Medical Informatics-Introduction and Overview.ppt

Informatics in medicine

1. Medical Informatics
Introduction and Overview
James J. Cimino, M.D.
Departments of Medicine
and Medical Informatics

2. Medical Informatics
Medical
Information
Science

3. We Are All Medical Informaticians
Medical Education
Patient Data Collection and Recording
Clinical Information Retrieval
Medical Knowledge Retrieval
Medical Decision Making

4. Some Definitions
Medical Informatics: the science of medical
information collection and management
Medical Decision Making: quantitative methods for
reasoning under uncertainty
Medical Computing: computer applications for
information management
Medical Decision Support: computer-based
information processing to help human decision
makers

5. A Brief History -Past to Future
Ledley and Lusted -Reasoning foundations
of medical diagnosis; Science1959
El Camino Hospital -1965
Help System -1970
Financial systems -driven by billing and
reporting requirements
Clinical Systems
Information Resources
Expert Systems

6. Medical Computing
Patient-Oriented Systems
Medical Information Resources
Medical Knowledge Systems

7. Patient Oriented Systems
Definition: systems which collect, store and
retrieve data about individual patients
Financial systems
Electronic medical records
Research databases

8. Medical Information Resources
Definition: systems which contain
general medical knowledge
Medline
Electronic textbooks
Computer-assisted instruction

9. Medical Knowledge Systems
Definition: systems which apply general
medical knowledge, whether through
pattern matching or application of
clinical algorithms, to specific patients
Stand-alone: Mycin, Internist-I/QMR,
DXplain
Integrated: Help, Columbia CIS

10. Case Presentation
Case Description: 74 y.o. female with history of right CVA in 1989 (LLE
weakness), one week of productive cough and increased debility. Exam
consistent with bronchitis, oral antibiotic prescribed, but patient had a tonic
grand mal seizure in clinic. Became flaccid, unconscious, pulseless, apneic,
but upon positioning for CPR, developed pulse and spontaneous respirations
and awoke about 2 minutes after start of episode, complaining of lower
sternal chest pain.
Actions:
»Transfer to Emergency Room
»Examination
»Bloodwork
»Chest Xray
»Cardiogram
»Admission and therapy

11. CIS Demo -Part I
Lab Data: ABG and CPK/Isoenzymes
Radiology: CXR, VQ, Doppler
Cardiology: ECG, Cardiac Cath
Medications
Alerts
Discharge Summary

12. Case Summary
Case Description: bronchitis, bed-bound, venous thrombosis, pulmonary
embolism, myocardial infarction, ventricular arrhythmia, hypotension, seizure,
adult respiratory distress syndrome, methicillin-resistant Staph aureus
Discharge Plan
»Where?
»What happened?
Outpatient Follow-up
»Medications
»Laboratory
»Health Maintenance

13. CIS Demo -Part II
Demographic Information
Additional Hospitalizations?
More Discharge Summaries?
Recent Lab Results
Outpatient Notes

14. How Did We Do It?
Information Science
Standards
Integration

15. Medical Informatics -Lecture II
Information Science
Standards
Integration

16. Information Science
Expert Systems
Decision Support Systems
Research Databases
Computer Assisted-Instruction

17. <Show 4 CAI Slides>

18. Standards
Messaging
Vocabulary
Logic
Databases

19. Standards for Messaging
Structured Query Language
Z39.50
Health Level 7 (HL7)

20. HL7 Example
MSH!^~\&!resquery!cicsu9!socratesqry!wash!19950314151110307!!ORF!199503141!!
MSA!AA!19941125165590!RESULT LIST COMPLETED.!!
QRD!19941125165542!R!I!0113142726!!!99!1644144!res!32309!!
QRF!*!19901101000000!19941230170100!PDQRES2~*~OPSTA!95~95~95~PF~~
OBR!!!M136903542294808^0001!35422^^L!!!1994080807190000000!!!!!!!!!!!!!!!!!F!!!!!!!!!
OBX!!TX!35456^^L!1^0!138$135-146]mM/l!!!!!!!
OBR!!!M140333542394808^0001!35423^^L!!!1994080807100000000!!!!!!!!!!!!!!!!!F!!!!!!!!!
OBX!!TX!35456^^L!1^0!136$135-146]mM/l!!!!!!!
OBR!!!X263 3542294807^0001!35422^^L!!!1994080706520000000!!!!!!!!!!!!!!!!!F!!!!!!!!!
OBX!!TX!35456^^L!1^0!140$135-146]mM/l!!!!!!!

