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Medical Informatics
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- 2. What is MedicalInformatics? Medical Informatics is the application of computers, communications and information technology and systems to all fields of medicine- Medical care Medical education Medical research MF Collen (MEDINFO ’80, Tokyo) 2
- 3. Medical informatics isa developing body of knowledge and a set of techniques concerning the organisational management of information in support of medical research, education and patient care. Assoc. of American Medical Colleges (AAMC) 1986 3
- 4. HISTORY • 1950s- “medicalapplications of computer science” • Medical computer science • Medical information science • Biomedical computing • Medical informatics • Health or healthcare informatics • Clinical informatics 4
- 5. HISTORY • 1949- GustavWager • 1950- United States National Bureau of Standards • mid 50’s- MYCIN • 1965- MEDLINE • 1968- Homer Warner founded the department of medical informatics • 1970- IMIA, MUMPS language and OS 5
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- 7. Standards in MedicalInformatics There are four ways in which a standard can be produced: 1. Ad hoc method: Ex.-American College of Radiology-> DICOM 2. De facto method: Ex- Microsoft’s Windows 3. Government-mandate method: Ex-HCFA’s UB92 insurance-claim form 4. Consensus method: Ex- Health Level 7 (HL7) 7
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- 9. Standards in MedicalInformatics The ISO/TC215 is the International Organization of Standardization's Technical Committee on Medical Informatics. TC215 works on the standardization of Medical Informatics and ICT, to allow for compatibility and interoperability between independent system. 9
- 10. Healthcare functions andInformation Technology INFORMATION TECHNOLOGY Patient Care Patient Safety Medical Educatio n Disease Manage ment Evidence Based Care Pharmac y,Laborat ory Medical Records Quality Manage ment 10
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- 14. Benefits of telemedicine Care for those living in remote places Consultation, education and back up for specialists in remote areas Decreased costs Better care in remote monitoring for patients Reduced visits TYPES: Store and forward telemedicine Remote monitoring Interactive telemedicines 14
- 15. KNOWLEDGE MANAGEMENT 15 Journals International Journalof Medical Informatics Indian Journal of Medical Informatics Journal of the American Medical Informatics Association The Open Medical Informatics Journal BMC Medical Informatics and Decision Making Journal of Medical Internet Research Consumer health information system refers to information sought by consumers or patients without the need for medication by health professionals E.g. Mayo Clinic Health Community, WebMD, VaxNation etc
- 16. Evidence based medicalinformation Evidence based medicine (EBM) is an approach to medical practice by emphasising the use of evidence from well designed and conducted research ‘Evidence based’-David M.Eddy ‘Evidence based medicine’- Gordon Guyatt E.g.Index medicus (1879-2004)- comprehensive bibliographic index MEDLARS/MEDLINE, PubMed LIMITATIONS: Quantitative research, may not be relevant always RCTs are expensive Lag between RCT and results Published studies may not be representative Research tends to focus on populations but individuals vary 16
- 17. Cochrane library Collection ofdatabases in medicine and other healthcare specialities Named after Archie Cochrane Cochrane reviews DARE- The Database of Abstracts of Reviews of Effects CENTRAL- The Cochrane Central Register of Controlled Trials Cochrane Methodology Register Health Technology Assessment Database (HTA) NHS Economic Evaluation Database (NHS EED) 17
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- 19. DECISION SUPPORT Reminder systems •SMS, Apps like talksoft, google now Diagnostic expert systems • Internist-I/QMR- internal medicine • Dx, Iliad • EON- guideline based therapy • MYCIN- for infectious diseases • ONCOCIN- support application of oncology protocols Drug interactions-Apps like Medscape Standard Treatment Guidelines Standard of Procedures 19
- 20. INFORMATION MANAGEMENT Electronic MedicalRecords Digital version of a paper chart containing all of a patient’s medical history, mostly used by providers NeHA- nodal authority ‘Electronics Health Record Standards for India’ approved E.g. Health centres in GZP and Dallupura Disease registries NCDIR (ICMR)- cancer, diabetes, CVD, stroke Billing transactions Ordering systems 20
- 21. Key players inmedical informatics • Online searches for health Information • Web portals for storing personal medical information, making appointments, checking lab results, etc • Search choice of physician, hospital or insurance plan • Online chat, blogs, podcasts and support groups • Access to electronic health records • Telemedicine Patient • Online searches with MEDLINE, Google and digital libraries • Patient and Physicians web portals • Clinical decision support, reminders and alert • Electronic health records (EHRs) • Telemedicine and telehomecare • Online continuing medical education (CME) • Electronic (e)-prescribing • Disease management and registries • Picture archiving and communication systems (PACS) • E-research Clinicians 21
- 22. Nursing and Support Staff • Patient enrolment •Electronic appointments • Electronic billing process • EHRs • Telehomecare monitoring • Secure patient-office e-mail communication • Electronic medication administration record (e-Mar) • Online educational resources and CME • Disease registries Public Health • Incident reports • Syndromic surveillance as part of bio-terrorism program • Establish link to all public health departments • Geographic information systems to link disease outbreaks with geography • Telemedicine • Remote reporting using mobile technology 22
