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Introduction_Medical_informatics_summary.ppt
- 1. Medical Informatics Representation and Computationon Medical and Health Care Information
- 2. Medical Informatics •Health recordsin paper Problems: •High chances of damage of patient records. •Automated processing of records is impossible. •Increased use of electronic media, devices. Advantages: •Less chances of damage, ease of maintenance. •Data insertion and retrieval is simple. •Easily interoperable. •Migration of healthcare industry to electronic domain.
- 3. Targeted at Designand Development of Information System for Medical Science and Technology Health Care Services Business world involving health care
- 4. Health Care Informatics Internet Suppliers’ Enterprise Systems • Pharmacies • Medical suppliers • Insurance providers Providers’ Enterprise Systems • ERP • GDSS • DSS • CDSS Physicians And Specialists Patients E X T R A N E T S I N T R A N E T S P R M Src:K.Siau, “Health Care Informatics”, IEEE trans. On Info. Tech. In Biomedicine, 7(1), March, 2003, pp. 1-7
- 5. Enterprise Resource Planning Full integration of an organization's information from pay-roll and human resources to accounting and finance. Database integration (Information Sharing) Information logged once and accessed by different modules maintaining the data consistency. Track inventory, order information and delivery requirements Determine equipment usage and maintenance schedule
- 6. Decision Support System(DSS) Conventional DSS: financial and scheduling. Clinical DSS (CDSS): diagnosis, pharmacy, emergency and nursing practices. CDSS used to send alerts and reminders to patients about preventive care.
- 7. Patient Relationship Management (PRM) Primary focus on determining and meeting patients' needs. Tracking patients’ information from diet and exercise data to past diagnosis information from family history and allergy information. Send E-mails satisfying queries, informing newly published health care studies and reminding about preventive measures.
- 8. Medical Informatics and Tele-consultation •Inearly days tele-consultation means •Sending all hardcopies of patient records. •takes significant amount of time. •Send the patient to a remote center. •nearly impossible for emergency patient. •Using medical informatics tele-consultation means •Sending the medical records only. •Most of the time, no need to send the patient. •Online consultation among doctors. •Large scope of knowledge sharing.
- 9. Standards HL7: Health LevelSeven. It is an international healthcare standard for medical data exchange between computer systems in healthcare. http://www.hl7.org/ LOINC: Logical Observation Identifiers Names and Codes. These identify the test results or clinical observations uniquely. http:// www.loinc.org/ ICD-10: International Statistical Classification of Diseases and Related Health Problems. ICD provides codes to classify diseases and a wide variety of signs, symptoms etc. Every health condition can be assigned to a unique category and given a code. http://www.who.int/classifications/icd/en/ ICD-10-PCS: ICD-10 Procedure Coding System. This is a system of medical classification used for procedural codes which is developed as a replacement of ICD-9-CM volume 3 (contains inpatient procedures). DICOM: Digital Imaging and Communications in Medicine. This is a
- 10. Message Transmission HL7-enabled system Receiver HL7-enabledsystem Sender Data Data HL7 Message HL7 Message Creation HL7 Message Parsing HL7 Standard HL7 Standard Hospital A Hospital B MSH|^~&| REGAEVN|A05| 199901PID|1|| 191919^NK1|1| MASSIE^ENK1|2| MASSIE^I…
- 11. HL7 Message Structure Event Message1 Message N Seg1SegN Field1 Field1 Comp 1 Comp N Terminated by <CR> Separated by '|' Separated by '^'
- 12. Message Encoding Sequenceof segments separated by '|' Compulsory and optional segments Segments as sequence of fields separated by '^' Compulsory and optional fields A field is described by a data type (e.g. AD data-type denoting an Address)
- 13. MSH | ^~ & | Clinic || Central|Reg ||| ADT^A01 |MSG00005 | P | 2.3 EVN | A01 | 199601051530 PID ||| 2-687005 || Evans^Carolyn || 19620324 | F ||| 903 Diane Circle^^Phoenixville^PA^19460 || (610) 555 – 1212 | (610) 555 – 1212 || S | C ||156 – 96 – 2542 PV1|| E | Emergency |||| 0148^Addison^James ||| SUR An example of HL7 message for patient admission
- 14. 1. Message Header (i)From: Clinic (ii) To : Central 2. Event (i) Date: 1996-01-05 (ii) Time: 15:30 3. Patient Identification (i) Internal Patient ID Number: 2-687005 (ii) Family Name: Evans (iii) Given Name: Carolyn (iv) Birth Date: 1962-03-24 (v) Sex: F Admit/Visit Notification
- 15. 3. Patient Identification(contd.) (vi) Street Address: 903 Diane Circle (vii) City: Phoenixville (viii) State of Province: PA (ix) Zip or Postal Code: 19460 (x) Phone (Home): (610) 555 – 1212 (xi) Phone (Office): (610) 555-1212 (xii) Marital Status: S (xiii) Religion: C (xiv) Social Security Number: 156-96-2542 4. Patient Visit (i) Patient Class: E (ii) Point of Care: Emergency (iii) Attending Doctor's ID: 0148 (iv) Family Name: Addison (v) Given Name: James (vi) Hospital Service: SUR Admit/Visit Notification (Contd.)
