INTRODUCTION TO MEDICAL
INFORMATICS
DR. ALI M. HADIANFARD
FACULTY MEMBER OF AJUMS
http://www.alihadianfard.info/download.html
Further reading
• Biomedical informatics computer applications in health care and biomedicine (3rd
edition), Edward H. Shortliffe, 2006 (chapter 1).
• ABC of health informatics, Frank Sullivan and Jeremy C Wyatt, 2006 (chapter 1).
• Informatics for healthcare professionals, Kathleen M. Young, 2000 (chapters 1
and 2).
‫‪INFORMATICS‬‬
‫انفورماتیک عبارت است مطالعه ساختار‪،‬‬
‫الگوریتم‪ ،‬رفتارو تعامل سیستمهای طبیعی و‬
‫مصنوعی که کارذخیره‪ ،‬پردازش و بازیابی اطلعات را‬
‫انجام می دهند‪.‬‬
‫پاره ای ازمتخصصین آن را مترداف و کوتاه شده‬
What is Informatics?
In 1968, the term “Informatics” was used to indicate that a
vast volume of information can be managed through
computer technology
Information Management
The process of creating/gathering, storing, finding/retrieving,
manipulating/analyzing/interpreting, displaying, and sharing
information
Informatics is made up of the elements of Data,
Information, and Knowledge
What is Medical Informatics?
This term was coined in the mid-1970s. It comes from the French expression ‘informatique Médicale’
The study of applying computer technology to manage medical information in order to affect
medical care and support problem-solving and decision-making
Medical informatics as an interdisciplinary scientific field includes:
Computer science;
Health care science;
Information science;
and Cognitive science
A multidisciplinary domain including cognitive
psychology,
artificial intelligence, neuroscience, linguistics,
anthropology, and philosophy to develop
theories about human perception, thinking, and
learning
Can be considered as the cognitive process (
the thought process) selecting a logical choice
from the available alternatives.
Health Informatics
the terms:
“Health Informatics”;
“Health Care Informatics”;
and “Clinical Informatics” are very popular.
It seems that regardless of the difference between medical and health terms, these terms to be
synonymous and exchangeable with Medical Informatics
Earlier terms (not common):
Medical Computing
Medical Information Science
‫محدوده مدیکال انفورماتیک‬
‫مدیکال انفورماتیک حوزه وسیعی را شامل می شود که به دو حوزه کلی قابل تقسیم است‪:‬‬
‫‪ -1‬حوزه مبتنی براطلعات مراقبتی بیمار‪:‬‬
‫پرونده الکترونیکی سالمت )‪(ELECTRONIC HEALTH RECORD‬‬
‫پزشکی از راه دور‬
‫)‪(TELEMEDICINE‬‬
‫پردازش تصاویر پزشکی )‪(MEDICAL IMAGING PROCESS‬‬
‫انفورماتیک پرستاری‬
‫)‪(NURSING INFORMATICS‬‬
‫انفورماتیک استفاده کنندگان )‪(CONSUMER HEALTH INFORMATICS‬‬
‫‪ -2‬حوزه مبتنی بردانش پزشکی برگرفته شده ازمتون پزشکی )‪:(KNOWLEDGE-BASED‬‬
‫سیستمهای بازیابی اطالعات )‪(INFORMATION RETRIEVAL SYSTEMS‬‬
‫پزشکی مبتنی بر شواهد‬
‫)‪(EVIDENCE-BASED MEDICINE‬‬
‫انفورماتیک تحقیقات بالینی )‪(CLINICAL RESEARCH INFORMATICS‬‬
Medical Informatics domain
 Electronic Health Record (including Expert Systems and Clinical Decision Support Systems)
 Medical Imaging Processing
 Hospital (Health) Information Systems
 Telemedicine
 Consumer Health Informatics (The study, implementation, and development of computers and
telecommunications to support consumers in obtaining information, analyzing their unique health care needs
and helping them make decisions about their own health)
 Public Health Informatics
 Discipline Informatics (such as Nursing Informatics, Dental Informatics, Nutrition Informatics, pharmacy
informatics, and so on)
 Information Retrieval Systems
 Evidence-based Medicine
 Clinical Research Informatics
 Medical Education (including Patient Education)
Biomedicine
Biomedicine is also known as Biomedical Informatics is a wide-ranging term that
encompasses the Bioinformatics domain and the Medical Informatics field
Bioinformatics demonstrates the combination of biology (including human genetics)
and information technology
Biomedical Engineering indicates the hardware aspect of medicine and focuses on
applying computer technology in medical devices
Relationship between the terms
Area
Molecular and
cellular processes
Bioinforma
tics
Imaging
informatics
Tissues and organs
Biomedical Informatics
Clinical
informatics
Public
health
informatics
Individuals
(patients)
Populations and
society
Some Journals on medical Informatics
• Journal of The American Medical Informatics Association
• BMC Medical Informatics and Decision Making
• Methods of Information in Medicine
• Artificial Intelligence in Medicine
Associations on medical Informatics
• AMIA - American Medical Informatics Association
• IMIA - International Medical Informatics Association
• HIMSS - Health Information Management Systems Society
• AMDIS - Association of Medical Director of Information Systems
• AHIMA - American Health Information Management Association
• E-health Initiative
• Medical Library Association
• NLM - National Library of Medicine
What do you
think?
Is there any difference between
health information management
and medical informatics?
