Topic: Overview of BMI. Baldi/Hayes/Smyth: Introduction to Biomedical Informatics: 1
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1 Introduction to Biomedical Informatics Topic: Overview of BMI Funded by NIH Grant XYZ Baldi/Hayes/Smyth: Introduction to Biomedical Informatics: 1
2 Outline Introduction to the class Motivating example: health records Origins ofbmi Relationship of BMI to other disciplines Data acquisition, storage, and use Electronic Medical Records Conclusions and discussion Recommended reading Baldi/Hayes/Smyth: Introduction to Biomedical Informatics: 2
3 Why take this class This class will NOT teach you to be a programmer teach you to fix broken computers tell you about every important biomedical computing system or application This class WILL introduce you to concepts underlying biomedical informatics encourage you to read additional related material help you connect broad concepts in biomedical informatics to your current and future work The practice of medicine is inexplicably entwined with the management of information (Shortliffe & Cimino, 3 rd ed.) Baldi/Hayes/Smyth: Introduction to Biomedical Informatics: 3
4 Motivating example: health records Modern paper based records grew out of the concept of lab notebooks for physicians What are some current challenges? Baldi/Hayes/Smyth: Introduction to Biomedical Informatics: 4
5 What are all the things that go into a medical record? Baldi/Hayes/Smyth: Introduction to Biomedical Informatics: 5
6 What are all of the ways in which the medical record is used? Baldi/Hayes/Smyth: Introduction to Biomedical Informatics: 6
7 Challenges to implementing electronic medical records: Impossible to fully automate record keeping processes Limited standards for clinical terminology, billing and diagnostic codes, and interoperability among systems (both within one medical center and beyond dt to many) Data privacy, confidentiality, and security (importantly three different but related issues) Baldi/Hayes/Smyth: Introduction to Biomedical Informatics: 7
8 Some terms medical computer science information science information theory biomedical computing or biocomputation medical informatics bioinformatics biomedical informatics Baldi/Hayes/Smyth: Introduction to Biomedical Informatics: 8
9 History of Biomedical Informatics 1890: Hollerith used punch card data processing in the US census; led to epidemiological surveillance via punch cards dannyman: punchcard loom (likely 19 th ctry) Marcin Wichary:1960 s IBM punch card Late 1950s: Started to see applications of digital computers in medicine in engineering gpublications 1960s: Computer Science as a discipline formed; mainframes the norm jovike: 1978 IBM System/370 Model s and 1980s: emergence of the personal computer (PC) or microcomputer Baldi/Hayes/Smyth: Introduction to Biomedical Informatics: 9
10 Theterm Informatics 1968: A.I. Mikhailov, along with others coined the term Informatika during thedevelopment ofthefield field ofinformation Science in Russia 1976: Nauchnye Kummunikatsii Informatika Informatics: the scientific c discipline dscp that studies sudes the structure u eand dgeneral e properties of scientific information and the laws of all processes of scientific communication. Late 1960 s: University departments in France, Holland, and Belgium established with the title informatique medicale 1974: Medical Informatics became the term of art at Kings College Hospital in London inform from d informatique, atics from d automatique. Baldi/Hayes/Smyth: Introduction to Biomedical Informatics: 10
11 Formal Definitions and Standards Bodies 1985: American Standards for Testing Materials (ASTM, develops voluntary standards) established Subcommittee on Medical Informatics 1986: AAMC defined medical informaticsformallyas formally as a developing body of knowledge and set of techniques concerning the organization and management of information in support of medical research, education andpatientcare care. For the purposes of this course, Biomedical informatics is a scientific field that deals with biomedical information, data, and knowledge their storage, retrieval and optimal use for problem solving and decision making. Baldi/Hayes/Smyth: Introduction to Biomedical Informatics: 11
