Introduction to Health Care Informatics

HS 6300Health Information Systems

François Sainfort, Ph.D.David Cowan

Healthcare Information & Technology Systems

• Healthcare– one of America’s largest industries

• Information– not data but information

• Technology– computers, sensors, imaging, robotics, etc.

• Systems– a way to organize, think, solve problems,

build

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

Technology

• Diagnostic Devices– Imaging– Chemistry– Flow /Pressure– Electronics

• Monitoring Devices– Telemetry– Imbedded

• Theraputic– Angiography– Prosthetics

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.

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

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

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

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

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

WHAT: Healthcare Informatics

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

Judith Ozbolt

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

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

Taxonomy: Health Informatics

• Bioinformatics (biomedical informatics)• Clinical Informatics• Computer Methods for Health

Applications• Consumer Health (E-health) Informatics• Health Information Policy• Knowledge Management

Bionic Convergence

• Convergence of the biological revolution with the information revolution, of biology with electronics

W.T. Anderson, “Evolution Isn’t What It Used To Be”, 1996

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

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 computer’s artificial reality.”

The future just isn’t what it used to be.

Will Rogers

The New Medicine

• Driven by Computing– semiconductors – software – fiber optic networks – automation – robotics– telemetry

• Driven by Molecular Biology– Genetics– Genomics – Proteomics

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.

“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

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.

Pace of new drugs will quicken, by 2008:

• 65% increase in number of potential medicines entering clinical development

• Success rate from 1:10 to 3:10• Time for development

– Discovery/preclinical - down 46%– Phase I/Iia – down 40%– Phase IIa/III down 27 %

Source: Sir R.D. Sykes (UK)

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

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.

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.

Evidence-based Medicine

• The plural of anecdotes is not data.

Randomized Clinical Trials:Looking 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

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

Quality & IT R&D

• 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”

Coming: A global health information infrastructure?

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

The Digital Divide: The 3 billion person question

• Half of the world’s people have never used a telephone.

• How many will use the Internet?• In Winter 2001 total volume of e-mail

communications exceeded telephone messages

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

Computer-based Patient Records (C3PRs)

•Personal - the person’s health record for own uses

•Patient - the care delivery record itself

•Population - without personal identifiers, aggregated records for planning and management

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

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

Predictions for 2001-2020 –

• Hospitals

• Primary care office

• Home & Community

Implications for 2001-2020

• Hospitals - from places for cure

to quality improvement for chronic illness

Predictions for 2001-2020

• Primary care office - from quality improvement to cure

Implications for 2001-2020

• Home – more prevention, primary care, and cure

• Community - illness prevention and health assurance

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)

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)

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)