CS580 Health InformaticsCS580 Health Informatics

Week 1 – Lecture 1Week 1 – Lecture 1

Vladimir BrusicVladimir Brusic

CS580/BU V. Brusic

HEALTH INFORMATICS

- An emerging discipline, part of Biomedical Informatics

- Use of information technologies and information science in health care

- Some aspects are shared with applications in other disciplines, some are unique to health informatics

- Health Informatics develops rapidly; it is rapidly changing both the health care system

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DEFINITION: BIOMEDICAL INFORMATICS

There is no consensus on the definition of BMI so various definitions have been proposed

Use of biomedical information, data, and knowledge: acquisition, storage, retrieval, management, modeling, and applications (concept perspective)

Processing and communication of biomedical information – both theory and practice (task perspective)

Study and development of information systems for medical, clinical, and biological practice, education, and research (role perspective)

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DEFINITION: HEALTH INFORMATICS

defined as an intersection of informatics, computer science, engineering, and health care disciplines

a systematic application of information technology and computer science in medicine, public health, and related disciplines

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DEFINITION: HEALTH INFORMATICS

UTILITY Health informatics provides the tools and skills for the development, implementation, and application of solutions for advancing:

- patient care- public health - medical education- health sciences- healthcare/hospital systems management

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HEALTH INFORMATICS

PATIENT CARE: 6 elements

1 Care acquisition2 Patient record3 Test and examination4 Diagnosis5 Treatment6 Monitoring, evaluation, revision

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PATIENT CARE: 6 care delivery elements

1 Care acquisition Entry and exit in the health care system

2 Patient record Create and maintain records of the encounters

3 Test and examination Perform an examination, assessment, professional evaluation, and technical diagnostic evaluation (invasive and noninvasive)

4 Diagnosis Issue a judgment/diagnosis, identify treatment care requirements, and issue care directives

5 Treatment Provide treatment, prevention, palliation (administration of therapeutic substances, invasive and non-invasive

procedures)

6 Monitor, evaluate, revise Monitor and evaluate patient outcomes and care, revise plan of care, plan to meet short-term and long-term care needs, and facilitate the acquisition of resources

INFRASTRUCTURE: equipment and processes that support and facilitate health care delivery

Smith SP, Flarey DL.Process-Centered Health Care Organizations. Aspen Publishers, Gaithersburg, MD, 1999, p. 71.

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EXAMPLE:

Transfer of patient care information

Computerized resident sign-out system

Key issues: Sachdeva, Surgery 136: 14-15

Details: Van Eaton et al, Surgery 136:5-13

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Sachdeva, Surgery 136: 14-15, 2004.

“…5 patient care elements: 1) demographic information; 2) medication information; 3) current medical condition (active problem list, recent procedures, and code status); 4) recent vital signs and laboratory test results; 5) a summary of the primary service’s intended treatment plan, (accompanied by a list of tasks to be completed by the cross-covering service). …The computerized system … provides data that are automatically downloaded from the … electronic health record, as well as data entered by the residents. …The flexibility offered to residents in entering additional information, the ability to combine information used during daily patient care with information needed during sign-outs, andthe consideration of human factors in designing the system are all positive features of the model.…In addition, the ability to print the reports is appealing. … The information system closelymimics the traditional systems used by residents, which involve handwritten notes. This should facilitate the acceptance of the system because it involves a small departure from the usual routines. The system also has the advantages of not requiring duplicative copying of patient information, which occurs often in surgical and medical services.… A critical next step that the authors should undertake is to objectively evaluate the impact ofthe new information support system on the efficiencies of patient care, patient safety, and resident satisfaction. Once its positive impact has been demonstrated, the system may be ready to be adopted or adapted for use by other institutions for a global positive impact on patient care and patient safety.”

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Zsenits B, et al. Systematically improving physician assignment during in-hospital transitions of care by enhancing a preexisting hospital electronic health record. J Hosp Med. 2009;4(5):308-12.

These examples of IT solutions for transfer of care in hospitals illustrate increasing need for IT specialists in the clinical environment.

Important points

- These are prototypic solutions- They are user-driven- Key IT issues not covered (e.g. safety of the patient data,

safety of the system, maintenance and upgrades, robustness, etc.)

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BIOlogicalsciences andapplications

MEDICALand clinicalscience andpractice

INFORMATICS:informationtechnology andscience

BIOMEDICALINFORMATICS

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BIOMEDICAL INFORMATICS: AN INTERDISCIPLINARY FIELD

BIOlogicalsciences andapplications

MEDICALand clinicalscience andpractice

INFORMATICS:informationtechnology andinformation science

BIOMEDICALINFORMATICS

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Bioinformatics Healthinformatics

Translationalbiomedicine

BIOlogicalsciences andapplications

MEDICALand clinicalscience andpractice

INFORMATICS:informationtechnology andinformation science

BIOMEDICALINFORMATICS

Bioinformatics Healthinformatics

Translationalbiomedicine

HEALTH INFORMATICS: MAIN COMPONENTS AND RELATED FIELDS

COMPONENTS

- Medicine - Public health

- Informatics (ICT) - Computer science

RELATED FIELDS:

medical laboratory science, biology, chemistry, physics, pharmacology, …

mathematics, statistics, artificial intelligence, engineering, …

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HEALTH INFORMATICS:HISTORY

Health informatics originates from 1950s with the rise of computers and their applications in hospitals.

