Escolar Documentos
Profissional Documentos
Cultura Documentos
Shmuel Rotenstreich
Friedman
Medical Informatics is not about using Microsoft Word to enter patient information Charles Friedman, PhD
University of Pittsburgh at the UW Symposium, Fall 2000
Shortliffe
Medical informatics is 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, MD, PhD 1995
Computers in Medicine
Information central to biomedical research and clinical practice Type
integrated information-management environments affect on practice of medicine and biomedical
Method
medical computing medical informatics clinical informatics bioinformatics
Value
Value of medical-informatics and informatics applications Computers and the Internet in biomedical computing Relation among
medical informatics clinical practice biomedical engineering molecular biology decision support
Difference
information in clinical medicine and regular information Changes in computer technology and change in medical care and finance Integration of medical computing into clinical practice and regular computing integration
Areas
Medical Decision making Probabilistic medical reasoning Patient care and monitoring systems Computer aided surgery Electronic patient records Clinical decision support Standards in medical informatics Imaging Image management systems Telemedicine
Medical Informatics
Medical Education Patient Data Collection and Recording
Information
Patient
Decision making
Therapy plan
Planning
Diagnosis/assessment
Scope:
Broad (e.g., Internist-I/QMR: internal medicine Dx; DxPlain; Iliad; EON for guideline-based therapy) Narrow (e.g., a system for diagnosis of acute abdominal pain; MYCIN: infectious diseases Dx; ECG interpretation systems; ONCOCIN: support of application of oncology protocols)
Interaction style:
Prescriptive (e.g., ONCOCIN) Critiquing (e.g., VT Attending)
Diagnostic/Prognostic Methods
Flow charts/clinical algorithms Statistical and other supervised and nonsupervised classification methods
Neural networks, ID3, C4.5, CART, clustering
Bayesian/probabilistic classification
Nave Bayes, belief networks, influence diagrams
Rule-based systems (MYCIN) Ad hoc heuristic systems (DxPlain) Cognitive-studies inspired systems (Internist I)
Results using survey data consistently better than the clinicians opinions and even the results using human probability estimates!
Definitions
Medical Informatics: the science of medical information collection and management Medical Decision Making: quantitative methods for reasoning under uncertainty
Case Presentation
Description: 74 female, history of right CVA (cerebrovascular accident*) in 1989 (LLE weakness), one week of productive cough and increased debility. Exam consistent with bronchitis, oral antibiotic prescribed, but patient had a tonic grand mal seizure in clinic Became flaccid, unconscious, pulseless, apneic, but upon positioning for CPR, developed pulse and spontaneous respirations and awoke about 2 minutes after start of episode, complaining of lower sternal chest pain.
Actions:
Transfer to Emergency Room Examination Bloodwork Chest Xray Cardiogram Admission and therapy * Of or relating to the blood vessels that supply the brain
Demo - Part I
Lab Data: ABG and CPK/Isoenzymes Radiology: CXR, VQ, Doppler Cardiology: ECG, Cardiac Cath Medications Alerts Discharge Summary
ABG - Arterial blood gas CPK - blood test CXR Chest X-Ray EKG: Electrocardiogram (ECG) Cardiac Cath - Interventional heart catheterization
Case Summary
Description: bronchitis, bed-bound, venous thrombosis, pulmonary embolism, myocardial infarction, ventricular arrhythmia, hypotension, seizure, adult respiratory distress syndrome, methicillin-resistant Staph aureus
Discharge Plan
Where? What happened?
Outpatient Follow-up
Medications Laboratory Health Maintenance
Demo - Part II
Demographic Information Additional Hospitalizations? More Discharge Summaries? Recent Lab Results
Outpatient Notes
Information Science
Standards Integration
Ambulatory Care
Aka Primary Care, Office Medicine Roles (information specific):
Patient Scheduling, Registration Nursing, Triage Physician Ancillary Services
Radiology
Patient
Able to request an appointment! Check meds! Self reported SF-36 functional Insurance Information!
