Medical informatics
Lecture 1
Introduction to Medical Informatics
Definition and scope of HI, medical
research to clinical practice lifecycle,
electronic patient records
The big picture
Standards based
formalisation of
clinical data and
research results
Understanding
diseases and
their treatment
Develop
and test
treatments
Patient-specific
Decision-making to
optimise and
personalise treatment
Clinical
engagement, postmarketing
surveillance, data
mining
Service delivery,
performance
assessment
Ensure right
Patients receive
right
intervention
Manage safe workflow,
professional
communication,
security
Course objectives
• Provide an overview of the main development
areas in health informatics.
• Understand the role of informatics in translating
medical research into clinical practice
• Look at 4 key topics in more depth
– Electronic patient records
– Formal representation of clinical data and medical
knowledge
– Clinical decision making and decision support
– Care pathways and workflow management
Recommended texts
• Guide to Health Informatics - Enrico Coiera
2nd edition 2003
• From Patient data to Medical Knowledge Paul Taylor 2006
• Other useful resources at
– www.openclinical.org
Biomedical informatics (1):
Bio-informatics
• Rapidly developing branch of biology: highly
interdisciplinary, using techniques and concepts from IT,
statistics, mathematics, chemistry, biochemistry, physics,
and linguistics!
• Seeks knowledge from computer analysis of
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biological data (e.g. genomics, proteomics)
experimental results
patient statistics
scientific literature.
• Research in bioinformatics includes development of
methods for storage, retrieval, and analysis of data,
modeling and simulation of cellular/molecular systems.
Biomedical informatics (2):
Health-informatics
• Also known as medical or clinical informatics
• It is applied to primary and specialist patient care,
nursing, dentistry, pharmacy, public health etc.
• Deals with the resources, devices, and methods
required to optimize the acquisition, storage, retrieval,
and use of information in delivery of healthcare
services
• A particular focus is on services at the point of care and
emphasis is increasingly being placed on informatics
for patients and carers as well as professionals.
Topics in health informatics (1):
traditional perspective
• Architectures for electronic medical records and
other health information systems used for
billing, scheduling, and research
• Standards (e.g. DICOM, HL7) … to facilitate the
exchange of information between healthcare
information systems - these specifically define
the means to exchange data, not the content
• Controlled vocabularies … used to allow a
standard, accurate exchange of data content
between systems and providers
• Software for specialist services and devices
Topics in health informatics (2):
new drivers
• Quality and safety
– US Institute of Medicine
•“To err is human”
•“Crossing the quality chasm”
•McGlynn data on service delivery
•Fineberg lecture on YouTube
– NHS
• Emergence of clinical decision support
and workflow management systems
Topics in health informatics (3):
Contemporary multidisciplinary view
• Traditional “engineering” topics
– Hardware and software service architectures
– Specialist technical services
– Digital signal processing
• Human and organisational factors in quality and safety
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User interface design (Tang lecture on YouTube)
Organisational memory
Learning from experience
Change management
• Formal representation of data and knowledge
– Controlled vocabularies, “ontologies”
– Applying knowledge to data: logic and description logics,
decision theory, guidelines and workflows
The key challenges
(adapted from Coiera p 104)
• How do we apply knowledge to achieve a
particular clinical objective?
• How do we decide how to achieve a
particular clinical objective?
• How do we improve our ability to deliver
clinical services?
Medical research, clinical practice
Understanding
diseases and
their treatment
Develop
and test
treatments
Health
Records
Service delivery,
performance
assessment
Ensure right
Patients receive
right
intervention
First …
• Capture your
data, accurately,
completely
• Make the data
readily accessible
Health
Records
The paper record, pros
• Portable
• Familiar and easy to use
– Exploits everyday skills of visual search,
browsing etc
• Natural: “direct” access to clinical data
– Handwriting
– Charts, graphs
– Drawings, images…
The paper record: cons
• Can only be used for one task at a time
– If 2 people need notes one must wait
– Can lead to long waits (unavailable up to 30% of time
in some studies)
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Records can get lost
Consume space
Large individual records are hard to use
Fragile and susceptible to damage
Environmental cost
Electronic health records
• An electronic health record is
a repository of information
about a single person in a
medical setting, including
clinical, demographic and
other data.
• The repository resides in a
system specifically designed
to support users by
– providing accessibility to
complete and accurate data
– may include services to provide
alerts, reminders, links to
medical knowledge and other
aids to clinical practice.
The electronic medical record
Examples
Functions of the EHR (1)
1. Supports structured data collection using a defined
vocabulary.
2. Accessible at any or all times by authorized individuals.
3. Contains a problem list - patient’s clinical problems and
current status
4. Supports systematic measurement and recording of data to
promote precise and routine assessment of the outcomes
of patient care
5. States the logical basis for all diagnoses or conclusions as
a means of documenting the clinical rationale for decisions
about the management of the patient’s care.
Functions of the EHR (2)
1.
Can be linked with other clinical records of a patient—from various
settings and time periods—to provide a longitudinal (i.e. lifelong)
record of events that may have influenced a person’s health.
2.
Can assist the process of clinical problem solving by providing
clinicians with decision analysis tools, clinical reminders,
prognostic risk assessment and other clinical aids.
3.
Can be linked to both local and remote databases of knowledge,
literature and bibliography or administrative databases and
systems so that such information is readily available to assist
practitioners in decision making.
4.
Addresses patient data confidentiality.
5.
Can help practitioners and health care institutions manage the
quality and costs of care.
Electronic health records: pros
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Compact
Simultaneous use
Easily copied/archived
Portable (handheld and wireless devices)
Secure
Supports many other services
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Decision support
Workflow management
Performance audits
Research
Electronic health records: cons
• High capital investment
– Hardware, software, operational costs
– Transition from paper to computer
• Training requirements
• Power outs – the whole system goes down!
• Continuing security debate
– Stealing one paper record is easy, 20 is harder, 10,000
effectively impossible – the security risks are very
different for electronic data
Views of record systems
Ad hoc view
User view
Service architecture view
Chronic
care
services
Acute
services
Primary
Care
services
Clinical data
Federated
“Organisational
EHR
Memory”
Communication &
Coordination
services
Terminologies
Ontologies
Point of
care
services
Clinical
guideline
repository
Search and
analysis
services
Clinical
trials
repository
Functional view
Medical record structures (1)
• Integrated record
– Data are recorded and presented chronologically
around episodes of care, following the sequence of
events, encounters and actions associated with the
patient’s medical needs.
• Source oriented record
– organized around the organization of the healthcare
service, with separate sections for medical notes,
nursing notes, laboratory data, radiological results
etc. No concept of a clinical task or process in this
form of data recording.
Medical record structures (2)
• Protocol-oriented record
– Often used when a patient is being treated according
to a standard treatment plan or pathway. Highly taskoriented, providing useful guidance for what needs to
be done at any point in treatment, but providing little
overview of the patient’s needs.
• Problem-oriented record
– Organised around a list of the patient’s medical
problems, which is used to index the whole record,
and an integrated treatment plan. The plan describes
what is to be done for each problem, with all
associated progress notes, lab tests, medications etc
linked to the initiating problem.
Point of care services
• Clinical documentation
• Patient administration
• Search services
• Decision support
• Workflow management
• Communication and coordination
“Grand Challenge”
The NHS of the future?