CSE5810: Intro to Biomedical Informatics CSE 5810 Prof. Steven A. Demurjian, Sr. Computer Science & Engineering Department The University of Connecticut 371 Fairfield Road, Box U-255 Storrs, CT 06269-2155 steve@engr.uconn.edu http://www.engr.uconn.edu/~steve (860) 486 - 4818 intrto-1 What is Informatics? CSE 5810 Informatics is: Management and Processing of Data From Multiple Sources/Contexts Involves Classification (Ontologies), Collection, Storage, Analysis, Dissemination Informatics is Multi-Disciplinary Computing (Model, Store, Process Information) Social Science (User Interactions, HCI) Statistics (Analysis) Informatics Can Apply to Multiple Domains: Business, Biology, Fine Arts, Humanities Pharmacology, Nursing, Medicine, etc. intrto-2 What is Informatics? CSE 5810 Heterogeneous Field – Interaction between People, Information and Technology Computer Science and Engineering Social Science (Human Computer Interface) Information Science (Data Storage, Retrieval and Mining) Informatics People Information Technology Adapted from Shortcliff textbook intrto-3 What is Biomedical Informatics (BMI)? CSE 5810 BMI is Information and its Usage Associated with the Research and Practice of Medicine Including: Clinical Informatics for Patient Care Medical Record + Personal Health Record Bioinformatics for Research/Biology to Bedside From Genomics to Proteomics Public Health Informatics (State and Federal) Tracking Trends in Public Sector Clinical Research Informatics Deidentified Repositories and Databases Facilitate Epidemiological Research and Ongong Clinical Studies (Drug Trails, Data Analysis, etc.) Clinical Informatics, Pharmacy Informatics, Consumer Health Informatics, Nursing Informatics intrto-4 What is Biomedical Informatics (BMI)? CSE 5810 A Exciting Emerging Discipline Biomedical Informatics/Health Information Technology Rapidly Emerging Discipline Cutting Edge, Incredible Career and Research Opportunities Wide Range of Data Clinical Data on Patients Diagnostic Data (Scans, Labs, EKG, etc.) Population Data (Public Health Surveillance) Research on Genomic and Biological Data Any Data Involved in Care of Patients Medical and Clinical Research intrto-5 Why is BMI/Clinical Practice Important? CSE 5810 Tracking all Information for Patient and his/her Care Medical Record, Medical Tests (Lab, Diagnostic, Scans, etc.), Prescriptions Dealing with Patients – Direct Medical Care Hospital or Clinic, Physician’s Office Testing Facility, Insurance/Reimbursement Bringing Together Information for Different Sources Health Information Exchange Gather Data from MD Offices, Clinics, Hospitals Informatics Support via: Personal Health Records Electronic Medical Record Linking/Accessing Data Repositories Collaborative and Secure (HIPPA) Web Portals intrto-6 CSE 5810 © T. Shortliffe 2006 Columbia University intrto-7 BMI and Computer Science & Engineering CSE 5810 Significant Impact Across CS&E Fields Including: Security and Data Protection/Privacy Sensor Networks to Monitor Elderly Artificial Intelligence &Clinical Decision Support Software Architectures for Integrating Health Information Bioinformatics (BI) to Process Biological Data Supercomputing for Genomic and Clinical Data Analysis Visualization to Conceptualize BMI/BI Data Algorithms for BMI/Clinical Data Analysis Mobile Computing to Impact Patient Health and Data Availability Etc… intrto-8 Semester Topics (14.5 weeks) CSE 5810 Core Topics: Introduction to BMI (1) Informatics/Information and Standards (2) Ontologies (1 week) EHRs and PHRs and MockEMR (1) Software Architectures and Interoperability (2) Security and Dynamic Coalition Problem (4) Service Based Computing (1) FHIR (1) Discussion of Individual/Team Project (1-2) intrto-9 Class Materials, Textbook, Projects, etc. CSE 5810 Course Web Site: http://www.engr.uconn.edu/~steve/Cse5810/cse5810.html Reading List Constant Updates and Changes Textbook – Biomedical Informatics: Computer Applications in Health Care and Biomedicine (Health Informatics), 4th edition, Edward H. Shortliffe (Editor), James J. Cimino (Editor), ISBN-10: 0387289860 http://www.springer.com/978-1-4471-4473-1 