Medical Informatics

For a Hospital Medical System Setting

By Dr. James G. Williams

Medical Informatics• Medical informatics is a broad field spanning electronic medical

records, telemedicine, information retrieval, image processing and analysis, bioinformatics, and evaluation methodologies.

• Outcomes research is the study of the effectiveness of health care using large data sources and other advanced technologies.

• Medical Informatics focuses on Health Care, including electronic medical records, information retrieval, medical decision-making, telemedicine, clinician information needs, artificial intelligence, and outcomes research.

• As a result of medical informatics training, graduates are better able to take on additional IT responsibilities in their existing careers or embark on new careers as developers and managers of healthcare IT systems.

• But what level of technical training is necessary to make a graduate’s skill set adequate for the career opportunities?

Islands of Information in Hospitals• Medical History• Order Processing• Blood Bank• Laboratory Tests• Pharmacy• ADT (Admissions, Discharge, Transfer)• Vital Signs• Transplant Units• Physical Therapy• Dietary• ICUs• Radiology, Cardiology, Nuclear Medicine• Out-Patient Clinics• Surgery• Billing Insurance, HMO, and Government• Scheduling Residents, rooms, equipment• Research Support

Best of Breed Approach

• Each functional area (department or lab) wants the best system for their area.

• For example, SunQuest for Laboratory Testing, MediPac for ADT.

• This creates multiple systems that are unable to exchange information easily

• The task of the IT department is to integrate the data from these systems

Integrated Medical Information

• Patient Medical Record should contain every piece of relevant medical data ever generated concerning a patient

• Patient Medical record should be available to health care workers anywhere, anytime.

• Need to get the data into a digital form.

• Need to create a database capable of storing data in multimedia formats.

Integrated Medical Information• Need to provide access to only that data as

needed by the health care worker.• Need to provide a means to correlate data from

various sources, e.g. symptoms, tests, diagnoses, family history.

• Need to present data in a form and format that is understandable

• Need to be Health Care Worker Oriented, not function or department oriented.

• Need to protect the patient’s right to privacy.• Can the Patient carry his/her medical record with

him/her?

IntegratedMedical record

Blood Bank

Pharmacy

Radiology

ADT

Surgery

Medical History

Health Care Workers

Physical Therapy

Dietary

Vital Signs

TransplantICUs

Out-PatientClinics

Billing

Cardiology Nuclear Medicine

Medical Archive(Data Mining Source)

Medical ArchiveDatabase

MedicalRecords

MedicalResearch

Information Retrieval, Artificial Intelligence,Medical Diagnosis Support, Survival Intelligence

Medical Archive Record System (MARS)

• University of Pittsburgh Medical Center has data feeds from all departments to a system called MARS.

• Surrogates are sent for image data that is maintained in separate databases.

• Each source (department) has a tagging system for individual data elements within the records or documents they send.

• MARS has meta data describing the data from each source.

MARS

• The data is stored in text format since this allows flexibility in searching

• All data about a patient is available at all times.

• Acts as a data warehouse for research

• Reference to images (X-Rays, sonograms, etc. are maintained)

• Full text of reports are maintained

To Do List A feature that helps keep track of the status of tasks

Prescription Writing Reduce the time spent refilling prescriptions by using the list of pre-built Rx codes or using previous prescriptions made.

Patient Summaries and H & P's

Track all of the pertinent historical information on your patients.

Note generationQuickly document a patient encounter with pre-built templates and codes.

All pertinent patient data on one screen

Reduces the amount of time spent searching a record for valuable information.

Patient Pictures Import a patient's picture into demographics section of their chart.

Free-text or template driven entry

You can enter the patient data the way you want to.

Lab/Radiology/Pathology Reports

Store ancillary reports for quick review.

All Codes/Protocols/Reports completely customizable

Generate patient information with a look that's all your own.

Phone Message Section

Record the who, what and when of non clinic based encounter.

Vital Sign Tracking and Charting

Tabulator format allows for easy review of vital signs over time and instant charting of data.

Import Reports from other systems

Import an ASCII or RTF formatted report directly into the chart.

Comprehensive Demographics

Track all pertinent demographics information

250+ Prebuilt Protocols (Templates)

Use the included templates out of the box or as a starting point for your own documentation guidelines.

Patient Education Handouts

Make sure your patients get the information they need by providing easy to understand informational handouts.

1000's of pre-built Dx/Rx/Plan/Follow Up Codes

Codes help to speed data entry by replacing long blocks of typing with small, easy to remember codes that "expand" to the full narrative.