- 16. File as ReferencePointer (RP) of OBX MSH|^~&|TELEMEDICINE||TELEMEDICINE||200808141246||ORU^R01|SUR|P|2.4| EVN|R01|200808141246| PID|||SUR05032008000||Mandal^Pulin^Bihari||198003050000|M|||Block - D^VSRC, IIT Kharagpur^Kharagpur^West Bengal^721302^India|91|754123||||Hindu| NK1|1|Sumita Mandal|Mother|Parikpur, Hansda West Midnapore| OBR|4|||ZIITKGP9903^Patient Images^HL7IITKGP|||200808141246| OBX||RP|ZIITKGP9903-1^Sample blood slide^HL7IITKGP||SUR0503200800005032008BLD00.JPG^TELEMEDIK 2005^IM||||||X|||20080209||||||20080305| OBX||RP|ZIITKGP9903-2^Routine Blood tests and Grouping {Blood R/E}^HL7IITKGP|| SUR0503200800005032008i0000.JPG^TELEMEDIK 2005^IM||||||X|||20080305||||||20080305| •Multimedia file is not contained within HL7 message. •Reference path to the file is kept in the message. •Multimedia file has to be sent with HL7 message.
- 17. File as EncodedData (ED) of OBX MSH|^~&|TELEMEDICINE||TELEMEDICINE||200705091251||ORU^R01|SUR|P|2.4| EVN|R01|200705091251| PID|||SUR17012007000||Kijhari^Punam^||196801170000|F|||aaaa^bbbb^eeee^West Bengal^897454^India|91|7855596|||| Hindu| NK1|1|kkkk|hhhh|gdagsv fg jfsgfgjadsg gdsa g fagsg| OBR|6|||ZIITKGP9903^Patient Images^HL7IITKGP|||200705091251| TXA|1|IM|multipart|200705091251||20040404||||||ZIITKGP9903-1|ZIITKGP9903||||AU| OBX||ED|ZIITKGP9903-1^blood slide^HL7IITKGP||^multipart^related^A^MIME-Version: 1.0 Content-Type: multipart/related; boundary="HL7-CDA-border-CDA-HL7" EXT:=JPG TYPE:=BLD ENTRYDATE:=20070117 SIZE:=16601 --HL7-CDA-border-CDA-HL7 Content-Location:SUR1701200700017012007BLD00.JPG Content-Transfer-Encoding:BASE64 Content-Type:image/pjpeg /9j/4AAQSkZJRgABAgEASABIAAD/7RBKUGhvdG9zaG9wIDMuMAA4QklNA+0AAAAAABAASAAAAAEA DAwRDAwMDAwMDAwMDAwMDAwMDAwMDAwMDAwMDAwMDAENCwsNDg0QDg4QFA4ODhQUDg4ODhQRDAwM CgAyADAAMAAgADMANgAzAAoA --HL7-CDA-border-CDA-HL7--||||||X|||200705091251|
- 18. Reference Information Model (RIM) Root of all information models. Provides a static view of the information. A HL7-wide common reference model that integrates all Technical Committees’ domain views. Committees and SIGs generally work with a small subset of the RIM - called Domain Information Model or DIM.
- 19. Reference Information Model (RIM)contd.. Foundation Classes Acts an intentional action in the business domain of HL7. Ex: patient observation Participations exists only in the scope of one act. Ex: surgeon Roles a socially expected behavior pattern usually determined by an individual's status in a particular society. Ex: doctor Entities physical thing or organization and grouping of physical things. Ex: a person Act Relationship To relate 2 acts. Role Link To relate 2 entity roles.
- 20. LOINC Logical ObservationIdentifiers Names and Codes. Names & codes uniquely identify observations. Laboratory Observations Clinical Observations Administrative Observations Compatible with HL7 and SNOMED Represent observation in HL7 message.