http://www.amazon.com/Biomedical-InformaticsComputer-Applications-Biomedicine/dp/1447144732/ 4th edition on itunes and amazon kindle. Questions? Comments? Suggestions? intrto-10 CSE 5810 Biomedical Informatics Textbook (4th edition) Springer - 2013 intrto-11 Course Projects CSE 5810 Research Project (due end of semester) Choose a Computer Science Topic Explore the Topic related to BMI Individual/Team Project (due thru semester) Explore Health Information Technology Systems Explore Open Source and Other Solutions Focus on Information Exchange and Interactions No Exam intrto-12 Research Project Deliverables 15 page paper 40-45 slide powerpoint Three Samples on Web page Potential Topics: Security and Data Protection/Privacy Sensor Networks to Monitor Elderly Artificial Intelligence & Clinical Decision Support Software Architectures for Integrating Health Information Bioinformatics (BI) to Process Biological Data Super /Grid computing for Genomic/Clinical Data Analysis Visualization to Conceptualize BMI/BI Data Algorithms for BMI/Clinical Data Analysis Any other CSE topic Area http://www.engr.uconn.edu/~steve/Cse5810/ResProj.pdf CSE 5810 intrto-13 Individual/Team Design/Development Project CSE 5810 Objectives Desire of Patients to Control Access to Own Health Data Pervasiveness & Ubiquity of Mobile Devices Explosion of Fitness/Health Devices, Apps, Data Collection Explore larger scale Health Information Technology Systems and their Interaction Standards, Frameworks, & Systems Support Interoperability via XML and Other Standards Individual/Team Structure To be Developed over Course of the Semester http://www.engr.uconn.edu/~steve/Cse5810/project.docx intrto-14 Motivation CSE 5810 Control Access to Protected health information PHI Fine-Grained Access ‘‘Anyone whom I designate as a family member may view my medication list, except for one of my medications that I’d rather not share. . .”; ‘‘Anyone whom I designate as a health care provider may view my medication list and my history of office visits and hospitalizations, but not modify these data. . .; ‘‘My primary physician, Dr. Albright, may view and modify my medication list and may view and annotate my log of meals and physical activities. . .” ‘‘Dr. Albright’s (Electronic Health Record) EHR system may automatically add new items to my medication list, but it may not change or retrieve any items unless Dr. Albright is logged in.” Sujansky WV1, Faus SA, Stone E, Brennan PF. A method to implement fine-grained access control for personal health records through standard relational database queries. J Biomed Inform. 2010 Oct;43(5 Suppl):S46-50. doi: 10.1016/j.jbi.2010.08.001. Epub 2010 Aug 7. intrto-15 Motivation CSE 5810 Survey of Patients on type and granularity of health and other information that they wanted control of their data in electronic medical records (EMRs) a family member may view my medication list (but not all of them) a medical provider may view my medication list and history of hospital visits (but not modify) my personal physician may both view and modify my health care and fitness data, etc. Define Recipients and Data Item Caine K1, Hanania R., Patients want granular privacy control over health information in electronic medical records. J Am Med Inform Assoc. 2013 Jan 1;20(1):7-15. doi: 10.1136/amiajnl-2012-001023. Epub 2012 Nov 26. intrto-16 Recipents CSE 5810 intrto-17 Data Items CSE 5810 intrto-18 Motivation CSE 5810 2015 of 1.9 billion mobile phones and 230 million tablets, “Gartner Says Global Devices Shipments to Grow 2.8 Percent in 2015” October 2014, 64% of American adults own a Smartphone while as of January 2014, 42% own a Tablet, and 32% own an e-reader. In 2014 that 497 million mobile devices were added that year, and 88% of that growth is accounted to smartphones and, predicted that by 2019 intrto-19 Motivation CSE 5810 Accessing data and executing apps on a mobile platform is substantially more dynamic than traditional computing on laptops and desktops Simultaneously open: email accounts (corporate, Gmail, yahoo, etc.) browsers social network apps (Facebook, Twitter, LinkedIn) communication apps (Skype, Snapchat, SMS) shopping