COMP 3830 Health Informatics A Guide to Startup

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COMP 3830Health InformaticsA Guide to Start-up
Success

• Dr CP Wong
• Chairman
• Clinical Informatics Program Steering Committee
• Hong Kong Hospital Authority

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Outline

• Definition Bioinformatics / Health Informatics
• Benefits
• Non-technical issues
• International Perspectives
• Local Perspectives

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Biomedical Informatics

• Medical Informatics
• Health Informatics, Clinical Informatics since
  1960s
• Bioinformatics
• only recent decade
• http//www.mc.vanderbilt.edu/dbmi/informatics.html

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This is health informatics!
Imaging and Signal Analysis36. Image processing
and transmission37. Image recognition,
registration, and segmentation methods38.
Imaging and signal standards39. Knowledge
representation and ontologies for imaging40.
Model-based imaging41. Signal processing and
transmission42. Virtual reality and active
vision methods and applications Innovative
Technologies in Health Care43.
Computer-communication infrastructures44.
Internet applications45. Mobile computing and
communication46. Portable patient records47.
Security and data protection48. Software agents
and distributed systems49. Telemedicine50.
Virtual reality51. Wireless applications and
handheld devicesKnowledge Management52.
Automated learning and discovery53. Clinical
guidelines and protocols54. Controlled
terminology, vocabularies, and ontologies55.
Intelligent data analysis and data mining56.
Decision support systems57. Knowledge
management58. Knowledge representation59.
Neural network techniques60. Pattern
recognition/classification Nursing
Informatics61. Nursing informatics62. Nursing
care systems63. Nursing vocabulary and
terminology64. Nursing education/Curriculum in
nursing informatics65. Nursing documentation

• Bioinformatics1. Biological structure
  informatics2. Computational biology3.
  Expression profiling and microarrays4. Genomic
  ontologies5. Genomics6. Linking the genotype
  and phenotype7. Neuroinformatics8.
  Pharmacogenomics9. Proteomics
• Clinical Informatics10. Barriers to clinical
  system implementation11. Clinical systems in
  ambulatory care12. Clinical systems in high
  intensity care13. Careflow and process
  improvement systems14. Disease management15.
  E-health and clinical communication16.
  Evaluation of health information systems17.
  Health data warehousing18. Health information
  systems19. Integrated health and financial
  systems
• Education and Training20. Computer-assisted
  medical education21. Consumer health
  information22. E-learning or distance
  learning23. Education and training24. Library
  information systems25. Medical informatics
  teaching26. Patient education and self-care27.
  Professional education
• Human Information Processing and Organizational
  Behavior28. Cognitive models and problem
  solving29. Data visualization30. Natural
  language understanding and text generation31.
  Human factors and usability32. Human factors and
  user interfaces33. Human-computer
  interaction34. Models of social and
  organizational behavior35. Natural language
  processing

Organizational Issues66. Careflow management
systems67. Care delivery systems68. Cooperative
design and development69. Economics of care70.
Ethical and legal issues71. Health services
evaluation performance and quality72.
Organizational impact of information systems73.
Quality assessment and improvement74. System
implementation and management issues75.
Technology assessment Patient Record76.
Cryptography, database security, and
anonymization77. Database access and
delivery78. Database design and construction79.
Data standards and enterprise data sharing80.
Patient record management81. Privacy,
confidentiality, and information protection82.
Standard medical vocabularies83. Standards for
coding84. Standards for data transfer Public
Health Informatics85. Administrative/financial
systems86. Biosurveillance87. Consumer health
informatics88. Emergency and disaster
response89. Genetic epidemiology90. Health
intervention systems91. Health promotion
systems92. Health outcomes assessment93.
Patient self-care and patient-provider interaction
Adapted from Bernstam University of Texas
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Clinical Informatics

• The design implementation of advanced
  information and computational technologies in
  health care.
• Deals with patients, hospitals, laboratory tests,
  physicians, and other health-care professionals.
• Pressures to increase quality decrease costs by
  using information technologies in health care.

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Bioinformatics
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Bioinformatics

• 1. Biological structure informatics2.
  Computational biology3. Expression profiling and
  microarrays4. Genomic ontologies5. Genomics6.
  Linking the genotype and phenotype7.
  Neuroinformatics8. Pharmacogenomics9. Proteomics

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Bioinformatics

• Information being produced by the genome
  sequencing projects
• For medical diagnostic therapeutic uses
• For other industrial applications

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Bioinformatics

• A discipline (or sub-discipline) recognized for
  less than 10 years
• Traced back to the early application of computers
  to biology in 1950s and 1960s
• Graphical rendering of 3D molecular structure
• 3D structure information
• Creation of databases of molecular sequence

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Bioinformatics

• Definition the study of how information
  technologies are used to solve problems in
  biology
• Narrow The creation and management of biological
  databases in support of genomic sequences
• Broad All applications of computers and
  information sciences to problems in biology

