Developments in Nursing Practice   Introduction to Health Informatics Paula Hicks Centre for Health Informatics Dept. of C...
Module Overview <ul><li>Introduction to Health Informatics </li></ul><ul><li>Introduction to Computers </li></ul><ul><li>D...
Presentation Overview <ul><li>1. What is health informatics? </li></ul><ul><li>2. History of health informatics </li></ul>...
1. What is health informatics? <ul><li>From the French ‘informatique’ </li></ul><ul><li>Medical informatics, medical compu...
Some definitions of health informatics <ul><li>‘ an umbrella term referring to the application of the methodologies and te...
Who does health informatics serve? <ul><li>Patient </li></ul><ul><li>Medical Profession </li></ul><ul><li>Government Bodie...
What services does Health Informatics involve? <ul><li>Data processing – (health is a data intense industry) </li></ul><ul...
What technologies does it employ? <ul><li>Computers and networks……  </li></ul><ul><li>But don’t forget paper-based informa...
Applications of Health Informatics <ul><li>For recording accurate data </li></ul><ul><li>To have data available in a timel...
Applications of Health Informatics contd. <ul><li>Drug control – medication dispensing/ordering </li></ul><ul><li>Purchasi...
2. History of Health Informatics <ul><li>Information revolutions </li></ul><ul><ul><li>First revolution = invention of wri...
Growth of IT <ul><li>‘ We have a computer here in Cambridge, there is one in Manchester and one in the National Physical L...
The development of Health Informatics <ul><li>Initial focus on administrative support </li></ul><ul><ul><li>Payroll </li><...
Artificial Intelligence in Health <ul><li>One of the major first expert systems was MYCIN for the diagnosis and treatment ...
Imaging systems in Health <ul><li>Impossible without the use of computers </li></ul><ul><li>Computers are used to: </li></...
3. Why bother? <ul><li>Information Technology is now an integral and essential part of health delivery </li></ul><ul><li>I...
4. Health sector today (citizen-centred care) <ul><li>Health and education are two major consumers of the public purse </l...
Health sector today contd. <ul><li>Distributed organisational structures  (independent clinics/labs) – strong local autono...
Health sector today contd. <ul><li>Information overload – nos., text, x-rays, ultrasounds </li></ul><ul><li>Complex (narra...
Implications for healthcare organisations <ul><li>Unnecessary duplication of tests and investigatons  </li></ul><ul><li>Va...
The strategy to improve the situation should include the following ideas.. <ul><li>Patient care requirements prime </li></...
This implies…. <ul><li>Ability to share information between care providers is key </li></ul><ul><li>The right information ...
The key issue is…… <ul><li>Efficient and cost-effective application of ICT in the health sector </li></ul>
5.  Modelling the Healthcare Environment <ul><li>IT is all about developing a model of the real world </li></ul><ul><li>Mo...
Models and Systems <ul><li>Systems are vital to human reasoning because they take us beyond simple cause and effect to all...
6. Challenges…. <ul><li>Legacy information systems (older systems) </li></ul><ul><li>Problems –  </li></ul><ul><ul><li>Mai...
Technical Challenges contd. <ul><ul><li>Complex nature of medical data </li></ul></ul><ul><ul><li>Alphnumberic (lab result...
What are the Organisational Challenges <ul><li>Integrating IT into the business process </li></ul><ul><li>Understanding th...
References <ul><li>Lecture Notes - Jane Grimson TCD and Gaye Stephens TCD </li></ul><ul><li>Guide to medical informatics, ...
