MEDICAL INFORMATICS. Sorana D. Bolboacă

Transcription

1 MEDICAL INFORMATICS Sorana D. Bolboacă

2 Despre... Definitions & History & ehealth & mhealth Standards (e.g. DICOM, HL7) Coding medical information (ICD-10, SNOMED, MeSH) Medical data management EMR Electronic Medical Record CPOE Computerized Physician Order Entry Medical education: Educational resources Medical databases & searching medical information Decision support systems 2

3 DEFINITION Medical Information Science is the science of using systemanalytic 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 3

4 DEFINITION: SPECIALITIES Healthcare Informatics Clinical Informatics Pathology Informatics Pharmacy Informatics Public Health Informatics (population level) Community Health Informatics Home Health Informatics Nursing Informatics Medical Informatics (individual patient level) Consumer Health Informatics Clinical Bioinformatics (molecular level) Informatics for Education & Research in Health & Medicine 4

5 HISTORY Database Retrieval Clinical support Mobile support 1958 National Library of Medicine and IBM bibliographic database 1971 Atkinson Morley's Hospital first clinical CT 1997 Newton PDA record the health parameters of villages in India 1966 Massachusetts General Hospital Utility Multi- Programming System 1974 Atkinson Morley's Hospital MYCIN an early expert system that used artificial intelligence to identify bacteria causing severe infections 5

6 ehealth ehealth = the use of information and communication technologies (ICT) for health. Examples include treating patients, conducting research, educating the health workforce, tracking diseases and monitoring public health. 6

7 ehealth e-insurance e-doctor e-health e-patient e-hospital Healthcare social media 7

8 mhealth mhealth (mobile Health) = the use of mobile technologies (e.g. mobile phones) to collect and access health information 8

9 mhealth 9

10 STANDARDS do not define the content Standards (e.g. DICOM, HL7) are used to facilitate the exchange of information between healthcare information systems Started in the late of 1960s: standards for laboratory message exchange 1965: nomenclature for pathology in : Uniform Hospital Discharge Data Set (UHDDS) 1985: Digital Imaging and Communications in Medicine (DICOM) 1987: Health Level Seven (HL7) 10

11 STANDARDS: DICOM DICOM (Digital Imaging and Communications in Medicine): standard for handling, storing, printing, and transmitting information in medical imaging. Enables the integration of scanners, servers, workstations, printers, and network hardware from multiple manufacturers into a Picture Archiving and Communication System (PACS) 11

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13 HL7 HL7 and its members provide a framework (and related standards) for the exchange, integration, sharing, and retrieval of electronic health information Define how information is packaged and communicated from one party to another, setting the language, structure and data types required for seamless integration between systems. HL7 standards support clinical practice and the management, delivery, and evaluation of health services, and are recognized as the most commonly used in the world. 13

14 ICD-10 = International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO) codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases 14

15 ICD-10 ONLINE English & French 15

16 ICD-10 Advantages Better Patient Care: level of detail - better standards, efficient structures and procedures, lowering risks, and better policies Better Research: better detailing data management with deeper data analytics Better Resource Utilization: allow determine the time and resources spent on treating a medical condition Better Claims Processing: reduce denial of claims and the time required for processing claims Disadvantages New Training: the number of codes in ICD-10 is 150,000; while ICD-9 had 18,000 codes Slowdown during The Transition: extra time for training & new degree of meticulousness as well as back-referring to the books Reimbursement Uncertainties in Initial Period: lack of complete understanding of how the new coding system works and doctors might miss out on important notations which eventually lead to lower payouts 16

17 DIAGNOSIS RELATED GROUP (DRG) Hospital reimbursement methodology Classify hospital cases into one of originally 467 groups Categorize patients with respect to diagnosis, treatment and length of hospital stay using the following data: Principal diagnosis Secondary diagnosis(es) Surgical procedures performed Comorbidities and complications Patient's age and sex Discharge status 17

18 SNOMED Systematized Nomenclature of Medicine a systematic, computerprocessable collection of medical terms, in human and veterinary medicine, to provide codes, terms, synonyms and definitions which cover anatomy, diseases, findings, procedures, microorganisms, substances, etc. Reference ontology 18

19 SNOMED T (Topography) Anatomic terms (T-28000) Lung M (Morphology) Changes found in cells, tissues and organs (M-40000) Inflammation L (Living organisms) Bacteria and viruses (L-21801) Mycobacterium tuberculosis C (Chemical) Drugs (C-C137A) Bufferin Analgesic Tablets F (Function) Signs and symptoms (F-03003) Fever 19

20 MeSH Is the National Library of Medicine's controlled vocabulary thesaurus. It consists of sets of terms naming descriptors in a hierarchical structure that permits searching at various levels of specificity. MeSH descriptors are arranged in both an alphabetic and a hierarchical structure. MeSH thesaurus is used by NLM for indexing articles from 5,400 of the world's leading biomedical journals for the MEDLINE /PubMED database. 20

21 MeSH 21

22 MeSH MeSH (Medical Subject Headings): vocabulary thesaurus 22

23 MEDICAL DATA MANAGEMENT is the management of personal health information in hospitals or other healthcare organizations enabling the delivery of quality healthcare to the public. Accumulation Storage Accuracy of patient data Health information management deals largely with patient or individual - related data One health care organization National interoperability standards Collected and maintained by the patient HIPPA Electronic medical record (EMR) Electronic health record (EHR) Personal health record (PHR) 23

