Medical Informatics:
Computers, Decisions, and Communications
Vlad Olchanski, PhD
o Moscow Institute of Physics and
Technology
o Institute of Control Sciences
o International Institute for Applied
Systems Analysis
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o World Health Organization
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o Medical College of Virginia
November 14, 2001
MCV Course for 4th year medical students
Dr. Olchanski Home Page
Medical Informatics
Outline of Course
Philosophy of Governing Life
Informatics
Component 1
Information Technology
Computers
Communications
Internet
Component 2
Decision Support and Theory
Medical Records
Diagnostic Support
Pharmaceutical Prescriptions
Health System Modeling
Data Mining
Medical Informatics
INTRODUCTION
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Why Learn Medical
Informatics?
Cutting Edge Technologies:
1930s
Radio communications
1990s
Computers, Internet
Why Learn Medical
Informatics?
In the 1920-1930s the
Radio was very cool.
In those days, the Radio
was not a black box with
buttons you have in your
car.
To get a good reception,
you had to know a little
bit about electronics and
things...
Why Learn Medical
Informatics?
Computers are cool
today.
If you don’t know a little
bit about what "coils”
are inside you will get frustrated
and will bother other
people.
And yet we want
computers and IT now!
Why Learn Medical
Informatics?
21st Century the Age of Informatics
Major Tool of Informatics -- INTERNET
IT is not as simple today as is Radio.
Internet will turn into a black box with
buttons.
But not today.
And not tomorrow.
Why Learn Medical
Informatics?
Therefore, to behave as a conscious
Medical Professional, a Physician of today
has to know the basics of Information
Technology as well as the basics of
Physiology and Pharmacology.
Yet the Information Technology alone
cannot help you without the intellectual
component of Medical Informatics: the
Decision Theory.
Phi Beta Kappa
- philosophia biou kybernetes
Philosophy Governs Life
Philosophy
Mathematics
Natural Philosophy
Physics
Engineering
General Theory of Systems
Cybernetics
Informatics
Kybernetes
Governs
Cybernetics
General Theory of Systems
Bertalanffy (Austria-Hungary), Bogdanov (Russia) - 1908
Crash of empires after the Great War
The Second World War: FLAK, Enigma
Norbert Wiener (MIT):
Cybernetics: Control and Communication in the
Animal and the Machine - 1948
Theory of Information, Finite Mathematics, Probabilities
John von Neumann (Princeton)
Alan Turing (Bletchley Park)
Claud Shannon (MIT)
Andrey Kolmogorov (Moscow State)
First Computers
This weaponry could not protect England:
Cybernetics
Theory of Information
Communications
Coding
Algorithms
Probabilities and Stochastic Processes
Theory of Control
Operations Research
Optimization
Management Science
Systems Analysis
Applications
Live, bio-systems
Engineering, machines, robots
Organizational systems
Computer Science
Systems Analysis
Decision Support, Artificial Intelligence
Whence Informatics?
Concept of Cybernetics too broad
Word Cybernetics tarnished, devalued by
Sci-Fi and Pop culture
Pragmatic reduction to Computer Science
in USA
CS translated into INFORMATIQUE in
France
Backward translation of CS as
INFORMATICS expanding the scope
Handbook of Medical
Informatics
 http://www.mieur.nl/mihandbook
 http://www.mihandbook.stanford.edu/
This excellent book unfortunately
has very little coverage of the
Internet applications.
Otherwise, this is the #1 Resource!
Medical Informatics
Definitions
Medical Information Science is the science of
using system-analytic tools . . . to develop
procedures (algorithms) for management,
process control, decision making and scientific
analysis of medical knowledge - Ted Shortliffe
Medical Informatics comprises the theoretical and
practical aspects of information processing and
communication, based on knowledge and
experience derived from processes in medicine
and health care - Jan van Bemmel
Whence Informatics?
Computer Science and Informatics are
practically synonyms: the difference in
emphasizing the application aspect
Informatics is frequently understood as
broadly as Cybernetics -Information Processing including Decision
Making and Systems Analysis
Names used for Medical
Informatics
medical computer science
medical information science
computer application(s) in medicine
health informatics,
and more specialized terms such as
nursing informatics
dental informatics
and so on.
Informatics - What?
