Download Medical Informatics Introduction and Overview

Medical Informatics
Introduction and Overview
James J. Cimino, M.D.
Departments of Medicine
and Medical Informatics
Medical Informatics

Medical

Information

Science
We Are All Medical Informaticians

Medical Education

Patient Data Collection and Recording

Clinical Information Retrieval

Medical Knowledge Retrieval

Medical Decision Making
Some Definitions

Medical Informatics: the science of medical
information collection and management

Medical Decision Making: quantitative methods for
reasoning under uncertainty

Medical Computing: computer applications for
information management

Medical Decision Support: computer-based
information processing to help human decision
makers
A Brief History - Past to Future
Ledley and Lusted - Reasoning foundations
of medical diagnosis; Science 1959
 El Camino Hospital - 1965
 Help System - 1970
 Financial systems - driven by billing and
reporting requirements
 Clinical Systems
 Information Resources
 Expert Systems

Medical Computing

Patient-Oriented Systems

Medical Information Resources

Medical Knowledge Systems
Patient Oriented Systems

Definition: systems which collect, store and
retrieve data about individual patients

Financial systems

Electronic medical records

Research databases
Medical Information Resources

Definition: systems which contain
general medical knowledge

Medline

Electronic textbooks

Computer-assisted instruction
Medical Knowledge Systems

Definition: systems which apply general
medical knowledge, whether through
pattern matching or application of
clinical algorithms, to specific patients

Stand-alone: Mycin, Internist-I/QMR,
DXplain

Integrated: Help, Columbia CIS
Case Presentation
Case Description: 74 y.o. female with history of right CVA in 1989 (LLE
weakness), one week of productive cough and increased debility. Exam
consistent with bronchitis, oral antibiotic prescribed, but patient had a tonic
grand mal seizure in clinic. Became flaccid, unconscious, pulseless, apneic,
but upon positioning for CPR, developed pulse and spontaneous respirations
and awoke about 2 minutes after start of episode, complaining of lower
sternal chest pain.

Actions:
» Transfer to Emergency Room
» Examination
» Bloodwork
» Chest Xray
» Cardiogram
» Admission and therapy
CIS Demo - Part I

Lab Data: ABG and CPK/Isoenzymes

Radiology: CXR, VQ, Doppler

Cardiology: ECG, Cardiac Cath

Medications

Alerts

Discharge Summary
Case Summary
Case Description: bronchitis, bed-bound, venous thrombosis, pulmonary
embolism, myocardial infarction, ventricular arrhythmia, hypotension, seizure,
adult respiratory distress syndrome, methicillin-resistant Staph aureus

Discharge Plan
» Where?
» What happened?

Outpatient Follow-up
» Medications
» Laboratory
» Health Maintenance
CIS Demo - Part II

Demographic Information

Additional Hospitalizations?

More Discharge Summaries?

Recent Lab Results

Outpatient Notes
How Did We Do It?

Information Science

Standards

Integration
Medical Informatics - Lecture II

Information Science

Standards

Integration
Information Science

Expert Systems

Decision Support Systems

Research Databases

Computer Assisted-Instruction
<Show 4 CAI Slides>
Standards

Messaging

Vocabulary

Logic

Databases
Standards for Messaging

Structured Query Language

Z39.50

Health Level 7 (HL7)
HL7 Example
MSH!^~\&!resquery!cicsu9!socratesqry!wash!19950314151110307!!ORF!199503141!!
MSA!AA!19941125165590!RESULT LIST COMPLETED.!!
QRD!19941125165542!R!I!0113142726!!!99!1644144!res!32309!!
QRF!*!19901101000000!19941230170100!PDQRES2~*~OPSTA!95~95~95~PF~~
OBR!!!M136903542294808^0001!35422^^L!!!1994080807190000000!!!!!!!!!!!!!!!!!F!!!!!!!!!
OBX!!TX!35456^^L!1^0!138$135-146]mM/l!!!!!!!
OBR!!!M140333542394808^0001!35423^^L!!!1994080807100000000!!!!!!!!!!!!!!!!!F!!!!!!!!!
OBX!!TX!35456^^L!1^0!136$135-146]mM/l!!!!!!!
OBR!!!X263 3542294807^0001!35422^^L!!!1994080706520000000!!!!!!!!!!!!!!!!!F!!!!!!!!!
OBX!!TX!35456^^L!1^0!140$135-146]mM/l!!!!!!!
Standards for Vocabulary

