vlad olchanski, phd o moscow institute of physics and technology o institute of control sciences o...

Vlad Olchanski, PhDo Moscow Institute of Physics and Technologyo Institute of Control Scienceso International Institute for Applied Systems Analysiso World Health Organizationo Medical College of Virginia

November 14, 2001

MCV Course for 4th year medical studentsDr. Olchanski Home Page

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Medical Informatics:Computers, Decisions, and Communications

http://www.medinf.vcu.edu/





http://www.medinf.vcu.edu/Medical_Informatics.ppt




Medical Informatics

Outline of Course

Philosophy of Governing LifeInformatics

Component 1Information TechnologyComputersCommunicationsInternet

Component 2Decision Support and TheoryMedical RecordsDiagnostic SupportPharmaceutical PrescriptionsHealth System ModelingData Mining

Medical Informatics

INTRODUCTION


http://views.vcu.edu/~volchans/medinf/Medical_Informatics.ppt

Why Learn Medical Informatics?

Cutting Edge Technologies:

1930s 1990s

Radio communications Computers, Internet


In the 1920-1930s the Radio was very cool.

In those days, the Radio was not a black box with buttons you have in your car.

To get a good reception, you had to know a little bit about electronics and things...


Computers are cool today.

If you don’t know a little bit about what "coils” are inside -

you will get frustrated and will bother other people.

And yet we want computers and IT now!


IT is not as simple today as is Radio.Internet will turn into a black box

with buttons.But not today. And not tomorrow.

21st Century the Age of InformaticsMajor Tool of Informatics -- INTERNET


Therefore, to behave as a conscious Medical Professional, a Physician of today has to know the basics of Information Technology as well as the basics of Physiology and Pharmacology.

Yet the Information Technology alone cannot help you without the intellectual component of Medical Informatics: the Decision Theory.

Phi Beta Kappa - philosophia biou kybernetes Philosophy Governs Life

PhilosophyMathematicsNatural PhilosophyPhysicsEngineeringGeneral Theory of Systems CyberneticsInformatics

KybernetesGovernsCybernetics

General Theory of Systems

Bertalanffy (Austria-Hungary), Bogdanov (Russia) - 1908 Crash of empires after the Great War The Second World War: FLAK, EnigmaNorbert Wiener (MIT):

Cybernetics: Control and Communication in theAnimal and the Machine - 1948

Theory of Information, Finite Mathematics, ProbabilitiesJohn von Neumann (Princeton)Alan Turing (Bletchley Park)Claud Shannon (MIT)Andrey Kolmogorov (Moscow State)

First Computers

This weaponry could not protect England:

Cybernetics

Theory of InformationCommunicationsCodingAlgorithmsProbabilities and Stochastic Processes

Theory of ControlOperations ResearchOptimizationManagement Science

Systems Analysis

Applications

Live, bio-systemsEngineering, machines, robotsOrganizational systemsComputer Science Systems Analysis

Decision Support, Artificial Intelligence

Whence Informatics?

Concept of Cybernetics too broadWord Cybernetics tarnished, devalued

by Sci-Fi and Pop culturePragmatic reduction to Computer Science

in USACS translated into INFORMATIQUE in

FranceBackward translation of CS as

INFORMATICS expanding the scope

Handbook of Medical Informatics

http://www.mieur.nl/mihandbook http://www.mihandbook.stanford.edu/

This excellent book unfortunatelyhas very little coverage of theInternet applications.

Otherwise, this is the #1 Resource!

http://www.mieur.nl/mihandbook


http://www.mihandbook.stanford.edu/



Medical InformaticsDefinitions

Medical Information Science is the science of using system-analytic 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

Whence Informatics?

Computer Science and Informatics are practically synonyms: the difference in emphasizing the application aspect

Informatics is frequently understood as broadly as Cybernetics --Information Processing including Decision Making and Systems Analysis

Names used for Medical Informatics

medical computer sciencemedical information sciencecomputer application(s) in medicinehealth informatics,

and more specialized terms such as nursing informaticsdental informaticsand so on.

Informatics - What?