12 Biomedical Informatics Application Domains Biomedical Informatics has major application domains (sub disciplines) including: Bioinformatics directed at the level of molecular and cellular processes Clinical Informatics (a.k.a. a healthcare informatics) directed at the level of individuals (includes medical informatics, nursing informatics, dental, etc.) Public Health informatics directed at populations p and society Social Informatics social impacts of information technology in healthcare field. Imaging informatics directed d at the level lof tissues and organs, e.g., pathology informatics, radiology informatics Baldi/Hayes/Smyth: Introduction to Biomedical Informatics: 12
13 How do you think Biomedical Informatics relates to other disciplines? i Baldi/Hayes/Smyth: Introduction to Biomedical Informatics: 13
14 Outline Introduction to the class Motivating example: health records Origins ofbmi Relationship of BMI to other disciplines Data acquisition, storage, and use Electronic Medical Mdi lrecords Conclusions and discussion Recommended reading Baldi/Hayes/Smyth: Introduction to Biomedical Informatics: 14
15 Medical practice is all about gathering, reviewing and interpreting data Dt Data are central lto all medical care Data are central to the process of decision making What are medical data? Baldi/Hayes/Smyth: Introduction to Biomedical Informatics: 15
16 An individual medical data point (datum) is a single observation about a patient The patient in question The parameter being observed The value of the parameter in question The time of the observation Baldi/Hayes/Smyth: Introduction to Biomedical Informatics: 16
17 Medical data are uncertain. Absence of standard medical vocabularies based on clear definitions makes all medical observations fuzzy. Common findings may mask rare ones. Symptoms and diagnoses can co occur even when not related. Context helps remedy this issue to a degree. Baldi/Hayes/Smyth: Introduction to Biomedical Informatics: 17
18 Return to our example: the medical record Legal document Growing tendency to structure data woodenmask: ancestry records from late 1800s benben: modern clinic records storage Often reviewed intensely mandiberg: medical record under review Baldi/Hayes/Smyth: Introduction to Biomedical Informatics: 18
19 Who (What) collects medicaldata? data? Physicians Nurses Radiologists Laboratory Office staffs admission personnel Technological devices Baldi/Hayes/Smyth: Introduction to Biomedical Informatics: 19
20 Potential Uses for Medical Information Historical Record Communication Diagnosis and Monitoring Legal Records Clinical and/or Epidemiological Research Perhaps custom treatments/personalized medicine Baldi/Hayes/Smyth: Introduction to Biomedical Informatics: 20
21 + Flexibility + Relative robustness + Accessibility (paper is everywhere) Pros and Cons of Paper Records - Logistical issues - Unable to share with multiple users - The incomplete of the records + Familiarity - Legibility - Disorganization of the paper records - Redundancy and inefficiency - Influence on Clinical Research - Accessibility (once the record is entered, its hard to access by paper alone) - Illegibility ofproviderhandwriting Baldi/Hayes/Smyth: Introduction to Biomedical Informatics: 21
22 Goals of Computerized Records Facilitate patient care by serving as organized external memory for practitioners Enhance communications between providers and specialists Ensure continuity of care during inpatient stays and across outpatient visits Legal and financial i purposes Research support Baldi/Hayes/Smyth: Introduction to Biomedical Informatics: 22
23 Pros and Cons of Electronic Records + Accessibility remotely and simultaneously + Legibility + Automatic decision making asking for missing information, alerts, reminders + Enhanced scope (have all inpatient and outpatient data and test results available even if a patient is outside local area) - Initial investment - Continuing costs (training, maintenance of confidentiality, etc.) - Subtle failures (e.g., transcription errors of handwritten notes by data entry person) - Catastrophic failures - Data glut difficulties (physicians often use a great deal of data of low decision value to make small decisions. Capture is difficult and expensive.) Baldi/Hayes/Smyth: Introduction to Biomedical Informatics: 23
24 Factors Influencing Benefits of EHR/EMR Use Comprehensiveness of information Duration of use and retention ti of data dt Degree ofstructure ofdata Ubiquity of access Baldi/Hayes/Smyth: Introduction to Biomedical Informatics: 24
