Medical Informatics : Overview

Student and Faculty PDAs

Stedmans Medical Dictionary InfoRetriever ePocrates PDxMD CPOnhand

Data Collection and Evaluation System

Arcstream System Avantgo Server SQL Server

Student Wireless Laptops

Microsoft Office Professional Dorlands Medical Spellchecker Photoshop Elements InfoRetriever Endnote

College of Medicine Network Infrastructure

Technology Enhanced Classrooms Campus Wide Wireless Coverage Video Conferencing File, Exchange, Web Servers

Virtual Library Resources

Blackboard Courseware
All Courses

IT Section Support
Database Development Web design Video Editing Tech Support

Medical Informatics
l

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

Medical Informatics
l

Deals with the resources, devices, and methods required to optimize the acquisition, storage, retrieval, and use of information in health and biomedicine

The field that concerns itself with the cognitive, information processing, and communication tasks of medical practice, education, and research, including information science and the technology to support these tasks

Medical Informatics
l

Medical or Health Care

l

Information Science
l

Computer Science

Medical Informaticians
l l

Medical Education

Patient Data Collection and Recording

l l

Clinical Information Retrieval

Medical Knowledge Retrieval
l

Medical Decision Making

Some Definitions
l

Medical Informatics: the science of medical information collection and management

Medical Decision Making: quantitative methods for reasoning under uncertainty

l

Medical Computing: computer applications for information management

l

Medical Decision Support: computer-based information processing to help human decision makers

A Brief History - Past to Future

l l l

l
l l l

Ledley and Lusted - Reasoning foundations of medical diagnosis; Science 1959 El Camino Hospital - 1965 Help System - 1970 Financial systems - driven by billing and reporting requirements Clinical Systems Information Resources Expert Systems

Health Informatics
l

Information Technology
Health care Research Education

Fundamentals
Communication Knowledge Management Decision support Clinical Information Management

Medical Informatics
Knowledge Management Clinical Information Management

Communication

Decision Support

Medical Computing

Patient-Oriented Systems Medical Information Resources Medical Knowledge Systems

Patient Oriented Systems

l

Definition: systems which collect, store and retrieve data about individual patients
Financial systems Electronic medical records Research databases

l l l

Patient Oriented Systems

Data collection: -History -Physical examinations -Laboratory and other tests

Data

Information

Patient

Decision making

Therapy plan

Planning

Diagnosis/assessment

Medical Information Resources

l

Definition: systems which contain general medical knowledge

Medline Electronic textbooks Computer-assisted instruction

l l l

Medical Knowledge Systems

l

Definition: systems which apply general medical knowledge, whether through pattern matching or application of clinical algorithms, to specific patients
Stand-alone: Mycin, Internist-I/QMR, DXplain Integrated: Help, Columbia CIS

Infrastructure for Medical Informatics

Student and Faculty PDAs
Stedmans Medical Dictionary InfoRetriever ePocrates PDxMD CPOnhand

Data Collection and Evaluation System

Arcstream System Avantgo Server SQL Server

Student Wireless Laptops

Microsoft Office Professional Dorlands Medical Spellchecker Photoshop Elements InfoRetriever Endnote

College of Medicine Network Infrastructure

Technology Enhanced Classrooms Campus Wide Wireless Coverage Video Conferencing File, Exchange, Web Servers

Virtual Library Resources

Blackboard Courseware
All Courses

IT Section Support
Database Development Web design Video Editing Tech Support

Case Presentation
Case Description: 74 y.o. female with history of right CVA in 1989 (LLE weakness), one week of productive cough and increased debility. Exam consistent with bronchitis, oral antibiotic prescribed, but patient had a tonic grand mal seizure in clinic. Became flaccid, unconscious, pulseless, apneic, but upon positioning for CPR, developed pulse and spontaneous respirations and awoke about 2 minutes after start of episode, complaining of lower sternal chest pain.

Actions:
Transfer to Emergency Room Examination Bloodwork Chest Xray Cardiogram Admission and therapy

CIS Demo - Part I

l l l l l l

Lab Data: ABG and CPK/Isoenzymes Radiology: CXR, VQ, Doppler Cardiology: ECG, Cardiac Cath Medications

Alerts
Discharge Summary

Case Summary
Case Description: bronchitis, bed-bound, venous thrombosis, pulmonary embolism, myocardial infarction, ventricular arrhythmia, hypotension, seizure, adult respiratory distress syndrome, methicillin-resistant Staph aureus

Discharge Plan
Where? What happened?

Outpatient Follow-up
Medications Laboratory Health Maintenance

CIS Demo - Part II

l l

Demographic Information
Additional Hospitalizations?

l
l l

More Discharge Summaries?

