Introduction_Medical_informatics_summary.ppt

Representation and computation on Medical and Healthcare information

1. Medical Informatics
Representation and
Computation on Medical and
Health Care Information

2. Medical Informatics
•Health records in 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 Design and 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
•In early 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 Level Seven. 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
standard for handling, storing, printing, and transmitting information
on medical imaging. http://medical.nema.org/

10. Message Transmission
HL7-enabled system
Receiver
HL7-enabled system
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
Seg1 SegN
Field1 Field1
Comp
1
Comp
N
Terminated by <CR>
Separated by '|'
Separated by '^'

12. Message Encoding
 Sequence of 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): [phone]
(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 Reference Pointer (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 Encoded Data (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 Observation Identifiers 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 fully specified 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 Imaging and 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 of Reference
Image
(Pixels)
Curve VOIL
UT
Modality
LUT
Overlay Waveform
1
1,n
1
1
1
1
1,n
1,n 0,n
0,n0,n 0,n 0,n 0,n0,1
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,n 0,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
Acquisition Context
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 EData ElementData Element
VFVLVRTag Explicit VR
< 4 bytes >< 2 bytes >< 2 bytes >
VFVLTag
< 4 bytes >
Implicit VR
DICOM Data formatDicom Information Structure

29. An Example of Data Element
Sridhar Raja000CPN0010 0010
Sridhar Raja0000 000C0010 0010
Patient
Informatio
n
Patien
t
Name
VR VL VF
Explicit VR
Implicit VR

30. Some vital tags for 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 Archiving and 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. PACS (Ref: http://www.advantech.com.cn/)

33. ICD-10

International Statistical Classification 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 health condition 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

2
nd
field of DG1: diagnosis coding method (deprecated).

4
th
field of DG1: diagnosis description (deprecated).

3
rd
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 Procedure Coding
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
Letters A-H, J-N, P-Z

37. SNOMED

Systematized Nomenclature of Medicine.

Collection of medical terminology covering
most areas of clinical information.

Diseases

Findings

Procedures

Microorganisms

Pharmaceuticals etc.

38. Standardization: Complexity in
Medical World
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.