Lecture 1 Introduction to the Discipline by l990juh

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									      HMP 668/SI 542/BIOINF 668: Introduction to Health Informatics

      Lecture 1: Introduction to the Discipline



      Kai Zheng

      Assistant Professor
      School of Public Health, School of Information
      The University of Michigan

      kzheng@umich.edu



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   Learning Objectives in this Lecture




                    What is health informatics? Why is it important?




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   Outline



      1 Introduction


      2 Motivations


      3 Major Applications


      4 History of Health Informatics




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                       How would you define “health informatics”?




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   Definition


      [Def. n.] Medical/Health Informatics (MI, HI) is:

         1   An evolving scientific discipline
         2   Deals with the collection, storage, retrieval, communication and
             optimal use of health related data, information and knowledge
         3   Utilizes the methods and technologies of the information, social
             and technology sciences for the purposes of problem solving and
             decision-making in healthcare
         4   Helps assure quality healthcare in all basic and applied areas of
             medical, biomedical and health sciences




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   Data versus Information
             Definition: Data




      A sequence of symbols that represents raw facts or concepts.

      Example: Patients record blood sugar levels several times a
      dayand create a daily log showing individual facts about their
      blood sugar levels. Each blood sugar reading represents
      individual data points, or facts.




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   Data versus Information
             Definition: Information




      Obtained by processing data with some known knowledge to
      increase the understanding of a situation.

      Example: A practitioner uses a series of blood sugar reading to
      determine the effectives of a patient’s lifestyle modifications and
      medication therapy. Together, these data points provide
      information.




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   Name of the Discipline




             Health/Healthcare Informatics
             Medical Informatics
             Biomedical Informatics




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   Name of the Discipline



      “Health informatics” is now tending to replace the previously
      commoner term “medical informatics”, reflecting a widespread
      concern to define an information agenda for health services
      which recognizes the role of citizens as agents in their own care,
      as well as the major information-handling roles of the
      non-medical healthcare professions.a

          a
              UK Health Informatics Society, What is Medical Informatics?




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   Sub-Disciplines


         1   Clinical Informatics
                     Primary Care Informatics
                     Nursing Informatics
                     Pharmaceutical Informatics
                     ...
         2   Dental Informatics
         3   Bioinformatics
         4   Public Health Informatics
         5   Consumer Informatics
             ...


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   Subdisciplines1




          1
              Adapted from Kukafka et al., JPHMP, 2001; (7)6:31–42

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   Component Sciences


         1   Biomedical Engineering
         2   Cognitive Science
         3   Computer Science
         4   Decision Science
         5   Industrial Engineering
         6   Information Science
         7   Information Systems
         8   Management Science
             ...


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   Component Sciences2




          2
              Adapted from Kukafka et al., JPHMP, 2001; (7)6:31–42

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   Objectives of Health Informatics


         1   Locate, manipulate, store, and disseminate healthcare
             related data, information, and knowledge
         2   Reduce uncertainties in decision-making
         3   Improve patient safety
         4   Reduce care disparity
         5   Promote efficacy and efficiency
         6   Improve access
         7   Help bring about the best outcomes possible
             ...



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   Objectives of Health Informatics




        Computerization or digitalization is a step toward the goal, but
                                not the goal.




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   Not this:




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   Avoid Common Misconceptions




                         Health Informatics <> Computer Support
              Health Informatics <> Computer Systems in Healthcare
                                  Health Informatics > Health IT




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   Outline



      1 Introduction


      2 Motivations


      3 Major Applications


      4 History of Health Informatics




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   Today’s Health Care Context
             (Poor) Management




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   Today’s Health Care Context
             Accessibility/Low Efficiency




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   Today’s Health Care Context
             Accessibility/Low Efficiency




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   Today’s Health Care Context
             Soaring Cost




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   Today’s Health Care Context
             Total U.S. Health Expenditures in Actual Dollars 1960–2005


                                  12% 16% 20%


                                                                                                                        1.2e+07
                                                                                                                        1.1e+07
                                                                                                 GDP                    1.0e+07
                                                                                                                        9.0e+06




                                                                                                                                  Billions of Dollars
                 HE as % of GDP




                                                                                                                        8.0e+06
                                                                                                                        7.0e+06
                                                                                                                        6.0e+06
                                  8%




                                                                                                                        5.0e+06
                                                                                                                        4.0e+06
                                                                                                                        3.0e+06
                                  4%




                                                                                                         HE             2.0e+06
                                                                                                                        1.0e+06
                                  0%




                                                                                                                        0.0e+00
                                                1960

                                                       1965

                                                              1970

                                                                     1975

                                                                            1980

                                                                                   1985

                                                                                          1990

                                                                                                  1995

                                                                                                          2000

                                                                                                                 2005

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   Today’s Health Care Context
             Total U.S. Health Expenditures in Actual Dollars 1960–2005


                                  12% 16% 20%


                                                                                                                        1.2e+07
                                                                                                                        1.1e+07
                                                                                                 GDP                    1.0e+07
                                                                                                                        9.0e+06




                                                                                                                                  Billions of Dollars
                 HE as % of GDP




                                                                                                                        8.0e+06
                                                                                                                        7.0e+06
                                                   HE as % of GDP                                                       6.0e+06
                                  8%




                                                                                                                        5.0e+06
                                                                                                                        4.0e+06
                                                                                                                        3.0e+06
                                  4%




                                                                                                         HE             2.0e+06
                                                                                                                        1.0e+06
                                  0%




                                                                                                                        0.0e+00
                                                1960

                                                       1965

                                                              1970

                                                                     1975

                                                                            1980

                                                                                   1985

                                                                                          1990

                                                                                                  1995

                                                                                                          2000

                                                                                                                 2005

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   Today’s Health Care Context
             Soaring Cost