International Classification of Diseases, 9th
Edition, with Clinical Modifications (ICD9-CM)
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Diagnosis-Related Groups (DRGs)
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Medical Subject Headings (MeSH)
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Unified Medical language System (UMLS)
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Systematized Nomenclature of Medicine
(SNOMED)
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Read Codes
ICD9- CM Example
003 Other Salmonella Infections
003.0 Salmonella Gastroenteritis
003.1 Salmonella Septicemia
003.2 Localized Salmonella Infections
003.20 Localized Salmonella Infection, Unspecified
003.21 Salmonella Meningitis
003.22 Salmonella Pneumonia
003.23 Salmonella Arthritis
003.24 Salmonella Osteomyelitis
003.29 Other Localized Salmonella Infection
003.8 Other specified salmonella infections
003.9 Salmonella infection, unspecified
DRG Example
75 - Respiratory disease with major chest operating room procedure, no
major complication or comorbidity
76 - Respiratory disease with major chest operating room procedure, minor
complication or comorbidity
77 - Respiratory disease with other respiratory system operating procedure,
no complication or comorbidity
79 - Respiratory infection with minor complication, age greater than 17
80 - Respiratory infection with no minor complication, age greater than 17
89 - Simple Pneumonia with minor complication, age greater than 17
90 - Simple Pneumonia with no minor complication, age greater than 17
475- Respiratory disease with ventilator support
538 - Respiratory disease with major chest operating room procedure and
major complication or comorbidity
MeSH Example
Respiratory Tract Diseases
Lung Diseases
Pneumonia
Bronchopneumonia
Pneumonia, Aspiration
Pneumonia, Lipid
Pneumonia, Lobar
Pneumonia, Mycoplasma
Pneumonia, Pneumocystis Carinii
Pneumonia, Rickettsial
Pneumonia, Staphylococcal
Pneumonia, Viral
Lung Diseases, Fungal
Pneumonia, Pneumocystis Carinii
SNOMED Example
D2-50000
D2-50100
D2-50100
D2-50100
D2-50100
D2-50100
D2-50104
D2-50110
D2-50120
D2-50130
D2-50130
D2-50140
D2-50140
D2-50142
D2-50150
D2-50152
D2-50160
D2-50170
SECTIONS 2-5-6 DISEASES OF THE LUNG
2-501 NON-INFECTIOUS PNEUMONIAS
Bronchopneumonia, NOS
(T-26000) (M-40000)
Lobular pneumonia
(T-28040) (M-40000)
Segmental pneumonia
(T-280D0) (M-40000)
Bronchial pneumonia
(T-280D0) (M-40000)
Peribronchial pneumonia
(T-26090) (M-40000)
Hemorrhagic bronchopneumonia
(T-26000) (M-40790)
Terminal bronchopneumonia
(T-26000) (M-40000)
Pleurobronchopneumonia
(T-26000) (M-40000)
Pleuropneumonia
(T-26000) (M-40000)
Pneumonia, NOS
(T-28000) (M-40000)
Pneumonitis, NOS
(T-28000) (M-40000)
Catarrhal pneumonia
(T-28000) (M-40000)
Unresolved pneumonia
(T-28000) (M-40000)
Unresolved lobar pneumonia
(T-28770) (M-40000)
Granulomatous pneumonia, NOS
(T-28000) (M-44000)
Airsacculitis, NOS
(T-28850) (M-40000)
Standards for Logic

HELP Sectors

CARE System

Arden Syntax for Medical Logic Modules
MLM Example
maintenance: title: Creatinine clearance;; version: 1.09;;
author: George Hripcsak, M.D. ([email protected]);; ;;
library: purpose: To calculate the creatinine clearance for every timed urine collection;;
explanation: When a timed urine collection is stored, the MLM checks for..... ;;
knowledge:
data:
let urine_creat_storage be event {'32506','1762'};
let (urine_creat, collect_time) be read last {'evoking', 'dam'="PDQRES1";'1762'; '1537'};;;
evoke: starting time of urine_creat_storage;;
logic:
let serum_creat be nearest (time of urine_creat) from (serum_creat_list where it is
number);
let creat_clear be 0.07 * (24 / collect_time) * (urine_creat / serum_creat);
conclude true;
;;
action: write "The creatinine clearance is " ||int(0.5+creat_clear)|| " ml/min based
upon a " ||collect_time|| " hour urine creatinine of " ||urine_creat||.....; ;;
end:
Standards for Databases

Definitions for Computer-Based Patient
Records

Data Model Standards
Integration

IAIMS: Integrated Advanced (Academic)
Information Management Systems

Five Levels of Integration

World Wide Web (WWW)
<5 Levels of Integration>
Architecture at CPMC
Local Area Network
Clinical
Departments
Web Browser
Clinical
Information
System
Clinical Data
Server
Workstations
Additional Information
Sources
Vocabulary
Server
Internet
Web Server
Resident Signout Editor
(RSE)
World Wide Web Demo
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Visual Bed Browser

JMW’s CIS Menu

JMW’s Labs

Lab Trend

Medline Button Q's

Medline Button Results

Medline button Abstract

DXplain Button Extract

DXplain Button Results

DXplain Button Disease
Cholesterol Guideline Input
Cholesterol Guideline Result
ECG
Xray
Xray Medline Q's
Xray Medline Abstract
Medications
Single Drug Order
Drug/Diet Information
PDR
JMW’s Discharge Summary
Summary

Classification of Systems

Development of Standards

Intelligent Integration
Challenges

Security and Confidentiality

Vocabulary

Data Entry

Changing Behavior
» Outcomes assessment
» Managed care
» New paradigms for information use