An Introduction to Medical Informatics Y. SINGH NELSON R. MANDELA SCHOOL OF MEDICINE DEPARTMENT OF TELEHEALTH SINGHY@UKZN.AC.ZA Welcome ladies and gentleman to this an introduction to medical informatics. My name is Yashik Singh and I am from the department of Telehealth at the Nelson R Mandela School of Medicine, South Africa Content licensed under Creative Commons Attribution-Share Alike 3.0 Unported

Learning Objectives Define medical informatics Get a sense of what medical informatics encompasses Why is medical informatics important Some examples of applications In this lecture we are going to try and define what medical informatics is, to try and get a sense of what medical informatics encompasses. We will also discuss why medical informatics is important and try and give examples along the way. All videos shown in this presentation is freely available at youtube

An Evolving Field 1950s Intuitively: “medical applications of computer science” Medical computer science Medical information science Biomedical computing Medical informatics Health or healthcare informatics Clinical informatics Lets start by trying to understand why this field of study is called medical informatics. Medical informatics began in the 1950s with the advent of computers. During this time scientist intuitively realized that they could create medical applications of computer science. They however did not know what they should call this field of study. They initially named it medical computer science but after a while the term computer science became a concern to many scientists. Computer science in the 1950s was not as defined at it is today. In the 1950s it mainly dealt with hardware, and specifically making hardware smaller and faster. They knew that this field of study that they trying to create encompasses more than just hardware. They wanted a term that described the fact that it encompasses the use, processing, analyzing and storage of information. They thus changed the name to medical information science. The term information science not only encompassed the aspects of computer science, but all fields associated with storage, processing, analysis and commutation of information e.g. Mathematics, library science, information systems, communication technology etc. After a while the validity of this domain name again began to be questioned, specifically the use of the word medical. This term did not explicitly indicate the other types of data was associated with this domain. This domain name did not include the biological data associates with the field like genome sequences, proteins, amino acids and bases etc. they therefore started using the term Biomedical computing. However after a while this term was also very limiting. They realized that this field of study also encompasses all of the associated medical data like demographics, information needed by health manager for resource allocation, HR data etc. They then called this domain medical informatics. This is probably the most common title, but in Europe health or health care informatics is used and in America clinical informatics is used. These three terms mean the same thing.

History 1949 Gustav Wager 1950 United States National Bureau of Standards mid 50’s MYCIN 1965 Medline 1968 Homer Warner founded the department of medical informatics 1970 IMIA, MUMPS language and OS In 1949, Gustav Wager established the first professionally organization for medical informatics in Germany. The first medical informatics application were in dental projects in 1950 by the unites states national bureau of standards. In the mid 50s expert systems like MYCIN were developed and used. In 1965 the national library of medicine stared using Medline. In 1968 homer Warner, who is one of the fathers of medical informatics, founded the department of medical informatics at the university of Utar. In 1970 the international medical informatics association was founded. In the same year the MUMPS language and operating system was developed and used for clinical applications.

Define Medical Informatics No clear cut definition Different schools of thought Video One It is very difficult to create a clear cut definition of medical informatics. There are various schools of thought all depending on the university of the scientist, research areas, what the environment is like, political pressures etc. Let us try and create a working definition for medical informatics for this lecture. There are two videos to this end. The first helps you determine the overall aim of medical informatics. This video is found in the resources material associated with this lecture, or you can get the url from the link found in the left of your screen.

Define Medical Informatics Dr David Zitner Four aspects of medical informatics: Clinical care Health service administration Research Patient and provider education Video Two The second video is by Dr David Zitner the director of medical informatics at the university of Dalhouse medical school. He describes the clinical care, Health service administration, Research and Patient and provider education aspects of medical informatics.