Recent Lab Results Outpatient Notes

How Did We Do It?

Information Science
l

Standards Integration

Information Science
l

Expert Systems
Decision Support Systems Research Databases

Computer Assisted-Instruction

Standards
l

Messaging
Vocabulary Logic Databases

Standards for Messaging

Structured Query Language Z39.50 Health Level 7 (HL7)

HL7 Example
MSH!^~\&!resquery!cicsu9!socratesqry!wash!19950314151110307!!ORF!199503141!! MSA!AA!19941125165590!RESULT LIST COMPLETED.!! QRD!19941125165542!R!I!0113142726!!!99!1644144!res!32309!! QRF!*!19901101000000!19941230170100!PDQRES2~*~OPSTA!95~95~95~PF~~ OBR!!!M136903542294808^0001!35422^^L!!!1994080807190000000!!!!!!!!!!!!!!!!!F!!!!!!!!! OBX!!TX!35456^^L!1^0!138$135-146]mM/l!!!!!!! OBR!!!M140333542394808^0001!35423^^L!!!1994080807100000000!!!!!!!!!!!!!!!!!F!!!!!!!!! OBX!!TX!35456^^L!1^0!136$135-146]mM/l!!!!!!! OBR!!!X263 3542294807^0001!35422^^L!!!1994080706520000000!!!!!!!!!!!!!!!!!F!!!!!!!!! OBX!!TX!35456^^L!1^0!140$135-146]mM/l!!!!!!!

Standards for Vocabulary

l

International Classification of Diseases, 9th Edition, with Clinical Modifications (ICD9-CM) Diagnosis-Related Groups (DRGs) Medical Subject Headings (MeSH)

l l

l
l

Unified Medical language System (UMLS)

Systematized Nomenclature of Medicine (SNOMED) Read Codes Knowledge-Based Vocabularies

l l

ICD9- CM Example
003 Other Salmonella Infections 003.0 Salmonella Gastroenteritis 003.1 Salmonella Septicemia 003.2 Localized Salmonella Infections 003.20 Localized Salmonella Infection, Unspecified 003.21 Salmonella Meningitis 003.22 Salmonella Pneumonia 003.23 Salmonella Arthritis 003.24 Salmonella Osteomyelitis 003.29 Other Localized Salmonella Infection 003.8 Other specified salmonella infections 003.9 Salmonella infection, unspecified

DRG Example
75 - Respiratory disease with major chest operating room procedure, no major complication or comorbidity 76 - Respiratory disease with major chest operating room procedure, minor complication or comorbidity 77 - Respiratory disease with other respiratory system operating procedure, no complication or comorbidity 79 - Respiratory infection with minor complication, age greater than 17 80 - Respiratory infection with no minor complication, age greater than 17 89 - Simple Pneumonia with minor complication, age greater than 17

90 - Simple Pneumonia with no minor complication, age greater than 17

475- Respiratory disease with ventilator support 538 - Respiratory disease with major chest operating room procedure and major complication or comorbidity

MeSH Example
Respiratory Tract Diseases Lung Diseases Pneumonia Bronchopneumonia Pneumonia, Aspiration Pneumonia, Lipid Pneumonia, Lobar Pneumonia, Mycoplasma Pneumonia, Pneumocystis Carinii Pneumonia, Rickettsial Pneumonia, Staphylococcal Pneumonia, Viral Lung Diseases, Fungal Pneumonia, Pneumocystis Carinii

SNOMED Example
D2-50000 D2-50100 D2-50100 D2-50100 D2-50100 D2-50100 D2-50104 D2-50110 D2-50120 D2-50130 D2-50130 D2-50140 D2-50140 D2-50142 D2-50150 D2-50152 D2-50160 D2-50170 SECTIONS 2-5-6 DISEASES OF THE LUNG 2-501 NON-INFECTIOUS PNEUMONIAS Bronchopneumonia, NOS (T-26000) (M-40000) Lobular pneumonia (T-28040) (M-40000) Segmental pneumonia (T-280D0) (M-40000) Bronchial pneumonia (T-280D0) (M-40000) Peribronchial pneumonia (T-26090) (M-40000) Hemorrhagic bronchopneumonia (T-26000) (M-40790) Terminal bronchopneumonia (T-26000) (M-40000) Pleurobronchopneumonia (T-26000) (M-40000) Pleuropneumonia (T-26000) (M-40000) Pneumonia, NOS (T-28000) (M-40000) Pneumonitis, NOS (T-28000) (M-40000) Catarrhal pneumonia (T-28000) (M-40000) Unresolved pneumonia (T-28000) (M-40000) Unresolved lobar pneumonia (T-28770) (M-40000) Granulomatous pneumonia, NOS (T-28000) (M-44000) Airsacculitis, NOS (T-28850) (M-40000)

