data integration and analysis i: medical information...

BiomedicalInformationTechnology

2.771J BEH.453J HST.958J Spring 2005

Lecture 26 April 2005

Data Integration and Analysis I:Medical Information Systems

© cfdewey 2005

Biomedical Information Technology

DATA INTEGRATION AND ANALYSIS I� Integration in the hospital environment ¾ Imaging and information flow ¾Use of DICOM standard ¾ The personal healthcare record ¾HL-7: the hospital standard for data interchange ¾ IHE: Integrated Healthcare Environment

� The importance of use cases: York Hospital � Adding metadata to medical records ¾ DICOM Structured Reporting (SR) ¾ Snomed

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Information flow in health care delivery

EpidemiologyStudies

Main Control

Resources

DiagnosticDatabase

ImageStorage

DiagnosticProcedure

Treatment Procedure

DiagnosticStatistics

Resources Treatment Statistics

Local Control

Local Control

© cfdewey 2005

© cfdewey 2005

Here’s a diagram of what is there today . . . . .

Radiology

Primary Care

Admissions

Laboratories

Hospital Administration

++Add to that the following:asdfsaklfd0sljf safds asfdsdasfd adf asdfsafdasfd asfdsasfdsaasfdd fdsfadfs afsa adf

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Semi-automatedPaper and film

BiomedicalInformationTechnology


Integrating the hospital information entities

Radiology Pathology Cardiology Intensive Care Others

DICOM Data Repository

DICOM Data

MRI X-Ray CAT-Scan Ultrasound Electrocard.

Devices

Services © cfdewey 2005


The personal Electronic Medical Record (EMR)

Patient Treatment

Patient Information

Diagnostic Protocols

Pharmacy and Other


Electronic Medical Record

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The enterprise healthcare systemThe enterprise healthcare system

Patient Admission

Outcome Studies

Physician Contacts Billing



Healthcare Enterprise Systems

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York tHeal hSM

S Y S T E M

Integrating Medical Imaging with aPerson-Centric EMR

WilliamWilliam ““BuddyBuddy”” GillespieGillespieChief Information OfficerChief Information Officer

www.yorkhealth.orgwww.yorkhealth.org19981998

Courtesy of William Gillespie. Used with permission.

© cfdewey 2005

YorkHospital

YorkMedicalGroup

Remote Clinicsand Facilities

HomeHealthcareFacilitiesAmbulatory

CenterApple Hill

Laboratoriesand DiagnosticCenters

HealthCentral

Employers

Payors

Affiliated an Offices

Physician 3Physician 1 Physician 2

South CentralPreferred

©

York

York Medical

Laboratories

Employers

Payors

YHS NETWORK

Physici (PHO, MSO, HMO)


South

Integrated Delivery NetworkYork l hS Y S T E M

SM

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Hospital Group

Remote Clinics and Facilities

Home Healthcare Facilities Ambulatory

Center Apple Hill

and Diagnostic Centers

Health Central

*Indemnity *Medicare

*HMO/PPO *Medicaid Affiliated Physician Offices (PHO, MSO, HMO)

Physician 3 Physician 1 Physician 2

Central Preferred

t Hea


Berks County

Hospital

York-Adams

Franklin-Fulton

Lancaster-Chester

Penn State Geisinger Health System

Capital Region

Health System (Hershey)stem

Regional AffiliationsYork tl hHea

SM

S Y S T E M

Reading St.

Summit Health

Summit Health (Waynesboro)

Hospital

Ephrata Hospital

CommunityHospital

HospitalSt. JosephHospital

inger

Hospital

Hospital

Sy

Joseph Medical Center

Community General Hospital

York Health System

Memorial Health Systems

Hanover HealthCare Plus

Gettysburg Hospital

(Chambersburg)

Columbia Lancaster Health Allianc e Brandywine

Pinnacle Health Syst em

Penn State GeisHoly Spirit

Commun ity General H ospital

G ood Samaritan

Pinnacle H ealth

Carlisle Hospital

Courtesy of William Gillespie. Used with permission. © cfdewey 2005

York Heal ht York Hospital Information FlowsSM

S Y S T E M

Lab Medical Pharmacy Food SvcMtl MgmtCardiology OR

Pat Mgmt

Registration

General Ledger

EMR

Imaging

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York Health System Information Flows

Medical

Registration

General Ledger

EMR Pat Mgmt

Data Warehouse

EMPI

Registration Registration

Billing Tracking

Hospital Physicians

Managed Care

York tl h S Y S T E M

SM

Imaging

Hea

Courtesy of William Gillespie. Used with permission. © cfdewey 2005


Generation and storage of metadata� Diagnostic analysis ¾Track and record changes to the image ¾ Store results (see MS image segmentation) ¾ Coding systems � HL-7 � Snomed � ICD 9/10 � UMLS

� Structured Reporting ¾ Originated with DICOM ¾ Is broader than DICOM

© cfdewey 2005


Diagnostic coding systems� Long history of nomenclature attempts¾ ICD ¾ DRG ¾ Read Codes¾ Unified Medical Language System (NLM)

� SNOMED is the current most accepted standard “SNOMED Clinical Terms provides a common language that makes

health care information accessible and usable, whenever and wherever it is needed, to improve health care across primary and specialty medicine settings internationally. Government entities and healthcare organizations in 28 countries have adopted SNOMED CT since its release in January 2002.” www.snomed.org

Ref: J.J. Cimino, Meth. Info. In Medicine 35: 273-284 (1996) © cfdewey 2005


Hospital information coding systems� HL-7 ¾ Started as simple set of transaction codes ¾ Grew to some 3,000 tags with definitions � Current version 2.08, March 2005

¾ Tags are a cumbersome way to enforce ontologies � HL-7 Version 3 is an object model ¾ Object model ¾ Strangely silent since 2002 ¾ Had major effort and use cases; see handout

www.HL7.org © cfdewey 2005


Metadata: viewing medical images

Diagram removed for copyright reasons.Depiction of different views and functions on a given image: magnifying glass, window/level, zoom, pan, flip vertical/horizontal, invert, annotate.

© cfdewey 2005


A complex case at BWH, Harvard Med. School�Multiple sclerosis �Design ¾100 patients ¾20 time points/patient ¾Four 3-D MR images/time point ¾60 GB raw data

�Analysis Courtesy of Dr. Charles Guttmann. Used with permission.

¾Segmentation of 3-D images forlesions

¾Time course of lesions (another 40 GB) ¾Associated patient genetic database © cfdewey 2005


Advanced image processing architecture

��Component Sharing & InteroperabilityComponent Sharing & Interoperability

Efficient Architectural Model:

PP WR

Image Database Memory

Database

�Image Stream / Pipeline ProcessingEfficient Execution Model:

= Edge (Gray (Sharpen ( ) ) )

© cfdewey 2005


Integration of metadata: An example of aStructured Report (SR)

Ref: David A. Clunie, DICOM Structured Reporting,PixelMed Publishing, 2000, p 30

© cfdewey 2005Courtesy of Dr. David Clunie. Used with permission.

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