MEDICAL IMAGING
INFORMATICS
DR. ALI M. HADIANFARD
FACULTY MEMBER OF AJUMS
H T T P : / / W W W. AL I H AD I AN FAR D . I N F O / D O W N L O AD . H T M L
Further reading
Biomedical informatics computer applications in health care and biomedicine
(3rd edition), Edward H. Shortliffe, 2006 (chapters 9 and 18).
PACS and Imaging Informatics Basic Principles and Applications (2nd edition), H.
K. Huang, 2010 (chapters 1 and 7).
PACS A Guide to the Digital Revolution, Keith J. Dreyer, David S. Hirschorn,
James H. Thrall, Amit Mehta, 2010 (chapter 2)
What is medical imaging informatics?
It is a subfield of biomedical informatics that has arisen in recognition of the
common issues that pertain to all image modalities and applications once
the images are converted to digital form.
Medical imaging informatics embraces the following areas:
Image Generation : The process of generating the images and converting
them to digital form if they are not intrinsically digital
Image Manipulation: Uses pre-processing and post-processing methods to
enhance, visualize, or analyze the images
Image Management : Includes methods for storing, transmitting, displaying,
retrieving, and organizing images
Image Integration : The combination of images with other information
needed for interpretation, management, and other tasks (e.g. Patient
record)
Because of
increasing
availability of
medical images
in digital form,
medical digital
images have
become a core
data type that
must be
considered in
many
biomedical
informatics
applications.
Why medical imaging is important?
Diagnosis (Detection)
Treatment planning
Image-guided treatment, e.g. Image-guided surgery produced minimally
invasive surgery
Assessment of response to treatment
Estimation of prognosis
Medical communication
Education
Research
Medical imaging progress over time
1980s: Medical imaging technology development
Computed radiograph(CR), MRI, CT, Ultrasonography(US), Digital Radiography(DR), WS, storage, networking
Late 1980s: Imaging systems integration
• PACS, the American College of Radiology and the National Electrical Manufacturers Association (ACR/NEMA),
DICOM, high-speed networks
Early 1990s: Integration of HIS/RIS/PACS
• DICOM, HL7, Intranet and Internet
Late 1990s–present: Workflow and application servers
•Integrating the Healthcare Enterprise (IHE), ePR, enterprise PACS,Web-based PACS
2000s–present: Imaging informatics
• Computer-aided diagnosis (CAD), image contents indexing,
• Knowledge base, decision support,
• Image-assisted diagnosis and treatment
Parameters of image quality
Spatial resolution : Is related to the sharpness of the image; the
number of pixels (voxels) per image area.
Contrast resolution: Is a measure of the ability to distinguish
small differences in intensity; the number of bits per pixel
Temporal resolution: Is a measure of the time needed to create
an image
Energy sources to create images
Light
X-rays: fluoroscopy, CT scan
Ultrasound: Ultrasonography
Nuclear Magnetic Resonance: MRI, positron-emission
tomography (PET) - nuclear-medicine imaging e.g.
radioactive isotope
What is PACS?
A Picture Archiving And Communication System (PACS)
consists of medical image and data acquisition, storage, and
display subsystems integrated by digital networks and
application software.
PACS Infrastructure
PACS infrastructure consists of a basic skeleton of:
hardware components (imaging device interfaces, storage devices, host computers,
communication networks, and display systems)
integrated by :
a standardized,
flexible software system for communication,
database management,
storage management,
job scheduling,
inter-processor communication,
error handling,
and network monitoring.
PACS Components
1) Data and Image Acquisition Gateways
2) PACS Server and Archive
3) Display Workstations (Diagnostic and Review)
4) Application Servers
5) System Networks
Data and Image Acquisition Gateways
PACS acquires images sent from imaging modalities (devices) and
related patient data from the hospital information system (HIS) and
the radiology information system (RIS).
There are two types of gateways (GW) to the PACS server and
archive, the database GW for textual data, and the image
acquisition GW for imaging data.
A major task in PACS is to acquire images reliably and in a timely
manner from each radiological imaging modality via the acquisition
GW, and relevant patient data, including study support text
information of the patient, description of the study, and parameters
relevant to image acquisition and processing through the database
GW.
Major functions of the PACS Server and Archive
• Receives images from examinations (exams) via acquisition gateways
• Extracts text information describing the received exam from the DICOM image header
• Updates the database management system
• Determines the destination workstations to which newly generated exams are to be forwarded
• Automatically retrieves necessary comparison images from historical exams from a cache
storage or long term library archive system
• Automatically corrects the orientation of computed or digital radiography images
• Determines optimal contrast and brightness parameters for image display
• Performs image data compression if necessary
• Performs data integrity check if necessary
• Archives new exams onto long-term archive library
• Deletes images that have been archived from the acquisition gateway
• Services query/retrieve requests from WSs and other PACS controllers in the enterprise PACS
• Interfaces with PACS application servers
Major functions of PACS workstations
Case preparation: Accumulation of all relevant images and information belonging to
a patient examination
Case selection: Selection of cases for a given subpopulation through DICOM
query/retrieve
Image arrangement: Tools for arranging and grouping images for easy review
Interpretation: Measurement tools for facilitating the diagnosis
Documentation: Tools for image annotation, text, and voice reports
Case presentation: Tools for a comprehensive case presentation, including 3-D
image display for a large 3-D file, and fusion images
Image reconstruction: Tools for various types of image reconstruction for proper
display
Application Servers
Application servers are connected to the PACS server
and archive. Through these application servers, PACS
data can be filtered to different servers tailored for
various applications.
