Transcript Medical Informatics - Amirkabir University of Technology

Medical Informatics
Dr. Shahram Yazdani
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© 2002 ATGCI
Medical Informatics
 Medical
informatics is the application
of computers, communications and
information technology and systems
to all fields of medicine-medical care,
medical education and medical
research
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© 2002 ATGCI
Dr. Shahram Yazdani
Information
Research
Decision-Support Systems
Biomedical
Medical information
Databases
Diagnosis / Interpretation
Search engines TherapyInformation
directed to:
/ Management
Value added Pub.
–a specific need
Automated reminders and alert systems
National
health databank
EB Pub.
Electronic prescription and order entry–at the right time
National
health
code
POEM collections
Drug IS and Automated dispensing –in the right place
National health card
Telemedicine
Computer Assisted Instruction
Care Providers
Web Based Learning
Dx/Tx
Data
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Data acquisition
Data storage
Vocabularies
Organization of data
Machine interfaces
Data retrieval
Patients
© 2002 ATGCI
–to the right person
Clinical
Judgment
Information
mastery
Diagnostic Reasoning
Critical
appraisal
Therapeutic Planning
Electronic medical records
Laboratory IS
Digital imaging and
Radiological IS
Patient monitoring systems
Dr. Shahram Yazdani
Medical Informatics is Multidisciplinary
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Medicine/ Biology
Mathematics
Information Systems
Computer Science
Statistics
Decision Analysis
Economics/Health Care Policy
Psychology
© 2002 ATGCI
Dr. Shahram Yazdani
Medical Records
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Investment in medical records
In UK, the cost of medical records units run
between 2% and 6% of NHS turnover
 Healthcare providers spend 20-75% of
their time reading, writing, sorting and
searching through the notes
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© 2002 ATGCI
Dr. Shahram Yazdani
Shortcomings of the paper medical
record
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Find the record (lost, being used elsewhere)
Find data within the record (poorly organized,
missing)
Read data (legibility)
Update data
Record fragmentation
Moving records
Redundancy (re-enter data in multiple forms)
Statistics and Research (can not search across
patients)
Passive (no automated decision support)
© 2002 ATGCI
Dr. Shahram Yazdani
Benefits of electronic medical record
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Access, Availability, transfer and retrieval
Legibility, Abstraction, reporting
Saves time: find data 4 times faster
Reduced data entry (reuse data)
Better organization by imposing structure
Storage space
Allow multiple views including aggregation
Automated checks on data entry (spelling
checks,k=50, sum of WBC, pregnant man)
Data quality and standards
Automated decision support
Statistics and research
© 2002 ATGCI
Dr. Shahram Yazdani
Images
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Picture Archiving and Communications System
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© 2002 ATGCI
Dr. Shahram Yazdani
Image management
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Traditional Film libraries
– Expensive
– Inefficient
– Film can only be in one place
– Problem in interpretation (20% on detection, 1050% on diagnosis)
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Digital image library
– Less expensive
– More efficient
– Tele-radiology
– Automated interpretation
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© 2002 ATGCI
Dr. Shahram Yazdani
3 Dimensional Imaging
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© 2002 ATGCI
Dr. Shahram Yazdani
Medical Errors
and
Point of Care Delivery of Information
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Lots of lives to save
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Medical error is the 3rd largest cause of death
in the U.S. exceeded only by heart disease and
cancer. (JAMA, July 26, 2000, p 483)
– 12,000 deaths/year from unnecessary surgery
– 7,000 deaths/year from medication errors in
hospitals
– 20,000 deaths/year from other errors in hospitals
– 80,000 deaths/year from nosocomial infections in
hospitals
– 106,000 deaths/year from adverse effects of
medications (4th leading cause of death)
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50-90% of medication errors can be eliminated
at time of installation of automation at the point
of care.
© 2002 ATGCI
Dr. Shahram Yazdani
Source: Wireless
and Mobile
Computing. First
Consulting Group,
Oct 2001.
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© 2002 ATGCI
Dr. Shahram Yazdani
Point of Care Automation Results
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Malcolm, BEliminating Medication Errors Through Point of Care Devices. Proceedings of
HIMSS 2000, Session 73, Dallas.
© 2002 ATGCI
Dr. Shahram Yazdani
PDA Medical Record
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All essential medical data on a
Palm Pilot or PocketPC.
