Medical Informatics: An Introduction

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1 Medical Informatics: An Introduction Michael Hogarth, M.D. Associate Professor Dept. of Pathology and Laboratory Medicine Dept. of Internal Medicine UC Davis School of Medicine

2 Overview What is medical informatics? A brief history Current state of the discipline Areas of sub-specialization

3 Medical Informatics "...the rapidly developing scientific field that deals with the storage, retrieval, and optimal use of biomedical information, data, and knowledge for problem solving and decision making." Shortliffe et al. Medical Informatics: Computer Applications in Healthcare. Addison Wesley, 1990.

4 Applied informatics

5 Knowledge transfer in Medicine The Gross Clinic by Thomas Eakins,1875

6 Medical Informatics: 1890 John Shaw Billings: US Army Surgeon general. Founding director of the NLM. Established Index Medicus in 1890 Responsible for the US Census 1890

7 National Library of Medicine NLM library hall (circa 1887)

8 Medical Informatics as a Discipline Oznovy Informatiki (Foundations of Informatics), 1968 (Russia) French article (1970): Study of an informatic system aplied to the Public Health Services Hatton, et al IFIP Medical Informatics Monograph Series (1974) MEDINFO 74: First Conference on Medical Informatics

9 Why Informatics? Introducing an in-depth understanding of healthcare information needs during system design Development of improved methods of information navigation Index Medicus (Billings, 1890) Roget s Thesaurus (Roget, 1911) MEDLARS (Rogers, 1965) Unified Medical Language System (1986-present) Development of clinical decision support mechanisms and evaluating their effectiveness

10 Key Point Evaluation of information systems using scientific methods

11 Informatics: MUMPS: Massachusetts General Hospital Utility Multi-Programming System, 1966 Mycin (1970): Ph.D. thesis by Ted Shortliffe,MD evaluating a software program which suggested antibiotic choices based on clinical information. COSTAR( ): Electronic medical record system developed in MUMPS GEMISCH(Generalized Medical Information System for Community Health): Hammond,Stead,1969

12 Informatics: MEDLINE (1966- today) 8 million citations MeSH terms (45,000) novel indexing and searching mechanisms

13 Informatics today MEDLINE: 8 million biomedical literature abstracts available from anywhere in the world with an internet connection QMR and Iliad: Decision support systems UMLS: Unified Medical Language System. The HELP program (LDS Hospital, Utah)

14 Why study knowledge and information transfer? Study of 1158 MEDLINE searches producing 476 changes in physician action or perception: diagnostic test ordering 34(7%) recognition of a medical problem or condition 104(22%) adjustment of development of a treatment plan 215(45%) treatment plan changes 67(14%) Other (12%) Lindberg, et al. Use of MEDLINE by physicians for clinical problem solving, JAMA 1993

15 Medical Information Needs Pittsburgh study on information needs Setting: academic medical center Results: 337 clinical information requests observed in a 17 hour period on one Internal Medicine care team 23% of questions could be answered by using medical literature: journal, textbook, MEDLINE 52% were facts that should have been in the medical record Conclusion: 75% of medical information needs require accessing the medical record or medical references

16 Knowledge Diffusion in Medicine Stross and Harlan (1979): photocoagulation in diabetic retinopathy more than 2 years after initial publication of its benefits, less than 50% of primary care physicians were aware of its benefits. Despite published guidelines, recommended screening examinations on diabetic patients are not perfomed due to physician lack of awareness of the recommendation Hersch,W. Information Retrieval: A Health Care Perspective. Springer-Verlag, 1996

17 Clinical Data Integrity Stanford study on information integrity: 168 consecutive clinic visits, computer lab results and charts available for all visits. In 81% of the cases some of the information desired by the physician in the decision making process was not available. foraging for information consumed 38% of a physician s time during a patient visit. The Workgroup for Electronic Data Interchange: 50% of paper-based medical records are either missing or contain incomplete data (1996)

18 Current status of Clinical Information 11% of laboratory tests must be reordered due to lost results (Institute of Medicine, 1996) 30% of treatment orders are not documented at all (IOM, 1996) Physicians spend 35% of their time doing paperwork (US Dept. of Commerce, 1996) Between 20 and 30% of national healthcare expenditures are associated with informational paperwork (IOM, 1996)

19 Areas of specialization Clinical Information standards development Organizational aspects of informatics Managing enterprise systems, implementations, etc.. Technology diffusion Knowledge representation Knowledge structures (AI) Terminologies and ontologies Information retrieval Decision Making Patients Healthcare professionals Decision Support Bayesian Fuzzy Logic Neural networks Medical Imaging

20 Medical Informatics Resources:Textbooks A History of Medical Informatics in the United States: (Collen, AMIA Press 1996) Information Retrieval: A Health Care Perspective (Hersch, Springer-Verlag, 1996) Medical Informatics : Computer Applications in Health Care (Shortliffe, Addison Wesley, 2000)

21 Medical Informatics Resources: Organizations American Medical Informatics Association ( Other organizations around the world: International Medical Informatics Association (IMIA) American Medical Informatics Association (AMIA) Australian Health Informatics Association (SA) Belgium Medical Informatics Association (MIM) Brazilian Health Informatics Society (SBIS) British Medical Informatics Society (BMIS) French Medical Informatics Association (AIM) (French) German Medical Informatics Association (GMDS)(German) Japanese Association for Medical Informatics (JAMI) Association for Informatics in Medicine, Singapore (AIMS) The Society for the Internet in Medicine Thai Medical Informatics Society (TMI)

22 Medical Informatics Resources: Journals JAMIA Methods of Information in Medicine Computers and Biomedical Research Medical Decision Making SCAMC Proceedings MEDINFO Proceedings

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