medical informatics -...

MEDICAL INFORMATICS

Sorana D. Bolboacă

https://www.google.ro/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCMuKo4zTqMgCFQa6FAodsjYBPw&url=http%3A%2F%2Fskynet.ohsu.edu%2F~hersh%2F&psig=AFQjCNFWeRTKogGhx07h_uTAQnkju6fIEw&ust=1444042297783218

©2015 - 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

Decision support systems

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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

Hospital

Hospital Utility Multi-Programming System

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

…


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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http://www.who.int/goe/policies/countries/en/

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCM-48Yy6tcgCFYp-Ggodk6oMlw&url=http%3A%2F%2Fwww.aer.eu%2Fknowledge-centre%2Fthematic-expertise-thematic-issues%2Fhealth%2Fe-health.html&psig=AFQjCNGUmEtOOhaDCcZhYcgKL33e5Ickkw&ust=1444482296330702


eHealth

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e-insurance e-doctor

e-patient e-hospital

e-health

Healthcare social media


mHealth

mHealth (mobile Health) = the use of mobile technologies (e.g. mobile phones) to collect and access health information

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http://healthitmhealth.com/what-business-is-a-hospital-really-in/

http://www.devicepharm.com/2013/05/heres-to-your-mhealth-today-and-tomorrow/

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCLHcqO_BtcgCFQs7FAod_7MFuA&url=http%3A%2F%2Fwww.mobilehealthglobal.com%2F&psig=AFQjCNFbYoMnerGrRj6XCB4w5V7wNpNE8g&ust=1444482280460186


mHealth

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http://blog.mobiversal.com/10-surprising-things-you-might-not-know-about-the-mhealth-app-market.html


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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TANDARDS

Standards (e.g. DICOM, HL7) are used to facilitate the

do not define the content


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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http://www.omicsonline.org/scientific-reports/images/srep236-g003.html

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https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCMHLnoDHtcgCFUHAFAodosMHnQ&url=http%3A%2F%2Fwww.brit.com%2Fdicom.html&psig=AFQjCNFM0N1d-G2gZDiMcl54NJsBmfxapg&ust=1444485710053393


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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http://www.hl7.org/implement/standards/


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

http://apps.who.int/classifications/icd10/browse/2015/en#/C43


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

… • …

https://en.wikipedia.org/wiki/Lung

https://en.wikipedia.org/wiki/Inflammation

https://en.wikipedia.org/wiki/Mycobacterium_tuberculosis

https://en.wikipedia.org/wiki/Bufferin

https://en.wikipedia.org/wiki/Analgesic

https://en.wikipedia.org/wiki/Tablet_%28pharmacy%29

https://en.wikipedia.org/wiki/Fever


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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https://www.nlm.nih.gov/bsd/disted/meshtutorial/themeshdatabase/


MeSH MeSH (Medical Subject Headings): vocabulary thesaurus

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https://www.nlm.nih.gov/mesh/

http://www.ncbi.nlm.nih.gov/mesh/68019586

http://www.ncbi.nlm.nih.gov/mesh/68019586


HIPPA

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


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


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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http://image.slidesharecdn.com/nlaffertymyshowcasepresentation1-150626141823-lva1-app6891/95/planning-an-implementation-of-myshowcase-for-medical-education-7-638.jpg?cb=1435328420

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCL-KiuHhtcgCFQbFFAodpCAF4w&url=http%3A%2F%2Fwww.unitedpatientsgroup.com%2Fblog%2F2014%2F12%2F03%2Fcontinue-your-cannabis-education-with-united-patients-group%2F&bvm=bv.104819420,d.d24&psig=AFQjCNHf7YlhV_qjCIhsSZMw76bWjFk9Xw&ust=1444492954359606


EDUCATIONAL RESOURCES

Visible Human Project

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Digital Anatomist Information System

CELLS alive!

e-Skeleton

The Visible Human Project

http://sig.biostr.washington.edu/projects/da/

http://www.cellsalive.com/

http://www.eskeletons.org/





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http://brainmaps.org/

http://onlinestatbook.com/

http://www.drketi.com/EduLinks.html

http://www.medicalstudent.com/

http://www.learnerstv.com/medical.php



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http://www.unboundmedicine.com/products/medicine

http://www.gfmer.ch/600_MedicalLinks_En.htm


MEDICAL DATABASES

= storage space for content

= organized collection of medical data and information

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http://www.cochranelibrary.com/

http://www.essentialevidenceplus.com/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC130063/

http://www.ncbi.nlm.nih.gov/pubmed

https://www.nlm.nih.gov/medlineplus/

http://www.bestbets.org/


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https://www.clinicalguidelines.gov.au/

http://www.guideline.gov/


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


SEARCH STATEMENT: BOOLEAN OPERATORS

(breast cancer) AND (treatment) Results contain BOTH terms

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AND OR

NOT



(breast cancer) OR (treatment) Results contain only one term

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AND OR

NOT



(breast cancer) NOT (treatment) Results contain only the first term (breast cancer)

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AND OR

NOT



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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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC130063/



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


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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

X-rays, angiograms, CT, MRI scans

Image recognition and interpretation

PERFEX



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http://www.visualdx.com/visualdx/visualdx6/launch.jsp?userName=VisualDxEGD&password=glob2014Free#dml?moduleId=50&view=results&findingIds=20002,20097,20001,10118,9845


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http://dxplain.org/dxplain_faq.html

http://www.isabelhealthcare.com/home/products

http://www.isabelhealthcare.com/home/pricing_ind


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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

http://www.openclinical.org/aisp_poems.html

http://www.openclinical.org/prj_vie-pnn.html



http://www.openclinical.org/aisinpracticeAcute.html

http://www.openclinical.org/aisp_smartcarePS.html

http://www.easydiagnosis.com/cgi-bin/expert/quest.cgi?accept.x=74&accept.y=24&accept=ACCEPT&mod=Chronic+Fatigue&code=


… Medical informatics could be useful in education and practice

Coding, standards and vocabularies contribute to management of data and information

The main important thing in searching medical information is to correctly identify the terms

Decisional systems can reduce the errors if and only if input data are correct

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http://www.google.com/url?sa=i&source=imgres&cd=&cad=rja&uact=8&ved=0CAkQjRwwAGoVChMIgNzZ-dS4yAIVZnByCh04VQ9L&url=https%3A%2F%2Fprezi.com%2Fopmeqmrefret%2Fcopy-of-e-health-and-consumer-health-informatics%2F&psig=AFQjCNHfMpygmj7plzRaBmPTOnpfb8xt-Q&ust=1444592604896656

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