 Designed to integrate with
global medical data system.
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© 2002 ATGCI
Dr. Shahram Yazdani
Decision Support
Systems
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Levels of Automated Support
(Van Bemmel and Musen, 1997)
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© 2002 ATGCI
Dr. Shahram Yazdani
Computerized reminders
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Computerized reminders can improve
compliance with recommended
guidelines
– Increase preventive services
– Increase use of appropriate medications
– Increase use of other interventions
Hunt et al. JAMA. 1998; Shea et al. J Am Med Inform Assoc.
1996
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© 2002 ATGCI
Dr. Shahram Yazdani
Computerized decision support
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Computerized decision support can
improve quality
– Prevention of venous thromboembolism
– Use of antibiotics
Durieux et al. JAMA. 2000; Teich et al. Arch Intern Med. 2000;
Evans et al. N Engl J Med. 1998
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© 2002 ATGCI
Dr. Shahram Yazdani
EMR with Decision Support
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Electronic medical records with decision
support can reduce costs
– Reducing medical errors and adverse events
– Recommending equally effective but less costly
alternative interventions
– Reducing the use of inappropriate tests
– Reducing the ordering of redundant tests
Teich et al. Arch Intern Med. 2000; Bates et al. JAMA. 1998; Glaser et al.
Proc Healthcare Information and Management Systems Society Annual Conf. 1996
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© 2002 ATGCI
Dr. Shahram Yazdani
de Dombal’s System
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Domain: Acute abdominal pain
Input: Signs and symptoms of patient
Output: Probability distribution of diagnoses
Method: Bayesian
Evaluation: an eight-center study involving 250 physicians
and 16,737 patients
Results:
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Diagnostic accuracy rose from 46 to 65%
The negative laparotomy rate fell by almost half
Perforation rate among patients with appendicitis fell by half
Mortality rate fell by 22%
Results using survey data consistently better than the
clinicians’ opinions and even the results using human
probability estimates!
© 2002 ATGCI
Dr. Shahram Yazdani
Electronic
Prescription
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Prescription warning messages generated by computerised system from October
1998 to August 1999
No of warning
messages
Category
Disallowed
Contraindications
Interactions
Password level warnings
Contraindications
Interactions
Maximum recommended single dose
No (%) of prescriptions
completed
58
37
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749
141
99
206
0
0
0
322 (43)
103 (73)
84 (85)
89 (43)
303
46 (15)
exceeded
Maximum recommended daily dose
exceeded
Low level warnings
Contraindications
Interactions
Maximum recommended single
dose exceeded
Maximum recommended daily dose
exceeded
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16 607
793
15 743
46
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BMJ 2000;320:750–3
© 2002 ATGCI
15 350 (92)
677 (85)
14 635 (93)
25 (54)
13 (52)
Dr. Shahram Yazdani
Computerized order entry
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Computerized order entry systems can
reduce medication errors
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Improve drug prescribing
Improve drug dosing
Drug-drug interactions
Drug allergies
Bates et al. JAMA. 1998; Bates et al. J Am Med Inform Assoc.
1999; Teich et al. Arch Intern Med. 2000
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© 2002 ATGCI
Dr. Shahram Yazdani
Automated
Dispensing
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Card Technologies
in
Health Care
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Functions of health care cards
Identification
 Access control
 Data carrier (portable record)
 Information transfer
 Authentication
 Encryption/Decryption
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© 2002 ATGCI
Dr. Shahram Yazdani
Card technologies
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Card technologies
Unit cost($)
Major benefits
Paper with barcode
0.01- 0.04
Inexpensive, bar code
Plastic, embossed
0.1- 0.15
Familiar, paper transfer
Serial memory card
1.5- 4.0
Additional storage
Computer chip card
3.5- 15.0
Additional data security,
difficult to copy
Optical card
6.0- 8.0
Much more storage
IC optical card
10.0- 15.0
Large storage and data
security
PC card
50.0- 100.0
More storage and
computational capacity
© 2002 ATGCI
Dr. Shahram Yazdani
Computer Literacy
among Physicians
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Barriers are neither technology nor cost,
Barriers are cultural: the doctors
Michael L. Millenson
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© 2002 ATGCI
Dr. Shahram Yazdani
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© 2002 ATGCI
Dr. Shahram Yazdani
Do you personally use a computer?