Information Technology and TheoryComputers, Communications, Data Processing, Algorithms

Decision Theory and ApplicationsBayesian Approach, Expert Systems, Artificial Intelligence, Knowledge-based Systems, Algorithms

A Good INTRO to Informatics

But should we go all the way together?

Medical Informatics

INFORMATION TECHNOLOGYCOMPUTERS


Computers: Evolution

Von Neuman and the first MAINFRAME at IAS (1948)

Vacuum tubes, punch cards or tapeBatch mode of operationLow reliability - maintenance team of electronics engineers

Transistors - Bill Shockley, 1956 NP

MINICOMPUTERSInteractive mode of operationHigher reliability due to Transistors

MICROCOMPUTERSInteractive mode of operationReduced size and enhancedreliability due to Integrated Circuits

PERSONAL COMPUTERSRenamed from minicomputers to show due respect

SUPERMINISWORKSTATIONS

SUPERCOMPUTERS

Computers: Operating Systems

Mainframe OS -- oriented to batch processingMinicomputers -- more interactive, usually designed by

hardware manufacturer, like RSX, VMS for lateDEC machines

Unix - an attempt to standardizePersonal computers -- CP/M, MS DOS, IBM OS/2,

Mac OS, Windows, Unix

Internet developed mainly on Unix machines

Computers: Operating Systems

Windows should not be used for critical applications

Programming Mainframe

Page 104 of a program listing

A punch card and the editing tool

H

Programming MainframeBooting your computer -- giving it a kick?

Programming Mainframe

Booting your computer --giving it a kick?

No!It is short from bootstrapping.

“Bootstrap” was the name ofa short length of the punchedtape that was fed to acomputer to initiate loading ofthe Operating System.

Computer Architecture

CPU, RAM, Bus, etc.are discussed in class

Computers: Objects

Files: Windows Commander: “http://www.ghisler.com”

Name long name, DOS name avoid spaces in names!Type extension, internal header, MIME typeSize actual / on diskTime creation / modification / accessAttrib hidden / systemOwner sysadmin/owner / group / world/other

Directories (folders):

c:\ root..\ parent

http://www.ghisler.com/




Computers: Startup Files

config.sysautoexec.batsystem.iniwin.ini

in Unix:.cshrc

Registry

System.datUser.dat SAM

Text editors: Notepad.exe UltraEdit.exe

Computers: Commands

dircddeletecopymkdirrmdirattribxcopydiskcopyformattree

date, timepathsetsortmore /p - by pagehelp

/? -? /h -h

Computer Architecture

Data storage on disksFile Allocation TableSecurity issuesare discussed in classafter Information Codingpresentation

Some Utilities

Calculator (scientific mode)Character Map (Symbols to

Computer Code)Notepad (Text editor)

Medical Informatics

INFORMATION TECHNOLOGYCOMMUNICATIONS


Communication Protocol Layers

the physical layer is a stream of bits

ISO Open System Interface

Internet

the application level is what we use: Email, FTP, Telnet, HTTP, etc.

Internet Protocols

FTP (file transfer protocol) serves to exchange data with a remote computer

Telnet allows to run programs on a remote computer

Terms:

Upload - send TO a remote recipientDownload - receive FROM a remote sender

Remote Computing - I

Wilma at CUNY has data, needs report!

Fred at UBC hasreport software...

Remote Computing - II

Wilma at CUNY has data, needs report!

Fred sends Wilmathe usernameand the password

Never by EMAIL !!!

Remote Computing - III

Wilma uploads her data with FTP


FTP

Remote Computing - IV

Wilma manipulates her data on Fred’scomputer with Telnet


Telnet

Remote Computing - V

Wilma downloads the report with FTP


FTP

Remote Computing - VI

Wilma prints the report in her officeand sends her kisses to Fred by email


Email

Remote Computing -Security

Using Email - 1

Email is very much like Regular Mail:sending mail and receiving are done quite differently!

To send mail, you may to drop it in any mail drop box in the street.

To send email, you may connect and use any SMTP serverin the world. It is for public convenience.