- 21. LOINC The fullyspecified name of a test result or clinical observation has five or six main parts <Analyte / component>: <kind of property of observation or measurement>: <time aspect>: <system (sample)>: <scale>: <method> QRS AXIS representation in LOINC: QRS AXIS : ANGLE : PT : HEART : QN : EKG 2951-2
- 22. LOINC in HL7 Message generator generates a message with observation results using LOINC. System supports LOINC, parse HL7 message, retrieve observation result. OBX||TX|2093-3^Total cholesterol^LN|0|78|^mg/dl|||||F|||20050223| OBX-3: Observation Identifier Code Text Coding System
- 23. DICOM Digital Imagingand Communications in Medicine Standard for handling, storing, printing, and transmitting information on medical imaging. Specifies the following- protocols for devices claiming conformance to DICOM syntax and semantics of data to be exchanged. format for storing media in DICOM compatible devices etc.
- 24. Patient is subject of Study contains series contains creates Spatially or Temporally defines Equipment Frame ofReference Image (Pixels) Curve VOIL UT Modality LUT Overlay Waveform 1 1,n 1 1 1 1 1,n 1,n 0,n 0,n 0,n 0,n 0,n 0,n 0,1 DICOM Composite Image IOD Information Model
- 25. Patient is subject of Study contains series contains creates temporally defines Equipment Frame of Reference 1 1,n 1 1 1 1 1,n 1,n0,n Waveform 1,n DICOM Waveform IOD Information Model
- 26. Patient is subjec of Study contain s Series Contain s Waveform Waveform contain s Multiplex Group contain s Channel contain s Sample Waveform Attribute Time of Acquisition AcquisitionContext Annotation Multiplex Group Attributes Number of Channels Sampling Frequency Timing Channel Definition Attributes Channel Source Metric Anatomic Location(s) Function Technique Channel Sensitivity Baseline Skew Filter Characteristics 1 1,n 1 1,n 1 1,n 1 1 1 1,n 1,n 1,n DICOM Waveform Information Model
- 27. Preamble (128 bytes) DICM(4 bytes) DE1 DEn DICOM File Structure
- 28. Data Element …………… D E DataElement Data Element VF VL VR Tag Explicit VR < 4 bytes > < 2 bytes > < 2 bytes > VF VL Tag < 4 bytes > Implicit VR DICOM Data format Dicom Information Structure
- 29. An Example ofData Element Sridhar Raja 000C PN 0010 0010 Sridhar Raja 0000 000C 0010 0010 Patient Informatio n Patien t Name VR VL VF Explicit VR Implicit VR
- 30. Some vital tagsfor rendering images in DICOM Standard Tag Description Hex Encoding (Group, Element) Transfer Syntax Tag Samples per pixel Numbers of Frames Number of Rows Number of Columns Number of Bits Allocated Number of Bits Stored Pixel Data (0x0002, 0x0010) (0x0028, 0x0002) (0x0028, 0x0008) (0x0028, 0x0010) (0x0028, 0x0011) (0x0028, 0x0100) (0x0028, 0x0101) (0x7FE0, 0x0010)
- 31. PACS Picture Archivingand Communication Systems. Goals of PACS are to improve operational efficiency while maintaining or improving diagnostic ability Computers or networks dedicated to the storage, retrieval, distribution and presentation of images. PACS network consists of a central server that stores a database containing the images. Web based PACS system is becoming more and more common. Based on DICOM standard, also accepts other media formats.
- 32.
- 33. ICD-10 International StatisticalClassification of Diseases and Related Health Problems. Provides codes to classify Diseases Signs, symptoms Abnormal finding Complaints External cause for injury and disease etc.
- 34. ICD-10 Every healthcondition can be assigned to a unique category and a given code. Can be used for Morbidity, mortality statistics Clinical decision support system. The limitations of ICD-9-CM Lack of specificity and details. Can’t support transition of IHDE etc.
- 35. ICD-10 in HL7 Segment for diagnosis: DG1 2nd field of DG1: diagnosis coding method (deprecated). 4th field of DG1: diagnosis description (deprecated). 3rd field of DG1: diagnosis code ICD-10 is used to construct 3rd field DG1|||H11.2^Conjunctival scars^ICD10|||F|||||||||||||20050223| DG1-3: Diagnosis Code Identifier Code Diagnosis description. Coding System
- 36. ICD-10-PCS (ICD-10 ProcedureCoding System.) Medical classification used for procedural codes. Codes are comprised of seven components. Each component is called a “character”. All codes are seven characters long Individual units for each character are represented by a letter or number. Each unit is called a “value” 34 possible values for each character Digits 0- 9
- 37. SNOMED Systematized Nomenclatureof Medicine. Collection of medical terminology covering most areas of clinical information. Diseases Findings Procedures Microorganisms Pharmaceuticals etc.