- 23. • Electronic claimstransmission • Physician profiling • Information systems for “pay for performance” • Monitor adherence to clinical guidelines and preferred formularies • Promote claims based personal health records and information exchanges • Reduce litigation by improved patient safety through fewer medication errors Insurance Company • Interoperable electronic health records • Electronic billing • Information systems to monitor outcomes, length of stay, disease management, etc • Bar coding and radio frequency identification (RFID) to track patients, medications, assets, etc • Patient and physician portals • E-prescribing • Health Information Organizations (HIOs) • Telemedicine • Picture archiving and communication systems (PACS) Hospitals 23
- 24. • Database creation •Online collaborative web sites e.g. CaBIG • Electronic case report forms (eCRFs) • Software for statistical analysis of data e.g. SPSS • Literature searches • Randomization using software programs • Improved subject recruitment using EHRs and e-mail • Online submission of grants Research 24
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- 26. CHALLENGES First: Prepare physiciansfor the changing behaviours of patients Second: To raise awareness among physician and medical students Third challenge: To motivate medical students and practitioners to use ICT Fourth challenge: How to implement this innovation into teaching and learning 26
- 27. FACTORS IN INCREASEOF MEDICAL INFORMATICS Increase in use of technology Mobility of population Specialization Managed care systems Rise in healthcare costs Improved hardware Improved methods Reduced computer costs Increased awareness 27
- 28. WHAT MEDICAL INFORMATICSIS NOT Overuse of the term “medical informatics” Do not refer to any activity involving medicine and computers Computers in medicine is not equivalent of “medical informatics” For e.g., nursing informatics is not The nurse who likes computers The nurse who hates computers The nurse who knows computers The nurse who is now a network analyst The programmer who is now a Nurse 28
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- 30. Objectives of IAMI 1.Develop computer awareness in people of medical profession 2. Give necessary assistance and guidance 3. Help to identify problems 4. Introduce computer education 5. Improve educational and training methodologies 6. Assist hospitals in planning, procurement and installation 7. Suggest improvements 8. Collaboration with other countries and companies 9. Assist in development and employment of manpower 10. Help India achieve high international standards 11. Periodic professional conferences 30
- 31. Courses on medicalinformatics in India 1. International Institute of Health Management in Research, New Delhi 2. Indira Gandhi National Open University, New Delhi 3. Indian Institute of Public Health, Hyderabad 4. Osania University, Hyderabad 5. Foundation of Healthcare Technologies Society, New Delhi 6. Medavarsity Online, Hyderabad 7. Indrapastha Apollo Hospital, New Delhi 8. Bioinformatics Institute of India, Noida 9. eHCF School of Medical Informatics 10.Manipal University, Karnataka 31
- 32. MRD VISIT e-scanning startedlast month They are entering NAME MLC No. IPD No. DOA/DOD Scanned copy of the record sheet kept Outsourced to some private company 32
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Editor's Notes
- #3 Simplistic definition: Computer applications in medical care, medical education and medical research Medical informatics is the rapidly developing scientific field that deals with the use of computers and communication technology to acquire, store, analyze, communicate and display medical information and knowledge to facilitate understanding and improve the accuracy, timeliness and reliability of decision-making.
- #4 It 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.
- #5 We will start by trying to understand why this field of study is called medical informatics. Medical informatics began in the 1950s with the advent of computers. During this time scientist intuitively realized that they could create medical applications of computer science. They however did not know what they should call this field of study. They initially named it medical computer science but after a while the term computer science became a concern to many scientists. Computer science in the 1950s was not as defined at it is today. In the 1950s it mainly dealt with hardware, and specifically making hardware smaller and faster. They knew that this field of study that they were trying to create encompasses more than just hardware. They wanted a term that described the fact that it encompasses the use, processing, analyzing and storage of information. They thus changed the name to medical information science. The term information science not only encompassed the aspects of computer science, but all fields associated with storage, processing, analysis and commutation of information e.g. Mathematics, library science, information systems, communication technology etc. After a while the validity of this domain name again began to be questioned, specifically the use of the word medical. This term did not explicitly indicate the other types of data was associated with this domain. This domain name did not include the biological data associates with the field like genome sequences, proteins, amino acids and bases etc. they therefore started using the term Biomedical computing. However after a while this term was also very limiting. They realized that this field of study also encompasses all of the associated medical data like demographics, information needed by health manager for resource allocation, HR data etc. They then called this domain medical informatics. This is probably the most common title, but in Europe health or health care informatics is used and in America clinical informatics is used. These three terms mean the same thing.