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  • Patient Medical Profession Government Bodies Primary Care/GP’s National Agencies Finance/Admin. Management in Hospitals Tax Payers General Population The public Policy makers (strategic management) Regional managers/tactical management Facility management/operational management Health care providers Healthcare researchers Healthcare educators and their students
  • Accountability – individual passwords Dependence on automation (what happens if systems crash Management of proceedures – no passwords to be written Ensuring all daylight savings setting etc. are accurate Emphasis is moving from admin to clinical ‘ benefit/value ‘ return on investment Should know what you expect to get out of a system Measuring the benefits What are we trying to achieve Proceedures for design, testing (must have user involvement) Engineers – need to do environment study effect on areas people etc. Comp. Scientists – effect of system on people
  • IntroHI.ppt

    1. 1. Developments in Nursing Practice Introduction to Health Informatics Paula Hicks Centre for Health Informatics Dept. of Computer Science, College Email: [email_address] Office: Oriel House, Room 4.14 Tel: 608 2181
    2. 2. Module Overview <ul><li>Introduction to Health Informatics </li></ul><ul><li>Introduction to Computers </li></ul><ul><li>Database Management Systems </li></ul><ul><li>Telecommunications, Networks & Information Exchange </li></ul><ul><li>Electronic Healthcare Record </li></ul><ul><li>Computer Applications in Healthcare </li></ul><ul><li>E-Health </li></ul><ul><li>IT and Society </li></ul><ul><li>Impact of IT on health Professionals & Patients </li></ul>
    3. 3. Presentation Overview <ul><li>1. What is health informatics? </li></ul><ul><li>2. History of health informatics </li></ul><ul><li>3. Why bother? </li></ul><ul><li>4. Health sector today </li></ul><ul><li>5. Modelling the healthcare environment </li></ul><ul><li>6. Some Challenges </li></ul>
    4. 4. 1. What is health informatics? <ul><li>From the French ‘informatique’ </li></ul><ul><li>Medical informatics, medical computing, computers in medicine,…. </li></ul><ul><li>Interdisciplinary field combining health sciences, computer science, statistics, engineering, management sciences,… </li></ul><ul><li>Many definitions…. </li></ul>
    5. 5. Some definitions of health informatics <ul><li>‘ an umbrella term referring to the application of the methodologies and techniques of information science, computing, networking and communications to support health and health related disciplines such as medicine, nursing, pharmacy, dentistry etc……’ WHO </li></ul><ul><li>‘ the field that concerns itself with the cognitive, information processing, and communication tools of medical practice, education, and research including the information science and the technology to support these tasks’ (Shortliffe) </li></ul><ul><li>‘ comprises the theoretical and practical aspects of information processing and communication, based on knowledge and experience derived from processes in medicine and health’ (van Bemmel) </li></ul><ul><li>‘ encompasses every possible aspect of information science and technology used in a health delivery system’ (DeDombal) </li></ul>
    6. 6. Who does health informatics serve? <ul><li>Patient </li></ul><ul><li>Medical Profession </li></ul><ul><li>Government Bodies </li></ul><ul><li>Primary Care/GP’s </li></ul><ul><li>National Agencies </li></ul><ul><li>Finance/Admin. Management in Hospitals </li></ul><ul><li>Tax Payers </li></ul><ul><li>General Population </li></ul><ul><li>The public </li></ul><ul><li>Policy makers (strategic management) </li></ul><ul><li>Regional managers/tactical management </li></ul><ul><li>Facility management/operational management </li></ul><ul><li>Health care providers </li></ul><ul><li>Healthcare researchers </li></ul><ul><li>Healthcare educators and their students </li></ul><ul><li>Will one solution suit all? </li></ul>
    7. 7. What services does Health Informatics involve? <ul><li>Data processing – (health is a data intense industry) </li></ul><ul><ul><ul><li>Includes collection, processing, transformation, presentation & use </li></ul></ul></ul><ul><li>Communication – main emphasis should be on supporting communication between people </li></ul><ul><li>Knowledge based services </li></ul><ul><ul><li>Includes computerised bibliographic services, on-line collections on non-numerical information such as practice guidelines, pharmacopoeias, essential drug lists, telephone directories, expert, decision-support and reminder systems </li></ul></ul>
