Ebtissam Al-Madi BDS, MSD, Cert Endo, Cert MI Assistant Professor College of Dentistry, King Saud Univeristy

Transcription

1 Ebtissam Al-Madi BDS, MSD, Cert Endo, Cert MI Assistant Professor College of Dentistry, King Saud Univeristy

2 1. Different definitions. 2. Origin of field. 3. History of discipline. 4. Medical informatics as a science? 5. Computer applications in healthcare. 6. Factors influencing use of computers in clinical care. 7. Related fields. 8. Informatics in Healthcare quality. 9. Role of medical informatician in healthcare. 10. MI organizations and centers. 11. Current issues in medical informatics research. 12. Research issues in medical informatics. 13. Where do we go from here? 29Nov

3 Section 1 29Nov

4 "Medical informatics is the application of computers, communications and information technology and systems to all fields of medicine medical care, medical education and medical research. Definition by MF Collen (MEDINFO '80, Tokyo, later extended) 29Nov

5 "Medical informatics is a developing body of knowledge and a set of techniques concerning the organizational management of information in support of medical research, education, and patient care. Medical Informatics combines medical science with several technologies and disciplines in the information and computer sciences and provides methodologies by which these can contribute to better use of the medical knowledge base and ultimately to better medical care. Definition by Asso. of American Medical Colleges (AAMC) Nov

6 Health informatics, Health care informatics or medical informatics is the intersection of information science, computer science, and health care. It deals with the resources, devices, and methods required to optimize the acquisition, storage, retrieval, and use of information in health and biomedicine. Health informatics tools include not only computers but also clinical guidelines, formal medical terminologies, and information and communication systems. It is applied to the areas of nursing, clinical care, dentistry, pharmacy, public health and (bio)medical research. 29Nov

7 Application Organization of information Intersection Set of techniques & Methodologies Resource Devices, and Methods. Body of Knowledge: Acquisition, storage, retrieval, and use of information Combination of and interface between several disciplines. Information management not computer application only. Patient care, research, and education 29Nov

8 General practical goal: to provide better health care 29Nov

9 Section 2 29Nov

10 Medical Informatics is an interface among disciplines Initially: computer science (AI) applied to medicine Later: biostatistics, DA, economics, cognitive psychology 29Nov

11 Russian = informatika 1968 structure and properties of scientific information French = informatique de medecine 1968 University departments established with this title English = informatics first appeared in 1970s Name changed from Medical Information Science 29Nov

12 Computer Applications Medicine Information 29Nov

13 Health informatics encompasses all the areas where technology and information contribute to the support of health care delivery, management, planning and research. Related to the core areas are themes such as ethics, attitudes learning, coping with third party interactions all into and utilizing health informatics. Other research has been identified into content provision, generating an evidence base and knowledge management. 29Nov

14 Section 3 29Nov

15 1960s - practical = early use only in departmental research = early ECG and diagnosis 1970s - practical = Huge size- administrative & departmental, imaging (CT), early bibliographic retrieval & research 1980s practical = results reporting, outpatient services growth of clinical systems and databases research = Artificial Intelligence, Information Retrieval 1990s - practical = integration, communication interfaces, coding, evaluation research = vocab, Note how medicine lags computer hardware 29Nov

16 Computers have been slow to enter clinical care: # hosp with billing, Administrative vs lab + clinical, Artificial Intelligence. # offices with clinical systems. but clinical care is largely the management of info. primarily in the background: practice mgmt, libraries, billing, financial 29Nov

17 recent increase of medical informatics not new field but marked increase in popularity, funding, publication eg 1984 AAMC recommended formation of MI academic units (first done in Europe, esp France, in the 1960s) 29Nov

18 Section 4 29Nov

19 Why need a new discipline? Pioneers in the field often cannot get credit in related fields for work at the interface of related disciplines Few were championing clinical applications 29Nov