- #6 In 1949, Gustav Wager established the first professionally organization for medical informatics in Germany. The first medical informatics application were in dental projects in 1950 by the unites states national bureau of standards. In the mid 50s expert systems like MYCIN were developed and used. In 1965 the national library of medicine stared using Medline. In 1968 homer Warner, who is one of the fathers of medical informatics, founded the department of medical informatics at the university of Utah. In 1970 the international medical informatics association was founded. In the same year the MUMPS language and operating system was developed and used for clinical applications.
- #7 MI is basically the collection, storage, analysis, dissemination of medical information by the means of computer and information technology so that quality care can be provided to the patient
- #8 Why do we require standardisation? excessive diversity creates inefficiencies or impedes effectiveness. Standardisation is required to allow interoperability btw independent system, so tht the information collected of a patient by one system can be used by another. There are four ways in which a standard can be produced: 1. Ad hoc method: A group of interested people and organizations (for example, laboratorysystem and hospital-system vendors) agree on a standard specification. These specifications are informal and are accepted as standards through mutual agreement of the participating groups. An example produced by this method is the American College of Radiology/National Electrical Manufacturers Association (ACR/NEMA) DICOM standard for medical imaging. 2. De facto method: A single vendor controls a large enough portion of the market to make its product the market standard. An example is Microsoft’s Windows. 3. Government-mandate method: A government agency, such as the Health-Care Financing Administration (HCFA) or the National Institute for Standards and Technology (NIST) creates a standard and legislates its use. An example is HCFA’s UB92 insurance-claim form. 4. Consensus method: A group of volunteers representing interested parties work in an open process to create a standard. Most health-care standards are produced by this method. An example is the Health Level 7 (HL7) standard for clinical-data interchange.
- #9 ISO estb in 1947 International Organization for Standardization Comité Européen de Normalisation Health Level Seven American National Standards Institute Also IEEE, DICOM, W3C, NCPDP, NCCLS etc
- #10 TC 251 Established by european committee of standardisation in 1991, to develop standards for communication among independent medical information systems so that clinical and management data produced by one system can be transmitted to another system. Groups are working together at various levels toward a common goal. Standards of interest include EUCLIDES, for interfacing reference laboratory systems to health-care settings, EDIFACT, for transmission of electronic documents, and a message standard developed by Project Team 007 (PT007) for transmitting content of electrocardiogram (ECG) carts to computers 1998, the International Standards Organization (ISO) created a new technical committee (TC 215) for medical informatics. The scope of this TC is standardization in the field of information for health and health information and communications technology to achieve compatibility and interoperability between independent systems.
- #11 Medical Informatics emphasizes information brokerage; the sharing of a variety of information back and forth between people and healthcare entities. Examples of medical information that needs to be shared: lab results, x-ray results, vaccination status, medication allergy status, consultant’s notes and hospital discharge summaries. Medical Informatics harnesses the power of information technology to expedite the transfer and analysis of data, leading to improved efficiencies and knowledge.
