The reasons for the slow adoption of known methods for dramatically improving the chances of surviving a heart attack are several, including delayed recognition by patients and bystanders that a person is having a heart attack, issues relevant to emergency transportation, and decisions and procedures within hospital emergency departments. Because 1.1 million people each year suffer a heart attack, the potential for saving lives is great.
The National Library of Medicine, with support from the National Heart, Lung, and Blood Institute's National Heart Attack Alert Program, is funding 14 projects that will apply medical informatics techniques to see if this record can be improved. Medical informatics is the discipline that applies computer and information technologies to the problems of health care.
"It would be difficult to imagine a more striking example of how information can save lives and I am pleased that the National Library of Medicine is helping in what is essentially a life and death matter," said Donald A. B. Lindberg, M.D., NLM director. "We will be measuring both the effectiveness of the methods devised and their practicality in real-life situations."
Milton Corn, M.D., Director of NLM's Extramural Program Division, said that the initiative is unusual because "it is uncommon in the U.S. to face the problem of gross underutilization of a treatment known to be effective in a major clinical problem. Another unusual aspect is that we are attempting to apply modern information technology to the notoriously difficult problems of mass health education and behavior change."
Renowned heart surgeon, Michael E. DeBakey, M.D., Chancellor Emeritus of the Baylor College of Medicine in Houston, Texas, commented that "this is an instance of how a national approach to a very local problem can make sense. If we can learn how to introduce these life-saving techniques, in various settings and circumstances, we will be able to save many thousands of lives each year."
The contracts, which total $1.4 million, are for planning projects that can compete in the future for modeling and full-scale implementation grants.
A list of the projects follows.
Computer-based, interactive, multi-media educational programs on early management of acute heart attack for emergency department personnel. Massachusetts General Hospital proposes to modify decision-making by Emergency Department personnel by exposing them to computerized scenarios that simulate real-life situations, and that involve the user in decision-making.
G. Octo Barnett, M.D.
Massachusetts General Hospital
Laboratory of Computer Science
Boston, MA 02114
Phone: 617-726-3651; Fax: 617-726-2796
Creation of a National Emergency Medicine Extranet to improve heart attack care. Infinity Healthcare, Inc./National Heart Attack Information Consortium proposes to address the political, hardware, and software problems involved in using the Internet to address the heart attack care problem nationally.
Edward Barthell, M.D.
Infinity Healthcare, Inc.
1251 Glen Oaks Lane
Mequon, WI 53092
Phone: 414-290-6700; Fax: 414-290-6781
Disease-management approach for high-risk patients. Utilizing a database of clinical profiles, WEB-based management aids, a case-manager, and provision of relevant information to health care providers as needed. Massachusetts General Hospital plans to provide a continuum of care spanning home, clinic, and hospital for patients at risk for heart attack.
Henry C. Chueh, M.D.
Laboratory of Computer Science
Massachusetts General Hospital
50 Staniford St., 5th Floor
Boston, MA 02114
Phone: 617-726-3909; Fax: 617-726-8481
Use of the web to provide patients and providers with access to their medical records. Columbia University intends to link patients, and, as needed, professional personnel, to the patients' health care records for education and to facilitate prompt, informed response to heart attack symptoms.
James Cimino, M.D.
630 W. 168th Street
New York, NY 10032
Phone: 212-305-4191; Fax: 212-305-3697
Enhancing and expanding the existing USC-ABBC rapid prototyping telehealthcare testbed to demonstrate revolutionary informatics for the National Heart Attack Alert Program; USC-ABBC plans to use medical informatics and advanced communication technology for education of patients/public, prehospital/paramedic practitioners, and physicians/healthcare workers.
David Faxon, M.D.
University of Southern California
Health Sciences Campus, CSC-219
2250 Alcazar Street
Los Angeles, CA 90033
Phone: 323-442-3671; Fax: 323-442-3672
UCLA intends to develop and evaluate a cardiac education module appropriate for patients, general practitioners, and remote specialists.
Hooshang Kangarloo, M.D.
1400 Ueberroth Bldg.
Los Angeles, CA 90095-1406
Phone: 310-794-3539; Fax: 310-794-3546
City of Las Vegas Department of Fire Services proposes to install and evaluate telemetry, including use of visual images and 12 lead electrocardiograms for its responses to calls for emergency services.
Steven Karch, M.D.
Las Vegas Fire Department
500 North Casino Center Blvd.
Las Vegas, NV 89101
Phone: 702-229-0146; Fax: 702-229-0444
Care of acute myocardial infarction in rural emergency rooms. The University of Missouri at Columbia will develop a project that uses informatics and telemedicine to provide training for physicians in rural emergency departments and to connect such physicians to specialists at a medical center.
Pat McLaughlin, M.D.
University of Missouri - Columbia
310 Jesse Hall
Columbia, MO 65211
Phone: 573-882-7560; Fax: 573-884-4078
EMC. Inc. proposes to develop "Listen to Your Heart," a suite of informatics-based tools to help reduce the time delay between initial symptoms suggestive of a heart attack and initiation of definitive medical work up and treatment.
Joel Nitzkin, M.D.
Engineering Management and Economics, Inc.
51 Monroe Street, Plaza Two West
Rockville, MD 20850
Phone: 301-738-1045; Fax: 301-738-1421
Decision support to help patients assess their risks for myocardial infarction. Brigham and Women's Hospital plans to create patient-centered, computer-based decision support systems to help patients assess their risks of heart attack, and to help patients and bystanders decide when to seek emergency care.
Lucille Ohno-Machado, M.D., Ph.D.
Decision Systems Group
75 Francis Street
Boston, MA 02115
Phone: 617-732-8543; Fax: 617-732-5753
Integrated information technologies for emergency medical care. The University of Utah plans to review a variety of informatics technologies for suitability in education and for improved efficiency with one or more aspects of the heart attack therapy problem. Particular emphasis is given to the transportation phase.
Helmuth Orthner, Ph.D.
Department of Medical Informatics
Bldg. 521 - Room AB193
University of Utah
Salt Lake City, UT 84132
Phone: 801-585-2486; Fax: 801-581-4297
Public education by kiosk and Web. The BE ALERT project of New England Research Institutes, Inc. plans education about heart attacks and thrombolytic therapy by creating educational material for patients and health-care providers, using innovative electronic educational materials and emergency hotlines.
Stavroula Osganian, M.D., Ph.D.
New England Research Institutes, Inc.
9 Galen Street
Watertown, MA 02172
Phone: 617-923-7747; Fax: 617-926-4252
Pre-hospital use of 12 lead computerized electrocardiographs. New England Medical Center plans a controlled clinical trial to evaluate value of 12 lead electrocardiographs with the addition of computerized predictive instruments during pre-hospital transport and treatment.
Harry P. Selker, M.D., MSPH
New England Medical Center
Division of Clinical Care Research
750 Washington Street
Boston, MA 02111
Phone: 617-636-6009; Fax: 617-636-8394
A new interactive multimedia channel on the Michigan Health Kiosk Network. The University of Michigan plans to provide widespread public education by developing an interactive multimedia Heart Attack Alert "channel" for use on 100 existing kiosks located in libraries, worksites, churches, shopping malls, and other sites convenient for the public.
Victor J. Strecher, Ph.D., MPH
University of Michigan
300 South State Street
Ann Arbor, MI 48109-1274
Phone: 734-764-7242; Fax: 734-764-8510