INTERNET OF MEDICAL THINGS (IOMT)
Sorana D. Bolboacă
©2016 - Sorana D. BOLBOACĂ
Despre ...
Definitions & History & eHealth & mHealth
Standards (e.g. DICOM, HL7)
Coding medical information (ICD-10, SNOMED, MeSH)
Medical data management EMR – Electronic Medical Record
CPOE – Computerized Physician Order Entry
Medical education: Educational resources
Medical databases & searching medical information
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DEFINITION
“Medical Information Science is the science of using system-analytic tools . . . to develop procedures (algorithms) for management, process control, decision making and scientific analysis of medical knowledge.” Ted Shortliffe
“Medical Informatics comprises the theoretical and practical aspects of information processing and communication, based on knowledge and experience derived from processes in medicine and health care” Jan van Bemmel
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DEFINITION: SPECIALITIES
Healthcare Informatics Clinical Informatics
Pathology Informatics
Pharmacy Informatics
Public Health Informatics (population level)
Community Health Informatics
Home Health Informatics
Nursing Informatics
Medical Informatics (individual patient level)
Consumer Health Informatics
Clinical Bioinformatics (molecular level)
Informatics for Education & Research in Health & Medicine
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1974 Atkinson Morley's Hospital MYCIN
1966 Massachusetts General Hospital Utility Multi-Programming System
HISTORY
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1958 National Library of Medicine and IBM bibliographic database
Database Retrieval Clinical support
an early expert system that used artificial intelligence to identify bacteria causing severe infections
1971 Atkinson Morley's Hospital first clinical CT
… Mobile support
1997 Newton PDA record the health parameters of villages in India
…
©2016 - Sorana D. BOLBOACĂ
eHealth
eHealth = “the use of information and communication technologies (ICT) for health. Examples include treating patients, conducting research, educating the health workforce, tracking diseases and monitoring public health.”
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eHealth
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e-insurance e-doctor
e-patient e-hospital
e-health
Social media
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mHealth
mHealth (mobile Health) = the use of mobile technologies (e.g. mobile phones) to collect and access health information
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mHealth
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STANDARDS
Standards (e.g. DICOM, HL7) are used to facilitate the exchange of information between healthcare information systems
Started in the late of 1960s: standards for laboratory message exchange
1965: nomenclature for pathology in 1965
1974: Uniform Hospital Discharge Data Set (UHDDS)
1985: Digital Imaging and Communications in Medicine (DICOM)
1987: Health Level Seven (HL7)
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do not define the content
©2016 - Sorana D. BOLBOACĂ
STANDARDS: DICOM DICOM (Digital Imaging and
Communications in Medicine): standard for handling, storing, printing, and transmitting information in medical imaging.
Enables the integration of scanners, servers, workstations, printers, and network hardware from multiple manufacturers into a Picture Archiving and Communication System (PACS)
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HL7 HL7 and its members provide a framework (and related
standards) for the exchange, integration, sharing, and retrieval of electronic health information
Define how information is packaged and communicated from one party to another, setting the language, structure and data types required for seamless integration between systems.
HL7 standards support clinical practice and the management, delivery, and evaluation of health services, and are recognized as the most commonly used in the world.
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ICD-10 = International Statistical Classification of Diseases and Related
Health Problems (ICD), a medical classification list by the World Health Organization (WHO)
codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases
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ICD-10 ONLINE
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English & French
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ICD-10
Advantages
Better patient care: ⤒ level of detail - better standards, efficient structures and procedures, lowering risks, and better policies
Better research: better detailing data management with deeper data analytics
Better resource utilization: allow determine the time and resources spent on treating a medical condition
Better claims processing: reduce denial of claims and the time required for processing claims
Disadvantages
New training: the number of codes in ICD-10 is 150,000; while ICD-9 had 18,000 codes
Slowdown during the transition: extra time for training & new degree of meticulousness as well as back-referring to the books
Reimbursement uncertainties in initial period: lack of complete understanding of how the new coding system works and doctors might miss out on important notations which eventually lead to lower payouts
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DIAGNOSIS RELATED GROUP (DRG)
Hospital reimbursement methodology
Classify hospital cases into one of originally 467 groups
Categorize patients with respect to diagnosis, treatment and length of hospital stay using the following data: Principal diagnosis
Secondary diagnosis(es)
Surgical procedures performed
Comorbidities and complications
Patient's age and sex
Discharge status
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SNOMED Systematized Nomenclature of Medicine a systematic, computer-
processable collection of medical terms, in human and veterinary medicine, to provide codes, terms, synonyms and definitions which cover anatomy, diseases, findings, procedures, microorganisms, substances, etc.
Reference ontology
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SNOMED
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T (Topography) – Anatomic terms • (T-28000) Lung
M (Morphology) – Changes found in cells, tissues and organs • (M-40000) Inflammation
L (Living organisms) – Bacteria and viruses • (L-21801) Mycobacterium tuberculosis
C (Chemical) – Drugs • (C-C137A) Bufferin Analgesic Tablets
F (Function) – Signs and symptoms • (F-03003) Fever
… • …
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MeSH
Is the National Library of Medicine's controlled vocabulary thesaurus.
It consists of sets of terms naming descriptors in a hierarchical structure that permits searching at various levels of specificity.
MeSH descriptors are arranged in both an alphabetic and a hierarchical structure.
MeSH thesaurus is used by NLM for indexing articles from 5,400 of the world's leading biomedical journals for the MEDLINE®/PubMED® database.
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MeSH
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MeSH MeSH (Medical Subject Headings): vocabulary thesaurus
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HIPAA (Health Insurance Portability and Accountability Act )
MEDICAL DATA MANAGEMENT is the management of personal health information in hospitals or
other healthcare organizations enabling the delivery of quality healthcare to the public.