System Networks
A basic function of any computer network and protocol (TCP/IP) are to provide
an access path by which end-Users.
At the local area network level, digital communication in the PACS infrastructure
design can consist of low-speed Internet (10 Mbits/s signaling rate), mediumspeed (100 Mbits/s) or fast (1 Gbit/s) Internet, and high-speed asynchronous
transfer mode technology (ATM, 155–622 Mbits/s and up). In wide area
networks, various digital service (DS) speeds can be used, which range from DS-0
(56 kbits/s) and DS-1 (T1, 1.544 Mbits/s) to DS-3 (45 Mbits/s) and ATM (155–622
Mbits/s).
System Networks – continue
A low-speed network is used to connect the imaging modalities (devices) to
the acquisition gateway computers because the time consuming processes of
imaging acquisition do not require high-speed connection.
Medium and high-speed networks are used on the basis of the balance of
data throughput requirements and costs. A faster image network is used
between GWs and the PACS server because several GWs may send
large image files to the server at the same time.
High-speed networks are always used between the PACS server and WSs.
Storage Requirements
Compression methods
Lossless compression: Maximum compression ratios achievable with lossless
methods are on the order of 2:1 or 3:1.
Lossy compression: Compression ratios as high as 20:1 can be obtained with JPEG
compression, but with variable quality.
Wavelet compression: Wavelet compression at ratios as high as 80:1 for plain
films such as mammograms have being evaluated, and found to be satisfactory,
although ratios of more than 60:1 are rarely used.( in the JPEG 2000 standard)
).‫ مجموعه اي از موجهاست كه توسط مقياس هايي از موجك مادر بدست می آيند‬،‫(اصول موجك‬
CONSUMER HEALTH
INFORMATICS
Dr. Ali M. Hadianfard
Faculty member of AJUMS
http://www.alihadianfard.info/download.html
Further reading
Biomedical informatics computer applications in health care
and biomedicine (3rd edition), Edward H. Shortliffe, 2006
(chapter 14).
Consumer Health Informatics, Deborah Lewis, Gunther
Eysenbach, Rita Kukafka, P. Zoë Stavri, Holly B. Jimison, 2005
(whole book, specially chapters 1,4,5,8,9,11,12).
Definitions
Health information consumer as a person who seeks information about
health promotion, disease prevention, treatment of specific conditions,
and management of various health conditions and chronic illnesses.
Consumer Health Informatics:
 Is the use of modern computers and telecommunications to support
consumers in obtaining information, analyzing their unique health care
needs and helping them make decisions about their own health.
 Is the branch of medical informatics that analyses consumers’ needs
for information; studies and implements methods of making information
accessible to consumers; and models and integrates consumers’
preferences into medical information systems.
Definitions - continue
The CHI includes patient-focused informatics, health literacy and
consumer education as well as Information Resources,
Communications, Remote Monitoring, Videoconferencing, and
Telepresence. The focus is on information structures and processes that
empower consumers to manage their own health--for example health
information literacy, consumer-friendly language, personal health
records, and Internet-based strategies and resources. The shift in this
view of informatics analyses consumers' needs for information; studies
and implements methods for making information accessible to
consumers; and models and integrates consumers' preferences into
health information systems. Consumer informatics stands at the
crossroads of other disciplines, such as nursing informatics, public
health, health promotion, health education, library science, and
communication science.
The areas of interest to consumer health informatics
1. Bringing medical knowledge to consumers
2. Making electronic health records accessible to patients
3. Building decision aides to support consumer’s choices
4. Developing quality control mechanisms for health information
available over the Internet
Consumer action
When patients (healthcare consumers) have a serious
medical concern, they don’t just accept whatever
treatment their local doctor offers. They’ll spend hours
and hours on the Internet learning about their
condition, communicating with other patients and
clinicians who share their interests, and tracking down
every lead they can find on the best new treatments.
Consumer action – 10 Level
Dr. Ferguson has delineated 10 levels in which consumers participate in the access and use
of health care Information
 Level 1. e-Patients search for health information.
 Level 2. e-Patients exchange e-mail with family members and friends.
 Level 3. e-Patients seek guidance from online patient-helpers.
 Level 4. e-Patients participate in online support groups (discussion groups, mailing lists).
 Level 5. e-Patients join with other online self-helpers to research their shared concerns.
 Level 6. e-Patients use online medical guidance systems.
 Level 7. e-Patients interact with volunteer online health professionals via chat rooms.
 Level 8. e-Patients use the paid services of online medical advisors and consultants.
 Level 9. e-Patients engage in electronic conversations with their local clinicians.
 Level 10. e-Patients receive one-way electronic messages from their clinicians.
Self-help
Since 1980s: The importance of the patient as a full participant in health
care. A shift from the patient as the silent recipient of ministrations from a
wise, beneficent clinician to an active collaborator whose values,
preferences, and lifestyle not only alter predisposition to certain illnesses but
also shape the characteristics of desirable treatments.
Patient participation takes many forms:
 Shared decision-making by Evaluating and choosing therapeutic
strategies from a set of acceptable alternatives
 Self-care by Self-monitoring
 Collaborative practices by Implementing the therapies and evaluating
the effects.
