Bmi Overview Done

IntroductiontoBiomedicalInformatics Introduction to Biomedical Informatics
Topic:OverviewofBMI
FundedbyNIHGrantXYZ Funded by NIH Grant XYZ
Baldi/Hayes/Smyth:IntroductiontoBiomedicalInformatics:1
Outline
Introductiontotheclass Motivatingexample:healthrecords Origins of BMI OriginsofBMI RelationshipofBMItootherdisciplines Dataacquisition,storage,anduse Electronic Medical Records ElectronicMedicalRecords Conclusionsanddiscussion Recommendedreading
Whytakethisclass Why take this class

ThisclasswillNOT
t h teachyoutobeaprogrammer t b teachyoutofixbrokencomputers tellyouabouteveryimportantbiomedicalcomputingsystemor application
ThisclassWILL
introduceyoutoconceptsunderlyingbiomedicalinformatics enco rage o to read additional related material encourageyoutoreadadditionalrelatedmaterial helpyouconnectbroadconceptsinbiomedicalinformaticstoyour currentandfuturework
The practice of medicine is inexplicably entwined with the Thepracticeofmedicineisinexplicablyentwinedwiththe managementofinformation(Shortliffe&Cimino,3rd ed.)
Motivatingexample:healthrecords Motivating example: health records

Modernpaperbasedrecordsgrewoutofthe conceptof labnotebooks for physicians concept of lab notebooksforphysicians Whataresomecurrentchallenges?
Whatareallthethingsthatgointoamedical record?
Whatareallofthewaysinwhichthemedical recordisused?
Challengestoimplementingelectronicmedical records: d
Impossibletofullyautomaterecordkeepingprocesses Limitedstandardsforclinicalterminology,billinganddiagnostic codes,andinteroperabilityamongsystems(bothwithinonemedical centerandbeyondtomany) t db dt ) Dataprivacy,confidentiality,andsecurity(importantlythreedifferent butrelatedissues)
Someterms Some terms

medicalcomputerscience informationscience i f ti i informationtheory biomedicalcomputingorbiocomputation medicalinformatics bioinformatics biomedicalinformatics biomedical informatics
HistoryofBiomedicalInformatics
1890:Hollerithusedpunchcarddata p processingintheUScensus; ledto g ; epidemiologicalsurveillanceviapunch cards Late1950s:Startedtoseeapplicationsof digitalcomputersinmedicinein engineeringpublications g gp 1960s:ComputerScienceasadiscipline formed;mainframesthenorm formed; mainframes the norm 1970sand1980s:emergenceofthe personalcomputer(PC)ormicrocomputer personal computer (PC) or microcomputer
dannyman: punchcard loom (likely 19th ctry)
Marcin Wichary:1960s IBM punch card
jovike: 1978 IBM System/370 Model 145
ThetermInformatics The term Informatics

1968:A.I.Mikhailov,alongwithotherscoinedtheterm InformatikaduringthedevelopmentofthefieldofInformation Informatika during the development of the field of Information ScienceinRussia 1976:NauchnyeKummunikatsiiInformatikaInformatics:the sc e f c d sc p e a s ud es e s uc u e a d ge e a scientificdisciplinethatstudiesthestructureandgeneral propertiesofscientificinformationandthelawsofallprocesses ofscientificcommunication. Late1960s:UniversitydepartmentsinFrance,Holland,and y p , , Belgiumestablishedwiththetitleinformatiquemedicale 1974:MedicalInformaticsbecamethetermofartatKings CollegeHospitalinLondon informfromdinformatique, g p q , aticsfromdautomatique.
FormalDefinitionsandStandardsBodies
1985:AmericanStandardsforTestingMaterials(ASTM, developsvoluntarystandards)establishedSubcommitteeon MedicalInformatics 1986: AAMC defined medical informatics formally as a 1986:AAMC definedmedicalinformaticsformallyas a developingbodyofknowledgeandsetoftechniquesconcerning theorganizationandmanagementofinformationinsupportof medicalresearch,educationandpatientcare. medical research education and patient care Forthepurposesofthiscourse,Biomedicalinformaticsisa scientificfieldthatdealswithbiomedicalinformation,data, andknowledge theirstorage,retrievalandoptimalusefor problemsolvinganddecisionmaking.
BiomedicalInformaticsApplicationDomains BiomedicalInformaticshasmajorapplication domains(subdisciplines)including: domains (sub disciplines) including:

Bioinformatics directedatthelevelofmolecularand cellularprocesses Clinical Informatics (a k a healthcare informatics) ClinicalInformatics (a.k.a.healthcareinformatics) directedatthelevelofindividuals(includesmedical informatics,nursinginformatics,dental,etc.) PublicHealthinformatics directedatpopulationsand p p society SocialInformatics socialimpactsofinformation technologyinhealthcarefield. I Imaginginformatics di t d t th l l f ti i i f ti directedattheleveloftissuesand d organs,e.g.,pathologyinformatics,radiologyinformatics
HowdoyouthinkBiomedicalInformaticsrelatesto otherdisciplines? h di i li ?
Outline
Introductiontotheclass Motivatingexample:healthrecords Origins of BMI OriginsofBMI RelationshipofBMItootherdisciplines Dataacquisition,storage,anduse El t i M di l R ElectronicMedicalRecords d Conclusionsanddiscussion Recommendedreading
Medicalpracticeisallaboutgathering,reviewingandinterpretingdata
D t Dataarecentraltoallmedicalcare t l t ll di l Dataarecentraltotheprocessofdecisionmaking
Whataremedicaldata?
Anindividualmedicaldatapoint(datum)isasingle observationaboutapatient b i b i
Thepatientinquestion Theparameterbeingobserved Thevalueoftheparameterinquestion Thetimeoftheobservation h i f h b i
Medicaldataareuncertain.
Absenceofstandardmedicalvocabulariesbasedon cleardefinitionsmakesallmedicalobservationsfuzzy. Commonfindingsmaymaskrareones. Symptomsanddiagnosescancooccurevenwhennot related.
Contexthelpsremedythisissuetoadegree.
Returntoour example:the medicalrecord
Legaldocument
woodenmask:ancestryrecordsfromlate1800s benben:modernclinic recordsstorage
Growingtendencytostructuredata Oftenreviewedintensely
mandiberg:medicalrecordunderreview
Who(What)collectsmedicaldata? Who (What) collects medical data?

Physicians Nurses Radiologists Laboratory Officestaffsadmissionpersonnel Technologicaldevices
PotentialUsesforMedicalInformation Potential Uses for Medical Information

HistoricalRecord Communication DiagnosisandMonitoring LegalRecords Legal Records Clinicaland/orEpidemiologicalResearch Perhapscustomtreatments/personalizedmedicine
ProsandConsofPaperRecords p
+ Flexibility + Relative robustness Relativerobustness + Accessibility(paperis everywhere) + Familiarity
Logisticalissues - Unabletosharewithmultiple users - Theincompleteofthe records - Legibility - Disorganizationofthepaper records Redundancyandinefficiency InfluenceonClinicalResearch Accessibility(oncetherecordis Accessibility (once the record is entered,itshardtoaccessby paperalone) Illegibilityofproviderhandwriting Illegibility of provider handwriting
GoalsofComputerizedRecords
Facilitatepatientcarebyservingasorganized externalmemoryforpractitioners Enhancecommunicationsbetweenprovidersand specialists Ensurecontinuityofcareduringinpatientstaysand acrossoutpatientvisits L l d fi Legalandfinancialpurposes i l Researchsupport
ProsandConsofElectronicRecords
+ Accessibility remotelyand simultaneously + Legibility + Automaticdecisionmaking askingformissing information,alerts, reminders + Enhancedscope(haveall inpatientandoutpatient dataandtestresults availableevenifapatientis ) outsidelocalarea)
Initialinvestment Continuingcosts(training, maintenanceofconfidentiality, etc.) Subtlefailures(e.g.,transcription errorsofhandwrittennotesby dataentryperson) Catastrophicfailures Dataglutdifficulties(physicians oftenuseagreatdealofdataof lowdecisionvaluetomake smalldecisions.Captureis difficultandexpensive.)
FactorsInfluencingBenefitsofEHR/EMRUse Factors Influencing Benefits of EHR/EMR Use

Comprehensivenessofinformation D ti Durationofuseandretentionofdata f d t ti fd t Degree of structure of data Degreeofstructureofdata Ubiquityofaccess q y
AutomatedDataCapture Automated Data Capture

Recordingdatainthemomentcantakeapersonoutofthat g p moment(e.g.,notesinclass,recordsduringpatientvisit) Comprehensivecaptureofalldataisimpractical need priorities i iti Relyingonselfreportalonecanleadtomissinginformation Insufficient detail (tests were normal) avoided when test Insufficientdetail( testswerenormal )avoidedwhentest resultsautomaticallygatheredfromoriginalsource Chancetotrackdataprovenanceindetail
Formoreonthisissuefromacomputersciencestandpoint(ratherthanBMI),seeTruong,K.N.andHayes,G.R.Ubiquitous ComputingforCaptureandAccess,FoundationsandTrendsinHumanComputerInteraction:(2):2,95171.2009.
Butwhendatacannotbegathered automatically ll
Emphasisonpersonnelinvestmentneeded Avoidanceoffreetextsinceinterpretationbyinput personnelintroduceserrors personnel introduces errors Carefulcoding emphasisontraining g p g Workonareastoincreaseaccuracyofdatainput(e.g., structureddataentry,voicerecognition)
Medicalcareisinformational
Physicianencountersareinformationrich Whataresomeexamplesfromyourexperiences?
Wheredidtheideaofstoringall thesedatadigitallyoriginate? these data digitally originate?