    8. 8. What technologies does it employ? <ul><li>Computers and networks…… </li></ul><ul><li>But don’t forget paper-based information systems, including input to and output from the computer </li></ul>
    9. 9. Applications of Health Informatics <ul><li>For recording accurate data </li></ul><ul><li>To have data available in a timely manner </li></ul><ul><li>Support and inform managers to make better decisions </li></ul><ul><li>Resource allocation and planning </li></ul><ul><li>Email therapy </li></ul><ul><li>Risk management </li></ul><ul><li>Training </li></ul><ul><li>Support for shared care </li></ul><ul><li>Patient Assessment </li></ul><ul><li>Evaluation of patient care </li></ul><ul><li>Monitoring patients </li></ul><ul><li>Staff coordination </li></ul><ul><li>Tracking patients in hospital </li></ul><ul><li>Stock management </li></ul><ul><li>Tracking sterile supplies </li></ul><ul><li>Integration engines </li></ul><ul><li>EHCR </li></ul><ul><li>Mobile computing </li></ul>
    10. 10. Applications of Health Informatics contd. <ul><li>Drug control – medication dispensing/ordering </li></ul><ul><li>Purchasing equipment </li></ul><ul><li>Payroll </li></ul><ul><li>Clinical Pathways </li></ul><ul><li>Labour management </li></ul><ul><li>Patient scheduling </li></ul><ul><li>Budget analysis </li></ul><ul><li>Research </li></ul><ul><li>Word processing </li></ul><ul><li>National database </li></ul><ul><li>Quality Assurance </li></ul><ul><li>Donor databases </li></ul><ul><li>Devices </li></ul><ul><li>Monitors </li></ul><ul><li>Analysers </li></ul><ul><li>Imaging equipment </li></ul>
    11. 11. 2. History of Health Informatics <ul><li>Information revolutions </li></ul><ul><ul><li>First revolution = invention of writing </li></ul></ul><ul><ul><li>Second revolution = invention of the printing press </li></ul></ul><ul><ul><li>Third revolution = digital information </li></ul></ul><ul><li>Healthcare is information intensive </li></ul><ul><li>Other information intensive industries rely totally on computers eg. banking, airlines </li></ul><ul><li>Where are the role models for best practice in health computing? </li></ul>
    12. 12. Growth of IT <ul><li>‘ We have a computer here in Cambridge, there is one in Manchester and one in the National Physical Laboratory. I suppose there ought to be one in Scotland, but that’s about all’. Douglas Hartree, an English mathematician and physicist, 1948 </li></ul><ul><li>‘ 6 computers would be sufficient to meet the needs of the entire USA’. Howard Aiken, an American mathematician, 1948 </li></ul><ul><li>‘ if the car industry had developed at the same rate as the computer industry then a Ferrari would cost $4.40, drive 5 million kilometres on one litre of petrol, and park comfortably on the head of a pin – and would need a 500 page instruction manual to explain to its owner how to open the door!! </li></ul>
    13. 13. The development of Health Informatics <ul><li>Initial focus on administrative support </li></ul><ul><ul><li>Payroll </li></ul></ul><ul><ul><li>Personnel </li></ul></ul><ul><ul><li>Finance </li></ul></ul><ul><ul><li>Stock control </li></ul></ul><ul><ul><li>I.e. traditional business functions </li></ul></ul><ul><li>Why? </li></ul><ul><ul><li>Traditional business applications driving IT development </li></ul></ul><ul><li>But… </li></ul><ul><ul><li>Health sector also drove technology e.g. in Artificial Intelligence and in imaging </li></ul></ul><ul><ul><li>Difficult to codify how the human body works </li></ul></ul><ul><ul><li>Protocol systems – rule based AI system (must be agreed between IT and Clinician) </li></ul></ul>
    14. 14. Artificial Intelligence in Health <ul><li>One of the major first expert systems was MYCIN for the diagnosis and treatment of bacterial infections of the blood </li></ul><ul><li>Many, many other examples of expert/decision support systems in health </li></ul><ul><li>But they are mainly confined to the research laboratory; very few have made it into routine clinical use </li></ul><ul><li>Why? </li></ul><ul><ul><li>Complexity (differenct work practices) </li></ul></ul><ul><ul><li>Integration (not compatible / difficult to transfer) </li></ul></ul><ul><ul><li>acceptability </li></ul></ul>
