MEDICAL INFORMATICS
IN THE AGE OF
INTERNET
Jan Pojer
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Major points
Hospital information systems
Medical information sources on the internet
Internet based applications of medicine
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Hospital information systems
Definition
A hospital information system (HIS) is a comprehensive information system dealing with
all aspects of information processing in a hospital. This encompasses human (and paperbased) information processing as well as data processing machines.
As an area of Medical Informatics the aim of an HIS is to achieve the best possible support
of patient care and administration by electronic data processing.
It can be composed of one or few software components with specialty specific extensions as
well as of a large variety of sub-systems in medical specialties (e.g. Laboratory Information
System, Radiology Information System)*.
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* LIS,RIS will be talked about later.
HIS
FUNCTIONS
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HIS
Area of use
Hospitals
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receptions, billing, laboratories, radiology, patient management
Usage of LIS and RIS is becoming a norm
PM (Practice Management)
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recording patient history, writing prescriptions, maintaining the treatment history,
accounts & billing, scheduling appointments and managing correspondence
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Laboratory Informational System
(LIS)
Software storing informations generated by labs
Must interface with other informationals system (HIS)
Functions : Order Entry, Patient Check In,Specimen Receipt, Results Entry,
Reporting ,Patient Demographics, Physician Demographics
Types : Hematology, Chemistry, Immunology, Blood bank donor center, Blood
bank transfusion, Surgical Pathology, Anatomical Pathology,
Radiological Information System
(RIS)
Comprises of patient tracking and scheduling, result reporting and image
tracking capabilities.
Design to store, manipulate and distribute patient radiological data and injuries
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HIS – case study
Two kinds of HIS in real life :
1.
Professional HIS
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2.
Hospitals all over the world
Nowadays every bigger hospital has some kind of HIS
Open source HIS

Care2x
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Hospital Na Homolce
Laboratory :

Clinical biochem., hematology a
imunology (OKBHI)
Hospital has Laboratory Informatinonal System (LIS)
All measured data are transmitted in to LIS and then properly managed
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Care2x
Care2x HIS is an open source development (OSD)
"GNU General Public License"
Its source code is freely-distributed and available to the general public.
Care2x integrates data, functions and workflows in a healthcare environment. It is currently composed of
four major components. Each of these components can also function individually.

HIS - Hospital/Healthservice Information System
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PM - Practice (GP) management
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It is designed to work in single department medical practices or clinics.
CDS - Central Data Server
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Care2x HIS solves the problems of multiple noncompatible programs.
Integration of almost any type of services, systems, departments, clinic, processes, data, communication, etc. that exist in a
hospital.
non-medical services or functions as well( like security, maintenance, etc.)
standard SQL database format for storing and retrieving data. The use of a single data format solves the problem of data
redundancy.
can support multiple database configuration to enhance data security and integrity.
no need for a special user interface software – simple web browser
central database server for the entire integrated healthcare environment.
HXP - Health Xchange Protocol