The application of technology in consumer informatics
Technology
Application
Information Resources
Web-based information resources, patient access to electronic medical
records, direct access to health information
Messaging
E-mail, chat groups, consumer health networks, personal clinical electronic
communications (PCEC)
Telephone
Scheduling, triage
Remote monitoring
Remote monitoring of pacemakers, diabetes, asthma,
hypertension, CHF.
Remote interpretation
PACS, remote interpretation of radiographic studies
and other images, such as dermatologic and retinal
photographs.
Videoconferencing
Wide range of applications, from low-bandwidth
telehome care over telephone lines, to high-bandwidth
telementoring and telepsychiatry
Telepresence
Remote Surgery, telerobotics
Telepresence
 Telepresence involves systems that allow clinicians to not only view
remote situations, but also to act on them e.g., Telesurgery, nursing home
and other long-term facilities, remote video rounds
 Telepresence requires high bandwidth, low latency connections.
 uses Real-time (live interactive or Synchronous) technology
Roles of Health Professionals in Consumer Health Informatics
 1. professionals serve as sources for content e.g., Working in
conjunction with software designers
 2. professionals provide important guidance in moderating
public electronic discussion groups and responding to patients’
electronic messages
 3. clinicians become information brokers and interpreters for
patients
The quality criteria of Consumer Health Information web sites
Quality = totality of characteristics of a product or service that
satisfy stated or implied needs of the user
Ethical Principles
HSWG quality criteria for health web sites
Silberg’s criteria, 1997
The American Health Information Management Association
(AHIMA) also has published “Recommendations to Ensure Privacy
and Quality of Personal Health Information on the Internet
Ethical principles
A number of organizations have provided ethical codes or high-level ethical
guidelines for provision of consumer health information on the Web:
 HONcode: the Health on the Net Foundation, 1995 - The code
originally consisted of eight broad principles for medical
Webmasters
 eHealth Code: by Internet Healthcare Coalition
 HI-Ethics Code of Conduct: by a group of leading for-profit
consumer health information Web sites
 AMA: the American Medical Association
 E-Europe Criteria: In 2002, the European Commission published a
communication called “Quality Criteria for Health related Web
sites”
Health Summit Working Group (HSWG)quality criteria for health web sites
 The quality criteria were adopted by the Institute of Electrical and Electronics
Engineers (IEEE) and the American Public Health Association (APHA)
 Credibility: includes the source, currency, relevance/utility, and editorial
review process for the information.
 Content: must be accurate and complete, and an appropriate
disclaimer provided.
 Disclosure: includes informing the user of the purpose of the site, as well
as any profiling or collection of information associated with using the site.
 Links: evaluated according to selection, architecture, content, and back
linkages.
 Design: encompasses accessibility, logical organization (navigability),
and internal search capability.
 Interactivity: includes feedback mechanisms and means for exchange
of information among users.
 Caveats: clarification of whether site function is to market products and
services or is a primary information content provider.
Silberg’s Criteria
 Authorship: Authors and contributors, their affiliations, and relevant
credentials should be provided.
 Attribution: References and sources for all content should be listed
clearly, and all relevant copyright information noted.
 Disclosure: Web site “ownership” should be prominently and fully
disclosed, as should any sponsorship, advertising, underwriting,
commercial funding arrangements or support, or potential conflicts of
interest. This includes arrangements in which links to other sites are
posted as a result of financial considerations. Similar standards should
hold in discussion forums.
 Currency: Dates that content was posted and updated should be
indicated.
Privacy Principles
According to these principles, consumer-oriented commercial
Web sites that collect personal identifying information from or
about consumers online would be required to comply with the
four widely accepted fair information principles which can be
summarized as :
“Notice”
“Choice”
“Access”
“Security”
Notice
Means that Web sites should provide clear and conspicuous notice
of their information practices, including
What information they collect,
How they collect it(e.g., directly or through non-obvious means
such as “cookies”),
How they use it,
How they provide choice, access, and security to consumers,
whether they disclose the information collected to other entities,
and whether other entities are collecting information through the
site.
This is typically done in a privacy statement that is easily accessible
from the home page and from all points of data collection.
Choice
Means that Web sites should offer consumers choices
as to how their personal identifying information is used
beyond the use for which the information was
provided (e.g., to consummate a transaction).
Typically this is implemented by opt-in checkboxes
within the form used to gather personal information.
Access
Means that Web sites should offer consumers
reasonable access to the information a Web site
has collected about them, including a reasonable
opportunity to review information and to correct
inaccuracies or delete information.
Security
Means that Web sites should take
reasonable steps to protect the security of
the information they collect from consumers.
Protecting health information
special regulations exist for exchanging and protecting health
information. In the United States, the Privacy Rule of the Health
Insurance Portability and Accountability Act of 1996 (HIPAA)
creates a set of requirements and restrictions for he handling of
so-called Protected Health Information (PHI)
PHI refers to individually identifiable health information that is or
has been electronically maintained or electronically
transmitted by a covered entity, as well as such information
when it takes any other form.
Accessibility
“Access” to information is another major issue often
discussed in the context of consumer health
informatics. On a macro level (policy level) “access”
mostly refers to physical access to the Web. On a meso
and micro level, “accessibility” of information is also
often quoted as a “quality criterion” for health Web
sites.