apps (Amazon, JCPenney, Walgreens) health and fitness apps (CVS Health, Microsoft HealthVault, MyQuest, etc.) Need for users to be authenticated on each individual application and often re-authenticated during sessions intrto-20 Motivation CSE 5810 Proliferation of health and fitness applications medications (myCVS, MEDWatcher, Drugs.com Medication guide and Pill Identifier Applications, etc.) personal health record (PHR) applications (CAPZULE PHR, MTBC PHR, suite of WebMD Applications, etc.) a wide array of fitness devices and applications that work with phones and wearables Frameworks and Smartwatches Apple’s HealthKit app Google Fit fitness tracker Apple’s ResearchKit, which is an open source framework for mobile applications to support medical research intrto-21 Motivation CSE 5810 Patients also seek to have access via their mobile devices to electronic medical records (EMRs) utilized by their medical providers, health information technology (HIT) systems that contain medical testing results or results from imaging testing Managing Chronic Diseases Diabetes, Asthma, Obesity, CHF Social media and mobile applications in chronic disease prevention and management http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4423338/ Evaluating Diabetes Mobile Applications for Health Literate Designs and Functionality, 2014 http://www.cdc.gov/pcd/issues/2015/14_0433.htm intrto-22 Motivation CSE 5810 Integration of Blue-Tooth Enabled Devices glucometers (for diabetes) weight scales blood pressure monitors peak-flow monitors ECG (heart) Microsoft HealthVault Can Accept Data from all of these Devices Physicians order Devices Holter Monitor 24hr or Longer Heart Trace intrto-23 Issues CSE 5810 Fitness/Health/Medical/Disease Data from a myriad of different and non-integrated sources collected and made available to patients easily provided to medical providers in either detailed or summary form. A patient may be utilizing multiple mobile apps to manage the different fitness and medical devices, Dedicated data repository (perhaps SQL lite on a phone or SQL DB on a server) with limited ability Inability to collect the data in a consistent format from multiple for integration Medical providers (hospitals, clinics, MD offices, pharmacies, imaging centers, etc.) all have their own health information technology (HIT) systems to manage healthcare and medical data on patients intrto-24 Challenges CSE 5810 Patients need the ability to be able to manage health/medical/fitness/chronic disease data across a wide range of applications (may be both mobile and web-based) involve separate and independent repositories Patients need the ability to share with stakeholders patient him/herself family members (child care, elder care, spousal care) nutritionists, personal trainers, therapists (physical, occupational, pulmonary), home health care aides internist, family medicine MD, nurse practitioner, physician assistants, pediatricians cardiologists, ENTs, orthopedic surgeons, physiatrist, phycologist, therapist, etc intrto-25 Challenges CSE 5810 Medical providers which need to have access to Granular/aggregated health/medical/fitness/chronic disease data Within an Electronic Medical Record (EMR) Each Provider has Separate EMR Sharing Across EMRs Difficult Want Information in EMR to Mesh with Medical Treatment/Workflow for Patients Medical providers give medical devices to patients collect data over a specific time period delivered back to the medical provider by phone, internet, or by returning the device itself intrto-26 Purpose of Project CSE 5810 Explore all of these different issues utilizing a variety of health information technology standards, frameworks, and systems Develop a working group of the entire class that will leverage the varied skill sets mobile app design/development interacting with devices databases, APIs) Exploring, evaluating, and utilizing a wide range of HIT standards, frameworks, and actual systems intrto-27 Standards include: CSE 5810 JSON: http://www.json.org/ RDF: https://www.w3.org/RDF/ XML: http://www.w3schools.com/xml/ HL7: http://www.hl7.org/implement/standards HL7 CDA: http://www.hl7.org/implement/standards/product_brief .cfm?product_id=7 HL7 CCD : http://www.hl7.org/implement/standards/product_brief .cfm?product_id=6 ICD-10: https://www.medicaid.gov/medicaid-chipprogram-information/by-topics/data-and-systems/icdcoding/icd.html intrto-28 Framworks include: CSE 5810 FHIR: Fast Healthcare Interoperability Resources https://www.hl7.org/fhir/overview.html https://www.hl7.org/fhir/index.html SMART: An App Platform for Healthcare http://smarthealthit.org with multiple apps https://gallery.smarthealthit.org/ Usage of FHIR http://smarthealthit.org/smart-onfhir/ Open mHealth: Open Source Code to Integrate digital health data http://www.openmhealth.org intrto-29 Systems include: CSE 5810 Open MRS: open source enterprise electronic medical record system http://openmrs.org with standalone version http://openmrs.org/download/ Open EMR: A Stage II meaningful use certified EHR http://www.open-emr.org with standalone version http://www.openemr.org/wiki/index.php/OpenEMR_Downloads Top 7 Free/Open Source: http://blog.capterra.com/top-7-free-open-sourceemr-software-products/ Open Clinical Organization: http://www.openclinical.org/opensource.html intrto-30 Spring 2014 Chosen Team Projects CSE 5810 Health Information Exchange (HIE) Team of 9 Among OpenEMR, WorldVista, SMART EMR Multiple Instance of First Two Varied Granularity Level for Data Exchange Records, Patients, Entire Data Set Programmatically, Databases, or APIs Promote Framework for HIE HIT Infra-structure for UConn/UCHC Team of 6 Expand Utility of MSHV and OpenEMR Include Additional Modules Include Capabilities for Triggers, etc. Expand APIs to Facilitate Easy Usage of Both for Web-Based and Mobile Apps intrto-31 Team T1 Advice CSE 5810 Survey and Identify Other Open Source and Freely Available EMRs For each EMR Assess regarding Database Platform and Accessibility APIs Patient vs. Provider Access Availability of Patient Portal, PHR, ePrescribing Support for CDS Explore Capabilities of Each re. Exporting/Importing via Standards and File Formats Review HIE and other Interop PPlatforms such as: (http://www.nchica.org/HIT_HIE/NHIN.htm ), Connect (http://www.connectopensource.org/), and http://wiki.directproject.org/home and http://wiki.directproject.org/Best+Practices+for+HISPs http://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/Certification.html intrto-32 Team T1 Division of Work Suggestions CSE 5810 Identify Two Individuals to co-Lead the Team Search and Identify EMR Open Source Platforms Try to Identify 9 Platforms (1 per team member) OpenEMR, World Vista, OpenMRS, gaiaehr If less than 9 …Two Options Look for Commercial Products with well-Defined APIs/Web Services/Import/Export Capabilities OR Look for Open Source Platforms such as Harvard SMART, open mhealth, etc. Explore Capabilities of Each (Comparison Metric) in terms of import/export/CCR/CDA/etc. See Matrix Objective – Propose Blueprint for Their Integration intrto-33 OEMR Export/Exchange Patient Data Set Filter Option Patient Set Size Scenario Export Format Path after Sign In. Role Req. Tech Skill Req. Nativ e Setup Backup All Data (no subset) N/A All Patients Backup or migration SQL Create Statement Admin> Create Backup Admin No Yes CSE Batch 5810 Personal Financial HIPAA Provider Age range App Date HIPAA All Patients List of data with non clinical info for exchange CSV, Email, Phone Call List Misc> Batch> Process Admin No Yes SQL All Data SQL Filter Any Patient Set Size Granular data search and export CSV Misc> Batch> Process Admin SQL No CCR Patient Demographics, Immunizations, Vital Signs, Problems & Diagnoses, Insurance Information, Health Care Providers, Encounter Information, Allergies/Alerting Data, Appropriate Results, Medication, Procedures, Results, Necessary Medical Equipment, Social History, Statistics, Family History, Care Plan Date Range Single Patient Print and handout Web Patient> Demo.> Reports> Button Admin; Physician; Clinician; FrontOffice Accounting No Yes CCD Header, Purpose, Problems, Procedures, Family history, Social history, Payers, Advance directives, Alerts, Medications, Immunizations, Medical equipment, Vital signs, Functional stats, Results, Encounters, Plan of care N/A Single Patient Print and handout Web Patient> Demo.