Standards for Logic

l

HELP Sectors
CARE System Arden Syntax for Medical Logic Modules

MLM Example
maintenance: title: Creatinine clearance;; version: 1.09;; author: George Hripcsak, M.D. (hripcsak@cucis.cis.columbia.edu);; ;; library: purpose: To calculate the creatinine clearance for every timed urine collection;; explanation: When a timed urine collection is stored, the MLM checks for..... ;; knowledge: data: let urine_creat_storage be event {'32506','1762'}; let (urine_creat, collect_time) be read last {'evoking', 'dam'="PDQRES1";'1762'; '1537'};;; evoke: starting time of urine_creat_storage;; logic: let serum_creat be nearest (time of urine_creat) from (serum_creat_list where it is number); let creat_clear be 0.07 * (24 / collect_time) * (urine_creat / serum_creat); conclude true; ;; action: write "The creatinine clearance is " ||int(0.5+creat_clear)|| " ml/min based upon a " ||collect_time|| " hour urine creatinine of " ||urine_creat||.....; ;; end:

Standards for Databases

l

Definitions for Computer-Based Patient Records Data Model Standards

Integration
l

IAIMS: Integrated Advanced (Academic) Information Management Systems

Five Levels of Integration World Wide Web (WWW)

Architecture at CPMC
Clinical Departments Local Area Network Web Browser
Clinical Information System Clinical Data Server Vocabulary Server

Internet

Workstations

Web Server

Additional Information Sources

Resident Signout Editor (RSE)

World Wide Web Demo

l l l l l l l l l l l l

Visual Bed Browser l JMWs CIS Menu l JMWs Labs l Lab Trend l Medline Button Q's l Medline Button Results l Medline button Abstract l DXplain Button Extract l DXplain Button Results l DXplain Button Disease Cholesterol Guideline Input Cholesterol Guideline Result

ECG Xray Xray Medline Q's Xray Medline Abstract Medications Single Drug Order Drug/Diet Information PDR JMWs Discharge Summary

Summary
l

Classification of Systems
Development of Standards Intelligent Integration

Challenges
l l l l

Security and Confidentiality Vocabulary Data Entry Changing Behavior

Outcomes assessment Managed care New paradigms for information use

MedicalStudent.com
A digital library of authoritative medical information for the medical student and all students of medicine

About.com www.about.com
The site contains the greatest collections of information on diseases and conditions on the Net. It spans the globe and provides interactive chats and forums for experts and patients to come together. This site not only directs you to outside sources, but also takes each topic and gives you the rundown from top to bottom.

Best Doctors www.bestdoctors.com

Find the best doctors and provide the best content on a site that others can access free of charge. Founded by a man who was diagnosed with an inoperable tumor and wanted the best doctors to treat him, he set out to empower other patients through information.

HealthAtoZ.com www.healthatoz.com
This is the kind of site that contains so much information that there's little chance you won't find what you're looking for. Not only are the diseases covered extensively, but the interactive tools make your search for information much more enjoyable. Come here to learn, then take advantage of links to other sources to intensify your search for information.

Healthcommunities.com www.healthcommunities.com
This site is specifically designed to give you disease-related information through what it calls channels. It's one of the most interactive medical portals on the Net, offering chats, discussion forums, and clinical trials. This site enables you to access the world of medicine in seconds.

Health finder www.healthfinder.gov

This government portal opens the world of Internet medicine. Whether it's through tools such as libraries, online journals, or medical dictionaries or hot topics that might interest you, this site delivers quickly and with reliability. A big bonus of the site is that it also provides content in Spanish.

InteliHealth www.intelihealth.com
It's important for a portal to "have it all." This one is a good example. Whether it's drug information, a medical dictionary, or a rundown on a long list of diseases and conditions, Intelihealth is your gateway to top-notch information. It doesn't hurt to have Harvard Medical School's consumer health information tied to the site.

National Institutes of Health www.nih.gov

Contain the leading collection of health research institutes in the world. Whether the topic is allergy and infectious disease or cancer, this is your gateway to health information. You'll find the latest in research and wellwritten fact sheets and brochures that reach out to inform all.

National Library of Medicine www.nlm.nih.gov

The best electronic medical library in the world. It gives you access to the most important research and links to thousands of sites, sending you around the globe for the best information in a matter of seconds. Physical medical libraries,

WebMD www.webmd.com
One of the most heavily marketed portals on the Net, this site stands up to most of the hype. It's nicely divided for different audiences, ranging from patients and doctors to physician assistants to health teachers. It has a robust television service that allows you to watch broadcasts on different health topics.