1. Computers in Medicine Lecturer and Coordinator Israel Gannot Tel: 6711, E-mail: gannot@eng.tau.ac.il Assistant Shamai Salzberger shamai@eng.tau.ac.il WEBsite: http://www.eng.tau.ac.il/~gannot/MI/

2. What does it mean computers in medicine ?

3. The Computer Meets Medicine and Biology: Emergence of a Discipline After taking this course, you should know the answers to these questions:

4.  Why is information management a central issue in biomedical research and clinical practice?  What are integrated information- management environments and how might we expect them to affect the practice of medicine and biomedical research in coming years?  What do we mean by the terms medical computer science, medical computing,medical informatics, clinical informatics, nursing informatics, bioinformatics, and health informatics?

5.  Why should health professionals and students of the health professions learn about medical-informatics concepts and informatics applications?  How has the development of mini- computers, microprocessors, and the Internet changed the nature of biomedical computing?  How is medical informatics related to clinical practice, biomedical engineering, molecular biology, decision science, information science, and computer science?

6.  How does information in clinical medicine and health differ from information in the basic sciences?  How can changes in computer technology and the way medical care is financed influence the integration of medical computing into clinical practice.

7. Subjects Index: Medical Decision making: Probabilistic medical reasoning. Patient care systems. Patient monitoring systems. Computer aided surgery. Computer based patient record systems. Clinical decision support systems. The internet. Standards in medical informatics. Imaging modalities. Image management systems. Telemedicine. Bioinformatics.

8. Inputs to the medical records Traditional paper medical records

9. Outputs of the medical records

10. Conventional data collection for clinical trial Clinical trial design Definition of data elements Definition of eligibility Process descriptions Stopping criteria Other details of the trial Data sheets Computer database Analyses Results Medical records

11. Role of EMR in supporting clinical trials Clinical trial design Definition of data elements Definition of eligibility Process descriptions Stopping criteria Other details of the trial Clinical trial database Analyses Results Medical records systems Clinical data repository

12. Networking the organization Enterprise network Patient workstation Clinical workstations Clerical workstation Research databeses Administrative systems (e.g. admissions, discharges and transfers) Library resources Radiology Billing and financial systems Cost accounting Microbiology Pharmacy Clinical databases Electronic medical records Personnel systems Material management Educational programs Clinical laboratory Data warehouse

13. Moving beyond the organization Patients Healthy individuals Providers in offices or clinics Information resources (Medline..) Government medical research agencies 3rd party payers The Internet Government health insurance programs Other hospitals and physicians Pharmaceuticals regulators Communicable disease agencies Health Science Schools Vendors of various types (e.g. pharmaceuticals companies

14. Healthcare institutes are seeking Integrated clinical work stations that will :.

15. assist with clinical matters by: reporting results of tests. allowing direct entry of orders by clinicians. facilitating access to transcribed reports. supporting telemedicine applications. Supporting decision-support functions.

16. administrative and financial topics tracking of patients within the hospital. managing materials and inventory.supporting personnel functions. managing the payroll.

17. research analyzing the outcomes associated with treatments and procedures. performing quality assurance. supporting clinical trials. implementing various treatment protocols.

18. scholarly information accessing digital libraries. supporting bibliographic search. providing access to drug-information databases. office automation (providing access to spreadsheets, word processors, and the like).

19. The key notion is that at the heart of the evolving clinical workstation lies the medical record in a new incarnation: electronic, accessible. Confidential. Secure. acceptable to clinicians and patients. integrated with other types of non-patient-specific information.

20. References: Course textbook: 1. HANDBOOK of MEDICAL INFORMATICS Editors: J.H. van Bemmel, Erasmus University, Rotterdam M.A. Musen, Stanford University Stanford, Springer, 1997. Additional books: 2. The computer based patient records: An essential Technology for Healthcare, Institute of Medicine National Academy Press, 1997. 3. Strategies and Technologies for healthcare information: Theory and practice, Marion J. Ball, Judith V. Douglas and David E. Garrets, editors, Springer, 1999. 4. Clinical decision support systems: Theory and practice. Eta S. Berner, Springer, 1998. 5. Telemedicine-Practicing in the information age, Stevan F. Viegas, Kim Dunn, Editors, Lippincott-Raven, 1998.