21. Standards for Vocabulary
International Classification of Diseases, 9th
Edition, with Clinical Modifications (ICD9-CM)
Diagnosis-Related Groups (DRGs)
Medical Subject Headings (MeSH)
Unified Medical language System (UMLS)
Systematized Nomenclature of Medicine
(SNOMED)
Read Codes
Knowledge-Based Vocabularies

22. ICD9-CM Example
003 Other Salmonella Infections
003.0 Salmonella Gastroenteritis
003.1 Salmonella Septicemia
003.2 Localized Salmonella Infections
003.20 Localized Salmonella Infection, Unspecified
003.21 Salmonella Meningitis
003.22 Salmonella Pneumonia
003.23 Salmonella Arthritis
003.24 Salmonella Osteomyelitis
003.29 Other Localized Salmonella Infection
003.8 Other specified salmonella infections
003.9 Salmonella infection, unspecified

23. DRG Example
75 -Respiratory disease with major chest operating room procedure, no
major complication or comorbidity
76 -Respiratory disease with major chest operating room procedure, minor
complication or comorbidity
77 -Respiratory disease with other respiratory system operating procedure,
no complication or comorbidity
79 -Respiratory infection with minor complication, age greater than 17
80 -Respiratory infection with no minor complication, age greater than 17
89 -Simple Pneumonia with minor complication, age greater than 17
90 -Simple Pneumonia with no minor complication, age greater than 17
475-Respiratory disease with ventilator support
538 -Respiratory disease with major chest operating room procedure and
major complication or comorbidity

24. MeSH Example
Respiratory Tract Diseases
Lung Diseases
Pneumonia
Bronchopneumonia
Pneumonia, Aspiration
Pneumonia, Lipid
Pneumonia, Lobar
Pneumonia, Mycoplasma
Pneumonia, Pneumocystis Carinii
Pneumonia, Rickettsial
Pneumonia, Staphylococcal
Pneumonia, Viral
Lung Diseases, Fungal
Pneumonia, Pneumocystis Carinii

25. SNOMED Example
D2-50000 SECTIONS 2-5-6 DISEASES OF THE LUNG
D2-50100 2-501 NON-INFECTIOUS PNEUMONIAS
D2-50100 Bronchopneumonia, NOS (T-26000) (M-40000)
D2-50100 Lobular pneumonia (T-28040) (M-40000)
D2-50100 Segmental pneumonia (T-280D0) (M-40000)
D2-50100 Bronchial pneumonia (T-280D0) (M-40000)
D2-50104 Peribronchial pneumonia (T-26090) (M-40000)
D2-50110 Hemorrhagic bronchopneumonia (T-26000) (M-40790)
D2-50120 Terminal bronchopneumonia (T-26000) (M-40000)
D2-50130 Pleurobronchopneumonia (T-26000) (M-40000)
D2-50130 Pleuropneumonia (T-26000) (M-40000)
D2-50140 Pneumonia, NOS (T-28000) (M-40000)
D2-50140 Pneumonitis, NOS (T-28000) (M-40000)
D2-50142 Catarrhal pneumonia (T-28000) (M-40000)
D2-50150 Unresolved pneumonia (T-28000) (M-40000)
D2-50152 Unresolved lobar pneumonia (T-28770) (M-40000)
D2-50160 Granulomatous pneumonia, NOS (T-28000) (M-44000)
D2-50170 Airsacculitis, NOS (T-28850) (M-40000)

26. Standards for Logic
HELP Sectors
CARE System
Arden Syntax for Medical Logic Modules

27. MLM Example
maintenance: title: Creatinine clearance;; version: 1.09;;
author: George Hripcsak, M.D. ([email protected]);; ;;
library: purpose: To calculate the creatinine clearance for every timed urine collection;;
explanation: When a timed urine collection is stored, the MLM checks for..... ;;
knowledge:
data:
let urine_creat_storage be event {'32506','1762'};
let (urine_creat, collect_time) be read last {'evoking', 'dam'="PDQRES1";'1762'; '1537'};;;
evoke: starting time of urine_creat_storage;;
logic:
let serum_creat be nearest (time of urine_creat) from (serum_creat_list where it is
number);
let creat_clear be 0.07 * (24 / collect_time) * (urine_creat / serum_creat);
conclude true; ;;
action: write "The creatinine clearance is " ||int(0.5+creat_clear)|| " ml/min based
upon a " ||collect_time|| " hour urine creatinine of " ||urine_creat||.....; ;;
end:

28. Standards for Databases
Definitions for Computer-Based Patient
Records
Data Model Standards

29. Integration
IAIMS: Integrated Advanced (Academic)
Information Management Systems
Five Levels of Integration
World Wide Web (WWW)

30. <5 Levels of Integration>

31. Architecture at CPMC
Workstations
Local Area Network
Internet
Clinical
Departments
Web Browser
Web Server
Vocabulary
Server
Additional Information
Sources
Clinical Data
Server
Clinical
Information
System
Resident Signout Editor
(RSE)

32. World Wide Web Demo
Visual Bed Browser
JMW’s CIS Menu
JMW’s Labs
Lab Trend
Medline Button Q's
Medline Button Results
Medline button Abstract
DXplain Button Extract
DXplain Button Results
DXplain Button Disease
Cholesterol Guideline Input
Cholesterol Guideline Result
ECG
Xray
Xray Medline Q's
Xray Medline Abstract
Medications
Single Drug Order
Drug/Diet Information
PDR
JMW’s Discharge Summary

33. Summary
Classification of Systems
Development of Standards
Intelligent Integration

34. Challenges
Security and Confidentiality
Vocabulary
Data Entry
Changing Behavior
»Outcomes assessment
»Managed care
»New paradigms for information use