International Medical Informatics Association (IMIA) was founded in 1970s

Health informatics tools include computersdatabasesanalytical tools clinical guidelinesregulationsformal medical terminologiesinformation and communication systems

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BIOINFORMATICS:HISTORY

Bioinformatics originates from 1970s with the rise of biological databases and tools for analysis of biomolecular data

Bioinformatics has been growing rapidly, boosted by high-throughput fields including genomics and proteomics

Medical informatics tools include computers databasesontologies and dictionariesanalytical tools

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Kane and Brewer, J Biomed Inform. 2007 Feb;40(1):67-72.

Unprecedented growth of biomedical informatics:

- recent availability of genomic sequences,

- high-content and high-throughput screening systems,

- computational biology to taking a leading role in drug discovery and disease characterization.

- much of life sciences research moved almost completely into the computational domain.

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BIOMEDICAL INFORMATICS: IMPACT

Kane and Brewer, J Biomed Inform. 2007;40(1):67-72.

educational training in biomedical informatics has been mainly limited to students enrolled in the life sciences curricula, while the skills needed to succeed in biomedical informatics involve training in information technology.

California Employment Development Department 2004 report:

- Top two occupations leading employment growth were in Biomedical Informatics

- Forecasts for the next 5 years included 99% job growth for Masters level Bioinformatics Specialists, and 59% growth for Bachelors level Scientific Programmers

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BIOMEDICAL INFORMATICS: EDUCATION

PURPOSE OF THIS COURSE

Aim: Health care and biomedical research are undergoing rapid transition from traditional forms to a fully digital and information technology intensive environment. This introductory course is designed to train the next generation of IT practitioners for biomedical informatics jobs of the future.

Unit expectations: CS580 is an introductory Health Informatics course for Masters students. Upon completing this unit, students will be familiar with the key concepts, problems and solutions that define the field of Health Informatics. They will know basic terminology, and will be familiar with a range of examples from main application fields. When addressing biomedical questions that require information technology to be answered, students will be able to apply general theories and methods of biomedical informatics to identify key issues, perform the high-level analysis, and design appropriate general solutions.

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SKILL SET

Informatics curricula need to balance emphasis of these fields forBiomedical Informatics; Friedman et al, JAMIA 11:167-72, 2004

Algorithms Basic mathematics, including calculus Cognitive/human factors and interfaces Data structures Database design Evaluation/research methods Information retrieval Knowledge representation Modeling Networking/architecture Ontology/vocabulary Probability/statistics Programming languages Simulation Software engineering

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SKILL SET

Informatics curricula need to balance emphasis of these fields forBiomedical Informatics Friedman et al, JAMIA 11:167-72, 2004

Algorithms Basic mathematics, including calculus Cognitive/human factors and interfaces Data structures Database design Evaluation/research methods Information retrieval Knowledge representation Modeling Networking/architecture Ontology/vocabulary Probability/statistics Programming languages Simulation Software engineering

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Health informatics goals

Future systems must be engineered for seamless sharing of data, with built-in guarantees of accurate updating and ways to verify a patient’s identity.

Developing of standardized and trusted systems for clinical decision support with seamless access to medical research information.

Electronic systems for systematic and rapid finding of relevant information to treat specific patients.

Early detection and protection of population against emerging pandemics.

Support for accurate and veritable transmission of information from portable monitoring devices.

Interoperability of monitoring devices and electronic health records.

Development of ultrasensitive diagnostic methods that can identify molecules, viruses, and other pathogens and their variants. 

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Health informatics challenges

Medical records today are still mixtures of old and new technologies (paper vs electronics)

Electronic health records are often incompatible, lacking standards.

Information sharing is difficult because of differences in computer systems and data recording rules.

Physicians suffer from information overload.

Continuous monitoring of health status of patients, including portable devices for use in the out-of-hospital environment.

Tracking and rapid response to medical emergencies, such as pandemics or terrorist attacks.

Addressing the combinatorial and hierarchical complexity of biological systems.

Development of sophisticated methods for disease monitoring.

Rapid development, production, and distribution of effective vaccines

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EXERCISES

Taken from a web site http://www.chkd.org

“In order to reach a diagnosis for digestive and liver problems, a thorough and accurate medical history must be taken by the physician, noting the symptoms your child has experienced and any other pertinent information. A physical examination is also done to help assess the problem more completely.Some patients need to undergo a more extensive diagnostic evaluation”

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EXERCISES

How many types of diagnostic tests are used in this hospital?

What are these tests?

What kind of information they yield?

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EXERCISES

Medical history contains various types of relevantdata

List data types and information that are included in medical history.

Discuss the types of information.

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