- #12 Uses of Medical Informatics : Informatics Use in Health Care can be in the following fields: 1) Communication : This includes Telemedicine, Tele-radiology, Patient e-mail and Presentations 2) Knowledge management : Including Journals, Consumer Health information and Evidence-based medical information 3) Decision Support : Including Reminder systems, Diagnostic Expert Systems and Drug Interaction 4) Information Management : Examples are Electronic Medical Records, Billing transactions and Ordering Systems
- #13 Telehealth: refers to clinical and non clinical services such as medical education, administration and research Telemedicine: refers only to the provision of clinical services Teleradiology: ability to send radiographic images from one location to another location Telecardiology: ECG etc can be transmitted using telephone and wireless Telepsychiatry: allows anonymity of patient and less social stigma, physical examinations are not important Correctional health: telehealth for prisoners in correctional health facilities Teledentistry: use of IT and telcommunications for dental care, consultation, educational, and public awareness
- #15 Reduced visits to hospitals and reduced congestion in hospitals Store and forward: involves acquiring medical data like medical images and then transmitting this data to a medical doctor or specialists 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 communications
- #16 - Official journal of the International medical informatics association and the European federation of medical informatics Indian assoc of medical informatics This app provides access to an online health community, where patients can connect with and learn from other patients experiencing similar health issues. It offers a members-only discussion forum, as well as medical news and information from the Mayo Clinic. VaxNation, an online vaccination tracker. You enter information such as your birth date, vaccinations that you've had, and the dates of those immunizations, and VaxNation provides age-appropriate recommendations, Families can set up joint accounts, and accounts can be linked to Facebook and Twitter so that information about immunizations can be shared
- #17 Although all medicine based on science has some degree of empirical support, EBM goes further, classifying evidence by its epistemologic strength and requiring that only the strongest types like from meta analysis, systematic reviews and RCTs can yield strong recommendations, weaker types such as case control studies can yield only weak recommendations Gold standard of clinical practice Index Medicus (IM) was a comprehensive bibliographic index of scientific journalarticles focusing on medical science fields, published from 1879 to 2004. It was initiated by John Shaw Billings, head of the Library of the Surgeon General's Office, United States Army. This library later evolved into the United States National Library of Medicine (NLM). In the 1960s, the NLM began computerizing the indexing work by creating MEDLARS, a bibliographic database, which became MEDLINE. Index Medicus thus became the print presentation of the MEDLINE database's content, which users accessed usually by visiting a library which subscribed to Index Medicus Contains 21.6 million records from5639 selected publications First use the term evidence based in 1988 in his workshops to teach specialty societies how to use formal methods to design guidelines. He laid out the principles upon which the first evidence based guidelines would be formulated, it was for ACS guidelines for cancer screening, first published the term in 1990 in an article in the JAMA
- #18 At its core is the collection of Cochrane Reviews, a database of systematic reviews and meta-analyses which summarize and interpret the results of medical research. The Cochrane Library aims to make the results of well-conducted controlled trials readily available and is a key resource in evidence-based medicine. Scottish doctor noted for his book Effectiveness and Efficiency: Random Reflections on Health Services.[1] This book advocated for the use of randomized control trials to make medicine more effective and efficient.[2] His advocacy of randomized controlled trials eventually led to the development of the Cochrane Library database of systematic reviews, COCHRANE REVIEWS-The Cochrane Database of Systematic Reviews DARE- Contains quality-assessed abstracts of systematic reviews, including a summary of the review and a critical appraisal of its overall quality CENTRAL- Is a database that contains details of articles of Controlled trials CMR- Is a bibliography of publications that report on methods used in the conduct of controlled trials. HTA- Brings together details of completed and ongoing health technology assessments NHS EED- This database systematically identifies economic evaluations from around the world, appraises their quality, and highlights their relative strengths and weaknesses
- #20 Medical decision support- computer based information processing to help decision makers Medical decision making- quantitative methods for reasoning under uncertainty SMS is popular and most widely welcomed mode of reminder, strong consistent evidence that mobile text message reminders improved rate of attendance compared with no reminders, SMS is also private in a way that voice calling is often not It improves drug dosing, improve preventive care but not diagnosis
- #21 “EMR is a repository of information regarding the health of a subject of care in computer-processable form that is able to be stored and transmitted securely, and is accessible by multiple authorized users. nodal authority that will be responsible for development of an Integrated Health Information System (including Telemedicine and mHealth) in India, while collaborating with all the stakeholders, Formulation of policies, strategies and implementation plan, Formulation and management of all health informatics standards for India; Laying down data management, privacy & security policies, standards and guidelines, promote setting up of state health records repositories, To deal with privacy and confidentiality aspects of Electronic Health Records (EHR). National Centre for Disease Informatics and Research- they maintain a national research database CCDC- Centre for Chronic Disease Control,Detection and Management of Coronary Heart Disease patients (DEMAT) in India. This is a nationwide disease registry for acute coronary syndromes in India. The DEMAT program was designed in year 2006 with an objective to understand the prevailing practice patterns in the management of Coronary Heart Disease patients. It also envisions to help physicians identify in-hospital trends of interventional procedures
- #22 Key Players in Medical Informatics and Information Technology is important to multiple players in the field of Medicine. The common goals of these different groups are to: • Reduce medical errors and resultant litigation • Provide better return on investment (ROI) • Improve communication and continuity among the key players • Improve the quality of care • Reduce duplication of tests or prescriptions ordered • Improve patient outcomes, like morbidity and mortality • Standardize care among clinicians, organizations and regions • Improve clinician productivity • Speed up access to care and administrative transactions • Protect privacy and ensure security Clinicians - Doctorspring, medeanta(telemedicine)
- #25 Database creation to study populations, genetics and disease states Online collaborative web sites e.g. CaBIG Electronic case report forms (eCRFs) Software for statistical analysis of data e.g. SPSS Literature searches with multiple search engines Randomization using software programs Improved subject recruitment using EHRs and e-mail Online submission of grants
- #26 P. L. Rogers (2000) identifies similar barriers based on the literature and two studies she conducted: availability and quality of hardware and software, faculty role models, funding, institutional support, models for using technology in instruction, staff development, student learning, teacher attitudes, technical support, and time to learn to use technology. However, she organizes these barriers differently. Some barriers have an internal source, such as a teacher’s attitude or perception about a technology as well as his or her competency with that technology. External barriers include: availability and accessibility of hardware and software, technical and institutional support, and stakeholder development. Time and funding barriers cross internal and external sources.