- 38. Standardization: Complexity in MedicalWorld Vast and dynamic knowledgebase. Close interaction of different complex systems. Patient Management, Diagnosis and Investigations, Treatment and Procedures, Drug and pharmacology, Disease classification etc. Process Standardization. Regional and demographic variations. Adjustment with real-life constraints. Infrastructure, Human resource, Material resource.
Editor's Notes
- #18 The term “Level 7” refers to the highest level of the Open System Interconnection (OSI) model of the International Organization for Standardization (ISO). This is not to say that HL7 conforms to ISO defined elements of the OSI’s seventh level. Also, HL7 does not specify a set of ISO approved specifications to occupy layers 1 to 6 under HL7’s abstract message specifications. HL7 does, however, correspond to the conceptual definition of an application-to application interface placed in the seventh layer of the OSI model.
- #19 The term “Level 7” refers to the highest level of the Open System Interconnection (OSI) model of the International Organization for Standardization (ISO). This is not to say that HL7 conforms to ISO defined elements of the OSI’s seventh level. Also, HL7 does not specify a set of ISO approved specifications to occupy layers 1 to 6 under HL7’s abstract message specifications. HL7 does, however, correspond to the conceptual definition of an application-to application interface placed in the seventh layer of the OSI model.
- #20 The term “Level 7” refers to the highest level of the Open System Interconnection (OSI) model of the International Organization for Standardization (ISO). This is not to say that HL7 conforms to ISO defined elements of the OSI’s seventh level. Also, HL7 does not specify a set of ISO approved specifications to occupy layers 1 to 6 under HL7’s abstract message specifications. HL7 does, however, correspond to the conceptual definition of an application-to application interface placed in the seventh layer of the OSI model.
- #22 The term “Level 7” refers to the highest level of the Open System Interconnection (OSI) model of the International Organization for Standardization (ISO). This is not to say that HL7 conforms to ISO defined elements of the OSI’s seventh level. Also, HL7 does not specify a set of ISO approved specifications to occupy layers 1 to 6 under HL7’s abstract message specifications. HL7 does, however, correspond to the conceptual definition of an application-to application interface placed in the seventh layer of the OSI model.
- #23 The term “Level 7” refers to the highest level of the Open System Interconnection (OSI) model of the International Organization for Standardization (ISO). This is not to say that HL7 conforms to ISO defined elements of the OSI’s seventh level. Also, HL7 does not specify a set of ISO approved specifications to occupy layers 1 to 6 under HL7’s abstract message specifications. HL7 does, however, correspond to the conceptual definition of an application-to application interface placed in the seventh layer of the OSI model.
- #24 The term “Level 7” refers to the highest level of the Open System Interconnection (OSI) model of the International Organization for Standardization (ISO). This is not to say that HL7 conforms to ISO defined elements of the OSI’s seventh level. Also, HL7 does not specify a set of ISO approved specifications to occupy layers 1 to 6 under HL7’s abstract message specifications. HL7 does, however, correspond to the conceptual definition of an application-to application interface placed in the seventh layer of the OSI model.
- #25 If medical information producers who wish to communicate with each other used the LOINC codes to identify their results in data transmissions, this problem would disappear. The receiving system with LOINC codes in its master vocabulary file would be able to understand and properly file HL7 results messages that identified clinical observations via LOINC codes. Similarly, if test and observation codes were reported test with the LOINC codes, government agencies would be able to pool results for tests from many sites for research management and public health purpose. The LOINC codes (and names) for test observations should be of interest to hospitals, clinical laboratories, doctors' offices, state health departments, governmental health care providers, third-party payers, and organizations responsible for quality assurance and utilization review. The LOINC codes are not intended to transmit all possible information about a test or observation. They are only intended to identify the test result or clinical observation. Other fields in the message can transmit the identity of the source laboratory and special details about the sample. (For instance, the result code may identify a blood culture, but the message source code can be more specific and identify the sample as pump blood.) The level of detail in the LOINC definitions was intended to distinguish tests that are usually distinguished as separate test results within the master file of existing laboratory systems. Indeed, at the outset, we used the master files from seven U.S. laboratories to shape this effort, and requests from commercial labs and hospitals continue to shape the content of the LOINC effort. Each LOINC record corresponds to a single test result or panel. The record includes fields for specifying: 1) Component (analyte) — e.g. potassium, hemoglobin, hepatitis C antigen. 2) Property measured — e.g. a mass concentration, enzyme activity (catalytic rate). 3) Timing - i.e. whether the measurement is an observation at a moment of time, or an observation integrated over an extended duration of time — e.g. 24-hour urine. 4) The type of sample — e.g. urine; blood. 5) The type of scale — e.g. whether the measurement is quantitative (a true measurement) ordinal (a ranked set of options), nominal (e.g. E. coli; Staphylococcus aureus), or narrative (e.g. dictation results from xrays). 6) Where relevant, the method used to produce the result or other observation. It also contains information about the amount, route, and timing of physiologic or pharmacologic challenges (e.g. oral glucose tolerance test, which would be expressed in LOINC as GLUCOSE^1H POST 100 G GLUCOSE PO1). The LOINC identifiers do not usually include the method in the name for chemistry tests, where tests are more often standardized to normalized methods; they do include methods for most serological tests and coagulation studies. This same principle is usually reflected in the master files of existing laboratories. Of course, the method can always be reported as a separate item of information in a result message regardless of whether it is part of the test name.
