Introduction to Health Care Informatics

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Introduction to Health Care Informatics

• HS 6300
• Health Information Systems
• François Sainfort, Ph.D.
• David Cowan

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Healthcare Information Technology Systems

• Healthcare
• one of Americas largest industries
• Information
• not data but information
• Technology
• computers, sensors, imaging, robotics, etc.
• Systems
• a way to organize, think, solve problems, build

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Information

• Not just data
• Clinical data, Scientific data, Manpower data,
  Facility data, Utilization data, Demographic
  data, Operational Data,
• My data, your data, our data
• concurrent, retrospective, forecasts
• Turning data into information
• statistical analysis
• benchmarks
• relevance
• presentation
• inference

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Technology

• Diagnostic Devices
• Imaging
• Chemistry
• Flow /Pressure
• Electronics
• Monitoring Devices
• Telemetry
• Imbedded
• Theraputic
• Angiography
• Prosthetics

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Systems

• Systems Thinking
• Break it up into its component parts, fix the
  parts and put it back together
• Complexity made simple
• Logic, Algorithms
• The System Design, Selection, Implementation,
  Management
• Integrating disparate systems to develop synergy
• Functionality, value, elegant
• Understanding the user.

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Terms

• Hospitals
• patient days, discharges, occupancy, Outpatient,
  Inpatient, Length of Stay
• obstetrics,orthopedics, neuro, pediatrics,
  cardiology,
• medical record, vital signs, ICD9 codes, CPT,
  diagnosis, mortality, nosocomial, abstracting,
• Radiology, Pharmacy, Respitory Therapy,
  Laboratory, ER, OR, PACU,
• DRGs, Medicare, Medicaid, Third Party Payer,

• Organizations
• HHS, CMS, HCFA, AHRQ, IOM, WHO, DCH, CDC, PHS,
  IHI
• HIMSS, CHIME
• AHA, GHA, AMA, MGMA, APHA
• HIPAA
• Security, Privacy, Transaction Standard
• HIS
• CPOE, EMR, HL7, PACS, EBM

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Topics for Discussion

• Applications
• Hospital IS
• Physician IS
• Public Health
• Health Planning
• Patient Consumer IS
• Medical Records
• Disease Coding
• Evidence Based Medicine
• Medical Devices
• Monitors, Imaging, Testing
• Robotics, Surgery
• HIS Vendor
• Cerner, IDX, Seimans, Philips, McKesson,
  Solucient, Meditech, GE, EPIC

• Techniques
• HCI
• Systems Planning
• Implementation Mngt
• Benefits Realization / ROI
• Systems Design
• Systems Support
• Systems Interfaces
• Process Reenginneering
• Database Design
• Computer Methods
• Infrastructure
• Organizations
• Vendors
• Public Policy

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The Past and Future of Care Defining Attributes

• Acute, episodic
• Patient passive
• Culture of deference
• Personal memory-based
• No systems awareness

• Acute and Chronic
• Patient empowered
• Accountability
• evidence driven
• Protocol supported
• IT Team-based
• Person Population

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WHAT Medical Informatics

• the field concerned with the cognitive,
  information processing, and communication tasks
  of medical practice, education, and research,
  including the information science and technology
  to support these tasks.
• Robert Greenes

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WHAT Medical Informatics

• the rapidly developing scientific field that
  deals with resources, devices and formalized
  methods for optimizing the storage, retrieval,
  and management of biomedical information for
  problem solving and decision making.
• Edward Shortliffe

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WHAT Healthcare Informatics

• Union of computer science, information science,
  and health sciences in service of health care
  delivery and management.
• Judith Ozbolt

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WHAT/WHY Health Informatics

• A scientific field that draws upon the
  information sciences and related technology to
  enhance the use and discovery of health sciences
  knowledge in order to improve health care,
  biomedical and clinical research, education,
  management, and policy.
• Don Detmer

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Many Disciplines

• Health Systems Engineering
• Clinical and basic medical knowledge
• Health policy and management
• Knowledge Management
• Decision support, Expert systems, etc.
• Human computer interaction
• Computer Science
• Library Science
• Health values and ethics

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Taxonomy Health Informatics

• Bioinformatics (biomedical informatics)
• Clinical Informatics
• Computer Methods for Health Applications
• Consumer Health (E-health) Informatics
• Health Information Policy
• Knowledge Management

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Bionic Convergence

• Convergence of the biological revolution with the
  information revolution, of biology with
  electronics
• W.T. Anderson, Evolution Isnt What It Used To
  Be, 1996

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1997 - A year to remember with no looking back

• Deep Blue ( IBM computer) beat Gary Kasparov,
  reigning chess champion. Kasparov resigned in
  last of six-game match after 19 moves. First time
  a human was defeated by a machine in head-to-head
  match.
• Blue Gene ready in 2004
• Million billion operations per second
• Over 500 x Deep Blue
• Use determine folding of proteins

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Computing Architectures

• Now and into the Future
• Discrete - devices, e.g. PC, PA, cellular phones
• Pervasive (ubiquitous) - imbedded computers, e.g.
  autos, ultimately in us too
• Virtual - We imbed ourselves into the computers
  artificial reality.

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The future just isnt what it used to be.

• Will Rogers

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The New Medicine

• Driven by Computing
• semiconductors
• software
• fiber optic networks
• automation
• robotics
• telemetry
• Driven by Molecular Biology
• Genetics
• Genomics
• Proteomics

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Areas of Biotechnology / Biomedicine to watch

• Nanotechnology
• Fiber optics - Video cameras
• Sensors
• Tissue engineering
• Robotics
• Modeling and simulations, e.g.,virtual clinical
  trials
• Genomics genetics databases
• Etc.