    15. 15. Imaging systems in Health <ul><li>Impossible without the use of computers </li></ul><ul><li>Computers are used to: </li></ul><ul><ul><li>Construct an image from measurements </li></ul></ul><ul><ul><li>Obtain an image reconstructed for optimal extraction of a particular feature from an image </li></ul></ul><ul><ul><li>Present images </li></ul></ul><ul><ul><li>Improve image quality by image processing </li></ul></ul><ul><ul><li>Store and retrieve images </li></ul></ul><ul><li>Ulstrasound, x-rays, computed tomography, MRI, nuclear imaging etc. …. </li></ul>
    16. 16. 3. Why bother? <ul><li>Information Technology is now an integral and essential part of health delivery </li></ul><ul><li>IT systems are prevalent in society </li></ul><ul><li>Training and education in the appropriate application of IT in healthcare essential - Council of Europe Recommendation 1990 recommends that the governments of all member states: </li></ul><ul><ul><li>Ensure that, as soon as possible, those staff involved in healthcare receive appropriate, multidisciplinary training, both theoretical and practical, for health information systems within an overall public health context </li></ul></ul><ul><ul><li>Develop training strategies for health information systems, which take account of their overall development and of the organisation and circumstances of local health, teaching and research establishments and commercial producers </li></ul></ul><ul><ul><li>Establish international co-operation through a network of reference centres, in order to facilitate the exchange of knowledge and resources in a new and rapidly changing field </li></ul></ul>
    17. 17. 4. Health sector today (citizen-centred care) <ul><li>Health and education are two major consumers of the public purse </li></ul><ul><li>Situation in the sector </li></ul><ul><ul><li>Cost containment </li></ul></ul><ul><ul><li>Information overload (data doubles every five years) </li></ul></ul><ul><ul><li>Shared care (team based care) </li></ul></ul><ul><li>Technological push vs. demand pull (users driving it) </li></ul><ul><li>Clinical focus - Should be driven by supporting clinical needs and not financial management (otherwise solutions in search of problems) </li></ul><ul><li>Cost containment is major driving force – planning resources (eg. cost of care for diabetes) </li></ul><ul><li>Improving quality of care equally important </li></ul>
    18. 18. Health sector today contd. <ul><li>Distributed organisational structures (independent clinics/labs) – strong local autonomy </li></ul><ul><li>Accountability </li></ul><ul><li>Increased dependence on automation </li></ul><ul><li>Emphasis is moving from administrative to clinical information systems </li></ul><ul><li>Public has more knowledge about healthcare (NLM, Medline, Web) </li></ul><ul><li>Tension between demand for increased quality of care vs. reduction in costs </li></ul><ul><li>Efficiency vs. cost-effectiveness </li></ul>
    19. 19. Health sector today contd. <ul><li>Information overload – nos., text, x-rays, ultrasounds </li></ul><ul><li>Complex (narrative) </li></ul><ul><li>Distributed </li></ul><ul><li>Multi-vendor (heterogeneous) – no one vendor can support all the processing needs of all systems, GP, A&E </li></ul><ul><li>Strong autonomy (need to relinguish a certain amount of automony to share data) </li></ul><ul><li>Data intensive </li></ul>
    20. 20. Implications for healthcare organisations <ul><li>Unnecessary duplication of tests and investigatons </li></ul><ul><li>Valuable time wasted trying to track down relevant information </li></ul><ul><ul><li>Studies have shown that at least 20% of healthcare professionals time is spent reading, writing, sorting and searching through notes (up to 70% has been claimed by some) </li></ul></ul><ul><ul><li>=> Appropriate healthcare not provided as efficiently and cost effectively as possible </li></ul></ul>
    21. 21. The strategy to improve the situation should include the following ideas.. <ul><li>Patient care requirements prime </li></ul><ul><li>Secure, reliable, on-line clinical information systems </li></ul><ul><li>Facilitate cost-effective use of IT </li></ul><ul><li>Establish stewardship for implementation of enterprise-wide solutions and standards </li></ul><ul><li>Connect and manage distributed information systems </li></ul><ul><li>Delivering healthcare today is no longer the sole responsibility of a single professional </li></ul><ul><li>Movement away from hospital (tertiary) to community (primary) – based shared care (Access to records by GPs) </li></ul>