% of the NOs who plan to do so in the next
12 months
Personal Computer Use
Total
YES
NO
No response
Overall
3128
78.6%
20.2%
1.2%
100.0%
37.2%
Females
938
73.0%
25.9%
1.1%
100.0%
42.0%
Males
2190
81.0%
17.7%
1.3%
100.0%
34.3%
< 35
320
76.3%
22.2%
1.6%
100.0%
43.7%
35-44
1033
84.2%
15.1%
0.7%
100.0%
44.2%
45-54
957
83.4%
15.3%
1.4%
100.0%
33.6%
55-64
585
72.1%
26.3%
1.5%
100.0%
39.0%
65+
233
53.6%
44.6%
1.7%
100.0%
25.0%
GP/FP
1685
74.7%
24.0%
1.4%
100.0%
38.4%
Med Spec
1035
84.6%
14.3%
1.1%
100.0%
38.5%
Surg Spec
408
79.7%
19.4%
1.0%
100.0%
29.1%
Rural
302
73.8%
24.2%
2.0%
100.0%
38.4%
Urban
2826
79.1%
19.7%
1.1%
100.0%
37.1%
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© 2002
CMAJ - October
19,ATGCI
1999
Dr. Shahram Yazdani
Barriers
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Lack of technology infrastructure
 Lack of standards
 Cultural barriers
– Eminence-based medicine
– Tradition
– Resistance to change
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Complexity of medicine
 Workflow issues
 Human factor issues
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© 2002 ATGCI
Dr. Shahram Yazdani
Web Based Learning
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Transformed view of knowledge
Static, finite, linear, and private.
Dynamic, open ended, multidimensional,
and public
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© 2002 ATGCI
Dr. Shahram Yazdani
Defining web-based teaching &
networked learning
materials + human interaction
materials +
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human interaction
© 2002 ATGCI
Dr. Shahram Yazdani
Online learning, Teaching,
Tutoring
Tutor enhanced
online learning
Classroom
teaching
Computer-enhanced
classroom teaching
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© 2002 ATGCI
Independent
online learning
Dr. Shahram Yazdani
Online learning, Teaching,
Tutoring
Tutor enhanced
online learning
Classroom
teaching
Computer-enhanced
classroom teaching
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© 2002 ATGCI
Collaborative and
independent
online learning
Distance learning
Dr. Shahram Yazdani
Advantages of CAI and WBL
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Self directed learning
Interactivity
Privacy
Individualized to student:
– Pace
– Weak area
24 hr access
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Social interaction and Group work
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© 2002 ATGCI
Dr. Shahram Yazdani
Advantages of CAI and WBL
Immediate Feedback
 Permanent record
 Economy of scale
 Promote active engagement
 Multimedia
 Access to global resources
 Information retrieval
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© 2002 ATGCI
Dr. Shahram Yazdani
Uses of CAI in clinical medicine
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Focus on diagnosis and therapy rather than
on facts
Encourage experimentation and exploration
Greater scope-see outpatient cases
Prototypic cases that are not complex
Include rare cases
Better measure of competency than multiple
choice test
© 2002 ATGCI
Dr. Shahram Yazdani
Uses of CAI in clinical medicine
Can experiment without danger to
patient
 Follow course of patient over time
 Uses physiologic models, production
rules, …
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© 2002 ATGCI
Dr. Shahram Yazdani
Virtual Reality
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Using the MIST system
(Mentice Medical Simulation
AB, Gothenburg, Sweden) for
training and assessment of
psychomotor skills for
minimally invasive surgery
BMJ VOLUME 323 20 OCTOBER 2001
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© 2002 ATGCI
Dr. Shahram Yazdani
The da Vinci Surgical System (Intuitive Surgical, California, USA)
for performing minimally invasive surgery. The surgeon sits at a
control console with 3D visualization of the surgical field and the
robotic surgical instruments
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BMJ VOLUME 323 20 OCTOBER 2001
© 2002 ATGCI
Dr. Shahram Yazdani
Virtual Reality
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© 2002 ATGCI
Dr. Shahram Yazdani
Virtual Reality
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© 2002 ATGCI
Dr. Shahram Yazdani
Goals of Collaborative eHealth:
Saving Time,
Saving Money,
Saving Lives
Turning the Promise of Mobile Computing into a Reality