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Medical Informatics I

Zlatko TrajanoskiAlexander Sturn

Institute for Genomics and BioinformaticsGraz University of Technology

http://genome.tugraz.atzlatko.trajanoski@tugraz.at

Medical Informatics I

• Introduction• Data and Data Management

– Databases and DBMS– LIMS– Standards– Data Integration– Electronic Patient Record

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Medical Informatics II

• Introduction• Mathematical Foundations

– Biostatistics– Probability theory

• Computational Methods– Classification Methods– Clustering Methods– Hidden Markov Models

Introduction

“Adjective” problem of the field:

• Medical Informatics• Bioinformatics• Biomedical Informatics• Biomedical Computing• Health Care Informatics• Public Health Informatics• Clinical Informatics• eHealth• Telemedicine• ….

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IntroductionThe term biomedical computing ...is non-descriptive and neutral, implying only that computers are employed for some purpose in biology or medicine...We define medical informatics as the … scientific field that deals with the storage, retrieval, and optimal use of biomedical information, data, and knowledge for problem solving and decision making.

Shortliffe, E.H., Perreault, L.E., Wiederhold, G., and Fagan, L.M. (eds.) (1990). Medical Informatics: Computer Applications in Health Care and Biomedicine, Menlo Park: Addison-Wesley.

…medical informatics is a field of study concerned with the broad issues in the management and use of biomedical information, including medical computing and the study of the nature of medical information.

Shortliffe, E.H., Perreault, L.E., Wiederhold, G., and Fagan, L.M. (eds.) (2001). Medical Informatics: Computer Applications in Health Care and Biomedicine, 2nd Edition. New York: Springer-Verlag

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storage, retrieval, and optimal use of biomedical information, data, and knowledge for problem solving, decision making, and research

Introduction

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Functions of computers in medicine

• Data acquisition and presentation• Record keeping and access• Communication and integration of information• Surveillance• Information storage and retrieval• Data analysis• Decision support• Education

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Types of doctors

• Primary care provider– Internist, family practitioner, pediatrician

• Specialist– Medical– Surgical

• Hospital based provider– Anesthesiologist– Pathologist– Radiologist

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Types of health interaction

• Healthy visit• Chronic visit• Diagnostic visit• Acute care

Locations of health care and documentation

• Office• Hospital• Home• Chronic care• Other hospitals• Abroad• Etc.

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Types of information

• Textual• Trend• Lab data• 2/3D images• Administrative• Billing

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• 2 and 3-d data sets– Echocardiography

Data storage

• Current approaches• Computerized approaches• Visualization of data

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History• John Snow (1813-1858)

a legendary figure in the history of public health, epidemiologyand anesthesiology.

http://www.ph.ucla.edu/epi/snow.html

The year was 1854; the scene was the Soho District of west London. During the stifling beat of August, there had been a handful of deaths from the dreaded disease cholera. Not unusual, in itself. But on August 31, the situation exploded: In a single evening, within a radius of only blocks, doctors reported 56 new cholera cases. By the next evening there were 143, and the death toll had reached 70 and was climbing. Residents started fleeing the district in panic. Medical authorities debated around the clock but couldn't settle on a plan of action.

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Napoleon's Invasion of Russia, 1812Chart by Minard

http://uts.cc.utexas.edu/~jrubarth/gslis/lis385t.16/Napoleon/

Issues• Nature of medical information• Technical challenges• Uses of medical information

– medicine– research

• Status of development in field• Ethical concerns• (Professional Career Trajectories)

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Uses of Medical Records

• Medical decision making-individual cases• Contractual (insurance…)

– Legal• Process improvement

– Clinical trials, evaluation of therapy• Basic human research

Information Types

• Textual– chief complaint, symptoms, history of present

illness, history, family history, physical exam, insurance information…

• Graphical– ECG, ultrasound, X-ray, hand-drawn figures…– longitudinal data (blood pressure graph)

• Digital/Image(X-rays, …)

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Text Information• Structured Data Entry (forms)• Natural Language

– Processing essential for interpretation• “parsing” algorithms• Thesauri

– thrombophlebitis=phlebothrombosis, DVT, blood clot in the leg, milk leg, phlegmasia caeruleadolens, dropsy…

– generalized idiopathic lymphandenopathy (1980) => AIDS!!!

» “Change over time”

Text Standards

• Ideal Terminology– Complete, Formal, Universal, Translatable

• Candidate languages– SNOMED, UMLS, ICD, Read Codes, DSM

• Digital– Entry, storage, retrieval, usage?

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Graphs/Images

• Archivable• Sharable• Searchable• Transmittable• Multiple input/output formats

– X-rays, ultrasounds, cameras…

Medical Uses of Enhanced Records

• Enhance clinical decision making• UKHMO: what are your current meds?• Rapid, rational query of records• Potential for increased use of knowledge systems (eg.

Drug interactions)– ACE inhibitor sensitivity, ER doc

• Enhanced delivery of care• Monitoring clinical success

– all patient records become clinical trials

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Research Uses

• Epidemiology– Infectious disease– Life history, risk factor...

• Medical Genetics– Basic disease work

• Pharmacogenomics

• Tissue Banks• Pedigrees/Populations• DATAMINING