Levels of accessibility barriers
Level 1 - Physical accessibility: the Internet is accessible from home, or only from a library or
school, in terms of convenience, privacy, filters, and costs. it is in the hands of health information
providers to prevent false-positive blockings—by labeling their health Web site with an appropriate
metadata vocabulary.
Level 2 – Findability: This refers mainly to an appropriate listing in search engines and directories
and cross-linking from relevant Web sites, so that users become aware of the Web site (external
findability). However,it also refers to findability of a certain piece of information within a Web site
(internal findability).
use appropriate keywords on all Web pages, Keywords should match terms users would use and
also include frequent misspelling
Level 3 - Readability, comprehendability: font size, font, and colors
Level 4 – Usability: is determined by the way the information is grouped and presented, by how
the user navigates through the information, and by the amount of help the system gives,
accessibility for special user groups such as seniors or disabled users
User’s guide: A CREDIBLE web site
A health information web site is trustworthy when is CREDIBLE
Current and frequently updated
References cited
Explicit purpose and intentions of the site
Disclosure of sponsors
Interests declared and no conflicts of interests
Balanced content, lists advantages and disadvantages
Level of Evidence indicated
Health Information Delivery Methods
Push: the user may initially join the system, but
subsequently the user receives information without the
need to request it further. E.g., mailing lists, pop-up
notification systems. Information “pushed” to the user is
assumed to be filtered so that it is of interest to the user
and the user will wish to view most items.
Pull: where resources are available for users to search or
browse and the user must take specific action (e.g.,
clicking a link) to retrieve an information resource.
Information that is “pulled” comes from large data sets
and only a small fraction of the data, which is identified
by the user as of definite interest, is retrieved for viewing
Health information distribution systems
There are several Ways to distribute health information:
 File Repository: File Transfer Protocol (FTP); e.g., Doc, PDF(PDF file viewer Adobe
Reader)
 Electronic Mail: in the body of e-mail messages or as e-mail attachments
 Mailing list: includes Announcement list or Newsletter (a one-way conduit of
information), and Discussion list (any opt-in subscriber may post)
 The World Wide Web: includes text and hyper text documents (Hypertext Markup
Language, HTML)
 Usenet: Newsgroups, It includes a world-wide network of bulletin board servers
accessible through the Internet. The system contains many thousands of active
discussion groups covering a wide variety of topics. Newsgroup servers use their own
communications protocol and client software
 Web-based discussion groups: e.g., Discussion Forums ; Weblogs or blogs are similar to
Web-based discussion groups except that the primary postings are usually all written
by the same person.
Using E-mail in patient care
• Prescription renewals
• Appointment requests
• Referrals to specialists
• Name, address, phone number, or insurance information changes
• Non-urgent medical issues
• Monitoring chronic conditions (e.g., diabetes, asthma, headaches)
• Monitoring effects of therapy
• Follow-up on behavioral interventions (e.g., smoking cessation,
dietary changes)
Situations in which E-mail should not be used
• Medical emergencies or time-sensitive issues because of its
asynchronous nature
• Issues requiring lengthy messages
• Issues requiring negotiation through long volleys of messages that
become cumbersome
• Communicating bad news, which is best done in person
• Sensitive issues at risk of disclosure due to potentially weak security
mechanisms
• When confronted with a patient who is unable to response
electronically
Disability Informatics
Disability informatics ,a subfield of medical informatics, seeks to
understand better how individuals with disabilities can use information
technology and information systems to address any functional issues
they encounter, improve their self-efficacy, and empower them to be
as independent as any other persons.
Disability informatics broadly defined can be any application that
collects, manages, and distributes information related to disability to
persons with disabilities, as well as to care providers and family and to
healthcare and rehabilitation professionals.
Disability Informatics- continue
A major area of disability informatics involves identifying and
addressing the particular needs and requirements of the
disabled population to utilize general information systems.
The main resolution is then educating and raising awareness
of these issues to information technology professionals and
the information technology (IT) industry.
Dr. Ali M. Hadianfard
Faculty member of AJUMS
http://www.alihadianfard.info/download.html
PUBLIC HEALTH INFORMATICS
Dr. Ali M. Hadianfard
Faculty member of AJUMS
http://www.alihadianfard.info/download.html
Further reading
• Biomedical informatics computer applications in health care
and biomedicine (3rd edition), Edward H. Shortliffe, 2006
(chapter 15).
Definition
 The systematic application of information and computer
science and technology to public health including
surveillance, prevention, preparedness, reporting, health
promotion, research, and learning.
 It is an interdisciplinary profession that applies
mathematics, engineering, information science, and
related social sciences (e.g., decision analysis) to
important public health problems and processes. It is
one of the subdomains of Health informatics.
 Public health informatics is distinguished by its focus on
populations, its orientation to prevention, and its
governmental context.
 Public health focuses on the health of the community, as
opposed to that of the individual patient.
Organizations
Organizations focused on public
health informatics to aid in the
detection and management of diseases
and syndromes in individuals and
populations:
o Centers for Disease Control and
Prevention
o The Public Health Surveillance and
Informatics Program Office
(PHSIPO)
Information Systems in Public Health
Most public health information systems
have focused on information about
aggregate populations.
• The HIV/AIDS reporting system
• The National Electronic Disease
Surveillance System (NEDSS): attempt to
track completely the incidence of many
conditions, including lead poisoning,
injuries and deaths in the workplace,
and birth defects.