24 ELECTRONIC MEDICAL RECORD + Provide accurate, up-to-date, and complete information about patients at the point of care Enable in time access to patient records efficient care Allows secure sharing of electronic information Allows more effectively diagnoses by reducing medical errors Improve the interaction between patient and healthcare providers Enable safer and reliable drug prescribing Helps to promote complete documentation and accurate coding and billing Enhance privacy and security of patient data Helps providers to improve productivity and work-life balance Enable healthcare providers to improve efficiency and meet their business goals Allows reduction of costs through decreased paperwork, improved safety, and reduced duplication of testing 24

25 ELECTRONIC MEDICAL RECORD - Costly Need to train the staff IT staff may be needed possible damage to system and software and or required upgrades True or False? 1. All EMR are the same 2. The basic rules for working with an EHR are the same as for a paper record 3. There is nothing you can do to correct any mistake in EHR 25

26 COMPUTERIZED PHYSICIAN ORDER ENTRY a process of electronic entry of medical practitioner instructions for the treatment of patients (particularly hospitalized patients) under his or her care Features: Ordering Patient safety Portability Billing 26

27 MEDICAL EDUCATION 27

28 EDUCATIONAL RESOURCES Visible Human Project e-skeleton Digital Anatomist Information System CELLS alive! 28

29 EDUCATIONAL RESOURCES 29

30 EDUCATIONAL RESOURCES 30

31 MEDICAL DATABASES = storage space for content = organized collection of medical data and information 31

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34 SEARCHING MEDICAL INFORMATION Where searching medical literature help you: Education: to learn about a medical topic Practice: to answer specific patient related question Guideline: to identify current best practice Different search interface do the same things in different ways 1. Identify the concept 2. Assign specific terms (use MeSH) 3. Identify for each term all synonyms 4. Define the search statement 5. Do the search 6. Refine the search according with the results 34

35 SEARCH STATEMENT: BOOLEAN OPERATORS (breast cancer) AND (treatment) Results contain BOTH terms AND OR NOT 35

36 SEARCH STATEMENT: BOOLEAN OPERATORS (breast cancer) OR (treatment) Results contain only one term AND OR NOT 36

37 SEARCH STATEMENT: BOOLEAN OPERATORS (breast cancer) NOT (treatment) Results contain only the first term (breast cancer) AND OR NOT 37

38 SEARCH STATEMENT: BOOLEAN OPERATORS Using boolean operators AND groupings contain terms for different ideas/concepts and can combine OR groupings (smoking and (lung cancer)) OR groupings contain terms for the same idea/concept and are usually put in parenthesis (cancer or neoplasm) NOT statements are usually put last and can contain an OR grouping; they are often used to get rid of a common subgroup (diabetes NOT juvenile) 38

39 SEARCHING MEDICAL INFORMATION Use controlled vocabulary: MeSH Accurate search Increases the relevancy of results Searchable tree structures of terms can help you find new terms to use Problems: Not all databases use a controlled vocabulary New concepts could me missed 39

40 SEARCHING MEDICAL INFORMATION Truncation: Therap* retrieves therapy OR therapies OR therapeutics OR therapeutic Organi?ation retrieves organisation OR organization 40

41 MEDICAL DECISION SUPPORT SYSTEMS A health information technology system that is designed to assist physicians and other health professionals with medical decision-making tasks Also known as Clinical Decision Support System (CDSS) software that designed to be a direct aid to clinical decision-making, in which the characteristics of an individual patient are matched to a computerized clinical knowledge base and patient-specific assessments or recommendations are then presented to the clinician or the patient for a decision (link to reference) 41

42 MEDICAL DECISION SUPPORT SYSTEMS Advantages: Reduce medical errors access to accurate clinical data Increase health care quality access to medical knowledge Increase health care efficiency on site feedback Features: diagnose chronic disease management: benchmarks and alerts public health surveillance: detecting pandemic diseases Higher effectiveness if linked with EMR and CPOE evidence-adaptive CDSSs Evidence-based medicine is the management of individual patients through individual clinical expertise integrated with the conscientious and judicious use of current best evidence from clinical care research 42

43 MEDICAL DECISION SUPPORT SYSTEMS Alert and reminders Diagnostic assistance Therapy critiquing Prescribing decision support systems Information retrieval Image recognition and interpretation Monitoring a patient (EKG / pulse oximeter) warn of changes in patient condition Complex cases can look for inconsistencies, errors and omissions in an existing treatment plan checks for drug-drug interactions, dosage errors, and prescribing formulation of specific and accurate clinical questions & act as information filters X-rays, angiograms, CT, MRI scans PERFEX 43

44 MEDICAL DECISION SUPPORT SYSTEMS 44

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46 POEMS Post-Operative Expert Medical System VIE-PNN Vienna Expert System for Parenteral Nutrition of Neonates SmartCare management of mechanical ventilation in Intensive Care Units 46

47 Medical informatics could be useful in education and practice Coding, standards and vocabularies contribute to management of data and information The main important thing in searching medical information is to correctly identify the terms Decisional systems can reduce the errors if and only if input data are correct 47

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