The gero-informatics history leading to the GOCAR includes the following elements and activities.

• Clinical decision support. Use of automated reminders as a form of clinical decision support, in areas such as cancer screening and vaccination for older adults.
• Videoconferencing. Videoconferencing studies between nursing-home residents and off-site, on-call physicians have identified medical conditions conducive to videoconferencing and established feasibility, satisfaction, and usefulness of videoconferencing in making medical decisions in the nursing home (Weiner, Abernathy, Dexter, McDonald, and colleagues). In a 2005 paper, we also report that videoconferencing facilitated clinical assessment in 71% of routine daytime encounters in the nursing home; face-to-face examinations were superior to videoconferencing in most cases, but videoconferencing was valuable especially for wound care; and 62% of alert nursing-home residents did not indicate understanding of physicians' recommended treatments.

Dr. Michael Weiner

• Electronic audit. We conducted and published the first report of a study comparing manual chart audit to automated electronic review of a clinical quality indicator, showing that electronic review was comparable but also had fewer false negative findings.

• Infrastructure support. Weiner, Abernathy, and colleagues have worked ad hoc to build infrastructure to support gero-informatics, especially by modifying the electronic Regenstrief Medical Records System (RMRS).

• Development of electronic health record. Creation of several geriatrics-relevant measures, such as documentation of cognitive and functional status, into the programming code of the RMRS.
• New encounter labels or type, such as “nursing home admission note” and “home care visit”.
• Templates were developed to enable integration of any electronic non-RMRS report, such as a transcribed nursing-home discharge summary
  or outpatient consultation report (in Microsoft Word format, for example), directly into RMRS as a valid, accessible electronic report within the system.

Gregory Abernathy, MD,
has worked as a clinical programming specialist at Regenstrief Institute since 1999. He contributes expertise in computer programming and is a liaison between GOCAR and RI medical informatics.

• External dissemination of information. The 2003 article, “ Using Information Technology to Improve the Health Care of Older Adults” (Weiner, Callahan, Tierney, Overhage, Mamlin, Dexter, and McDonald), described many activities and related advances and helped to build the case for gero-informatics.

• Internal information center. GOCAR created an intranet as a central resource for information about internal geriatrics resources, such as schedules and contact information. Due to the success of this site, all new IU Geriatrics schedules are now updated and distributed primarily in electronic format through the site.