Information Technology and Theory
Computers, Communications, Data
Processing, Algorithms
Decision Theory and Applications
Bayesian Approach, Expert Systems,
Artificial Intelligence, Knowledge-based
Systems, Algorithms
A Good INTRO to Informatics
But should we go all the way together?
Medical Informatics
INFORMATION TECHNOLOGY
COMPUTERS
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Computers: Evolution
Von Neuman and the first MAINFRAME at IAS (1948)
Vacuum tubes, punch cards or tape
Batch mode of operation
Low reliability - maintenance team of electronics engineers
Transistors - Bill Shockley, 1956 NP
MINICOMPUTERS
MICROCOMPUTERS
Interactive mode of operation
Higher reliability due to Transistors
Interactive mode of operation
Reduced size and enhanced
reliability due to Integrated Circuits
SUPERMINIS
WORKSTATIONS
PERSONAL COMPUTERS
Renamed from minicomputers to show due respect
SUPERCOMPUTERS
Computers:
Operating Systems
Mainframe OS -- oriented to batch processing
Minicomputers -- more interactive, usually designed by
hardware manufacturer, like RSX, VMS for late
DEC machines
Unix - an attempt to standardize
Personal computers -- CP/M, MS DOS, IBM OS/2,
Mac OS, Windows, Unix
Internet developed mainly on Unix machines
Computers:
Operating Systems
Windows should not be used for critical applications
Programming Mainframe
A punch card and the editing tool
Page 104 of a program listing
H
Programming Mainframe
Booting your computer -- giving it a kick?
Programming Mainframe
Booting your computer -giving it a kick?
No!
It is short from bootstrapping.
“Bootstrap” was the name of
a short length of the punched
tape that was fed to a
computer to initiate loading of
the Operating System.
Computer Architecture
CPU, RAM, Bus, etc.
are discussed in class
Computers: Objects
Files:
Windows Commander: “http://www.ghisler.com”
Name
Type
Size
Time
Attrib
Owner
long name, DOS name avoid spaces in names!
extension, internal header, MIME type
actual / on disk
creation / modification / access
hidden / system
sysadmin/owner / group / world/other
Directories (folders):
c:\
..\
root
parent
Computers: Startup Files
config.sys
autoexec.bat
system.ini
win.ini
Registry
System.dat
User.dat
SAM
in Unix:
.cshrc
Text editors: Notepad.exe
UltraEdit.exe
Computers: Commands
dir
cd
delete
copy
mkdir
rmdir
attrib
xcopy
diskcopy
format
tree
date, time
path
set
sort
more
/p - by page
help
/? -? /h -h
Computer Architecture
Data storage on disks
File Allocation Table
Security issues
are discussed in class
after Information Coding
presentation
Some Utilities
Calculator (scientific mode)
Character Map (Symbols to Computer
Code)
Notepad (Text editor)
Medical Informatics
INFORMATION TECHNOLOGY
COMMUNICATIONS
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Communication Protocol
Layers
ISO Open System Interface
Internet
the application level is what we use:
Email, FTP, Telnet, HTTP, etc.
the physical layer is a stream of bits
Internet Protocols
FTP (file transfer protocol) serves to
exchange data with a remote computer
Telnet allows to run programs on a
remote computer
Terms:
Upload - send TO a remote recipient
Download - receive FROM a remote sender
Remote Computing - I
Fred at UBC has
report software...
Wilma at CUNY has data, needs report!
Remote Computing - II
Fred sends Wilma
the username
and the password
Never by EMAIL !!!
Wilma at CUNY has data, needs report!
Remote Computing - III
Fred at UBC has
report software...
FTP
Wilma uploads her data with FTP
Remote Computing - IV
Fred at UBC has
report software...
Telnet
Wilma manipulates her data on Fred’s
computer with Telnet
Remote Computing - V
Fred at UBC has
report software...
FTP
Wilma downloads the report with FTP
Remote Computing - VI
Fred at UBC has
report software...
Email
Wilma prints the report in her office
and sends her kisses to Fred by email
Remote Computing Security
Using Email - 1
Email is very much like Regular Mail:
sending mail and receiving are done quite differently!
To send mail, you may to drop it in any mail drop box in the
street.
To send email, you may connect and use any SMTP server
in the world. It is for public convenience.