21. WEBsites: National Institutes of Health http://www.nih.gov National Library of Medicine (Medline)- http://igm.nlm.nih.gov/ American Medical Informatics Association- http://www.amia.org/ The international Society for computer aided surgery. http://igs.slu.edu/ The helath level 7 committee: http://www.hl7.org The European Committee for Standardization Technical Committee for Health Informatics http://www.centc251.org/ BioInformatics resources on the WEB http://www.niehs.nih.gov/science/bioinfo.htm Tools for DNA gene and protein sequencing. http://www.ncbi.nlm.nih.gov/Tools/index.html

22. Journals: CRITICAL REVIEWS IN MEDICAL INFORMATICS. HEALTH COMMUNICATIONS AND INFORMATICS HEALTHCARE INFORMATICS INTERNATIONAL JOURNAL OF MEDICAL INFORMATICS JOURNAL OF THE AMERICAN MEDICAL INFORMATICS ASSOCIATION MEDICAL INFORMATICS MEDICAL INFORMATICS AND THE INTERNET IN MEDICINE STUDIES IN HEALTH TECHNOLOGY AND INFORMATICS BIOINFORMATICS COMPUTERS AND BIOMEDICAL RESEARCH COMPUTERS IN BIOLOGY AND MEDICINE COMPUTERS IN HEALTHCARE COMPUTERS IN HOSPITALS COMPUTERS IN NURSING

23. Journals: http://www.interscience.wiley.com:83/cas/

24. Bioinformatics: DNA, protein gene sequencing. Bioinformatics is the study of how information is represented and transmitted in biological systems, starting at the molecular level. Whereas clinical informatics deals with the management of information related to the delivery of health care, bioinformatics focuses on the management of information related to the underlying basic biological sciences.

25. NIH group maintains a database of macromolecular 3D structures, as well as tools for their visualization and comparative analysis. MMDB, the Molecular Modeling Database, contains experimentally determined biopolymer structures obtained from the Protein Data Bank.

26. National library of medicine. Medline

27. Standards in Medical Informatics Medical Information Bus - IEEE 1073 HL-7 Health Level 7 DICOM - Digital Imaging and Communications in Medicine.

28. HL7 Mission Statement To provide standards for the exchange, management and integration of data that supports clinical patient care and the management, delivery and evaluation of healthcare services.

29. A domain-specific, common protocol for the exchange of health care information. ISO-OSI Communication Architecture Model 1 Physical 2 Data Link 3 Network 4 Transport Communication 5 Session 6 Presentation 7 Application FunctionFunction What does “HL7” stand for?

30. DICOM Application Domain MAGN ETOM Information Management System Storage, Query/Retrieve, Study Component Query/Retrieve, Patient & Study Management Query/Retrieve Results Management Print Management Media Exchange LiteBox

31. Medical Information Bus IEEE 1073, Standard for Medical Device Communications. This standard for medical device communication defines a family of standards for providing interconnection and interoperability of medical devices and computerized healthcare information systems. Medical devices include a broad range of clinical monitoring, diagnostic and therapeutic equipment. Computerized healthcare information systems similarly include broad range of clinical data management systems, patient care systems and hospital information systems.

32. Applications of Medical Informatics by NASA to provide : Telemonitoring –people –environment –systems Tele-education Telecare Telescience

33. Virtual Reality Biocomputation –improved skills –pre-surgery planning –new techniques testing –immersive robotic surgery

34. 1995 ARC telemed demo with Trident & Mt. Sinai Medical Center Spacebridge to Russia 1997 NASA Commercial Space Center the Medical Informatics and Technology Applications Consortium (MITAC) 1998 Andes/Ecuador surgery consult Everest Extreme Expedition I 1999 Virtual Hospital demonstration with ARC Everest Extreme Expedition II

35. Schedule