Asinotherdomains,complexityandquantityof informationrequiresdigitaldatabasesolutions(toa i f i i di i l d b l i ( degree) 1950s:Splitbetweenclinicalandresearchinformation repositories
1960s:adventofcomputerbasedhospital informationsystems(HIS) information systems (HIS) 1969:LawrenceWeedintroducedproblem orientedmedicalrecord(POMR) oriented medical record (POMR)
EMR
Thesourceorientedinformationofamedicalchart plusademandorientedfrontend.(Stead,1987) Lindberg id l i db idealEMRconcepts:
Carefulmeasurementsoverpatientsconditionsshouldbemade, recordedandmonitored; Lifelongrecordmustbecompleteandmachinereadable; Linkagesshouldbeincludedtosourcesofmedicalknowledge.
FunctionalComponentsofEMR Functional Components of EMR

Integratedviewofpatientdata Clinicaldecisionsupport Clinicianorderentry Accesstoknowledgeresources Access to knowledge resources Integratedcommunicationandreportingsupport
WhatisthedifferencebetweenanEMRandan EHR?
WhatissocomplicatedaboutEHR? What is so complicated about EHR? Lotsoftypesofdatatostore
L Lotsofpeopletomakehappy f l k h
WhatdoestheEMRinparticularhavetodo?
DesirableFeatures
Modular OpenSource(meansdifferentthingstodifferentpeople); Patientcentric Usableinresearchcontext(iftheclinicalsettingusingthe EMRdoesresearch)
Issues,Barriers,Bottlenecks Issues, Barriers, Bottlenecks

Privacy Interoperability Standards Usability Workflow
Oneexample: One example:

DemofromQuestSystem
TranslatingMedicalDataintoKnowledge Translating Medical Data into Knowledge

Data:single,uninterruptedobservationpoint(e.g., g , p p ( g, oneBPreading) Information:elementsofdataarrangedtoconvey meaning Knowledge:generalizedtruthsformedfrom analysisofinformation l i fi f ti
Discuss:Whatisthedifferencebetweenadatabaseanda Discuss: What is the difference between a database and a knowledgebase?Whydoesitmatter?
Discussion
Whatdoyouthinkisthelongtermrelationshipbetweenhealth workersandcomputers? workers and computers? Forthepractitionersintheclass,howhavethingschangedforyouin yourprofessionovertheyears? Will li i i Willcliniciansbeviewedasoutmodediftheydonotturnto b i d t d d if th d tt t computationaltoolsforassistance?
RecommendedReading Recommended Reading

HeathandLuff Documentsandprofessionalpractice:bad organisationalreasonsforgoodmedicalrecords organisational reasons for good medical records MarcBerg Themultiplebodiesofthemedicalrecord Altman Informaticsinthecareofpatients:Tennotablechallenges Institute of Medicine Crossing the Quality Chasm: A New Health Systems InstituteofMedicine CrossingtheQualityChasm:ANewHealthSystems forthe21st Century Collen1995 ahistoryofmedicalinformaticsintheUnitedStates Weed1969 MedicalRecords,MedicalEvaluation,andPatientCare:The ProblemOrientedRecordasaBasicTool. bl d d l Chapters1,2,and12inbluebook p , ,

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IntroductiontoBiomedicalInformatics Introduction to Biomedical Informatics

FundedbyNIHGrantXYZ Funded by NIH Grant XYZ

Whytakethisclass Why take this class

Motivatingexample:healthrecords Motivating example: health records

Someterms Some terms

dannyman: punchcard loom (likely 19th ctry)

Marcin Wichary:1960s IBM punch card

jovike: 1978 IBM System/370 Model 145

ThetermInformatics The term Informatics

BiomedicalInformaticsApplicationDomains BiomedicalInformaticshasmajorapplication domains(subdisciplines)including: domains (sub disciplines) including:

Absenceofstandardmedicalvocabulariesbasedon cleardefinitionsmakesallmedicalobservationsfuzzy. Commonfindingsmaymaskrareones. Symptomsanddiagnosescancooccurevenwhennot related.

Returntoour example:the medicalrecord

woodenmask:ancestryrecordsfromlate1800s benben:modernclinic recordsstorage

Who(What)collectsmedicaldata? Who (What) collects medical data?

PotentialUsesforMedicalInformation Potential Uses for Medical Information

FactorsInfluencingBenefitsofEHR/EMRUse Factors Influencing Benefits of EHR/EMR Use

AutomatedDataCapture Automated Data Capture

Wheredidtheideaofstoringall thesedatadigitallyoriginate? these data digitally originate?

FunctionalComponentsofEMR Functional Components of EMR

WhatissocomplicatedaboutEHR? What is so complicated about EHR? Lotsoftypesofdatatostore

Issues,Barriers,Bottlenecks Issues, Barriers, Bottlenecks

Oneexample: One example:

TranslatingMedicalDataintoKnowledge Translating Medical Data into Knowledge

RecommendedReading Recommended Reading

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