20 Medical informatics as a science broad spectrum (theory to practice) basic science (knowledge for itself, models) experimental science (hypothesis, experiment, analysis) applied science, engineering (practical goals) 29Nov

21 29Nov

22 Section 5 29Nov

23 Patient Monitoring systems Computerized Physician Order Entry (CPOE) systems Decision Support Systems Electronic Health Records Medical Education Applications Telemedicine Bioinformatics Imaging 29Nov

24 29Nov

25 Telehealth is the delivery of health-related services and information via telecommunications technologies. Telehealth delivery could be as simple as two health professionals discussing a case over the telephone, or as sophisticated as using videoconferencing between providers at facilities in two countries, or even as complex as robotic technology. 29Nov

26 Direct access to health information resources by consumers Consumer health related messaging Remote monitoring Remote interpretation Video based telehealth 29Nov

27 Telehealth: refer to clinical and non-clinical services such as medical education, administration, and research Telemedicine: telemedicine often refers only to the provision of clinical services Telecardiology ECG or electrocardiograph can be transmitted using telephone and wireless Teleradiology; is the ability to send radiographic images (xrays, CT, MR, PET/CT, SPECT/CT, MG, US...) from one location to another Telepsychiatry: Allows anonymity of patient and less social stigma, physical examinations are not important. Correctional telehealth: Telehealth for prisoners in correctional facilities Teledentistry: is the use of information technology and telecommunications for dental care, consultation, education, and public awareness 29Nov

28 Family, friends other patients Specialist Patient Images Imaging Peer support networks Patient Consumer health resources EHR Health Related websites General information websites Primary care provider Video conferencing - telephonemessaging Tele presences, remote surgery Tel Home Care Surgeon Nurs e 29Nov

29 Provides care for those living in remote areas Provides consultation, education and back up for specialists in remote areas Decreases costs Better care in remote monitoring for patients Reduce visits to hospital and reduce congestion in hospitals Provide help for patients in areas not able to be reached conventionally 29Nov

30 Store-and-forward telemedicine involves acquiring medical data (like medical images, biosignals etc) and then transmitting this data to a doctor or medical specialist at a convenient time for assessment offline Remote monitoring: also known as self-monitoring/testing, enables medical professionals to monitor a patient remotely using various technological devices. Interactive telemedicine: provide real-time interactions between patient and provider, to include phone conversations and online communication. 29Nov

31 Section 6 29Nov

32 Involves complex organisms (unlike physical processes) If over-simplify, not useful (vs bank transaction) therefore need sophisticated abstraction + detail technology for gathering complex info. Just emerging, eg low use of QMR or dxplain therefore providers have not entered info. Reimbursement has not been linked to clinical info., Therefore many admin. Systems but few clinical 29Nov

33 Health care administered by individuals, small groups Less need for coordination Inertia Fear: "cookbook medicine" Liability Ignorance Money Security, integrity Lack of standards Language Previous failures Rapid turnover of technology 29Nov

34 Increase in use of technology - more data generated Mobility of population - need to communicate Specialization - need to communicate Managed care systems - need to communicate Rise in health care costs - attempt to control care Improved hardware - faster and more memory Improved methods - acquisition, transfer, retrieval Reduced computer costs Increased awareness 29Nov

35 Section 7 29Nov

36 Consumer health informatics is the branch of medical informatics that analyses consumers' needs for information; studiesand implements methods of making information accessible to consumers; and models and integrates consumers' preferences into medical information systems. 29Nov

37 Analyzing and modeling consumer preferences, information needs, and information use; Exploring ways informatics can optimize the healthcare partnership of provider and patient Developing and evaluating methods and applications to support consumers in obtaining and using health information; Developing and evaluating methods and applications to integrate consumer needs and preferences into information management systems in clinical practice, education, and research; Developing technology and software to educate and empower consumer and to allow patients participate in healthcare decisions. Identifying factors that the affect the use of technology in the providerclient relationship. Studying the effects of these systems on public health, the patientprofessional relationship, and society. Evaluating the effectiveness of health care informatics in patient outcomes. 29Nov