Works with Voice Recognition systems

Use the latest versions of popular voice recognition software to reduce the amount of typing required.

Critical Design Factors

• Unique Patient Identification that will never change

• Unique Identification for every health care worker

• Unique Identification for every product, e.g. blood product, X-ray, etc.

• Unique Identification for every service, e.g. transfusion, physical therapy, etc.

AI in Medical Informatics

• Problem-Knowledge Couplers help to guide the medical care of an individual by soliciting information from a patient about a medical condition, and then coupling, or linking that information to a medical knowledge database. The result of the coupling is a list of care recommendations based on the patient's unique set of medical findings.

Medical Couplers

• Screening Couplers, such as Wellness, Physical Examination, and Medical History, are used to discover medical problems.

• Diagnostic Couplers, such as Chest Pain, and Knee Problem, are used to help determine the cause or causes of medical problems

• Management Couplers, such as Asthma, Hypertension, and Diabetes, are used to manage medical problems where the cause is known.

Telemedicine

• Home telemedicine for the management of diabetes in elderly patients in medically underserved areas. Informatics research areas include logistics, user interfaces, patient education, user interfaces, security and videoconferencing technology.

Discovering Knowledge

• Machine learning and visualization are methods for discovering knowledge in large databases. Research focuses on testing and extending existing discovery methods to improve their performance on clinical data. Important issues include training set size, data accuracy, data completeness, and representation.

Patient Access to Medical Records

• Patients' access to their own medical records is assumed to be a consequence of the emergence of electronic medical records and is being mandated by federal regulations. Yet, very little is known about how patients will fare in comprehending and using the information, and how it will impact the patient-caregiver relationship.

Reducing Medical Errors

• Two common causes of medical errors are– inadequate access to information needed for decision

making and – ineffective communication among members of the

patient care team.

– Reduce errors by (a) link patient data to relevant on-line information resources, (b) a virtual whiteboard to facilitate the coordination of patient care tasks among the house staff, attending physicians and nurses, and (c) deployment on a wireless, handheld platform.

Medical Decision Making

• University of Utah Study has suggested that nurses use different problem-structuring and knowledge-structuring principles than those used by physicians for medical decision making

Nursing Informatics

• (a) data and information are symbolic representations of the phenomena with which nursing is concerned,

• (b) expertise in problem structuring is domain specific and

• (c) algorithms and heuristics used in solving domain problems are peculiar to nursing.

Critical Design Factors

• Interfaces must be tailored for the health care worker, e.g. physician, nurse, pharmacist, radiologist, lab tech, etc.

• Minimize keying and use scanning technologies, e.g. bar codes, optical character recognition, etc. to avoid mistakes.

• Date and Time Stamp every piece of data

Critical Design Factors

• Allow for multimedia data objects, optical (X-rays, sonograms, strip charts…), voice (dictations), numeric (test results), text (medical history, diagnosis, orders)

• Provide for indexing optical and voice data objects either automatically or manually (Content Analysis, Voice Recognition)

• Provide for searching across medical records and finding patterns

Critical Design Factors

• Provide for drug interaction verification• Provide high speed access and

presentation• Provide for remote and mobile access to

archive and ICU monitoring data• Utilize colors for presentation of test

results that indicate safe/negative (green), caution/borderline (yellow), positive/danger (red)

Critical Design Factors

• Provide standard statistical analysis capabilities (BMDP)

• Provide graphing capabilities

• Provide for report writing templates from medical test results (Phrase Paragraph)

• Provide for text to voice or voice to voice over the telephone system of test/diagnosis for referring physician

Critical Design Factors• Use Visualization techniques for presentation of

massive amounts of data.• Provide for on-line help for every data element,

e.g. test result, drug, conversions (milliliters to liters, grams to milligrams, etc.)

• Track every access to data for security, privacy, and utilization purposes.

• Fault Tolerant Systems• Off the shelf system software – Not MUMPS

Visualization of Multiple Characteristics

Age

Weight

Sex - Male

BP (Average)

Economic Status (Average)

(Female)High)

(BP High)

Technologies Required

• High Speed Computers• Large Primary Memory• Massive and Fast Storage Devices (disk)• Graphical Devices (high resolution)• Digital X-Ray, Sonograms, etc.• High Speed Network• Mobile and Handheld interface devices• Scanning Technologies (Bar Code, OCR)• Voice Processing Hardware

Technologies Required

• Database Management Systems• Graphical Software• IR Software• AI software• Voice Recognition and Text to Speech Software• Decision Support Software• Statistical Analysis Software• Application Specific Software• Fault Tolerant Systems