computer science

1. Medical informatics
Lecture 1
electronic patient records

2. The big picture
Understanding
diseases and
their treatment
Ensure right
Patients receive
right
intervention
Service delivery,
performance
assessment
Develop
and test
treatments
Clinical
engagement, post-
marketing
surveillance, data
mining
Manage safe workflow,
professional
communication,
security
Patient-specific
Decision-making to
optimise and
personalise treatment
Standards based
formalisation of
clinical data and
research results

3. Course objectives
• Provide an overview of the main development
areas in health informatics.
• Understand the role of informatics in translating
medical research into clinical practice
• Look at Electronic patient records topics in more
depth.

4. Biomedical informatics (1):
Bio-informatics
• Rapidly developing branch of biology: highly
interdisciplinary, using techniques and concepts from IT,
statistics, mathematics, chemistry, biochemistry, physics,
and linguistics!
• Seeks knowledge from computer analysis of
– biological data (e.g. genomics, proteomics)
– experimental results
– patient statistics
– scientific literature.
• Research in bioinformatics includes development of
methods for storage, retrieval, and analysis of data,
modeling and simulation of cellular/molecular systems.

5. Biomedical informatics (2):
Health-informatics
• Also known as medical or clinical informatics
• It is applied to primary and specialist patient care,
nursing, dentistry, pharmacy, public health etc.
• Deals with the resources, devices, and methods
required to optimize the acquisition, storage, retrieval,
and use of information in delivery of healthcare
services
• A particular focus is on services at the point of care and
emphasis is increasingly being placed on informatics
for patients and carers as well as professionals.

6. Topics in health informatics (1):
traditional perspective
• Architectures for electronic medical records and
other health information systems used for
billing, scheduling, and research
• Standards (e.g. DICOM, HL7) … to facilitate the
exchange of information between healthcare
information systems - these specifically define
the means to exchange data, not the content
• Controlled vocabularies … used to allow a
standard, accurate exchange of data content
between systems and providers
• Software for specialist services and devices

7. Topics in health informatics (2):
new drivers
•Quality and safety
– US Institute of Medicine
•“To err is human”
•“Crossing the quality chasm”
•McGlynn data on service delivery
•Fineberg lecture on YouTube
– NHS
• Emergence of clinical decision support
and workflow management systems

8. Topics in health informatics (3):
Contemporary multidisciplinary view
• Traditional “engineering” topics
– Hardware and software service architectures
– Specialist technical services
– Digital signal processing
• Human and organisational factors in quality and safety
– User interface design (Tang lecture on YouTube)
– Organisational memory
– Learning from experience
– Change management
• Formal representation of data and knowledge
– Controlled vocabularies, “ontologies”
– Applying knowledge to data: logic and description logics,
decision theory, guidelines and workflows

9. The key challenges
(adapted from Coiera p 104)
• How do we apply knowledge to achieve a
particular clinical objective?
• How do we decide how to achieve a
particular clinical objective?
• How do we improve our ability to deliver
clinical services?

10. Medical research, clinical practice
Understanding
diseases and
their treatment
Ensure right
Patients receive
right
intervention
Service delivery,
performance
assessment
Develop
and test
treatments
Health
Records

11. First …
• Capture your
data, accurately,
completely
• Make the data
readily accessible

12. The paper record, pros
• Portable
• Familiar and easy to use
– Exploits everyday skills of visual search,
browsing etc
• Natural: “direct” access to clinical data
– Handwriting
– Charts, graphs
– Drawings, images…

13. The paper record: cons
• Can only be used for one task at a time
– If 2 people need notes one must wait
– Can lead to long waits (unavailable up to 30% of time
in some studies)
• Records can get lost
• Consume space
• Large individual records are hard to use
• Fragile and susceptible to damage
• Environmental cost

14. Electronic health records
• An electronic health record is
a repository of information
about a single person in a
medical setting, including
clinical, demographic and
other data.
• The repository resides in a
system specifically designed
to support users by
– providing accessibility to
complete and accurate data
– may include services to provide
alerts, reminders, links to
medical knowledge and other
aids to clinical practice.

17. The electronic medical record

18. Examples

19. Driving Factor to Adopt an EMR
• Different charting methods in different
offices
• Growing practice – adding new docs
• Rising transcription costs - $250k/year in
1998 and going up
• Need to enhance quality of care
• Reduce practice overhead

20. Goals of Using the EMR
• Provide a single, uniform medical record.
• Ability to access medical records from any
location.
• Improve documentation and coding.
• Improve research / clinical trials data /
enhance quality.
• Reduce transcription and other rising costs.

21. Functions of the EHR (1)
1. Supports structured data collection using a defined
vocabulary.
2. Accessible at any or all times by authorized individuals.
3. Contains a problem list - patient’s clinical problems and
current status
4. Supports systematic measurement and recording of data to
promote precise and routine assessment of the outcomes
of patient care
5. States the logical basis for all diagnoses or conclusions as
a means of documenting the clinical rationale for decisions
about the management of the patient’s care.

22. Functions of the EHR (2)
1. Can be linked with other clinical records of a patient—from various
settings and time periods—to provide a longitudinal (i.e. lifelong)
record of events that may have influenced a person’s health.
2. Can assist the process of clinical problem solving by providing
clinicians with decision analysis tools, clinical reminders,
prognostic risk assessment and other clinical aids.
3. Can be linked to both local and remote databases of knowledge,
literature and bibliography or administrative databases and
systems so that such information is readily available to assist
practitioners in decision making.
4. Addresses patient data confidentiality.
5. Can help practitioners and health care institutions manage the
quality and costs of care.

23. Benefits Realized
• Staff to physician ratio decreased below national
ratio average.
• Practice overhead costs will be reduced.
• Patient perception of practice improved.
• Better patient coverage during off hours since
information was more consistent, complete and
accessible.

24. Benefits continued…
• e-Prescribing improves patient safety (instructions,
warnings and legibility)
• Sharing data efficiently outside the practice.
• improves quality of care at other provider
organizations
• Rewards (financial) for documenting clinical
performance
• Improved quality of life for physicians

25. Electronic health records: pros
• Compact
• Concurrent use
• Easily copied/archived
• Portable (handheld and wireless devices)
• Secure
• Supports many other services
– Decision support
– Workflow management
– Performance audits
– Research

26. Electronic health records: cons
• High capital investment
– Hardware, software, operational costs
– Transition from paper to computer
• Training requirements
• Continuing security debate
– Stealing one paper record is easy, 20 is harder, 10,000
effectively impossible – the security risks are very
different for electronic data.
• Power outs – the whole system goes down!

27. Ad hoc view

28. User view

29. Service architecture view
Terminologies
Ontologies
Clinical
guideline
repository
Clinical
trials
repository
Acute
services
Primary
Care
services
Point of
care
services
Federated
EHR
Search and
analysis
services
Clinical data
“Organisational
Memory”
Chronic
care
services
Communication &
Coordination
services

30. Functional view