38 Health providers have better way to communicate with patients and involve them in their treatments. Patients get a better understanding of their conditions with the help of their physicians during consultations. Patients are more involved in making decisions regarding their health and have a better understanding of treatment options, risks, and benefits. 29Nov

39 Any electronic tool, technology, or system that is: primarily designed to interact with health information users or consumers (anyone who seeks or uses health care information for nonprofessional work) Interacts directly with the consumer who provides personal health information to the CHI system and receives personalized health information from the tool application or system the data, information, recommendations or other benefits provided to the consumer, may be used with a healthcare professional, but is not dependent on a healthcare professional. 29Nov

40 Applications and technologies that facilitate knowing/tracking/understanding clinical parameters (disease management) Applications and technologies that facilitate knowing/tracking/understanding observations of daily living (ODL s) Applications and technologies that facilitate calendaring (lifestyle management assistance) Applications and technologies that facilitate prevention and health promotion Applications and technologies that facilitate self-care Applications and technologies that facilitate assisted care and caregiving. 29Nov

41 General Health sites: Semi personalized: om/ Personal Health Records: Online, web-based PDA, or Phone applications 29Nov

42 Internet-delivered computer assisted health education program for diet, nutrition and exercise More effective than non computer based web-based computer-tailored smoking cessation program more effective than a control of web-based non-tailored materials. Web-based, multi-component, interactive self-help intervention for problem drinkers without therapist guidance Reduced consumption than brochure readers Asthma computer interactive games application: An internet based interactive asthma program, monitoring peak expiratory flows with an asthma diary. Improved care with patients. Computer messages and alerts for cancer patients: Increased satisfaction and care for follow up 29Nov

43 29Nov

44 Public Health Informatics has been defined as the systematic application of information and computer science and technology to public health practice, research, and learning. It focuses on: Populations (versus the individual) Orientation to prevention (rather than diagnosis and treatment) Governmental Context 29Nov

45 Registries of conditions: Gather data and statistics. Databases of diseases: Cross-tabulate, study trends, look for patterns. Aggregation or wide-spread surveys: Study incidence or prevalence of trends 29Nov

46 WHO pandemic diseased registries Immunization registries. Cancer Registries HIV/AIDS registries Many articles of spread of disease 29Nov

47 Interdisciplinary communications Organization and collaboration issues Funding and sustainability System design Standards Measuring progress 29Nov

48 29Nov

49 Nursing Informatics, a term coined to describe the integration of nursing science with information and computer science, has developed into a mandatory focus for all registered nurses on a global scale. It has evolved from the need to ensure that nurses have the necessary informatics competencies (knowledge, skills, attitudes and decision making) to effectively meet their responsibilities and standards for nursing practice. 29Nov

50 Nursing Informatics, through the use of computers, can facilitate and speed information sharing in all practice areas. For this to be most effective, nurses must have a basic understanding of informatics. Understanding current and evolving technology for the management and processing of nursing information helps the nursing profession assume a leadership position in health reform. If nurses understand the power of technology they can play an active role in evaluating and improving the quality of care, cost containment, and other consumer benefits." (Hebda, Czar & Mascara, 1999) 29Nov

51 to improve the health of populations, communities, families, and individuals by optimizing information management and communication. This includes the use of information and technology in the direct provision of care, in establishing effective administrative systems, in managing and delivering educational experiences, in supporting lifelong learning, and in supporting nursing research. 29Nov

52 use information and communication technologies to enter, retrieve and manipulate data interpret and organize data into information to affect nursing practice combine information to contribute to knowledge development in nursing 29Nov

53 Section 8 29Nov

54 A system to manage processes to improve care. Translate research into practice Documentation of processes, structures, and outcomes. Transform reaction to proaction Data-driven, not data-frightened Population care and individual care 29Nov