SMTP server sends email

Using Email - 2

You send a letter thru a Mail Drop Box

You may use any one you find in the street

Using Email - 3

You send an email thru a SMTP server

You may use any one you find in the Internet

access controlledaccess controlled

access controlled

access controlled

access controlled access controlled

open for all

Using Email - 4

Email is very much like Regular Mail:sending mail and receiving are done quite differently!

To receive mail, you must have either your own mailboxor rent a box at any Post Office.

To receive email, you must have an account with any POP3 server. It will be your private possession. You mayhave as many as you may wish.

POP3 server receives email

Using Email - 5

To receive a letter, you must have a homeor a number in a US Post Office

Using Email - 6To receive an email, you must have an accountat a POP or IMAP mail server

you may have as many of these as you like

Using Email - 7POP server delivers all messages to your computer --

good when you are on a fast connection

IMAP server delivers only message headers and messageson demand -- good when you are on a dial-upYet you will not have all messages on your computer

T’bird, Eudora, TheBat! support multiple email accounts

Webmail allows to use email with your browser --good when you are on the go

Hotmail, Yahoo, etc. may be used for simple purposes --but it is not a true email

Using Email - 8

You read and send email with Email Client

There are so many different Email Client programs --make your own choice

BUT

some of Email Clientsand some of Email USERS

go outside of Internet Standards

- incompatibility of messages- errors in transmission and reception

Using Email - 9

SMTP POP3

An operativeset of POP3 boxes

Using Email - 10 Basic Rules of Nice Conduct

1. Never consider email as confidential

2. Email should best be a simple message

3. Do not send messages formatted with HTML -- not all email clients can deal with them, confirms a hit for spammers (impossible in AOL email program ) 4. Avoid sending binary attachments these may come corrupted and can carry virusesHow to avoid binary attachments in Email, see“http://www.intmed.vcu.edu/inm/advice.html”

http://www.intmed.vcu.edu/inm/advice.html

http://www.intmed.vcu.edu/inm/advice.html

The Most Intimate Secret

Like Wine dichotomy in Russia

- White wine: Moonshine, Vodka, Brandy

- Red wine:all the rest


Data dichotomy in Internet

- Text files: Plain English text: A-Z, a-z, 0-9

- Binary files:all the rest

The Most Intimate SecretSymbols -- Bytes -- Octets

Bits

Secret == 53 65 63 72 65 74

1010011 1100101 1100011 1110010 1100101 1110100

Sept “bits” fassent un “octet”! This is the ASCII Standard. Yet --

Éç == C9 E7 == 11001001 11100111Now you see that the French have a reason to callthe “byte” not “septet” but “octet”!

If you strip the 8th bit then corruption occurs:

É -> 49 == I and ç -> 67 == g


The 7-bit data trasmission was set into the infrastructure

The Most Intimate SecretThe Revelation

Only text files may be sent through InternetBinary files will come corrupted

To send a binary, it must be converted toa text file (encoded) and on the receiving endthe encoded file must be decoded.

In FTP protocol, the type must be told explicitlyIn Email, binary files go as attachments.

There are different encode/decode procedureswhich may lead to confusion and errors

Security: Cryptography

Sherlock Holmes: The Dancing men

ELSIE .RE . ARE . O EET . HY . O .

elsie PrePare To Meet Thy GoD

come here at once


53++!305))6*;4826)4+.)4+);806*;48!8`60))85;]8*:+*8!83(88)5*!; 46(;88*96*?;8)*+(;485);5*!2:*+(;4956*2(5*-

Edgar Allan Poe: Gold-bug

4)8`8*; 4069285);)6!8)4++;1(+9;48081;8:8+1;48!85;4)485!528806*81(+9;48;(88;4(+?3 4;48)4+;161;:188;+?;

8 there are 33.; " 26.4 " 19.+ ) " 16.* " 13.5 " 12.6 " 11.! 1 " 8.0 " 6.9 2 " 5.: 3 " 4.? " 3.` " 2.- . " 1.

