2. Introduction to Health Informatics Leon Geffen MBChB MCFP(SA) lgeffen@iafrica.com

3. Introduction to Health Informatics What is Health Informatics Why do we need Health Informatics Data and Information Coding & Classification Patient Record Keeping Systems Decision support systems

4. What is Health Informatics …development & use of systems for management of health information… 1 Intersection of the following disciplines –Computer science –Healthcare sciences

5. Why do we need Health Informatics Increasing complexity of healthcare Explosion of information Improve patient care

6. Data, Information & Knowledge Data –A series of observations, measurements or facts, e.g the numbers, digits, characters and symbols Information –Interpretation of data to give it meaning Knowledge –Integration of data and information, involves conscious thinking and reasoning

7. patient clinician Interaction Data interpretation Induction Body of knowledge Insight Knowledge Information

8. Coding & Classification Code –Assignation of alphabetical, numerical or alphanumerical object to a class CAR = Cardiology, ID = Infectious Diseases ICD 9: 001 – 139 Infectious & parasitic diseases –001 – 009 Infectious diseases of the GI Tract –003 Other Salmonella Infections »003.0 Salmonella Gastroenteritis »003.1 Salmonella Septicemia »003.2 Localized Salmonella infections »003.21 Salmonella meningitis

9. Coding & Classification Classification –Ordered system of concepts within a domain ICPC – International classification of primary care ICD 10 – International classification of Diseases DSM 4 – Diagnostic and statistical manual for mental disorders SNOMED – Systematized nomenclature of human and veterinary medicine UMLS – Unified medical language system

10. The patient record - History Traditionally paper based –Contains notes of from clinicians, other care providers, lab results, radiology, endoscopy etc. Account of patient’s health & disease after seeking medical care Hippocrates 5BC –Should accurately reflect course of disease –Should indicate possible cause of disease

11. The patient record - History Mayo Clinic –1880 William Mayo insisted all records be kept by dr’s of their encounters with patients –1907 – One file per patient – patient centred record –1920 – Minimum data set Weed 1960’s POMR –SOAP

12. The patient record - purpose Support patient care –Source for evaluation & decision making –Source of info that is shared amongst care providers A legal report of medical actions Supporting research –Clinical, epidemiological, quality of care, surveillance of drugs Educating clinicians Healthcare management

13. The patient record -problems Can only be in one place at a time Contents are in free text –Variable in order –Illegible –Incomplete –Ambiguous Mitigates against scientific analysis –Transcription errors Increasing specialisation Rewriting information Cannot give rise to reminders, warnings or advice

14. Electronic Medical Record Well structured data –Allows for research, recall, improved data sets Instant access from many sites Single entry for prescriptions, radiology, pathology Rapid generation of forms Patient recalls, preventive care, treatment guidelines Reminders of drug interactions, allergies Online display of radiology, ECG’s etc.

15. Electronic medical record What about security? Who enters data? Is it a true reflection of patient’s story? Who pays?

16. Clinical decision support systems System designed to provide advice to a clinician Currently cannot operate independently Generates a list of multiple diagnostic suggestions rather than a single diagnosis

17. Clinical decision support systems What diseases should I consider given a particular finding? Is finding Y typical of disease X? Can disease X produce Y finding? What is the best test to rule in / out disease X? What diseases may be caused by disease X, associated with it, or cause it?