    22. 22. This implies…. <ul><li>Ability to share information between care providers is key </li></ul><ul><li>The right information in the right place, in the right format and at the right time </li></ul><ul><li>IT is key-enabling technology for shared care </li></ul><ul><li>Tension between demand for increased quality of care vs. reduction in costs </li></ul><ul><li>Efficiency vs. cost-effectiveness </li></ul>
    23. 23. The key issue is…… <ul><li>Efficient and cost-effective application of ICT in the health sector </li></ul>
    24. 24. 5. Modelling the Healthcare Environment <ul><li>IT is all about developing a model of the real world </li></ul><ul><li>Models are the basis of the way we learn about and interact with the physical world </li></ul><ul><li>Models that copy the world are abstractions of the real words </li></ul><ul><ul><li>Models are less detailed than the real world </li></ul></ul><ul><ul><li>Models are abstractions of the real world, ignoring aspects that are not considered essential (I.e. they impose a point of view upon the observed world) </li></ul></ul><ul><ul><li>Many models can be created of any given physical object depending upon the level of detail and point of view selected </li></ul></ul><ul><ul><li>The point of view used to build a model is based upon the use to which the model will be put </li></ul></ul><ul><ul><li>There is no such thing as the most correct model: models are simply better or worse suited to accomplishing a particular task </li></ul></ul>
    25. 25. Models and Systems <ul><li>Systems are vital to human reasoning because they take us beyond simple cause and effect to allow us to look at complex relationships </li></ul><ul><li>Examples of an information system include: </li></ul><ul><ul><li>The routine way in which a clinician records patient details in a notebook </li></ul></ul><ul><ul><li>The way a triage nurse assess patients on arrival in A&E </li></ul></ul><ul><ul><li>Complex computer-based system for handling the finances of a large hospital </li></ul></ul><ul><li>Modeling is required to appropriately automate these Systems </li></ul>
    26. 26. 6. Challenges…. <ul><li>Legacy information systems (older systems) </li></ul><ul><li>Problems – </li></ul><ul><ul><li>Maintenance 80% of IT costs (eg Y2K problems) </li></ul></ul><ul><ul><li>Inflexible and brittle (cannot interface with newer systems – can crash/old code not properly documented (cannot interface with new systesm) </li></ul></ul><ul><li>Fear </li></ul><ul><li>Challenge </li></ul><ul><ul><li>Migrate/evolve </li></ul></ul><ul><li>IT gets in the way sometimes </li></ul>
    27. 27. Technical Challenges contd. <ul><ul><li>Complex nature of medical data </li></ul></ul><ul><ul><li>Alphnumberic (lab results) </li></ul></ul><ul><ul><li>Text (discharge summary) </li></ul></ul><ul><ul><li>Signals (monitors) </li></ul></ul><ul><ul><li>Images (x-rays) </li></ul></ul><ul><ul><li>Video (endoscopy, ultrasound) </li></ul></ul><ul><ul><li>User interfaces – data entry </li></ul></ul><ul><ul><li>Highly reliable, efficient and secure information management </li></ul></ul><ul><ul><li>Integration of IT into routine clinical practice – paperless hospital </li></ul></ul><ul><ul><li>Co-operative hospital computing </li></ul></ul><ul><ul><li>Multi-vendor </li></ul></ul>
    28. 28. What are the Organisational Challenges <ul><li>Integrating IT into the business process </li></ul><ul><li>Understanding the domain to which the application is being applied </li></ul><ul><li>Training Staff on the new systems </li></ul><ul><li>Introducing the new systems to patients </li></ul><ul><li>Maintenance of the systems </li></ul><ul><li>Resources – location, staff, money </li></ul>
    29. 29. References <ul><li>Lecture Notes - Jane Grimson TCD and Gaye Stephens TCD </li></ul><ul><li>Guide to medical informatics, the internet and telemedicine, Enrico Coiera, Chapman Hall Medical, 1997 (610.28 N73) </li></ul><ul><li>Medical Informatics: the essentials, F T de Dombal, Butterworth heinemann, 1996 (JB-2-337) </li></ul><ul><li>Handbook of Medical Informatics, J H van Bemmel and M A Musen, Springer, 1997 </li></ul><ul><li>Health informatics: an overview, Evelyn Hovenga, Michael Kidd and Branko Cesnik (eds), Churchill Livingstone, 1996 (610 N69) </li></ul>
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