, Birmingham, AL

Dynamic Imaging of Fluid Forces in Developing Mouse Vasculature
Mary Dickinson, Beckman Institute–Caltech, Pasadena, CA

Microscopic Imaging of Angiogenesis
Donald M. McDonald, University of California, San Francisco, CA

Watching Hematopoietic Stem Cell Engraftment and Hematopoiesis in Living Animals
Christopher H. Contag, Stanford University School of Medicine, Stanford, CA

Questions from the audience
 

This workshop will focus on available simulation technology and its application to pediatrics. The incorporation of a pediatric human patient simulator (METI), with the ability to respond in real-time fashion to student interventions, will be the basis of the workshop. Minilectures and demonstrations will clarify educational theory and the required elements for simulation program development. Small and large group activities will concentrate on practical aspects of simulation use including resource allocation, financing, scenario development, competency-based evaluation and incorporation of simulation technology in a pediatric educational program. Videos (DVDs) will be used to demonstrate the use of a patient simulator as well as generate discussion of its utility and application to pediatrics.

The participant will:

1. Be able to describe various types of medical simulation.
2. Be able to describe the capabilities of the pediatric human patient simulator, a computerized life size simulated pediatric patient. The simulator can reproduce normal and abnormal breath sounds, heart sounds, pulses, papillary responses and cardiac rhythms. In addition it responds in real time to student interventions such as medication or fluid administration and physiologic states such as hypoxia, hypercarbia and shock. The student can also perform endotracheal intubation (with and without a difficult airway), defibrillation and cardioversion.
3. Understand the educational theory behind simulation technology—why it works.
4. Understand the elements required to develop and sustain a successful simulation program including issues of personnel, utilization and financing.
5. Be able to summarize methods in which simulation technology can be incorporated into medical education including incorporation into existing classes, development of effective teaching scenarios and the use of simulation in competency-based evaluations.
6. Discuss methods of evaluation of the effectiveness of simulation technology in the medical educational setting.

Participants will be encouraged to adapt this information to their own environment.
 

This workshop will focus on the successes and pitfalls associated with implementation of telemedicine to provide healthcare to rural, underserved populations. An introductory didactic presentation will describe the basics of telemedicine, including a brief technical description of the evolution of telemedicine techniques. Four examples of current clinical programs will be presented: an outpatient model assisting in the care of children with special healthcare needs, a pediatric ICU to rural adult ICU model to help in the care of moderately sick children, a pediatric ED to rural adult ED model to help in the care of acutely ill and injured children and a pediatric physical assault and sexual abuse model to assist rural counties in the assessment and evidentiary exams of acutely abused children. Discussion on these telemedicine programs' effect on quality of care, financial viability, sustainability and benefits to rural communities will be discussed.
 

Worldwide, more than 1,500 children per day become infected with HIV through mother-to-child transmission. Currently there are 2.7 million children living with HIV infection across the globe, >90% of whom reside in developing countries. While there have been enormous successes in the prevention and treatment of pediatric AIDS in the United States and Europe, it remains an open question as to how effectively these public health gains can be replicated in the poor countries of the world, which bear the greatest burden of disease. Efforts to develop an HIV vaccine appropriate for preventing infection among the world's children and adolescents are finally under way on a global scale. We will discuss these issues and accompanying controversies as they apply to the children of the developing world.

AIDS in Children—A Global Public Health Crisis
David L. Pugatch, Hasbro Children's Hospital and Brown Medical School, Providence, RI

Preventing Mother-to-Child Transmission of HIV in Developing Countries—Successes, Failures and Challenges
Catherine M. Wilfert, Elizabeth Glaser Pediatric AIDS Foundation, Santa Monica, CA and Washington, DC

HIV Treatment for Children—Can the Successes of Rich Countries Be Duplicated in Resource-Poor Settings?
Mark W. Kline, Baylor College of Medicine, Houston, TX

Finding an AIDS Vaccine That Works for the World's Children
Richard A. Koup, Vaccine Research Center, National Institutes of Health, Bethesda, MD

Patient safety has become a national focus and initiative from government to regulatory/accreditation bodies to institutions. A substantial proportion of the initial efforts are on understanding epidemiology and risk factors and developing organizational models and tools for identifying concerns and fostering safety improvements. Research to date has identified that children do experience medical errors, these events have unique risk factors and while some types of errors are comparable to adult populations, other types are unique to children. In this session we will examine several key elements in efforts to address safety now and in the future: how to tackle patient safety in real time and create cultural change, role of information technology, how to create and promote metrics to measure performance and sources of funding for ongoing work.

In specific, we will examine one institution’s successes and lessons learned from implementing a combined ‘top down’ and ‘bottom up’ system of teams to address safety. We will examine the history of information technology and hear work evaluating the use of information technology in the primary care setting. Next we will examine national efforts to create pediatric-specific measures of quality of care and how these measures are being promoted and implemented nationwide. Last we will hear an overview of research findings to date from the Agency for Healthcare Research and Quality’s $165 million investment in patient safety research and explore new and ongoing funding sources for this research.

The Josie King Patient Safety Program at Johns Hopkins University
Marlene R. Miller, Johns Hopkins University, Baltimore, MD

Role of IT in Patient Safety
Kevin B. Johnson, Vanderbilt University Medical Center, Nashville, TN

PediQS and National Efforts To Promote Measurement of Children’s Healthcare
Stephen Lawless, Nemours Foundation, Wilmington, DE

AHRQ’s Patient Safety Initiative and Findings to Date
Dan Stryer, Agency for Healthcare Research and Quality, Rockville, MD

Discussion
 

Computers, PDAs and the Web are integral tools for academic physicians, teachers and students. Though available resources and their ease of use are increasing, their potential for advancing academic programs remains relatively untapped. The University of Utah's Eccles Health Sciences Library has led several projects enabling and integrating digital and multimedia resources for academic applications, including the Health Education Assets Library (HEAL) and the Utah MedHome Portal. This workshop will offer:

1. An overview of digital resources and the expertise/support required to take advantage of them;
2. Detail on new technologies for communication, collaboration and teaching;
3. A survey of PDA resources and applications for use in the clinic and classroom; and
4. Hands-on experience with some of the resources described.