55 Information/ Knowledge needed is: Enormous Challenging Lacking In the wrong form Time-consuming to communicate 29Nov

56 Culture of medicine as an art resists implementing it as a science: Past Present Future Cottage Industry Scientific Management Microsystems Hand-crafted medicine for individual patients Specialized providers treating specific diseases Patient-centered, protocol-based care for most common problems. 29Nov

57 The ISO/TC 215 is the International Organization for Standardization's (ISO) Technical Committee (TC) on health informatics. TC 215 works on the standardization of Health Information and Communications Technology (ICT), to allow for compatibility and interoperability between independent systems. 29Nov

58 The cause-and-effect or Ishikawa diagram The check sheet The control chart The histogram The Pareto chart The scatter diagram Stratification (alternately flow chart or run chart) 29Nov

59 Section 9 29Nov

60 Composition of medical informatics groups MDs, RNs, dentists, other health care workers PhDs, esp computer science (also physics,...) Administrators, policy planners Masters, PhD programs in medical informatics Industry Part-time vs full-time 29Nov

61 Institutional organization Division within medicine Aspect of computer science Inter-disciplinary center Department (like biostatistics): relatively unusual in USA 29Nov

62 Medical Informatics Project Manager: Create databases for hospitals, schools, research institutes, or clinics. Medical Informatics Project Designer: Designers of systems to effectively collect, store, and access data. Medical Informatics Researcher or Research Assistant: Discover new ways of utilizing technology to benefit medical professionals and their patients. Medical Informatics Systems Analyst: Analyze existing systems and maximize efficiency. Teacher or Professor of Medical Informatics: Teaching the next generation of medical informatics professionals, and communicating complex concepts. Medical Database Administrator: Maintain, foresee and avoid problems, as well as troubleshooting for the users of the system 29Nov

63 Section 10 29Nov

64 American Medical Informatics Association (AMIA): non-profit independent organisation in the United States dedicated to the development and application of biomedical and health informatics in the support of patient care, teaching, research, and health care administration 29Nov

65 International Medical Informatics Association (IMIA): the promotion of informatics in health care and biomedical research the advancement of international cooperation the stimulation of research, development and education the dissemination and exchange of information 29Nov

66 European Federation for Medical Informatics (EFMI): advance international co-operation and dissemination of information in Medical Informatics in Europe promote high standards in the application of medical informatics promote research and development in medical informatics encourage high standards in education in medical informatics function as the autonomous European Regional Council of the International Medical Informatics Association (IMIA) 29Nov

67 American Health Information Management Association: American Nursing Informatics Association: Canada s Health Informatics Association: Healthcare Information and Management Systems Society UK Health Informatics Society: Saudi Arabian Health informatics Association: 29Nov

68 1. Journal of Medical Internet Research (3.6) 2. Journal of the American Medical Association (3.1) 3. International Journal Medical Informatics (2.75) 4. Medical Decision Making (2.2) 5. Journal of Biomedical Informatics (2.0) 6. Artificial Intelligence Medicine (1.8) 29Nov

69 Section 11 29Nov

70 Cost Accessibility of health care Coordinating care and setting policy Standards of terminology Acquisition and retrieval of data (eg across inst.) Data Privacy, confidentiality and security Acquisition and sharing of knowledge (eg specialist). 29Nov

71 Section 12 29Nov

72 Medical informatics research mirrors clinical issues Data acquisition Data storage - databases, modeling Vocabularies - format, content Organization of data Machine interfaces - standards like HL7, security Data retrieval - query languages Knowledge acquisition Knowledge representation Application of knowledge when needed Decision analysis, alerts, diagnosis Education Care plans and practice guidelines 29Nov

73 General research questions in medical informatics Knowledge extraction from databases Structuring knowledge: impact on acquisition, storage and retrieval Linking different classes of knowledge Using knowledge to make decisions Human factors in computing Taxonomy Linking disparate systems 29Nov

74 Section 13 29Nov

75 29Nov