5 represents a ! " d 8 " e 3 " g 4 " h 6 " i * " n + " o ( " r ; " t

In English, the letter which most frequently occurs is e. Afterwards, the succession runs thus:

a o i d h n r s t u y c f g l m w b k p q x z

A good glass in the bishop's hostel in the devil's seat twenty-one degrees and thirteen minutes northeast and by north main branch seventh limb east side shoot from the left eye of the death's-head a bee line from the tree through the

shot fifty feet out.

Security: Criptography

Enigma, German Coding Machine

Security: CryptographyEncryption with a keyword

“this is plaintext” , the key is “key”+ (add codes)

“keykeykeykeykeyke”Encrypted text:

“dxkfpsnputmsodjss”

Decryption with a keyword -- the key must be sent to the recipient this is the weakest point

Encrypted text:

“dxkfpsnputmsodjss” , the key is “key”- (subtract codes)

“keykeykeykeykeyke”Decrypted text:

“this is plaintext”

Plain book, a simplebut efficient tool

One-timepad


My key ring of public keys of my correspondents

My secret private key

My public keystored on mywebsite and inpublic depositories

Fred’spublickey

PGP:Pretty GoodProtection

Security: CryptographyI send message to Fred Fred reads my message

I read Fred’s answer

Dear Fred, bla-bla... Dear Fred, bla-bla...]hk@s#2kdMs0fHquja...

Fred’s publickey

Fred’s private key

Dear Vlad, bla-bla... Dear Vlad, bla-bla...Msios$[\iqN7dkoZnu...

My private keyMy public key

Fred answers my message

Communications. Security

80% trash, 5% pearls

Internet Protocols

Usenet, News, Forums -- NNTP Protocol

A small ISP carries ~45,000 groups.

Different ISPs give different groups,have different scopes

Medical and HealthRelated Groups listed:www.mipt.vcu.edu/ng.html

http://www.mipt.vcu.edu/ng.html

Internet Protocols

World Wide Web == HTTP protocolUser client -- browser Netscape, Internet Explorer, Opera, Firefox

WWW is only a small part of Internet !!!

AOL and MSN are not Internet at all !!!

InternetAOL MSN

gateway gatewayarchive.salon.com/tech/feature/2001/06/26/locking_up_the_web/index3.html

Internet Services Providers give you full Internet

Internet Connectivity

Internet AddressesDSN:views.vcu.edu

Host fileDomain Name Server

IP:128.172.65.8

TelephonesName:Vlad Olchanski

Personal notebookPhone Directory

Number:804.828.5384

look uplook up

dialconnect

PING and TRACERT accessible through START/RUN

Internet Connectivity

A decent ISP must give a client:o SMTP address to send emailo POP3 address to access the mailboxo NNTP address to get Newsgroups

Additionally:o Space to host website at ISP’s IP addresso FTP access to update website

Optionally:o Static IP address for hosting own website

Information TechnologyViruses

Viruses, Trojans, Worms, Bots, Denial of ServiceVirus Shields, Firewalls

are discussed in class.

Read also Steve Gibson’s saga about a virus attack:

http://grc.com/dos/intro.htm



Information Technology: Secure Use of Internet

Now let us see a presentation on how to practice Internet connectivity safely.

Information TechnologyBasics of Security - 1

• make sure workstation is physically safe and secure• never send passwords by email• never paste passwords beside the workstation• install and regularly (weekly) update virus protection• avoid sending attachments• never open unsolicited attachments, always check and double-check the attachment’s file extension

Information TechnologyBasics of Security -2

never open unexpected file with extensions EXE COM DOC DLL PIF LNK VBS (Windows does not show LNK and PIF extensions)

Never click on a link – hover the link with mouse and look at the status bar where the link leads when clicked

firewall may protect both yourself and the world but may also cheat you)

Information Theory

Sender and ReceiverNoise and DistortionCodes Detecting ErrorsCodes Correcting ErrorsChecksumsData Packets

are discussed in class

Information Theory

Data Compressionzip, arj, rar, tar, gz, binhex, 7u, etc.

Image CompressionImage Formats

bmp, tiff, gif, jpg, png, etc.

are discussed in class.

Image compression immediately leads to WEB DESIGN

Web Design

What is a good website?