25 Automated Data Capture Recording data in the moment can take a person out of that moment (e.g., notes in class, records during patient visit) Comprehensive capture of all data is impractical need priorities iti Relying on self report alone can lead to missing information Insufficient detail ( tests were normal ) avoided when test results automatically gathered from original source Chance to track data provenance in detail For more on this issue from a computer science standpoint (rather than BMI), see Truong, K.N. and Hayes, G.R. Ubiquitous Computing for Capture and Access, Foundations and Trends in Human Computer Interaction: (2):2, Baldi/Hayes/Smyth: Introduction to Biomedical Informatics: 25
26 But when data cannot be gathered automatically Emphasis on personnel investment needed Avoidance of free text since interpretation by input personnel introduces errors Careful coding emphasis on training Work on areas to increase accuracy of data input (e.g., structured data entry, voice recognition) Baldi/Hayes/Smyth: Introduction to Biomedical Informatics: 26
27 Medical care is informational Physician encounters are information rich What are some examples from your experiences? Baldi/Hayes/Smyth: Introduction to Biomedical Informatics: 27
28 Where did the idea of storing all these data digitally originate? As in other domains, complexity and quantity of information i requires digital i database solutions (to a degree) 1950 s: Split between clinical and research information repositories 1960s: advent of computer based hospital information systems (HIS) 1969: Lawrence Weed introduced problem oriented medical record (POMR) Baldi/Hayes/Smyth: Introduction to Biomedical Informatics: 28
29 EMR The source oriented information of a medical chart plus a demand oriented front end. (Stead, 1987) Lindberg ideal EMR concepts: Careful measurements over patient s conditions should be made, recorded and monitored; Lifelong record must be complete and machine readable; Linkages should be included to sources of medical knowledge. Baldi/Hayes/Smyth: Introduction to Biomedical Informatics: 29
30 Functional Components of EMR Integrated view of patient data Clinical decision support Clinician order entry Access to knowledge resources Integrated communication and reporting support Baldi/Hayes/Smyth: Introduction to Biomedical Informatics: 30
31 What is the difference between an EMR and an EHR? Baldi/Hayes/Smyth: Introduction to Biomedical Informatics: 31
32 What is so complicated about EHR? Lots of types of data to store Lots of people to make happy Baldi/Hayes/Smyth: Introduction to Biomedical Informatics: 32
33 What does the EMR in particular have to do? Baldi/Hayes/Smyth: Introduction to Biomedical Informatics: 33
34 Desirable Features Modular Open Source (means different things to different people); Patient centric Usable in research context (if the clinical setting using the EMR does research) Baldi/Hayes/Smyth: Introduction to Biomedical Informatics: 34
35 Issues, Barriers, Bottlenecks Privacy Interoperability Standards Usability Workflow Baldi/Hayes/Smyth: Introduction to Biomedical Informatics: 35
36 One example: Demo from Quest System Baldi/Hayes/Smyth: Introduction to Biomedical Informatics: 36
37 Translating Medical Data into Knowledge Data: single, uninterrupted observation point (e.g., one BP reading) Information: elements of data arranged to convey meaning Knowledge: generalized truths formed from analysis of information Discuss: Whatisthe the difference between a database and a knowledge base? Why does it matter? Baldi/Hayes/Smyth: Introduction to Biomedical Informatics: 37
38 Discussion What do you think is the long term relationship between health workers and computers? For the practitioners in the class, how have things changed for you in your profession over the years? Will clinicians i i be viewed as outmoded dif they do not turn to computational tools for assistance? Baldi/Hayes/Smyth: Introduction to Biomedical Informatics: 38
39 Recommended Reading Heath and Luff Documents and professional practice: bad organisational reasons for good medical records Marc Berg The multiple bodies of the medical record Altman Informatics in the care of patients: Ten notable challenges Institute of Medicine Crossing the Quality Chasm: A New Health Systems for the 21 st Century Collen 1995 a history of medical informatics in the United States Weed 1969 Medical Records, Medical Evaluation, and Patient Care: The Problem Oriented Record as a Basic Tool. Chapters 1, 2, and 12 in blue book Baldi/Hayes/Smyth: Introduction to Biomedical Informatics: 39
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