Good for medical imaging students

1. ECU-M 213: HEALTH
INFORMATICS
By: Patience A. Jaffu
Bsc Maths, CSC(Mak 2012) and MHI(Mak 2020)

2. Informatics
• Health informatics is part of a larger subject referred to as Biomedical
Informatics which includes bio-informatics and health informatics as its major
sub-disciplines.
• Health informatics is applied to the areas of nursing, clinical care, dentistry,
pharmacy, public health and medical research.

3. Bioinformatics
• Bioinformatics is defined as the application of computational and analysis
tools to the capture and interpretation of biological data.
• It is an interdisciplinary field, which harnesses computer science, mathematics,
physics, and biology especially for the field of genetics and genomics e.g DNA
sequences of genes or full genomes; amino acid sequences of proteins; and
three-dimensional structures of proteins, nucleic acids and protein–nucleic
acid complexes.
• .

4. What then is Health Informatics?
The practice of acquiring, studying and managing health data and applying medical concepts in
conjunction with HIT systems to help clinicians provide better healthcare.
Information engineering applied to the field of heath care essentially the management and use
of patient healthcare information.
Informatics is found at the intersection of healthcare and technology. It is where skills in
both medical and computer sciences come together in an effort to improve healthcare and
patient outcomes.
Professionals in this hybrid field draw on expertise from both disciplines to put
technology to its best use in patient care, clinical and research settings.
health care informatics, medical informatics, nursing informatics, clinical informatics, or biomedical informatics

5. Health Information Technology
Health IT systems can categorize patient experiences by type and stage of
disease, additional medical conditions (co-morbidities), medications
prescribed and adherence to treatment, as well as identify anonymized
patients’ geographic locations, age, gender, weight, and other factors.
This information is used to predict prognoses for particular patients or to
predict therapies most likely to succeed under very specific conditions(patient
similarity)

6. • Health informatics deals with the resources, devices, and methods required
to optimize the acquisition, storage, retrieval, and use of information in
health.

7. • Informatics is the heart of evidence-based, value-based medicine.
Healthcare professionals are increasingly turning to mined data to support
their decisions.
• Health informatics specialists help managers throughout the healthcare
industry access the right information to produce actionable insights that can
improve both therapeutic and institutional efficiency.

8. Informatics examples
• Creating, maintaining or facilitating new ways for medical facilities and practices to
keep EHR.
• Improving communication between healthcare providers and facilities to ensure the
best patient outcomes e.g. billing, insurance (HMO like AAR, IAA etc)
• Storing, managing and analyzing data for research (methods that ensure data re-use
for decision making)…..UgandaEMR, DHIS2, Clinic Master, OpenMRS, etc
• Interpretation of Medical Images using computing algorithms in absence of a
radiologists.
• PHR, EHR, EMR, Tele-medicine, Tele-health…….

9. Personal Health Record
• A personal health record, or PHR, is an electronic application through which
patients can maintain and manage their health information (and that of
others for whom they are authorized) in a private, secure, and confidential
environment.
It is operated by institutions (such as hospitals) and contains data
entered by clinicians or billing data to support insurance claims.
Intention of the PHR is to provide a complete and accurate summary of
an individual’s medical history which is accessible online.

10. Types of PHR Systems
1. Standalone systems: These are not tied to any healthcare system e.g Google
Health PHR, Microsoft’s Health Vault.
2. Tethered systems: These are tied into a healthcare system. e.g My
HealtheVet PHR
3. Networked systems: These access data from multiple locations

11. Why is a PHR important?
• It provides complete and accurate patient record documentation that is used
to foster quality and continuity of care.
• It creates a means of communication between providers and members
about health status, preventive health services, treatment, planning, and
delivery of care.
What does the patient do with the PHR?
Email their doctor, track immunizations, transfer information to the new
doctor, receive and track their test results.

12. Benefits of PHR
1. Improve Patient Engagement:
2. Coordinate and combine information from multiple providers
3. Helps to ensure that patient information is available
4. Reduces administration cost
5. Encourages family health management
6. Enhance patient communication
7. Track and assess one’s health
8. Make the most of a doctor’s visit
9. Manage your health between visits

13. Tele-health
• WHO: Tele-health involves the use of telecommunications and virtual
technology to deliver health care outside of traditional health-care facilities.
• Tele-health, which requires access only to telecommunications, is the most
basic element of “eHealth,” which uses a wider range of information and
communication technologies (ICTs).

14. Tele-medicine
• Telemedicine is the remote delivery of healthcare services, such as health
assessments or consultations, over the telecommunications infrastructure.
• It allows healthcare providers to evaluate, diagnose and treat patients using
common technology, such as video conferencing and smartphones, without
the need for an in-person visit.

15. Types of telemedicine
Telemedicine can be classified into three main categories:
1. Remote patient monitoring: Also known as tele-monitoring, allows
patients with chronic diseases to be monitored in their homes with mobile
medical devices that collect data about blood sugar levels, blood pressure or
other vital signs. Remote caregivers can review the data instantly.
2. Store-and-forward: Also known as asynchronous telemedicine, lets
providers share patient information, such as lab results, with a physician at
another location.