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Applications

• Prediction of protein structure and function
• Design of small molecules to augment or inhibit
  biological function
• Analysis of complex genetic phenomena
• Design of modified macromolecules for medical or
  industrial uses
• Understanding how genetic factors contribute to
  host susceptibility to disease ( pathogenicity
  of infectious agents)

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Recent Explosive Growth

• Emergence of the genome sequencing projects
  (GENBANK, EMBL)
• Large scale data collection efforts in biology
  (Protein Data Bank)
• The Human Genome Project

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Potential Applications

• Pharmaceutical industry
• New therapeutic and diagnostic approaches
• Cancer research

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Clinical Bioinformatics

• Sequence information will routinely be stored in
  the medical records in next 5 to 10 years
• Lessons learned in the creation and maintenance
  of biological genetic databases will be useful in
  electronic medical record
• Genetic background of patients is a critical
  element of patients past medical history
• Tracking of infectious disease and optimal
  antibiotics treatment will be driven by genetic
  features of the pathogens

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What is Health Informatics?

• Simplistic definition
• Computer applications in medical care
• Complicated definition
• the study, invention, implementation of
  structures algorithms to improve communication,
  understanding management of medical information

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What is Health Informatics?

• End objective
• Coalescing of data, knowledge the tools
  necessary to apply that data knowledge in
  decision-making processes
• Focus on the structures algorithms necessary to
  manipulate the information
• Separates from other medical disciplines where
  information content is the focus.

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Computers in Medicine?

• Informatics not just application of computers to
  medicine
• Computers are transforming tools
• There are other tools drawn from
• Clinical and basic (biological) science
• Decision analysis
• Probability and statistics
• Cognitive and social science, pedagogy
• Etc.

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Krusch, 2002 Definition

• Intersection of the art science of medicine
  with the information technology tools that are
  used to
• Enhance delivery of patient care (applied
  informatics)
• Discover new knowledge about disease processes
  and outcomes (research medical informatics,
  decision support medical informatics)
• Discover new knowledge about the science of
  medical information processing (basic science
  medical informatics)

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Clinical Informatics

• 10. Barriers to clinical system
  implementation11. Clinical systems in ambulatory
  care12. Clinical systems in high intensity
  care13. Careflow and process improvement
  systems14. Disease management15. E-health and
  clinical communication16. Evaluation of health
  information systems17. Health data
  warehousing18. Health information systems19.
  Integrated health and financial systems

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Education and Training

• 20. Computer-assisted medical education21.
  Consumer health information22. E-learning or
  distance learning23. Education and training24.
  Library information systems25. Medical
  informatics teaching26. Patient education and
  self-care27. Professional education

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Human Information Processing and Organizational
Behaviour

• 28. Cognitive models and problem solving29.
  Data visualization30. Natural language
  understanding and text generation31. Human
  factors and usability32. Human factors and user
  interfaces33. Human-computer interaction34.
  Models of social and organizational behavior35.
  Natural language processing

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Imaging and Signal Analysis

• 36. Image processing and transmission37. Image
  recognition, registration, and segmentation
  methods38. Imaging and signal standards39.
  Knowledge representation and ontologies for
  imaging40. Model-based imaging41. Signal
  processing and transmission42. Virtual reality
  and active vision methods and applications

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Innovative Technology in Healthcare

• 43. Computer-communication infrastructures44.
  Internet applications45. Mobile computing and
  communication46. Portable patient records47.
  Security and data protection48. Software agents
  and distributed systems49. Telemedicine50.
  Virtual reality51. Wireless applications and
  handheld devices
• Knowledge Management52. Automated learning and
  discovery53. Clinical guidelines and
  protocols54. Controlled terminology,
  vocabularies, and ontologies55. Intelligent data
  analysis and data mining56. Decision support
  systems57. Knowledge management58. Knowledge
  representation59. Neural network techniques60.
  Pattern recognition/classification

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Nursing Informatics

• 61. Nursing informatics62. Nursing care
  systems63. Nursing vocabulary and
  terminology64. Nursing education/Curriculum in
  nursing informatics65. Nursing documentation

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Organizational Issues

• 66. Careflow management systems67. Care
  delivery systems68. Cooperative design and
  development69. Economics of care70. Ethical and
  legal issues71. Health services evaluation
  performance and quality72. Organizational impact
  of information systems73. Quality assessment and
  improvement74. System implementation and
  management issues75. Technology assessment

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Patient Records

• 76. Cryptography, database security, and
  anonymization77. Database access and
  delivery78. Database design and construction79.
  Data standards and enterprise data sharing80.
  Patient record management81. Privacy,
  confidentiality, and information protection82.
  Standard medical vocabularies83. Standards for
  coding84. Standards for data transfer