Define Medical Informatics Systematic study Deals with all forms of “data” Biological data Medical data Associated data Problem solving Decision making From these videos we find there should be some important aspects in the definition. It is a systematic and scientific field of study. This means that there has to be a method of enquiry that deals with gathering observable, empherical and measurable data subject to a certain set of principles of reasoning. There must be a observations, a measurement, experiments, hypotheses, testing, analysis, then possibly a change the hypotheses and the cycle goes on. It deals with all forms of data and is used for problem solving or decision making

Define Medical Informatics Medical informatics is a scientific/systematic field of study that deals with the acquiring, storage, retrieval, and processing of medical, biological and associated data, information and knowledge for the purpose of problem solving and decision making Medical informatics is a scientific/systematic field of study that deals with the acquiring, storage retrieval, and processing of medical, biological and associated data, information and knowledge for the purpose of problem solving and decision making

Data, Information, Knowledge Data are the raw facts obtained Information is outcome of analyzing data Knowledge is obtained from analyzing information Data, knowledge and information are three distinct aspects of what we commonly call data. Data is the raw facts obtained e.g. my blood pressure is 150/90. Information is outcome of analyzing data e.g. yashik’s blood pressure is high. Knowledge is obtained from analyzing information e.g. hypertension is diagnosed when blood pressure is higher that 150/90

Medical Informatics Computerized Medical Records Computer-Aided Instruction Medical Software Security Veterinary Informatics Telemedicine Medical Informatics Nursing Informatics Policy Making Physician Order Entry Systems This slide describes various fields in the domain of medical informatics. One must note that because there is no clear cut definition of the medical informatics, there are many researcher that will disagree with this slide. According to some, Telemedicine is an aspect of medical informatics. Telemedicine is the field of study where one tries to provide medical care over distance. So you may be sitting in a rural hospital in Rwanda and there is a doctor or specialist treating you from a hospital in America. Other examples are nursing informatics, medical expert systems (computer programs that can aid with medical decisions). Medical informatics that deals with animals are called veterinary informatics. Others include computer aided instruction, medical software security, policy making, medical software engineering, clinical systems and health information networks. Three important aspects of medical informatics is security, mobile health and e-economics in health care. Medical Expert Systems Medical Software Engineering Health Information Networks Clinical Information Systems

Why Medical Informatics Why is proper management of medical data important ? Patient health record Administrative purposes Research and knowledge discovery Legal issues And the list goes This slide describes why medical informatics is important. When you ask yourself that question your are actually asking why is proper management of medical data important. Some reasons include: Patient health record: this data forms part of the patient health record. No clinical staff will be able to remember details about patient treatment in detail. Thus there needs a place to record it inorder to remind clinicians about treatment protocols, treatment history, continuity of care etc. Administrative purposes: information needs to be properly managed to administrate the hospital. This aids in resources allocation. Research and knowledge discovery: imagine doing research when data is not recorded. Legal issues: there are also legal issues. Proper data management is particularly important when it comes to malpractice lawsuits. The doctor will use this record to prove that his treatment would be the same as another doctor in a similar situation.

Why Medical Informatics What is lacking in the current approach ? Organizational Logistical Research Passive nature of paper What is lacking in the current approach to health care? Currently paper is used as a means to record, store, and communicate all observations. Paper has many intrinsic disadvantages that can be divided into organizational, logistical, research and the passive nature of paper. We will go through each of these in detail in the introduction to electronic medical records lecture. For now a simple idea about what these consist of will suffice: Organizational: this refers to the manner in which the paper is organized i.e. the way in which the data is stored in the paper record and also how this facilitates the retrieval of information Logistical: this deals with the aspects of communication and backup. Research: this deals with issues pertaining to obtaining data from paper for research purposes Passive nature of paper: paper can inform you actively of any mistake there may be in data enrty

Medical Informatics Solutions Databases Information Retrieval Internet Computer programs There are solutions that use technology to overcome the four categories of problems. These are medical informatics solutions. One of the simplest ways to actually solve these problems is the use of a database. By recording data in a structured electronic way in a database, one can easily retrieve and process the information. It also aids in finding links in the information that you would not normally find if you were using paper. The internet allows you to communicate so much easier. It allows you to find sources of information both for your self and for your patients. Computer programs can prevent you from making mistakes like medication errors, help you in making decision on drug treatment etc. These programs can also help the patient itself e.g. helping educate the patient about his/her aliment, help the hospital manager allocate resources etc.