         1   A study conducted at Brigham and Women’s Hospital,
             Boston, MA found about 40% of diagnostic laboratory tests
             performed were unnecessary
         2   More than $930,000 could be saved annually if these
             redundant tests were avoided
         3   Nevertheless, avoiding these redundant tests may not
             actually contribute to the hospital’s revenue increase




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   Today’s Health Care Context
             Medical Errors




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   Today’s Health Care Context
             Medical Errors
             Medical Errors                                                   National costs of these
                                                                            preventable adverse events:
                                                                                  $17–29 billion

                  LEADING CAUSES OF DEATH IN THE U.S.
                    Diseases of the Heart                                            726,974
                    Cancer                                                           539,577
                    Cerebrovascular Disease                                          159,791
                    Chronic Obstructive                                              109,029
                    Preventable Medical Errors                                    44,000–98,000
                    Accidents and Adverse Effects                                      95,644
                    (motor vehicle accidents 43,458; others = 52,186)
                    Pneumonia and Influenza                                             86,449
                    Diabetes                                                           62,636
                    Suicide                                                            30,535
                    Kidney Disease                                                     25,331
                    Liver Disease                                                      25,175
                                                                Source: Centers for Disease Control and
                                                       Prevention, 1997; IOM, To Err Is Human: Building a
                                                                               Safer Health System, 2000




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                Health informatics and health informatics applications
                          can help alleviate these problems.




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   Outline



      1 Introduction


      2 Motivations


      3 Major Applications


      4 History of Health Informatics




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   Electronic Health Records (EHR)



         1   Preserves patient data in an electronic format
         2   Allows patient data to be searchable, analyzable, and
             transferable
         3   Enables access anywhere and anytime
         4   Provides a foundation for supporting clinical
             decision-making, secondary data analysis, and medical
             research




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   Electronic Health Records
             Similar Names




         1   Electronic Medical Records (EMR)
         2   Patient Health Records (PHR)

             Note: PHR may also mean Personal Health Records




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   Electronic Health Records
             Example




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   Computerized Physician Order Entry (CPOE)




         1   Also known as Computerized Prescriber Order Entry
         2   Allows medication orders to be electronically prescribed
         3   Electronic prescriptions will be automatically sent to
             pharmacies to fulfill




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   Computerized Physician Order Entry
             Benefits




         1   Electronic data exchange eliminates manual and paper
             processes (faxes, phone calls, etc.)
         2   Pre-defined order sets
         3   Drug-drug, drug-allergy interaction alerts




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   Computerized Physician Order Entry
             Outstanding Issues




         1   Problematic implementation can result in severe
             consequences
         2   Costly to purchase, deploy, and maintain




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   Computerized Physician Order Entry
             Example




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   Clinical Decision Support Systems (CDSS)



         1   Facilitates finding, selecting, and applying valid, appropriate
             clinical information when making decisions about the care of
             individual patients
         2   Reduces medical errors and care disparity, and improves
             quality of care
         3   Related terms: Artificial Intelligence, Diagnostic Systems,
             Expert Systems, Knowledge-Management Systems, etc.




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   Clinical Decision Support Systems
             Example




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   Outline



      1 Introduction


      2 Motivations


      3 Major Applications


      4 History of Health Informatics




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   History
             The Origins of the Field




         1   First application: A punchcard data-processing system used
             in the 1920s and 1930s public health surveys by U.S. Census
         2   First professional organization for informatics was founded
             by Gustav Wagner in Germany in 1949
         3   The term “medical informatics” first appeared in France in
             1968 (informatique de medecine)
         4   General Electric pioneered a total hospital information
             system in the mid-1960s




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   History
             The early 1980s to 1994




         5   Modern personal computers were introduced: Smaller and
             increasingly powerful, making them suitable as a clinical tool
         6   Commercial vendor products became available
         7   Health Level 7 was established in 1987 to develop protocols
             for transmitting healthcare data (headquartered in Ann
             Arbor!)
         8   The American Medical Informatics Association (AMIA) was
             funded in 1990




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   History
             Early Generation Microcomputer-based Clinical Tools




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   History
               HeartLab, 1986, first multimedia patient simulation on a microcomputer3




          3
              Image Source: AMIA, History of Medical Informatics

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        Most of the early-generation AI (artificial intelligence) systems
                                have failed.




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   History
             1995–present




        10   The current era of health informatics is characterized by
             extensive, highly connected network environments where
             clinical data and information can flow freely
        11   Ubiquitous computing and the internet give clinicians access
             to information anytime from any internet-connected device
        12   Search engine and healthcare websites are popular
        13   Widespread broadband and wireless internet connectivity is
             becoming available




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   History
             Healthcare Websites




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   History
             Healthcare Websites




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   History
               Evolution of Health Informatics4


                                                                                                                Automate
                                                                                                                 Services

                                                                                       Automate
                                                                                        Systems
                                                                                                           Consumer    Wellness
                                                               Automate
                                                               Processes
                                                                                 Inpatient    Outpatient
                                                                                                                  EHealth
                                             Automate
                                            Departments
                                                                       Revenue
                                                           Admin                        Post Acute
                                                                        Cycle
                       Automate
                        Paper
                                         Finance     A/R       Ancillaries


                  Income
                                  Bill
                 Statement




                        1970                  1980             1990                     2000                     2010

          4
              Source: UPMC, 2005

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   Next time ...
             Self-Introduction (1–2 Minutes)




         1   Your academic program and your background
         2   Previous experience in health IT/informatics
         3   (if any) A problem originating from your experience or
             observation that can be potentially developed into a class
             project topic




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