standard data exchange protocol being used by Care2x to communicate transparently with other healthcare applications
regardless of their platforms.
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MEDICAL INFORMATION
SOURCES ON THE INTERNET
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Medicine & Internet
Most common use of computers in medicine :
 communication by Email
 searching for medical information
Other reasons :
 eCommerce - sale & purchase of drugs, equipment,
instruments
 books
 medical software
eJournals
MEDLINE
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Medical Libraries
Design to assist finding health and science
informations, which will improve or evaluate health
care
Instituitions – hospitals, medical schools, privat
industry, health association
Every medical library should have access to
MEDLINE
World largest medical library – National Library of
medicine (US)
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National library of medicine
(NLM)
• Operated by federal government
• More then 7 000 000 books, journals, technical support, manuscript,, microfilms, photographs, images
• World’s rarest and oldest works
• established 1836 (now Bethseda, Maryland)
• Runs National Center of Biotechnological Informatics
•The NLM Catalog -1.2 million journals, books, audiovisuals, computer software, electronic resources, and other materials
( the NCBI Entrez retrieval system).
•Updated every weekday,
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National Center of
Biotechnological Informatics
(NCBI)
Most visible part of NLM
Houses biological databases
Freely accessible over internet through Entrez engine
and PubMed
PubMed - MEDLINE
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MEDLINE
Medical Literature analysis and retrieval online system
database of life science and biomedical informations
covers the fields of medicine, nursing, dentistry, veterinary medicine, and the
health care system.
freely available on the Internet through PubMed, searchable with the Entrez
engine.
14 000 000 records from 4800 publications (medical journals) from 1950’s till
now
Daily added
Global coverage (mostly English sources)
Medical Subject Headings for information retrieval
Engines design to search Medline uses Boolean Expressions (combining MeSH
terms, article words and date of publications)
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Structure information
retrieval through
PubMed
Examples of MeSH
HEADINGS :
STRUCTURE :
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MEDLINE II.
Many tutorials
Important source for biomedical scientists and
journal clubs.
Many other sources build on MedLine.
MedLine influences researchers in their choice of
journals in which to publish.
MedLinePlus – Health informations for patients and
health consumers.
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MedlinePlus
for patients and health care consumers
extensive information from the National Institutes of Health and other trusted sources on
over 650 diseases and conditions
interactive health tutorials
lists of hospitals and physicians
a medical encyclopedia (adam.com Health Illustrated Encyclopedia)
a medical dictionary (Merriam-Webster)
health information in Spanish
extensive information on prescription and nonprescription drugs
health information from the media
links to thousands of clinical trials
links to pre-formulated searches of the MEDLINE/PubMed database for recent research
articles on selected health topics
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OMIN
Online Mendelian Inheritance in Man
Database that catalogues all the known diseases with a genetic
component (genetic disorders)
Main focus inherite, heritable, genetic disorders
Part of NLM
Based on book : Mendelain Inheritance in Man (John Hopkins
University) author : Dr. Victor A. McKusick
Each OMIM entry is given a unique six-digit number whose first digit indicates the mode of inheritance of the gene involved:
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1----- (100000- ) Autosomal loci or phenotypes (entries created before May 15, 1994)
2----- (200000- ) Autosomal loci or phenotypes (entries created before May 15, 1994)
3----- (300000- ) X-linked loci or phenotypes
4----- (400000- ) Y-linked loci or phenotypes
5----- (500000- ) Mitochondrial loci or phenotypes
6----- (600000- ) Autosomal loci or phenotypes (entries created after May 15, 1994)
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INTERNET BASED
APPLICATIONS
OF MEDICINE
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Consumer Health Informatics
(CHI)
“Provide patients and health consumers with the tools,
skills and support they need to better manage their
health decisions “
CHI tools :
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Web sites providing self-care information,
Internet-based disease management tools
telemedicine
personal health records (PHRs)
online support groups
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Electronic Medical Records
An electronic medical record (EMR) is a computer-based patient medical
record.
An EMR facilitates :
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access of patient data by clinical staff at any given location
accurate and complete claims processing by insurance companies
building automated checks for drug and allergy interactions
clinical notes
prescriptions
scheduling
sending and viewing labs
The goal of NHS (National Health Service,UK) is to have 60,000,000 patients
with a centralized electronic medical record by 2010.
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TELEMEDICINE
The term Telemedicine is “the delivery of medicine at a distance”.
The term is composed of the Greek word τελε (tele) meaning 'far', and medicine. “
Samples from history
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African villagers – smoke signals in case of disease
1900’s – two way radios to communicate with Royal Flying Doctor Service of Australia
Two basic forms :
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Live telemedicine
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Telephone call, vidoconference
Both sides, high-bandwidth, low latency
Remote tactile support
Store-and-Forward telemedicine
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acquiring data, images and/or video and transmitting this material to a doctor or medical specialist at a
convenient time for assessment offline
Not both parties at the same time
Low bandwidth, high latency
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TELEMEDICINE II.
A proper Telemedicine interaction would involve store and forward followed by a live
interaction
Time tables :
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“JJ Hospital shall be talking to BB Clinic at 11.00 Hrs to discuss patient ABC”
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Telemedicine Consultant Sessions (TCS)
 patient – doctor
 local doctor - specialist
Special links at mobile phones in case of emergency
Use : extremely isolated cases, very high demand of specialist
radiology, ophtalmology, otolaryngology, dermatology, etc.
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e-Health
health care practice which is supported by electronic processes and
communication.
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Electronic Medical Records: enable easy communication of patient data between different healthcare professionals (GPs, specialists, care team,
pharmacy)
Telemedicine: includes all types of physical and psychological measurements that do not require a patient to travel to a specialist. When this service
works, patients need to travel less to a specialist or conversely the specialist has a larger catchment area.
Evidence Based Medicine: entails a system that provides information on appropriate treatment under certain patient conditions. A healthcare
professional can look up whether his/her diagnosis is in line with scientific research. The advantage is that the data can be kept up-to-date.
Citizen-oriented Information Provision: both healthy individuals and patients want to be informed on medical topics.
Specialist-oriented Information Provision: e.g. in an overview of latest medical journals, best practice guidelines or epidemiological tracking.
Virtual healthcare teams: consist of healthcare professionals who collaborate and share information on patients through digital equipment
TeleHealth
Umbrella term to describe all possible variations of healthcare services using
telecommunications
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Future of Telemedicine
TELESURGERY
 “Ability for a doctor to perform surgery on a patient even though
they are not physically in the same location.”
 It is a form of telepresence.
TELEPRESENCE

a human/machine system in which the human uses of (head-mounted)
displays and body-operated remote actuators and sensors to control distant
machinery.
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Statistics
69% patients discussed information found on the internet with their
health care professionals
80% doctors found this fact to be helpful (improving knowledges,
shorten general practice)
20% thought the opposite – risk of self-treatment
78% doctors recommended medical websites
72% doctors recommended support groups
1 million health webs
1000 new added every month
Health – the second most searchable word on the internet
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Obstacles with internet
Insufficient IT
training
23%
Lack of time
51%
Poor quality of
informations
26%
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CyberMedicine
(future)
Global exchange of open, non-clinical information by patients and doctor
Preventive medicine/ Public Health (Telemedicine/ diagnostic/curative)
Advances in communication technology - Increasing bandwidth, faster speed of
access images,voice, data
Free Internet
Online hospitals
Telemedicine/Telesurgery
Global teaching
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Reference
Internet :
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www.wikipedia.org
www.care2x.com
www.nlm.nih.gov
www.health-infosys-dir.com
www.google.com
Knihy :
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Informatika v klinické praxi : Josef Berger
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