- #27 • First challenge: We have to prepare physicians for the changing behaviours of patients who are increasingly internet savvy and who sometimes appear to know more about their diseases than their doctors • Second challenge: closely linked to the first, is to raise awareness among physician and medical students in training of many benefits of using ICT to improve not only the qualities of interventions and health care delivery but, from a broader perspective, the organizations of health care system itself • Third challenge: is to motivate medical students and practitioners to use ICT to find information, learn and develop, e-literacy should be a mandatory skill for all medical students • Fourth challenge: how to implement this innovation into teaching and learning
- #28 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 healthcare costs- attempt to control care Improved hardware- faster and more memory Improved methods- acquisition, transfer and retrieval Reduced computer costs Increased awareness
- #30 IAMI, established in 1993 Office being the Department of Clinical Pharmacology, Nizam’s Institute of Medical Sciences in Hyderabad, is a professional society that plays a role to sensitize the Indian medical community to the benefits of Information Technology (IT), bring about awareness and ensure greater utilization of IT in healthcare facilities across the length and breadth of India. The IAMI also aims to provide necessary assistance and guidance to other organizations to implement and reap the benefits of IT for health care. It supports introduction of computer literacy along with medical education, development of computerized as well as medical digital libraries, access to information and creation of databases. IAMI emphasizes on research and development of medical informatics as an independent discipline. It provides various communication and interaction channels among its members by means of e-groups and through publication of scholarly journals ”Indian Journal of Medical Informatics” started in may 2004.
- #31 To develop computer awareness in people of Medical Profession (including Dental, Nursing and Pharmacy) and Administrative Medical Authorities through lectures, seminars workshops, exhibitions and demonstrations of medical software in all parts of country and impress upon all the concerned on the necessity and benefits of various computer applications in Medicine, Health and Hospital Services. To give necessary assistance and guidance to develop collaboration with those who are interested in developing equipment / software for enhancement of professional efficiency of doctors, nurses and paramedical technicians and any software for the benefit of patients, betterment of hospital services and for improving administrative functions in Health Services of States and Central Government as well as local bodies like Municipalities & Corporations. To help organizations, hospitals, institutions, health & hospital administrators who are life members of I.A.M.I. to identify their health and administrative problems that can be solved through computerization and pass them on to Information Technology companies (both software and hardware) for a solution. To make all the required efforts to introduce computer education in all the colleges of medical sciences, dental sciences, nursing and pharmacy in India at both UG and PG levels through MCI (Medical Council of India) and respective University Authorities. To make all the efforts to improve the medical, dental, nursing and pharmacy colleges in their educational and training methodologies through computer-aided techniques and computerized library information services. To assist government / public / private hospitals, nursing homes & clinics and other organizations / institutions / establishments having their own hospitals / dispensaries in planning, procurement and installation of hospital computer systems including computerbased medical instruments & equipment and other health related software through standard companies at reasonable rates through life membership in the association. To suggest improvements in the existing services and computer systems if approached by any hospital / nursing home / clinic / organization / establishment / institution / laboratory / dispensary / pharmaceutical company and find suitable software & hardware firms to do that job in an internationally standard design. To develop collaboration links with other countries, other national and international organizations / associations / societies / institutions and software companies for software development, knowledge base creation, software exchanges, bibliographic references etc. To assist in development and employment of medical manpower for medical informatics in Indian hospitals / medical institutes / medical organizations and pharmaceutical companies. To help India to achieve high international standards through standardization in all the hospital procedures, including patient care, medical documentation, health statistics, computer-based medical instruments, patient monitors and other hospital equipment. To conduct periodic professional conferences at national level in medical informatics and periodic conferences / seminars / workshops at regional level to keep the members of IAMI abreast of concerned technologies involving computers and information sciences related to medical and allied fields. To bring out periodical news bulletins, Indian Journal of Medical Informatics and proceedings of the conferences to encourage members of IAMI in professionalism, research, innovations, publications and knowledge sharing.