16. Types of telemedicine
3. Interactive telemedicine: This allows physicians and patients to
communicate in real time.
Such sessions can be conducted in the patient's home or in a nearby medical
facility and include telephone conversations or the use of video
conferencing software that complies with HIPAA regulations. e.g TMCG

17. Difference between Tele-health and Tele-
medicine
• Tele-health: The term tele-health includes a broad range of technologies and services to
provide patient care and improve the healthcare delivery system as a whole. It refers to a
broader scope of remote healthcare services. Tele-health refers both clinical and non-
clinical services, such as provider training, administrative meetings, and continuing medical
education, in addition to clinical services.
• Tele-medicine: Telemedicine is a subset of tele-health that refers solely to clinical health
care services. Telemedicine involves the use of electronic communications and software to
provide clinical services to patients without an in-person visit. Telemedicine technology is
frequently used for follow-up visits, management of chronic conditions, medication
management, specialist consultation and many other services that can be provided remotely
via video conferencing

18. Tele-health example

19. • Well-designed tele-health schemes can improve health care access and
outcomes, particularly for chronic disease treatment and for vulnerable
groups.
• Not only do they reduce demands on crowded facilities, but they also
create cost savings and make the health sector more resilient.

20. Examples of applications in HI
1. Brain Computer Interfaces(BCIs)-Direct interfaces between the human mind
and technology . It is powered by AI and have been used to decode the neural
activities associated with intended movements of the hand for people with
neurological diseases and trauma to the nervous system that can take away some
patients’ ability to speak, move and interact meaningfully.
BCIs acquire brain signals, analyze them, and translates them into commands that are
relayed to an output device to carry out a desired action.
This can eventually improve the patient’s quality of life e.g strokes etc
Reference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3497935/

21. 2. Using AI to predict whether the cancer is going to progress rapidly or slowly and
how that might change how patients will be treated based on an AI algorithm rather
than clinical staging.
3. Smart devices used in monitoring patients in the ICU and elsewhere. e.g Neopenda
4. Tool that identifies developmental diseases by analyzing images of child’s face. The
algorithm can detect discreet features e.g a child’s jaw line, eye and nose placement
and other attributes that might indicate a craniofacial abnormality. Currently, the tool
can match the ordinary images to more than 90 disorders to provide clinical decision
support.

22. 5. Predicting of hospital utilization rates thus able to know when the hospital is
likely to get busier than usual.
Using analytics to predict patterns in utilization can help to ensure optimal
staffing levels while reducing waiting time and raising patient satisfaction.

23. Importance of Health Informatics
1. Maintained Electronic Patient Records
• Patients visit more than one care provider and paper based records make it
difficult to safely manage patients since these records do not get consolidated
across physicians, specialists, laboratories and hospitals.
• Saves patient time since upon entering the hospital, medical staff already has
much of the patient’s information available in an EHR thus less paper work,
shorter and fewer forms for patients to fill out.

24. Importance of HI cont’d
2. Reduced Costs: HI lessens costly(fatal, law suits) medical errors and also lessens
the number of labor intensive tasks out of the busy hands of medical staff e.g
routines get automated thus saving costs.
3. Less Trial and Error: EHRs ensure that patients receive the right medication the
first time to prevent allergic reactions to antibiotics or other medicines.
They even warn physicians before prescribing a specific drug if it shows dangerous
interactions with a medication already in use by the patient. These systems help take
human error out of the equation

25. 4. Improved Ability to Self-Manage Illness: A patient’s success story often
depends as much on their own application of a physician’s directions than on
the actual medical advice and guidelines.
e.g imagine a patient with a chronic illness e.g cancer, diabetes, HIV etc that is
able to view a graph(weekly) that shows their progress in adherence to
medication, able to input information in a mobile application regarding drug
reactions (know when to rush to the hospital and when not to )

26. 3. Patient Participation: When patients have electronic access to their own
health history and recommendations, it empowers them to take their role in
their own health care more seriously.
Patients who have access to care portals are able to educate themselves more
effectively about their diagnoses and prognoses, while also keeping better track
of medications and symptoms.
They are also able to interact with doctors and nurses more easily, which yields
better outcomes, as well.(patient portal)

27. 4. Impersonalisation of care: As data is gathered regarding a patient,
algorithms can be used to sort it in order to determine what is wrong and what
care should be offered.
Having a valid and accurate record that the patient and his care providers can
access remains vital.

28. 5. Increased Coordination: As care gets more specializations, patients receive care
from different specialists in one hospital stay e.g pharmacy, laboratory, nutrition,
physiotherapy, x-ray, discharge etc
6. Improved Outcomes: Electronic medical records result in higher quality care and
safer care as coordinated teams provide better diagnoses and decrease the chance for
errors.
Doctors and nurses are able to increase efficiency, which frees up time to spend with
patients, and previously manual jobs and tasks are automated, which saves time and
money not just for hospitals, clinics, and providers, but for patients, insurance
companies, and the state.