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Sniff Technology- Biosensors

• Bacteria and viruses give off an odor
• Odor can be sensitively evaluated against its
  signature smell
• Offers major help on prompt decision regarding
  need for antibiotic and if so, which one

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Or, since the Europeans love their dogs, take a
biological approach and teach your dog to sniff
out melanomas.

• In 1989, the British Journal Lancet published a
  case report from London.A female half Border
  collie, half Doberman, had alerted a 44 year old
  woman to a lesion on her thigh. The woman
  reported that the dog kept sniffing at this
  lesion, but it ignored other moles. In fact, the
  dog even attempted to bite off the offending mole
  when she was wearing shorts. The woman consulted
  her doctor and the mole was excised.
• The diagnosis? Malignant melanoma.
• Dr. Armand Cognetta, dermatologist in Florida got
  a friend to help train a retired bomb-sniffing
  dog to sniff out melanomas.

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Pace of new drugs will quicken, by 2008

• 65 increase in number of potential medicines
  entering clinical development
• Success rate from 110 to 310
• Time for development
• Discovery/preclinical - down 46
• Phase I/Iia down 40
• Phase IIa/III down 27
• Source Sir R.D. Sykes (UK)

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Diffusion of Technology

• Telephone 40 years to reach 10 million
  customers
• Internet 4-5 years to reach 100 million users
• Today The daily volume of electronic messages
  equals traditional telephonic messages

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Simon Says (Herbert A. Simon)

• What information consumes is rather obvious it
  consumes the attention of its recipients. Hence a
  wealth of information creates a poverty of
  attention, and a need to allocate that attention
  efficiently among the overabundance of
  information sources that might consume it.

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The Truth about Knowledge

• Today it is as much a river as a mountain.
• One can drown in information so many choose to
  stay on land.
• We need all the help we can get because we must
  swim.

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Evidence-based Medicine

• The plural of anecdotes is not data.

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Randomized Clinical TrialsLooking at last 30
years of growth

• First 5 years - 1 of all articles
• Last 5 years - 49 of all articles
• From just over 100 per year to nearly 10,000
  annually
• Chassin - Milbank Quarterly 1998

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Assured Process Improves Outcomes and Reduces
Costs

• Prevention is preferred to detection
• The patient is central
• Focus on the system and not the individual
• Variation in clinical practices is endemic
• Quality can be constantly improved
• Reed Gardner, 1995

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Quality IT RD

• Multiple IT quality systems are needed. Among
  them, they should
• assure safety and monitor where lapses can still
  occur
• shift the mean performance upward
• diligently assess errors and near misses that
  occur so systems are improved
• audit for rotten apples

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Coming A global health information
infrastructure?

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Elements of a Global Health Information
Infrastructure

• Computer-based health records
• International collaboration digital divide
• Knowledge-management/decision support for
  practice and education based upon evidence
• Privacy, confidentiality, security
• Research, education, development
• Standards development
• Telemedicine Tele-education
• Universal access

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The Digital Divide The 3 billion person question

• Half of the worlds people have never used a
  telephone.
• How many will use the Internet?
• In Winter 2001 total volume of e-mail
  communications exceeded telephone messages

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Needed High Tech - Low Touch Technologies

• Hand-powered web-surfer/telephone/fax
• Touch-button spoken English for Medline abstracts
• Touch-button translations of Medline articles
  into multiple languages
• Your choices

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Computer-based Patient Records (C3PRs)

• Personal - the persons health record for own
  uses
• Patient - the care delivery record itself
• Population - without personal identifiers,
  aggregated records for planning and management

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Patient access to information

• Data about their care system and its value
• Health information for wellness, general health
  promotion, or specific conditions
• Access to same data professionals utilize for
  best practices in diagnosis and treatment
• Access to data relating to their own care

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IT Staging in Organizations (Hebert 1998)

• I - Substituting IT for past existing discrete
  tasks - direct automation of past
• II - Proceduralization - re-design with new
  procedures separate tasks grouped together
• III -Totally new activities occur, including some
  that in the past were simply impossible

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Predictions for 2001-2020

• Hospitals
• Primary care office
• Home Community

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Implications for 2001-2020

• Hospitals - from places for cure

to quality improvement for chronic illness
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Predictions for 2001-2020

• Primary care office - from quality improvement to
  cure

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Implications for 2001-2020

• Home more prevention, primary care, and cure
• Community - illness prevention and health
  assurance

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Taxonomy Health Informatics and YOU

• Bioinformatics (biomedical informatics)
• IT dimensions of Genomics research
• Clinical Informatics
• Computer-based Patient Records
• Database Design and Management
• Decision-support systems
• Telemedicine (distant Dx /or Rx)

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Taxonomy Health Informatics And YOU

• Computer Methods for Health Applications
• Care, Education, Evaluation, Research
• Authentication, security, etc.
• Consumer Health (E-health) Informatics
• Computer-based Personal Health Records
• Telehealth (health education)

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Taxonomy Health Informatics And YOU

• Health Information Policy
• National Information Infrastructure
• Privacy, Confidentiality, and Security Policy
• Knowledge Management
• Language, Terminology, and Messaging
• Standards
• Digital Libraries
• (Evaluating the Evidence)