SMTP server sends email
Using Email - 2
You send a letter thru a Mail Drop Box
You may use any one you find in the street
Using Email - 3
You send an email thru a SMTP server
You may use any one you find in the Internet
Using Email - 4
Email is very much like Regular Mail:
sending mail and receiving are done quite differently!
To receive mail, you must have either your own mailbox
or rent a box at any Post Office.
To receive email, you must have an account with any
POP3 server. It will be your private possession. You may
have as many as you may wish.
POP3 server receives email
Using Email - 5
To receive a letter, you must have a home
or a number in a US Post Office
Using Email - 6
To receive an email, you must have an account
at a POP or IMAP mail server
you may have as many of these as you like
Using Email - 7
POP server delivers all messages to your computer -good when you are on a fast connection
IMAP server delivers only message headers and messages
on demand -- good when you are on a dial-up
Yet you will not have all messages on your computer
T’bird, Eudora, TheBat! support multiple email accounts
Webmail allows to use email with your browser -good when you are on the go
Hotmail, Yahoo, etc. may be used for simple purposes -but it is not a true email
Using Email - 8
You read and send email with Email Client
There are so many different Email Client programs -make your own choice
BUT
some of Email Clients
and some of Email USERS
go outside of Internet Standards
- incompatibility of messages
- errors in transmission and reception
Using Email - 9
SMTP
An operative
set of POP3 boxes
POP3
Using Email - 10
Basic Rules of Nice Conduct
1. Never consider email as confidential
2. Email should best be a simple message
3. Do not send messages formatted with HTML -not all email clients can deal with them,
confirms a hit for spammers
(impossible in AOL email program
)
4. Avoid sending binary attachments
these may come corrupted and can carry
viruses
How to avoid binary attachments in Email, see
“http://www.intmed.vcu.edu/inm/advice.html”
The Most Intimate Secret
Like Wine dichotomy in Russia
- White wine:
Moonshine, Vodka, Brandy
- Red wine:
all the rest
The Most Intimate Secret
Data dichotomy in Internet
- Text files:
Plain English text: A-Z, a-z, 0-9
- Binary files:
all the rest
The Most Intimate Secret
Symbols -- Bytes -- Octets
Secret == 53 65 63 72 65 74
Bits
1010011 1100101 1100011 1110010 1100101 1110100
Sept “bits” fassent un “octet”! This is the ASCII Standard.
Yet -Éç == C9 E7 == 11001001 11100111
Now you see that the French have a reason to call
the “byte” not “septet” but “octet”!
If you strip the 8th bit then corruption occurs:
É -> 49 == I and ç -> 67 == g
The Most Intimate Secret
The 7-bit data trasmission was set into
the infrastructure
The Most Intimate Secret
The Revelation
Only text files may be sent through Internet
Binary files will come corrupted
To send a binary, it must be converted to
a text file (encoded) and on the receiving end
the encoded file must be decoded.
In FTP protocol, the type must be told explicitly
In Email, binary files go as attachments.
There are different encode/decode procedures
which may lead to confusion and errors
Security: Cryptography
Sherlock Holmes: The Dancing men
ELSIE . .RE . ARE .TO M.EET .THY
.GO .
elsie PrePare To Meet Thy GoD
come here at once
Security: Cryptography
Edgar Allan Poe: Gold-bug
53++!305))6*;4826)4+.)4+);806*;48!8`60))85;]8*:+*8!83(88)5*!; 46(;88*96*?;8)*+(;485);5*!2:*+(;4956*2(5*4)8`8*; 4069285);)6!8)4++;1(+9;48081;8:8+1;48!85;4)485!528806*81(+9;48;(88;4(+?3 4;48)4+;161;:188;+?;
8 there
;
"
4 "
+) "
*
"
5 "
6 "
!1 "
0 "
92 "
:3 "
? "
` "
-. "
are 33.
26.
In English, the letter which most frequently occurs is e.
19.
Afterwards, the succession runs thus:
16.
13.
aoidhnrstuycfglmwbkpqxz
12.
11.
8.
6.
5.
4.
3.
2.
1.
5 represents a
! "
d
8 "
e
3 "
g
4 "
h
6 "
i
* "
n
+ "
o
( "
r
; "
t
A good glass in the bishop's hostel in the devil's seat twenty-one degrees and
thirteen minutes northeast and by north main branch seventh limb east side
shoot from the left eye of the death's-head a bee line from the tree through the shot fifty
feet out.