• Immunization Registries: contain data
about children and vaccinations
Categories of public health informatics
The work of public health informatics can be
divided into three categories.
1) The study and description of complex
systems (e.g., models of disease
transmission or public health nursing work
flow).
2) The identification of opportunities to
improve the efficiency and effectiveness of
public health systems through innovative
data collection or use of information.
3) The implementation and maintenance of
processes and systems to achieve such
improvements.
Elements of public health surveillance systems
1) Planning and system design: Identifying information and sources
that best address a surveillance goal; identifying who will access
information, by what methods and under what conditions; and
improving analysis or action by improving the surveillance system
interaction with other information systems.
2) Data collection: Identifying potential bias associated with different
collection methods (e.g., telephone use or cultural attitudes toward
technology); identifying appropriate use of structured data
compared with free text, most useful vocabulary, and data
standards; and recommending technologies (e.g., global positioning
systems and radio-frequency identification) to support easier, faster,
and higher-quality data entry in the field.
3) Data management and collation: Identifying ways to share data
across different computing/technology platforms; linking new data
with data from legacy systems; and identifying and remedying dataquality problems while ensuring data privacy and security.
Elements of public health surveillance systems
4) Analysis: Identifying appropriate statistical and visualization
applications; generating algorithms to alert users to aberrations in
health events; and leveraging high-performance computational
resources for large data sets or complex analyses.
5) Interpretation: Determining usefulness of comparing information from
one surveillance program with other data sets (related by time, place,
person, or condition) for new perspectives and combining data of other
sources and quality to provide a context for interpretation.
6) Dissemination: Recommending appropriate displays of information for
users and the best methods to reach the intended audience; facilitating
information finding; and identifying benefits for data providers.
7) Application to public health programs: Assessing the utility of having
surveillance data directly flow into information systems that support
public health interventions and information elements or standards that
facilitate this linkage of surveillance to action and improving access to
and use of information produced by a surveillance system for workers in
the field and health-care providers.
NURSING INFORMATICS
Dr. Ali M. Hadianfard
Faculty member of AJUMS
http://www.alihadianfard.info/download.html
Further reading
• Nursing Informatics Where Technology and Caring, Marion J.
Ball, 2011.
• Biomedical Informatics-Computer Applications in Health Care
and Biomedicine, Edward H. Shortliffe, James J. Cimino, 3rd Ed.,
2006 (chapter 17).
What is nursing informatics?
• Nursing Informatics is the "science and practice (that) integrates nursing, its
information and knowledge, with management of information and communication
technologies to promote the health of people, families, and communities worldwide”
(IMIA, 2009).
• A specialty that integrates nursing science, computer science, and information
science to manage and communicate data, information, and knowledge in nursing
practice. Nursing informatics facilitates the integration of data, information and
knowledge to support patients, nurses and other providers in their decision-making
in all roles and settings.
• The goal of nursing informatics is to design and implement systems that improve
documentation accuracy, eliminate unnecessary work, enhance accuracy and enable
analysis of clinical data.
• Informatics is no longer an option for nurses and other health care providers. It is a
requirement.
How do Informatics Nurses Impact the Nursing Process?
o Communicate & coordinate care with all other clinical
disciplines
o Coordinate discharge planning, education & teaching,
transitions of care
o Manage all information related to the nursing process and
patient care delivery
Because informatics is integrated into nursing practice.
They are now additional steps in the nursing process.
TIGER
Technology Informatics Guiding Educational Reform (TIGER;
www.tigersummit.com) Initiative is a major resource for nursing informatics
competencies. The purpose of TIGER is to integrate informatics to the practice of
every nurse.
The TIGER was formed in 2004 to bring together nursing stakeholders to develop
a shared vision, strategies, and specific actions for improving nursing practice,
education, and the delivery of patient care through the use of health information
technology (IT). In 2006, the TIGER Initiative convened a summit of nursing
stakeholders to develop, publish, and commit to carrying out the action steps
defined within this plan. The Summary Report titled Evidence and Informatics
Transforming Nursing: 3-Year Action Steps toward a 10-Year Vision.
The TIGER Allows informatics tools, principles, theories and practices to be used
by nurses to make healthcare safer, effective, efficient, patient-centered, timely
and equitable.
Point of Care (POC) systems
POC include services provided to patients at the bedside such as diagnostic
and laboratory testing using automated information entry systems.
Clinicians want a product that can help them do everything they need to do
at the point of care.
Smart POC systems have key attributes, namely:
• They anticipate your needs – have data/information you need before you
need it
• They understand your context-dependent workflows
• They wait on you
• They hide all the complexity of underlying health IT systems with
simplicity (“magical” IT)
• They are built to bring immediate value to you
The Smart POC system is designed to:
- Automatically present relevant clinical data and
information via prefilled “Clinical Widgets”
- Offer “Executable” patient care plans
- Unobtrusively collect patient data
- Generate relevant charge or billing information as a
by-product
- Adapt to the nurse’s and communities’ best practices
Benefits of the Point-of-Care (POC) Model
-
Improvements in data completeness and accuracy, and timeliness of
reports
-
Clinical decision support
-
Encoding of clinical protocols and guidelines in the system
-
Improvements in efficiency
-
Immediate availability of information in the system to the healthcare
practitioners while managing the patient
-
Supporting a team-based approach to patient management
-
Clinical calculation
-
Noninvasive methods: The recent trend has been to design noninvasive
methods. Much of development of noninvasive technology can be
attributed to the availability of microcomputers and solid-state sensors.