Accumulation
Storage
Accuracy of patient data
Health information management deals largely with patient or individual - related data
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Electronic medical record (EMR)
Electronic health record (EHR)
Personal health record (PHR) Collected and maintained by the patient
National interoperability standards
One health care organization
©2016 - Sorana D. BOLBOACĂ
ELECTRONIC MEDICAL RECORD + Provide accurate, up-to-date, and complete information about patients
at the point of care
Enable in time access to patient records efficient care
Allows secure sharing of electronic information
Allows more effectively diagnoses by reducing medical errors
Improve the interaction between patient and healthcare providers
Enable safer and reliable drug prescribing
Helps to promote complete documentation and accurate coding and billing
Enhance privacy and security of patient data
Helps providers to improve productivity and work-life balance
Enable healthcare providers to improve efficiency and meet their business goals
Allows reduction of costs through decreased paperwork, improved safety, and reduced duplication of testing
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ELECTRONIC MEDICAL RECORD - Costly
Need to train the staff
IT staff may be needed
possible damage to system and software and or required upgrades
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True or False?
1. All EMR are the same
2. The basic rules for working with an EHR are the same as for a paper record
3. There is nothing you can do to correct any mistake in EHR
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COMPUTERIZED PHYSICIAN ORDER ENTRY
a process of electronic entry of medical practitioner instructions for the treatment of patients (particularly hospitalized patients) under his or her care
Features:
Ordering
Patient safety
Portability
Billing
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MEDICAL EDUCATION
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EDUCATIONAL RESOURCES
Visible Human Project
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Digital Anatomist Information System
CELLS alive!
e-Skeleton
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EDUCATIONAL RESOURCES
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EDUCATIONAL RESOURCES
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MEDICAL DATABASES = storage space for content
= organized collection of medical data and information
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SEARCHING MEDICAL INFORMATION
Where searching medical literature help you: Education: to learn about a
medical topic
Practice: to answer specific patient related question
Guideline: to identify current best practice
Different search interface do the same things in different ways
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1. Identify the concept
2. Assign specific terms (use MeSH)
3. Identify for each term all synonyms
4. Define the search statement
5. Do the search
6. Refine the search according with the results
©2016 - Sorana D. BOLBOACĂ
SEARCH STATEMENT: BOOLEAN OPERATORS
(breast cancer) AND (treatment) Results contain BOTH terms
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AND OR
NOT
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SEARCH STATEMENT: BOOLEAN OPERATORS
(breast cancer) OR (treatment) Results contain only one term
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AND OR
NOT
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SEARCH STATEMENT: BOOLEAN OPERATORS
(breast cancer) NOT (treatment) Results contain only the first term (breast cancer)
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AND OR
NOT
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SEARCH STATEMENT: BOOLEAN OPERATORS
Using boolean operators
AND groupings contain terms for different ideas/concepts and can combine OR groupings (smoking and (lung cancer))
OR groupings contain terms for the same idea/concept and are usually put in parenthesis (cancer or neoplasm)
NOT statements are usually put last and can contain an OR grouping; they are often used to get rid of a common subgroup (diabetes NOT juvenile)
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SEARCHING MEDICAL INFORMATION
Use controlled vocabulary: MeSH
Accurate search
Increases the relevancy of results
Searchable tree structures of terms can help you find new terms to use
Problems:
Not all databases use a controlled vocabulary
New concepts could me missed
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SEARCHING MEDICAL INFORMATION Truncation:
Therap* retrieves therapy OR therapies OR therapeutics OR therapeutic
Organi?ation retrieves organisation OR organization
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MEDICAL DECISION SUPPORT SYSTEMS
A health information technology system that is designed to assist physicians and other health professionals with medical decision-making tasks
Also known as Clinical Decision Support System (CDSS)
“software that designed to be a direct aid to clinical decision-making, in which the characteristics of an individual patient are matched to a computerized clinical knowledge base and patient-specific assessments or recommendations are then presented to the clinician or the patient for a decision” (link to reference)
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MEDICAL DECISION SUPPORT SYSTEMS
Advantages: Reduce medical errors access to accurate clinical data
Increase health care quality access to medical knowledge
Increase health care efficiency on site feedback
Features: diagnose
chronic disease management: benchmarks and alerts
public health surveillance: detecting pandemic diseases
Higher effectiveness if linked with EMR and CPOE
evidence-adaptive CDSSs Evidence-based medicine is the management of individual patients
through individual clinical expertise integrated with the conscientious and judicious use of current best evidence from clinical care research
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Monitoring a patient (EKG / pulse oximeter) warn of changes in patient condition
MEDICAL DECISION SUPPORT SYSTEMS
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Alert and reminders
Complex cases
Diagnostic assistance
can look for inconsistencies, errors and omissions in an existing treatment plan
Therapy critiquing
checks for drug-drug interactions, dosage errors, and prescribing
Prescribing decision support systems
formulation of specific and accurate clinical questions & act as information filters
Information retrieval
Diagnosis assistance & research X-rays, angiograms, CT, MRI scans
Image recognition and interpretation
PERFEX
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MEDICAL DECISION SUPPORT SYSTEMS
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POEMS Post-Operative Expert Medical System
VIE-PNN Vienna Expert System for Parenteral Nutrition of Neonates
SmartCare management of mechanical ventilation in Intensive Care Units
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… Medical informatics could be useful in education and practice
Coding, standards and vocabularies contribute to management of data
The main important thing in searching medical information is to correctly identify the terms
Decisional systems can reduce the errors if and only if the input data are correct
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