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Public Health Informatics

• 85. Administrative/financial systems86.
  Biosurveillance87. Consumer health
  informatics88. Emergency and disaster
  response89. Genetic epidemiology90. Health
  intervention systems91. Health promotion
  systems92. Health outcomes assessment93.
  Patient self-care and patient-provider interaction

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Computerized Patient Record CPRElectronic
Medical Record EMRElectronic Patient Record
ePRElectronic Health Record EHR

• Integrated view of patient data
• Access to knowledge resources
• Physician order entry and clinician data entry
• Integrated communications support
• Clinical decision support

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Computerized Patient Records

• The key to all health information system
• To document the care activities applied to each
  individual patient
• To coordinate clinical work flow among the
  professionals and their resources
• To provide comparable data about costs, charges,
  effectiveness, and anticipated demand with
  respect to various patient cohorts

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Disadvantages of manual systems

• NOT TIMELY Information is only available in
  batches, e.g. every five years, and publication
  of the results can be considerably delayed
• UNRELIABLE Relies on the cooperation of health
  care workers to manually complete detailed
  questionnaire
• INEFFICIENT Waste of a lot of resources and time
• DUPLICATION Double entries at multiple sites
• SINGLE USER One copy to be used by one user only
• INCOMPLETE Data may be incomplete because of
  human errors
• INAPPROPRIATE Difficulty in identifying the
  target groups
• INACCURATE Unreliable data from memory or records

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Healthcare Delivery Challenges

• Medical error, patient safety, quality and cost
  issues
• 1 in 4 prescriptions taken by a patient are not
  known to the treating physician
• 1 in 5 lab and x-ray test ordered because
  originals cannot be found
• Patient data unavailable in 81 of cases in one
  clinic, with an average of 4 missing items per
  case
• 18 of medical errors are estimated to be due to
  inadequate availability of patient information
• 40 of outpatients prescriptions are unnecessary
• Patients receive only 54.9 of recommended care

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Healthcare Delivery Challenges

• A fractured and unwired healthcare system
• Medicare beneficiaries see 1.3 to 13.8 unique
  providers annually, on average 6.4 different
  providers per year
• 90 of the gt30 billion US healthcare
  transactions in the US every year are conducted
  via mail, fax or phone

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Potential for improving health care by computers

• Support administrative/clerical processes faster
  completion of tasks, fewer transcription errors,
  reduced numbers of personnel, increase
  accessibility, efficiency productivity
• Produce good quality information, both clinical
  operational
• Error checking, drug interactions, allergies
  dosages
• Improve communication between health care
  professionals patients, including records,
  appointments education.
• Opportunities for new ways of managing patient
  populations their medical problems, e.g. care
  plan, critical pathways, quality assurance, etc.

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CPR Benefits

• Patients
• Whole records available at point of care
• No need for repeated tests
• Doctors
• More efficient clinical practice
• Better decision making with comprehensive info
• Avoid errors associated with paper records
• Access data and images at home or remote sites
• Organization
• Better use of resources
• Data for planning, research and management

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Human Issues
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Issues in Medical Informatics

• Human-machine interface acceptance
• Standards for exchanging clinical data (Health
  Level Seven HL-7, 1994), images (ACR/NEMA,
  DICOM), clinical observations (ASTM Committee
  E-31), bedside instrument data (IEEE, 1995),
  prescription data (NCPDP, 1992), and
  administrative data associated with claims
  (Accredited Standards Committee X12N).

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Issues in Medical Informatics

• Coding sets ICD9-CM, ICD10, SNOMED III, CPT,
  NANDA, Read Classification, LOINC, and MEDRA
• Security Privacy Confidentiality
• Infrastructure
• Cost-benefit analysis
• Education and Training

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International Perspectives
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Health IT Around The Globe

• HK
• Corporate
• 1.9 (5)
• gt Central
• In-House
• No
• Advanced
• Most
• No
• No
• No

• USA
• Local
• 4 (14)
• gt Central
• Packages
• Yes
• Advanced
• Few
• Yes
• Yes
• Yes

• UK
• Local
• 2 (6)
• gt Central
• Packages
• Yes
• Implement
• Few
• Yes
• No
• Yes

Australia Corporate 2 (9) gt Central Packages Yes
Implement Few Yes No Yes
Manage Funding Operations Software ERP
System CPR System Doctors Use Outsource ASPs Loca
l Vendor
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Local Perspectives
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A long journey of development

• 1990 Green field no legacy system
• 1991 Patient Administration only
• 1992 Pharmacy System added
• 1993 Lab results online
• 1994 Radiology Information System
• 1995 Clinical Management System
• Order Entry Outpatient progress notes
  Discharge summaries
• 2000 Electronic Patient Records
• 2004 Radiology Images online
• 2006 ePR sharing with GP

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Conclusion

• Health informatics is the enabler for healthcare
  service development and quality assurance
• Every country is aiming at national electronic
  health record for all citizens
• There is tremendous potential for growth in this
  field