Using computer in Point of Care
ICU units use computer almost universally for the following purposes:
-
To acquire physiological data frequently or continuously, such as blood pressure
readings
-
To communicate information from data-producing systems to remote locations
(e.g., laboratory and radiology departments)
-
To store, organize, and report data
-
To integrate and correlate data from multiple sources
-
To provide clinical alerts and advisories based on multiple sources of data
-
To function as a decision-making tool that health professionals may use in
planning the care of critically ill patients
-
To measure the severity of illness for patient classification purposes
-
To analyze the outcomes of ICU care in terms of clinical effectiveness and cost
effectiveness
Point of Care Laboratory Testing
Many laboratory tests, including pH, PO2, PCO2, HCO3,
electrolytes, glucose, ionized calcium, other chemistries,
hemoglobin, and hematocrit, can be performed in 2 minutes using
two or three drops of blood.
Results are displayed on the bedside physiological monitor and are
stored in the monitor’s database for comparison with previous
results. These laboratory results obtained at the bedside are also
automatically
transmitted through the monitoring network and hospital’s
backbone network to the laboratory computer system, and other
systems as required, so that the results can be integrated into the
patient’s long-term records.
Automated data capture from bedside
medical devices is now possible using
the IEEE MIB 1073 communications
standards (the Institute of Electrical and
Electronics Engineers Medical
Information Bus P1073 standard) . With
these standards in place, it is possible
for vendors and hospitals to implement
“plug and play” interfaces to a wide
variety of bedside medical devices such
as bedside monitors, IV pumps, and
ventilators.
MEDICAL EDUCATION
INFORMATICS
Dr. Ali M. Hadianfard
Faculty member of AJUMS
http://www.alihadianfard.info/download.html
Further reading

Biomedical Informatics-Computer Applications in
Health Care and Biomedicine, Edward H. Shortliffe,
James J. Cimino, 3rd Ed., 2006 (chapter 21).

Information Technology for the Practicing Physician,
Joan M. Kiel, 2001 (chapter 6).
Computer in medical education
The application of computer technology to
education is often referred to as:
Computer Assisted Learning
Computer-based Education (CBE)
Computer-aided Instruction (CAI)
Advantages of Using Computers in Medical Education







Vast storage capacity
Providing quick access to reference
Multimedia capabilities such as images, atlas, sounds, video
clips, three-dimensional environment, and interactive
teaching modules
“Any time, any place, any pace” learning becomes practical.
Be individualized and interactive; the learner is able to
proceed at his or her own pace, independent of the larger
group.
By placing the student in simulated clinical situations, or in a
simulated examination, a computer-based teaching program
can exercise the student’s knowledge and decision-making
capabilities in a nonthreatening environment.
Well-constructed computer-based learning can be enjoyable
and engaging, maintaining the interest of the student.
Computer-Based Learning Methods
• Drill and Practice: Teaching material is presented to the
student, and the student is evaluated immediately via
multiple-choice questions. The computer grades the
selected answers and, based on the accuracy of the
response, repeats the teaching material, or allows the
student to progress to new material.
• Didactic: The Lecture: A professor can choose to record
a lecture and to store, on the computer, the digitized video
of the lecture as well as the related slides or other
teaching material. This approach has the advantage that
relevant background or remedial material can also be
made available through links at specific points in the
lecture.
• Discrimination Learning: Is the process that teaches the
student to differentiate between the different clinical
manifestations. A computer program, through a series of
examples of increasing complexity, can train the student
to detect the subtle differences.
Computer-Based Learning Methods - continue
• Exploration: Programs create an exploratory
environment in which students can experiment without
guidance or interference.
• Constrained: Students are free to query the program
and to specify actions using unconstrained natural
language.
• Construction
• Simulation: Simulation programs may be either static
or dynamic. Under the static simulation model, each
case presents a patient who has a predefined problem
and set of characteristics. Dynamic simulation
programs simulate changes in patient state over time
and in response to students’ therapeutic decisions.
• Feedback and Guidance
• Intelligent Tutoring Systems
Why patient education?
