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The Structure of Medical
      Data
•   Medicine is remarkable for its failure to
    develop a standarized vocabulary and
    nomenclature
•   Issues of data retrieval and analysis are
    confounded by discrepancies between
    observers and data analysts
•   Imprecission and a lack of standarized
    vocabulary are problematic when we wish to
    aggregate data recorded by multiple health
    professionals
•   EHR’s, their encoding must be able to
    presume a specific meaning for the terms
Coding systems
 Because of the needs to know about
  health trends for populations and to
  recognize epidemics in the early
  stages, there are various health
  reporting requirements for hospitals
  and physicians.
 Also reporting discharge
  diagnosis, procedures performed on
  pacients
 The codes used must be well defined
Coding systems
 Coding systems have limitations when
  are applied in more general clinical
  settings
 Researchers have worked to develop
  a unified medical language system
  (UMLS), a common structure that ties
  together the various vocabularies the
  have been created
The Data Knowledge
Spectrum
 A central focus in medical informatics
  is the information base that constitutes
  the substance of medicine
 Three terms are frequently used to
  describe the content of computed
  based systems: data, information and
  knowledge
 A database is a collection of individual
  observations without summarizing
  analysis
Strategies of Medical Data
Selection and Use
 All medical databases are basically
  incomplete because they reflect the
  selective collection of data by the
  health care personnel
 The challenge is to ask only questions
  that are necessary, to perform only the
  examinations that are required and to
  record only pertinent data
The Hypothetico - Deductive
Approach
 Studies of medical decision makers have
  shown that strategies for data collection
  and interpretation may be imbedded in
  an interative process known as
  hypothetico-deductive approach
 The central idea is one of
  seuqential, staged data
  collection, followed by data interpretation
  and the generation of
  hypotheses, leading to hipothesis-
  directed selection of the next most
  appropiate data to be collected.
The Hypothetico - Deductive
Approach
 Physicians refers to the set of active
  hypothesis as the differential
  diagnosis
 Physicians have developed safety
  measures to avoid missing important
  issues. They are focused in four
  categories:
    ◦   Past medical history
    ◦   Family history
    ◦   Social history
    ◦   Review of systems
The Hypothetico - Deductive
Approach
 After finishing with the physical
  examination the list of hipotheses may
  be narrowed down sufficiently that the
  physician can undertake specific
  treatment
 It often is necessary to gather aditional
  data
 The response of the patient to
  treatment is itself a datum point that
  may affect the hypotheses about a
  patient’s illness
The relationship between data
and hypotheses
 Observation evokes a hypothesis
 Sensitivity: the likehood that a given
  datum will be observed in a patient
  with a given disease or condition
 Specificity. An observation is highly
  specific for a disease if it is generally
  not seen in patients who do not have
  that disease
The relationship between data
and hypotheses
 The prevalence of a disease is simply
  a measure of the frequency with which
  the disease occurs in the population of
  interest
 The predictive value of a test is simply
  the post-test probability that a disease
  is present based on the results of a
  test
Methods for selecting questions
and comparing tests
   Given a set of current
    hypotheses, how does the physician
    decide what additional data should be
    collected?
The Computer and Collection of
Medical Data
 The need for data entry by physicians
  has posed a problem for medical
  computing systems since the earliest
  days of the field
 In some applications is possible for
  data to be enterred automatically into
  the computer
 The use of touch-
  screens, mouse, PDA’s can help to
  reduce the resistance to computer use

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Structure of medical data

  • 1. The Structure of Medical Data • Medicine is remarkable for its failure to develop a standarized vocabulary and nomenclature • Issues of data retrieval and analysis are confounded by discrepancies between observers and data analysts • Imprecission and a lack of standarized vocabulary are problematic when we wish to aggregate data recorded by multiple health professionals • EHR’s, their encoding must be able to presume a specific meaning for the terms
  • 2. Coding systems  Because of the needs to know about health trends for populations and to recognize epidemics in the early stages, there are various health reporting requirements for hospitals and physicians.  Also reporting discharge diagnosis, procedures performed on pacients  The codes used must be well defined
  • 3. Coding systems  Coding systems have limitations when are applied in more general clinical settings  Researchers have worked to develop a unified medical language system (UMLS), a common structure that ties together the various vocabularies the have been created
  • 4. The Data Knowledge Spectrum  A central focus in medical informatics is the information base that constitutes the substance of medicine  Three terms are frequently used to describe the content of computed based systems: data, information and knowledge  A database is a collection of individual observations without summarizing analysis
  • 5. Strategies of Medical Data Selection and Use  All medical databases are basically incomplete because they reflect the selective collection of data by the health care personnel  The challenge is to ask only questions that are necessary, to perform only the examinations that are required and to record only pertinent data
  • 6. The Hypothetico - Deductive Approach  Studies of medical decision makers have shown that strategies for data collection and interpretation may be imbedded in an interative process known as hypothetico-deductive approach  The central idea is one of seuqential, staged data collection, followed by data interpretation and the generation of hypotheses, leading to hipothesis- directed selection of the next most appropiate data to be collected.
  • 7. The Hypothetico - Deductive Approach  Physicians refers to the set of active hypothesis as the differential diagnosis  Physicians have developed safety measures to avoid missing important issues. They are focused in four categories: ◦ Past medical history ◦ Family history ◦ Social history ◦ Review of systems
  • 8. The Hypothetico - Deductive Approach  After finishing with the physical examination the list of hipotheses may be narrowed down sufficiently that the physician can undertake specific treatment  It often is necessary to gather aditional data  The response of the patient to treatment is itself a datum point that may affect the hypotheses about a patient’s illness
  • 9. The relationship between data and hypotheses  Observation evokes a hypothesis  Sensitivity: the likehood that a given datum will be observed in a patient with a given disease or condition  Specificity. An observation is highly specific for a disease if it is generally not seen in patients who do not have that disease
  • 10. The relationship between data and hypotheses  The prevalence of a disease is simply a measure of the frequency with which the disease occurs in the population of interest  The predictive value of a test is simply the post-test probability that a disease is present based on the results of a test
  • 11. Methods for selecting questions and comparing tests  Given a set of current hypotheses, how does the physician decide what additional data should be collected?
  • 12. The Computer and Collection of Medical Data  The need for data entry by physicians has posed a problem for medical computing systems since the earliest days of the field  In some applications is possible for data to be enterred automatically into the computer  The use of touch- screens, mouse, PDA’s can help to reduce the resistance to computer use