Security: Criptography
Enigma, German Coding Machine
Security: Cryptography
Encryption with a keyword
“this is plaintext” , the key is “key”
+ (add codes)
“keykeykeykeykeyke”
Encrypted text:
“dxkfpsnputmsodjss”
Plain book, a simple
but efficient tool
Decryption with a keyword -- the key must be sent to the
recipient
this is the weakest point
Encrypted text:
“dxkfpsnputmsodjss” , the key is “key”
- (subtract codes)
“keykeykeykeykeyke”
One-time
Decrypted text:
pad
“this is plaintext”
Security: Cryptography
PGP:
Pretty Good
Protection
Fred’s
public
key
My key ring of public keys of
my correspondents
My secret
private key
My public key
stored on my
website and in
public depositories
Security: Cryptography
I send message to Fred
Dear Fred, bla-bla...
Fred reads my message
]hk@s#2kdMs0fHquja...
Fred’s
public
key
Fred’s private key
Fred answers my message
I read Fred’s answer
My public key
Dear Vlad, bla-bla...
Dear Fred, bla-bla...
My private key
Msios$[\iqN7dkoZnu...
Dear Vlad, bla-bla...
Security: Cryptography
Communications. Security
80% trash, 5% pearls
Internet Protocols
Usenet, News, Forums -- NNTP Protocol
A small ISP carries
~45,000 groups.
Different ISPs
give different groups,
have different scopes
Medical and Health
Related Groups listed:
www.mipt.vcu.edu/ng.html
Internet Protocols
World Wide Web == HTTP protocol
User client -- browser
Netscape, Internet Explorer, Opera, Firefox
WWW is only a small part of Internet !!!
AOL and MSN are not Internet at all !!!
Internet
AOL
gateway
MSN
gateway
archive.salon.com/tech/feature/2001/06/26/locking_up_the_web/index3.html
Internet Services Providers give you full Internet
Internet Connectivity
Internet Addresses
DSN:
views.vcu.edu
look up
Host file
Domain Name Server
connect
IP:
128.172.65.8
Telephones
Name:
Vlad Olchanski
look up
Personal notebook
Phone Directory
dial
Number:
804.828.5384
PING and TRACERT accessible through START/RUN
Internet Connectivity
A decent ISP must give a client:
o SMTP address to send email
o POP3 address to access the mailbox
o NNTP address to get Newsgroups
Additionally:
o Space to host website at ISP’s IP address
o FTP access to update website
Optionally:
o Static IP address for hosting own website
Information Technology
Viruses
Viruses, Trojans, Worms, Bots, Denial of Service
Virus Shields, Firewalls
are discussed in class.
Read also Steve Gibson’s saga about a virus attack:
http://grc.com/dos/intro.htm
Information Technology:
Secure Use of Internet
Now let us see a presentation on how to
practice Internet connectivity safely.
Information Technology
Basics of Security - 1
• make sure workstation is physically safe and secure
• never send passwords by email
• never paste passwords beside the workstation
• install and regularly (weekly) update virus protection
• avoid sending attachments
• never open unsolicited attachments, always check and
double-check the attachment’s file extension
Information Technology
Basics of Security -2
 never open unexpected file with extensions
EXE COM DOC DLL PIF LNK VBS
(Windows does not show LNK and PIF extensions)
 Never click on a link – hover the link with mouse and
look at the status bar where the link leads when clicked
 firewall may protect both yourself and the world
but may also cheat you)
Information Theory
Sender and Receiver
Noise and Distortion
Codes Detecting Errors
Codes Correcting Errors
Checksums
Data Packets
are discussed in class
Information Theory
Data Compression
zip, arj, rar, tar, gz, binhex, 7u, etc.
Image Compression
Image Formats
bmp, tiff, gif, jpg, png, etc.
are discussed in class.
Image compression immediately leads to
WEB DESIGN
Web Design
What is a good website?
-- presentable for all users: WIN, Mac, Unix, etc.
-- acceptable for all browsers: Opera, Netscape,
Firefox, MSIE, Safari, etc.
-- loads fast: byte size < 50 kB
-- does not use Cutting Edge technologies
Learn the culture of Web Design at
webpagesthatsuck.com
review the Daily Sucker site daily!