o Medications
o Home treatments
o Precautions
o Referrals and follow-up
o Illustrations
‫پزشکی ازراه دور‬
Telemedicine
‫علی محمد هادیانفرد‬
‫عضو هیأت علمی دانشکده پیراپزشکی‬
http://sites.google.com/site/ahadianfard/Courses-Taught
‫تعریف‬
‫تله مدیسین مفهومی است که به ارائه خدمات پزشکی (تشخیص ی‪ ،‬درمانی‪،‬‬
‫مشاوره ای) و آموزش ی (بیمارو کادر پزشکی) از مسافت دور و از طریق‬
‫شبکههای ارتباط راه دور که انتقال متن‪ ،‬صوت‪ ،‬تصویر و ویدو را پشتیبانی‬
‫میکنند‪ ،‬اطالق می شود‪ .‬ممکن است به آن ‪ Telehealth‬نیز گفته شود‪.‬‬
‫سیر توسعه پزشکی از راه دور‬
‫بصورت عمومی از زمان پیدایش وسایل ارتباطی نظیر تلگراف و تلفن‬
‫‪ -1959‬استفاده توسط روانپزشکان دانشکده پزشکی نبراسکای آمریکا‪.‬‬
‫‪ -1960‬استفاده توسط سازمان ملی هوا و فضای آمریکا )‪ (NASA‬در منطقه رد ایندیا‪.‬‬
‫‪ -1968‬استفاده توسط پزشکان بیمارستان عمومی ماساچوست در بستون آمریکا‪.‬‬
‫دهه‪ -۱۹۷۰‬توسط توماس برد بصورت پزشکی از راه دور بکار برده شد‪ .‬از طريق شبكه هاي ماهواره اي‬
‫در بخشهاي دور افتاده ای در آالسكا و كانادا بکار گرفته شد‪.‬‬
‫سیر توسعه پزشکی از راه دور‪ -‬ادامه‬
‫‪ -1980‬بکارگیری در پروژه شبکه تصویری تعاملی سیستم بهداشتی روستایی و شهری‪.‬‬
‫‪ -1985‬استفاده از یک شبكه ماهواره اي برای درمان از راه دور درنواحي دور از دسترس استراليا ‪.‬‬
‫دهه ‪ -1990‬توسعه آن به رادیولوژی و تشخیص بیماریهای پوست از راه دور‪.‬‬
‫‪ -2000‬گسترش آن به آسیب شناس ی از راه دور‪.‬‬
‫مزایای پزشکی از راه دور‬
‫– ارائه بهتر و بیشتر خدمات پزشکی به مناطق دور از دسترس نظیر جنگلها‪،‬‬
‫کوهستانها‪ ،‬هوا و فضا‪ ،‬دریاها‪.‬‬
‫– ارائه بهتر و بیشتر خدمات پزشکی به افرادی که امکان جابجایی آنها دشوار یا غیر‬
‫ممکن است‪ .‬نظیر افراد ساملند و زندانیان‬
‫– ارائه خدمات پزشکی در بالیای طبیعی‬
‫– کاهش نقل و انتقال بیمار‬
‫– امکان تبادل اطالعات پزشکی‬
‫مزایای پزشکی از راه دور‪ -‬ادامه‬
‫– فراهم نمودن زمینه یکپارچگی پرونده بیمار‬
‫– توزیع مناسب و عادالنه خدمات پزشکی در کلیه مناطق نظیر مناطق شهری‬
‫و روستایی‬
‫– فراهم نمودن زمینه توسعه دانش پزشکی‬
‫– ایجاد تحول در دوره های آموزش مداوم پزشکی‬
‫– ارتقاء کیفیت خدمات پزشکی و آموزش ی‬
‫– کاهش هزینههای مراقبت پزشکی‬
‫جنبه های پزشکی از راه دور‬
‫‪.I‬‬
‫جنبه خدمات پزشکی‬
‫‪ .II‬جنبه آموزش پزشکی‬
‫موارد استفاده پزشکی از راه دور‬
 Teleconferencing: Videoconferencing, Teleconsulting, Telediagnosis
,Telecommunication, uses Real-time(live interactive or Synchronous)
technology, Two way interactive Television
 Telesurgery: Robotic Surgery
 Teleradiology: uses store and forward (SAF) or Asynchronous technology
 Telecardiology: heart and lung sound, chest pain, pacemaker
 Telepsychiatry
 Teledermatology
 Tele -audiology
‫ ادامه‬-‫موارد استفاده پزشکی از راه دور‬
 Telepathology: Microscopic Images
 Telenursing: Telehome cares, Remote Monitoring (sensors are used to
capture and transmit biometric data), Recommendation, Telephone Triage
(the management of patient health concerns and symptoms via a telephone
interaction ), mHealth (mobile health) used for the practice of
medical and public health, supported by mobile devices. Using of
The Electronic Mail.
 Telepharmacy
 Teledentistry
 Distance Education :including Continuing Medical Education, Grand
Rounds, and Patient Education.
‫تجهیزات مورد نیاز پزشکی از راه دور‬
‫‪ ‬وجود شبکه ارتباط راه دور نظیر ماهواره و یا شبکه مخابراتی‬
‫‪ ‬وجود شبکه اینترنت با پهنای باند مناسب )‪ (Bandwidth‬حداقل ‪Kbps128‬‬
‫‪ ‬وجود تجهیزات پزشکی دیجیتالی‬
‫‪ ‬وجود تجهیزات تبدیل اطالعات غیردیجیتالی به دیجیتالی‬
‫‪ ‬وجود کامپیوتر مجهز به ضبط صوت و ویدئو دیجیتالی‬
‫‪ ‬تجهیزات ذخیره سازی و نمایش دیجیتالی اطالعات‬
‫‪ ‬وجود تجهیزات امنیتی‬
‫‪ ‬وجود نرم افزارهایی که امکان پردازش متن‪ ،‬تصویر و ویدئو را فراهم نماید‪.‬‬
‫محدودیتهای پزشکی از راه دور‬
‫‪ ‬محدودیتهای تکنولوژی‬
‫‪ ‬هزینه باال راه اندازی و نگهداری‬
‫‪ ‬عدم امکان استفاده از آن در همه جا‬
‫‪ ‬نا آشنایی کادر مراقبت و بیماران‬
‫‪ ‬عدم اعتماد به آن‬
‫‪ ‬محدودیتهای امنیتی‬
‫‪ ‬محدودیتهای قانونی و مسئولیت خطاهای پزشکی‬