Why Medical Informatics What is lacking in the current paper based approach ? Medication errors: Patient has allergic reactions Wrong medication given to patient Wrong dosage given to patient Medication errors are the greatest cause of erroneous death in developing countries. Medication error consists of: patient has an allergic reactions, wrong medication given to patient and wrong dosage given to patient. In 2006 the institute of medicine of the national academics in the USA reported that common medical errors harm 1.5 million people a year. The url of the report ishttp://www8.nationalacademies.org/onpinews/newsitem.aspx?recordid=11623. They also reported that such medication error costs an estimated $3.5 billion. This estimate however does not take into account wages, productivity and associated health care costs. http://www8.nationalacademies.org/onpinews/newsitem.aspx?recordid=11623

Medical Informatics Solutions Medication errors may be prevented by a simple scanning device Video Three There are simple ways to overcome the medication errors. Once approach is to attach barcodes to the patient wrist. Before any medication is given, the barcode should be scanned in order to determine if there are any allergies, dosage issues or adverse interactions between the medication. An example of such a system is shown in video three.

Why Medical Informatics What is lacking in the current paper based approach ? Cost: Paper and storage Environmental Cost Time: Find record, perform tests The cost and time factors are also disadvantageous. A complete paper based approach to medical records is much more expensive in the long run. One needs large amounts of paper, printers and ink, an environment to store the paper, another storage location outside the hospital as a backup location. There is also an environmental cost associated with using paper. We need to preserve trees and adhere to the greener way of life our leaders are encouraging us to live. Using a paper based record takes a lot of time to retrieve data, to process the information for tests.

Medical Informatics Solution 3D- Imaging Other examples of medical informatics applications Video four This video shows examples of medical informatics solution may help in the clinical environment.

Medical Informatics Solutions Message from the American academy of family physicians Video Five This video is a message from the American academy of family physicians and it describes how important electronic medical records are in family medicine. It also shows examples of how these are used in real practices.

Ultimate goal is to improve the quality of health care, research and education in medicine and health The ultimate goal is to improve the quality of health care, research and education in medicine and health

Public Health Aggregated clinical data can be analyzed to identify emerging diseases within a region, country, or around the world. Public health alerts (e.g., new flu strain) can be incorporated into clinical information systems used by primary care clinicians. Medical informatics may help in public health. Aggregated clinical data can be analyzed to identify emerging diseases within a region, country, or around the world. It also aids in Public health alerts (e.g., new flu strain) and this may beincorporated into clinical information systems used by primary care clinicians.

Personalized Medicine Genomic medicine Manage greater quantities of data and more complex data over time Medicine is moving towards what is termed personalized medicine. No long will there just be a list of symptoms that is used to diagnose and prescribe medication. Genomic data will be used to do most of this. The problem however, it that genomic data is very large and complex to store and retrieve. Thus there needs to be a management system that will facilitate its use. This again indicates the importance and use of medical informatics.

Does it Always Work No It is important to note that not all medical informatics solutions actually work. Not all solutions are beneficial.

Steps to Success According to Haux: Change Management Patient centered recording and use of data Process integrated decision support Comprehensive use of patient data for clinical and reporting Change Management Workflow analysis Simple technology (Health care in the information society. A prognosis for the year 2013 -- Haux R, et al. Int J Med Inf 2002 Nov;66(1-3):3-21) Haux et al published a paper indicating some of the important aspects of a successful medical informatics solution. They reported that the system must be patient centered, must incorporate an integrated decision support and must make comprehensive use of patient data for clinical and reporting Other important steps to ensure the successful implementation of a medical informatics system is change management. This is probably the most important aspect of ensuring a successful implementation of a medical informatics solution. One should not change the workflow just because the system can not be built accordingly. If the systems may improve efficiency in the clinical environment, then by all means change the workflow. One should also use the simplest for of technology to perform a task

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