- #26 The fully specified name of a test result or clinical observation has five or six main parts including: the name of the component or analyte measured (e.g. glucose, propranolol), the property observed (e.g. substance concentration, mass, volume), the timing of the measurement (e.g. is it over time or momentary), the type of sample (e.g. urine, serum), the scale of measurement (e.g. qualitative vs. quantitative), and where relevant, the method of the measurement (e.g. radioimmunoassay, immune blot).
- #27 The term “Level 7” refers to the highest level of the Open System Interconnection (OSI) model of the International Organization for Standardization (ISO). This is not to say that HL7 conforms to ISO defined elements of the OSI’s seventh level. Also, HL7 does not specify a set of ISO approved specifications to occupy layers 1 to 6 under HL7’s abstract message specifications. HL7 does, however, correspond to the conceptual definition of an application-to application interface placed in the seventh layer of the OSI model.
- #46 The term “Level 7” refers to the highest level of the Open System Interconnection (OSI) model of the International Organization for Standardization (ISO). This is not to say that HL7 conforms to ISO defined elements of the OSI’s seventh level. Also, HL7 does not specify a set of ISO approved specifications to occupy layers 1 to 6 under HL7’s abstract message specifications. HL7 does, however, correspond to the conceptual definition of an application-to application interface placed in the seventh layer of the OSI model.
- #48 The term “Level 7” refers to the highest level of the Open System Interconnection (OSI) model of the International Organization for Standardization (ISO). This is not to say that HL7 conforms to ISO defined elements of the OSI’s seventh level. Also, HL7 does not specify a set of ISO approved specifications to occupy layers 1 to 6 under HL7’s abstract message specifications. HL7 does, however, correspond to the conceptual definition of an application-to application interface placed in the seventh layer of the OSI model.
- #49 The term “Level 7” refers to the highest level of the Open System Interconnection (OSI) model of the International Organization for Standardization (ISO). This is not to say that HL7 conforms to ISO defined elements of the OSI’s seventh level. Also, HL7 does not specify a set of ISO approved specifications to occupy layers 1 to 6 under HL7’s abstract message specifications. HL7 does, however, correspond to the conceptual definition of an application-to application interface placed in the seventh layer of the OSI model.
- #50 The term “Level 7” refers to the highest level of the Open System Interconnection (OSI) model of the International Organization for Standardization (ISO). This is not to say that HL7 conforms to ISO defined elements of the OSI’s seventh level. Also, HL7 does not specify a set of ISO approved specifications to occupy layers 1 to 6 under HL7’s abstract message specifications. HL7 does, however, correspond to the conceptual definition of an application-to application interface placed in the seventh layer of the OSI model.
- #51 The term “Level 7” refers to the highest level of the Open System Interconnection (OSI) model of the International Organization for Standardization (ISO). This is not to say that HL7 conforms to ISO defined elements of the OSI’s seventh level. Also, HL7 does not specify a set of ISO approved specifications to occupy layers 1 to 6 under HL7’s abstract message specifications. HL7 does, however, correspond to the conceptual definition of an application-to application interface placed in the seventh layer of the OSI model.
- #52 The term “Level 7” refers to the highest level of the Open System Interconnection (OSI) model of the International Organization for Standardization (ISO). This is not to say that HL7 conforms to ISO defined elements of the OSI’s seventh level. Also, HL7 does not specify a set of ISO approved specifications to occupy layers 1 to 6 under HL7’s abstract message specifications. HL7 does, however, correspond to the conceptual definition of an application-to application interface placed in the seventh layer of the OSI model.