-- presentable for all users: WIN, Mac, Unix, etc.-- acceptable for all browsers: Opera, Netscape, Firefox, MSIE, Safari, etc.-- loads fast: byte size < 50 kB-- does not use Cutting Edge technologies

Learn the culture of Web Design at

webpagesthatsuck.com

review the Daily Sucker site daily!

A web design project is doneby students.Collection here

http://webpagesthatsuck.com/

http://views.vcu.edu/napcrg/student/index.html

Medical Informatics

DECISION SUPPORT AND THEORY


The Fundamental Principle of Decision Theory

THE BAYES THOREM[New Knowledge] = [Experimentation] x [Old Knowledge]

Application: Making Diagnosis[Old Knowledge] - we know disease D prevalence, p(D)[New Knowledge] - we need to know if the patient has

disease D if he has symptom S, p(D|S)[Experimentation] - Bayes Theorem builds the Likelihood

Function: L(D|S) = p(S|D) / {p(S|D) p(D) + p(S|’D) p(‘D)}

Now this Likelihood Function modifies the Old Knowledge:p(D|S) = L(D|S) p(D)

Medical Decision Supportto mention a few

Clinical SystemsFinancialMedical RecordsComprehensive

Diagnostic SystemsQMR, Iliad, DXPlain, etc.

Pharmaceutical Prescriptions

ResearchData Mining

Health System Modeling

Medical Decision SupportClinical Systems

Computerized Medical Record systems are discussed in class:TMR -- CMR from Duke Medical CenterMedicaLogica

Pharmaceutical System for Multiple DrugTherapy in ICU, Pharm-X is discussed in class

Comprehensive system for VCU HealthSystemis discussed in class.

Medical Decision SupportDiagnostic Systems

Knowledge Engineering, Expert Systems, AIare discussed in class

observationsknowledge base

decision mechanism diagnoses

explanations

feedback to adjust observations

Medical Decision SupportHealth Systems Modeling - 1

Primary Care Physician Supply - 1

Medical Decision SupportMeasurement and Statistics

Use only reasonable precision, round up numbers to convey your purpose

Medical Informatics

RECOMMENDED RESOURCEFOR ADVANCED STUDIES



http://www.mieur.nl/mihandbook http://www.mihandbook.stanford.edu/

MCV Course for 4th year medical students







I. Data and Information

1 Introduction and Overview

2 Information and Communication


II. Data in Computers

3 Data Processing 4 Database Management 5 Telecommunication, Networking and

Integration


III. Data from Patients

6 Coding and Classification

7 The Patient Record

8 Biosignal Analysis

9 Medical Imaging

10 Image Processing and Analysis


IV. Patient-Centered Information Systems

11 Primary Care

12 Clinical Departmental Systems

13 Clinical Support Systems

14 Nursing Information Systems


V. Medical Knowledge and Decision Support

15 Methods for Decision Support

16 Clinical Decision-Support Systems

17 Strategies for Medical Knowledge Acquisition

18 Predictive Tools for Clinical Decision Support


VI. Institutional Information Systems

19 Modeling of Health Care for Information SystemsDevelopment

20 Hospital Information Systems: Clinical Use

21 Hospital Information Systems; Technical Choices

22 Health Information Resources


VII. Methodology for Information Processing

23 Logical Operations 24 Biostatistical Methods 25 Biosignal Processing Methods 26 Advances in Image Processing 27 Pattern Recognition 28 Modeling for Decision Support 29 Structuring the Computer-based Patient Record 30 Evaluation of Clinical Information Systems


VIII. Methodology for Information Systems

31 Human-Computer Interaction in Health Care

32 Costs and Benefits of Information Systems

33 Security in Medical Information Systems

34 Standards in Health-care Informatics and Telematics in Europe

35 Project Management


IX. Medical Informatics as a Profession

36 Education and Training in Medical Informatics

37 International Developments in Medical Informatics


Unfortunately lacks the details on the Internet

Education vs Vocational Training

Medical Informatics

THE END OF PRESENTATION

MCV Course for 4th year medical students


vlad olchanski, phd o moscow institute of physics and technology o institute of control sciences o...

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