> Reports> Button Admin; Physician; Clinician; FrontOffice Accounting No Yes EMR Direct Header, Purpose, Problems, Procedures, Family history, Social history, Payers, Advance directives, Alerts, Medications, Immunizations, Medical equipment, Vital signs, Functional stats, Results, Encounters,Plan of care N/A Single Patient Messages are processed and a new Patient Note is delivered to a specified user and appears in that user's Message and Reminder Center. Web Patient > Demo > Reports > Transmit Admin; Physician; Clinician; FrontOffice Accounting No No Export All Data (no subset) N/A All Patients Fast and easy export of entire data set. CSV, CSV, LaTeX, PDF, SQL, YAML Admin > Database > Export Button Admin Database PHPMyAd min No intrto-34 Team T2 Advice CSE 5810 Explore the Open Community and Wiki for OpenEMR Search for Universities Using OpenEMR in a Classsetting Search for Free Addons/Plug-ins for Patient Portal and PHR ePrescribing, and others Expand existing APIs with ability to retrieve, store, exchange and display information in MSHV and OpenEMR – Assess Backend impact of to PHA Design a set of Generalized APIs towards an ability to allow Interactions with an PHR/EMR Combination Demonstrate Generalized APIs by Adding API for another EMR and another PHR. Each Team Member Must Decide Focus on Addons/Usability (1/2 team?) Focus on API Development (1/2 team?) http://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/Certification.html intrto-35 Team T2 Division of Work Suggestions CSE 5810 Identify One Individual to Lead the Team Each Team Member should Immerse Him/Herself into the OpenEMR Community (wiki) Conduct Web Searches for AddOns Divide Responsibilities by: Entire Team Should Provide Detailed Survey of Adds on Including an Assessment/Evaluation of Each Propose Recommendations of AddOns Expand Current APIs for MHSV/OpenEMR Using REST to “Hide” both Behind the Scene REST Implement call Product APIs Develop New APIS for AddOns If Relevant intrto-36 OEMR Export/Exchange Patient Data Set Filter Option Patient Set Size Scenario Export Format Path after Sign In. Role Req. Tech Skill Req. Nativ e Setup Backup All Data (no subset) N/A All Patients Backup or migration SQL Create Statement Admin> Create Backup Admin No Yes CSE Batch 5810 Personal Financial HIPAA Provider Age range App Date HIPAA All Patients List of data with non clinical info for exchange CSV, Email, Phone Call List Misc> Batch> Process Admin No Yes SQL All Data SQL Filter Any Patient Set Size Granular data search and export CSV Misc> Batch> Process Admin SQL No CCR Patient Demographics, Immunizations, Vital Signs, Problems & Diagnoses, Insurance Information, Health Care Providers, Encounter Information, Allergies/Alerting Data, Appropriate Results, Medication, Procedures, Results, Necessary Medical Equipment, Social History, Statistics, Family History, Care Plan Date Range Single Patient Print and handout Web Patient> Demo.> Reports> Button Admin; Physician; Clinician; FrontOffice Accounting No Yes CCD Header, Purpose, Problems, Procedures, Family history, Social history, Payers, Advance directives, Alerts, Medications, Immunizations, Medical equipment, Vital signs, Functional stats, Results, Encounters, Plan of care N/A Single Patient Print and handout Web Patient> Demo.> Reports> Button Admin; Physician; Clinician; FrontOffice Accounting No Yes EMR Direct Header, Purpose, Problems, Procedures, Family history, Social history, Payers, Advance directives, Alerts, Medications, Immunizations, Medical equipment, Vital signs, Functional stats, Results, Encounters,Plan of care N/A Single Patient Messages are processed and a new Patient Note is delivered to a specified user and appears in that user's Message and Reminder Center. Web Patient > Demo > Reports > Transmit Admin; Physician; Clinician; FrontOffice Accounting No No Export All Data (no subset) N/A All Patients Fast and easy export of entire data set. CSV, CSV, LaTeX, PDF, SQL, YAML Admin > Database > Export Button Admin Database PHPMyAd min No intrto-37