Medical Informatics An Emerging Discipline by ps94506

VIEWS: 47 PAGES: 75

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



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      "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)


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"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) 1986
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 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.

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 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
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   General practical goal:
to provide better health care




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                                                           Section 2



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              Medical Informatics is
         an interface among disciplines

                   Initially:
   computer science (AI) applied to medicine

                       Later:
biostatistics, DA, economics, cognitive psychology


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 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



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                Computer
               Applications




Medicine                          Information




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 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.

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                                                           Section 3



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 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                        research = vocab,
     interfaces, coding, evaluation

       Note how medicine lags computer hardware
                 Medical Informatics- An Emerging Discipline   29Nov 2010   15
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



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 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)




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                                                           Section 4



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 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




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 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)




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                                                           Section 5



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



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 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.




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




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   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



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                               Family, friends
                               other patients

                                                    Peer                            EHR
                                                  support
             Patient                             networks
             Images                                                                        Health
                                                                     Consumer             Related
                          Imaging                                      health             websites
                                                                     resources
Specialist
                                                                                      General
                                                 Patient                            information
                                                                                      websites

    Primary                 Video
      care              conferencing                                 Tel Home
    provider            - telephone-                                   Care
                         messaging                                                     Nurs
                                                    Tele                               e
                                                 presences,
                                                  remote
                                                  surgery
                                                                 Surgeon

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 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


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 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.


                Medical Informatics- An Emerging Discipline   29Nov 2010   30
                                                           Section 6



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 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


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 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
                Medical Informatics- An Emerging Discipline   29Nov 2010   33
 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

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                                                           Section 7



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




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 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 provider-
    client relationship.
   Studying the effects of these systems on public health, the patient-
    professional relationship, and society.
   Evaluating the effectiveness of health care informatics in patient
    outcomes.
                     Medical Informatics- An Emerging Discipline   29Nov 2010    37
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.



              Medical Informatics- An Emerging Discipline   29Nov 2010   38
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.

               Medical Informatics- An Emerging Discipline   29Nov 2010   39
 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.

                  Medical Informatics- An Emerging Discipline   29Nov 2010   40
    General Health sites: 
 http://www.webmd.com/
      Semi personalized: 
http://symptoms.webmd.c
                    om/
Personal Health Records: 
     Online, web-based 
 http://www.myphr.com/
        PDA, or Phone 
           applications

              Medical Informatics- An Emerging Discipline   29Nov 2010   41
 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


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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




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 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




               Medical Informatics- An Emerging Discipline   29Nov 2010   45
 WHO pandemic diseased registries
 Immunization registries.
 Cancer Registries
 HIV/AIDS registries
 Many articles of spread of disease




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 Interdisciplinary communications
 Organization and collaboration issues
 Funding and sustainability
 System design
 Standards
 Measuring progress




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 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.


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 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)
                Medical Informatics- An Emerging Discipline   29Nov 2010   50
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.




             Medical Informatics- An Emerging Discipline   29Nov 2010   51
 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




               Medical Informatics- An Emerging Discipline   29Nov 2010   52
                                                           Section 8



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 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




               Medical Informatics- An Emerging Discipline   29Nov 2010   54
 Information/ Knowledge needed is:
   Enormous
   Challenging
   Lacking
   In the wrong form
   Time-consuming to communicate




               Medical Informatics- An Emerging Discipline   29Nov 2010   55
 Culture of medicine as an art resists implementing it
 as a science:



   Past        Cottage Industry             Hand-crafted medicine for individual
                                                         patients
  Present   Scientific Management Specialized providers treating specific
                                                diseases
  Future        Microsystems                Patient-centered, protocol-based care
                                                 for most common problems.




                  Medical Informatics- An Emerging Discipline   29Nov 2010          56
 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.




              Medical Informatics- An Emerging Discipline   29Nov 2010   57
 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)




               Medical Informatics- An Emerging Discipline   29Nov 2010   58
                                                           Section 9



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 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




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




               Medical Informatics- An Emerging Discipline   29Nov 2010   61
   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
                          Medical Informatics- An Emerging Discipline   29Nov 2010          62
                                                           Section 10



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 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




              Medical Informatics- An Emerging Discipline   29Nov 2010   64
 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




               Medical Informatics- An Emerging Discipline   29Nov 2010   65
 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)



                 Medical Informatics- An Emerging Discipline   29Nov 2010   66
 American Health Information Management
    Association: www.ahima.org
   American Nursing Informatics Association:
    www.ania.org
   Canada’s Health Informatics Association:
    www.coachorg.com
   Healthcare Information and Management
    Systems Society
   UK Health Informatics Society: www.bmis.org
   Saudi Arabian Health informatics Association:
    www.sahi.org
               Medical Informatics- An Emerging Discipline   29Nov 2010   67
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)




                Medical Informatics- An Emerging Discipline   29Nov 2010   68
                                                           Section 11



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 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).




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                                                           Section 12



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 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
                  Medical Informatics- An Emerging Discipline   29Nov 2010   72
 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



                 Medical Informatics- An Emerging Discipline   29Nov 2010   73
                                                           Section 13



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ealmadi@ksu.edu.sa



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