29. 7. Improved Disaster recovery techniques: Disaster recovery techniques are
techniques that are put in place to ensure business continuity in case of any
disaster like fire, theft etc.
A cold site: This is a site where there is little hardware set up. Provides power,
simple server which waits in the event of a significant outage. Cold sites are
the cheapest cost-recovery option for businesses to utilize.
You’re saving a lot of money by not having equipment set up and running, but
it will be challenging to get your site back online.

30. • A warm site: This is a site where you have hardware and network connections
established from your site to a second site, but they are not equal.
• Your recovery will still be delayed while you retrieve your data from your remote
backup site.
• Its like driving on the road and your extra car is following behind you but this may
be several miles behind you, when the one you are driving gets a problem, it takes
you time to catch up to where you are but in this car there is fuel, engine works
which are the basics you need to start with- may not be as fancy as the one you are
driving.

31. A hot site: A hot site is a complete copy of your original site, including personnel,
network systems, power grids and almost instant backups of your data. There is very
minimal downtime when moving from the hot site to the backup one.
Here you can’t afford any delays.
So if your car breaks down, you’ve got your extra car right in the next lane next to
you, driving at the same speed but this comes with costs of maintaining two cars to the
same standard.
Hot Site can be configured in a branch office, data center or even in cloud. Hot Site
must be online and must be available immediately.

32. • Data is regularly backed up or replicated to the hot site so that it can be made
fully operational in a minimal amount of time in the event of a disaster at
the original site.
• Hot Site must be located far away from the original site, in order to prevent
the disaster affecting the hot site also.

33. Health Care applications

34. Predictive modelling
• Using historical data to build a model for predicting future
events/outcome(s).
Example: You want to build a model to predict which patients are at risk of
heart failure

35. Motivation for predicting heart failure

37. Computational phenotyping

38. Things to deal with :
• Missing data
• Duplicates
• Irrelevant
• Redundant

39. Patient similarity(Case based reasoning)

40. Group the patients(treatment and outcome)

41. HMIS
• Health Management Information System(HMIS) is an integrated reporting system
used by the MoH, Development Partners and Stakeholders to collect relevant and
functional information on a routine basis to monitor the Health Sector Strategic
Plan (HSSP) indicators to enable planning, decision making and M&E of the health
care delivery system.
• It is designed to assist managers carry out evidence based decision making at all
levels of the health care delivery.
• At the health Unit level, HMIS is used by the health unit in-charge and the Health
Unit Management Committee to plan and coordinate health care services in their
catchment area.

42. Objectives of HMIS
• Provide quality information to support decision-making in the Health Sector
• Aide in setting performance targets at all levels of health service delivery
• Assist in assessing performance at all levels of the Health Sector
• Encourage use of Health information

43. Uses of HMIS
• Information from the HMIS can be used in the following ways:
• Planning
• Epidemic prediction
• Epidemic detection
• Designing Diseases specific Interventions
• Monitoring Work plan performance
• Resource allocation

44. Basis for HMIS formulation
• The information collected is relevant to the policies and goals of the Government of
Uganda, and to the responsibilities of the health professionals at the level of
collection.
• The information collected is functional; it is to be used immediately for management
and should not wait for feedback from higher levels.
• Information collection is integrated; there is one set of forms and no duplication of
reporting.
• The information is collected on a routine basis from every health unit in all districts
within Uganda.

45. • HMIS provides data collection tools for capturing patient level data, which is
aggregated into Summary reports for submission to the next level.
• The flow of HMIS information is from the lowest level which is the
community, to the health unit, health Sub-district, district and finally
to the National Health Databank /Resource Centre of the Ministry of
Health.

46. • HMIS must provide accurate, timely and relevant information in order to
accomplish the long-term goal of optimizing health care delivery and achieve
health for all.

47. ACCURACY
• To ensure accuracy of HMIS information, data must be collected using
standard methods, correctly following procedures for compiling data,
continuously cross checking to eliminate errors and make corrections where
necessary, and store data in a format ready for analysis at any time.

48. TIMELINESS
• To ensure timeliness of HMIS information, all levels of reporting should
comply with the agreed deadlines.
• A DATABASE BOOK is required at the health units, HSDs and the
Districts to record and monitor aggregated information in one central place.

49. RELEVANCE
• To ensure relevance of HMIS information, HMIS is regularly reviewed to
ensure that it is in-line with the goals and objectives of the major health
policies and programs, and that the collected information is actually utilized
and or consumed by the stakeholders.

50. Advantages and Disadvantages of paper based
records

51. Advantages
• Portable
• Familiar and easy to use
• Exploits everyday skills of visual search, browsing etc
• Natural: “direct” access to clinical data
• Hand writing, drawings, images, charts …)

52. Disadvantages
• Can only be used for one task at a time
• If 2 people need clinical notes, one has to wait. This can lead to long waits
• Records can get lost or out of order (effectively lost)
• Consume space
• Large individual records are hard to use
• Fragile and susceptible to damage
• Environmental cost

53. Electronic Health Record
• An electronic health record is a repository of information about a single
person in a medical setting, including clinical, demographic and other data
shared within and across different health facilities.
• A patient record system is the set of components that form the mechanism
by which patient records are created, used, stored and retrieved.