Clinic Receptionist
Appointment scheduling Check-in Insurance Information Billing Follow-up visit
Nurse
Triage (certain settings) Chief Complaint Brief History Vital signs & Initial Exam Pulse, BP, Respirations, Pulse Oximeter Psychosocial Assessment Discharge Instructions (Pt Education)
Physician
Review Chart Data, Studies Document History and Physical Exam Dx, Tx plan (orders, follow-up) SOAP note
Subjective Objective Assessment Plan
Data sheets Clinical trial design Definition of data elements Definition of eligibility Process descriptions Stopping criteria Other details of the trial Computer database Analyses
Results
Clinical trial design Definition of data elements Definition of eligibility Process descriptions Stopping criteria Other details of the trial
Patient workstation
Clerical workstation
Research databeses
Radiology Material management Clinical Data laboratory warehouse Administrative systems (e.g. admissions, discharges and transfers)
Educational programs
NIH maintains a database and tools of macromolecular 3D structures for visualization and comparative analysis MMDB - Molecular Modeling Database - contains experimentally determined biopolymer structures obtained from the Protein Data Bank
HL7
A protocol for the exchange of health care information
MAGN ETOM
Read Codes
Knowledge-Based Vocabularies
ICD9- CM Example
003 Other Salmonella Infections 003.0 Salmonella Gastroenteritis 003.1 Salmonella Septicemia 003.2 Localized Salmonella Infections 003.20 Localized Salmonella Infection, Unspecified 003.21 Salmonella Meningitis 003.22 Salmonella Pneumonia 003.23 Salmonella Arthritis 003.24 Salmonella Osteomyelitis 003.29 Other Localized Salmonella Infection 003.8 Other specified salmonella infections 003.9 Salmonella infection, unspecified
DRG Example
75 - Respiratory disease with major chest operating room procedure, no major complication or comorbidity 76 - Respiratory disease with major chest operating room procedure, minor complication or comorbidity
77 - Respiratory disease with other respiratory system operating procedure, no complication or comorbidity
79 - Respiratory infection with minor complication, age greater than 17 80 - Respiratory infection with no minor complication, age greater than 17 89 - Simple Pneumonia with minor complication, age greater than 17 90 - Simple Pneumonia with no minor complication, age greater than 17 475- Respiratory disease with ventilator support
538 - Respiratory disease with major chest operating room procedure and major complication or comorbidity
MeSH Example
Respiratory Tract Diseases Lung Diseases Pneumonia Bronchopneumonia Pneumonia, Aspiration Pneumonia, Lipid Pneumonia, Lobar Pneumonia, Mycoplasma Pneumonia, Pneumocystis Carinii Pneumonia, Rickettsial Pneumonia, Staphylococcal Pneumonia, Viral Lung Diseases, Fungal Pneumonia, Pneumocystis Carinii
SNOMED Example
D2-50000 D2-50100 D2-50100 D2-50100 D2-50100 D2-50100 D2-50104 D2-50110 D2-50120 D2-50130 D2-50130 D2-50140 D2-50140 D2-50142 D2-50150 D2-50152 D2-50160 D2-50170 SECTIONS 2-5-6 DISEASES OF THE LUNG 2-501 NON-INFECTIOUS PNEUMONIAS Bronchopneumonia, NOS (T-26000) (M-40000) Lobular pneumonia (T-28040) (M-40000) Segmental pneumonia (T-280D0) (M-40000) Bronchial pneumonia (T-280D0) (M-40000) Peribronchial pneumonia (T-26090) (M-40000) Hemorrhagic bronchopneumonia (T-26000) (M-40790) Terminal bronchopneumonia (T-26000) (M-40000) Pleurobronchopneumonia (T-26000) (M-40000) Pleuropneumonia (T-26000) (M-40000) Pneumonia, NOS (T-28000) (M-40000) Pneumonitis, NOS (T-28000) (M-40000) Catarrhal pneumonia (T-28000) (M-40000) Unresolved pneumonia (T-28000) (M-40000) Unresolved lobar pneumonia (T-28770) (M-40000) Granulomatous pneumonia, NOS (T-28000) (M-44000) Airsacculitis, NOS (T-28850) (M-40000)
Dr. Smith operated on Mr. Jones before Mr. Jones was alive?
Is Before the inverse of After?
Understanding a Narrative
List all, find at least one, or prove the impossibility of a legal scenario for the following statements:
John had a headache after the treatment While receiving treatment, John read a paper before the headache, John experienced a visual aura
Monitoring
Determine if an oncology patients record indicates a second episode that has been lasting for more than 3 weeks, of Grade II bone-marrow toxicity (as derived from the results of several different types of blood tests), due to a specific chemotherapy drug.
Temporal Abstraction
Many clinical tasks require a great deal of [time-oriented] patient data of multiple types to be measured and captured for interpretation, often using electronic media. This is particularly true in the management of patients with chronic conditions. Diagnostic or therapeutic decisions depend on context sensitive interpretation of these data. Most stored data include a time stamp at which a particular datum is valid. Temporal trends and patterns in clinical data add significant insights to static analysis. Thus it is desirable automatically to create abstractions (short, informative, and context-sensitive interpretations*) of time-oriented clinical data, and to be able to answer queries about these abstractions. The provision of this capability would benefit both a physician and a decision support tool (e.g., for patient management, quality assessment and clinical research). To be of optimum use, a summary should not only use time points such as dates when data were collected; it should also be capable of aggregating significant features over intervals of time.
Temporal Abstraction
Clinical tasks require time-oriented patient data of multiple types to be measured and captured for interpretation.
Particularly true in the management of patients with chronic conditions.
Diagnostic or therapeutic decisions depend on context sensitive interpretation of these data. Most stored data include a time stamp at which a particular datum is valid. Temporal trends and patterns in clinical data add significant insights to static analysis. Desirable automatically create abstractions (short, informative, and context-sensitive interpretations*) of time-oriented clinical data, and to be able to answer queries about these abstractions. The provision of this capability would benefit both a physician and a decision support tool (e.g., for patient management, quality assessment and clinical research). Of optimum use, a summary should not only use time points such as dates when data were collected; it should also be capable of aggregating significant features over intervals of time.
events Output: interval-based abstractions Identifies past and present trends and states Supports decisions based on temporal patterns modify therapy if the patient has a second episode of Grade II bone-marrow toxicity lasting more than 3 weeks Focuses on interpretation, rather than on forecasting
PAZ protocol
Expected CGVHD
M[0] Platelet counts ( )
150K
D D
D D D D
D D
D
D D
D D D
400
Time (days)
Temporal Reasoning Versus Temporal Maintenance Temporal reasoning supports inference tasks involving time-oriented data; often connected with artificial-intelligence methods Temporal data maintenance deals with storage and retrieval of data that has multiple temporal dimensions; often connected with database systems Both require temporal data modeling
DB TM Clinical decision-support application TR
Conclusion
Multidisciplinary research, development, and application
inspired by and benefits underlying core scientific/engineering areas