A web design
project is done
by students.
Collection here
Medical Informatics
DECISION SUPPORT AND THEORY
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The Fundamental Principle
of Decision Theory
THE BAYES THOREM
[New Knowledge] = [Experimentation] x [Old Knowledge]
Application: Making Diagnosis
[Old Knowledge] - we know disease D prevalence, p(D)
[New Knowledge] - we need to know if the patient has
disease D if he has symptom S, p(D|S)
[Experimentation] - Bayes Theorem builds the Likelihood
Function:
L(D|S) = p(S|D) / {p(S|D) p(D) + p(S|’D) p(‘D)}
Now this Likelihood Function modifies the Old Knowledge:
p(D|S) = L(D|S) p(D)
Medical Decision Support
to mention a few
Clinical Systems
Financial
Medical Records
Comprehensive
Diagnostic Systems
QMR, Iliad, DXPlain, etc.
Pharmaceutical Prescriptions
Health System Modeling
Research
Data Mining
Medical Decision Support
Clinical Systems
Computerized Medical Record systems
are discussed in class:
TMR -- CMR from Duke Medical Center
MedicaLogica
Pharmaceutical System for Multiple Drug
Therapy in ICU, Pharm-X is discussed in class
Comprehensive system for VCU HealthSystem
is discussed in class.
Medical Decision Support
Diagnostic Systems
observations
knowledge base
decision mechanism
diagnoses
explanations
feedback to adjust observations
Knowledge Engineering, Expert Systems, AI
are discussed in class
Medical Decision Support
Health Systems Modeling - 1
Primary Care Physician Supply - 1
Medical Decision Support
Health Systems Modeling - 2
Primary Care Physician Supply - 2
Medical Decision Support
Health Systems Modeling - 3
Primary Care Physician Supply - 3
Medical Decision Support
Measurement and Statistics
Use only reasonable precision,
round up numbers to convey your purpose
Medical Informatics
RECOMMENDED RESOURCE
FOR ADVANCED STUDIES
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Handbook of Medical
Informatics
 http://www.mieur.nl/mihandbook
 http://www.mihandbook.stanford.edu/
MCV Course for
4th year medical students
Handbook of Medical
Informatics
I. Data and Information
1 Introduction and Overview
2 Information and Communication
Handbook of Medical
Informatics
II. Data in Computers
3 Data Processing
4 Database Management
5 Telecommunication, Networking and
Integration
Handbook of Medical
Informatics
III. Data from Patients
6 Coding and Classification
7 The Patient Record
8 Biosignal Analysis
9 Medical Imaging
10 Image Processing and Analysis
Handbook of Medical
Informatics
IV. Patient-Centered Information Systems
11 Primary Care
12 Clinical Departmental Systems
13 Clinical Support Systems
14 Nursing Information Systems
Handbook of Medical
Informatics
V. Medical Knowledge and Decision Support
15 Methods for Decision Support
16 Clinical Decision-Support Systems
17 Strategies for Medical Knowledge Acquisition
18 Predictive Tools for Clinical Decision Support
Handbook of Medical
Informatics
VI. Institutional Information Systems
19 Modeling of Health Care for Information Systems
Development
20 Hospital Information Systems: Clinical Use
21 Hospital Information Systems; Technical Choices
22 Health Information Resources
Handbook of Medical
Informatics
VII. Methodology for Information Processing
23 Logical Operations
24 Biostatistical Methods
25 Biosignal Processing Methods
26 Advances in Image Processing
27 Pattern Recognition
28 Modeling for Decision Support
29 Structuring the Computer-based Patient Record
30 Evaluation of Clinical Information Systems
Handbook of Medical
Informatics
VIII. Methodology for Information Systems
31 Human-Computer Interaction in Health Care
32 Costs and Benefits of Information Systems
33 Security in Medical Information Systems
34 Standards in Health-care Informatics and Telematics
in Europe
35 Project Management
Handbook of Medical
Informatics
IX. Medical Informatics as a Profession
36 Education and Training in Medical Informatics
37 International Developments in Medical Informatics
Handbook of Medical
Informatics
Unfortunately lacks the details on the Internet
Education vs Vocational Training
Medical Informatics
THE END
OF PRESENTATION
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MCV Course for 4th year medical students