Jan Pojer 1

MMEDICAL INFORMATICSEDICAL INFORMATICSIN THE AGE OF IN THE AGE OF

INTERNETINTERNET

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Major points

Hospital information systemsMedical information sources on the internetInternet based applications of medicine

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Hospital information systems

DefinitionA hospital information system (HIS) is a comprehensive information system dealing with all aspects of information processing in a hospital. This encompasses human (and paper-based) information processing as well as data processing machines.As an area of Medical Informatics the aim of an HIS is to achieve the best possible support of patient care and administration by electronic data processing.It can be composed of one or few software components with specialty specific extensions as well as of a large variety of sub-systems in medical specialties (e.g. Laboratory Information System, Radiology Information System)*.

* LIS,RIS will be talked about later.

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HISFUNCTIONS

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HIS

Area of use

Hospitals receptions, billing, laboratories, radiology, patient management Usage of LIS and RIS is becoming a norm

PM (Practice Management) recording patient history, writing prescriptions, maintaining the treatment

history, accounts & billing, scheduling appointments and managing correspondence

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Laboratory Informational System (LIS)

Software storing informations generated by labsMust interface with other informationals system (HIS)Functions : Order Entry, Patient Check In,Specimen Receipt, Results Entry,

Reporting ,Patient Demographics, Physician DemographicsTypes : Hematology, Chemistry, Immunology, Blood bank donor center, Blood bank transfusion, Surgical Pathology, Anatomical Pathology,

Radiological Information System (RIS)

Comprises of patient tracking and scheduling, result reporting and image tracking capabilities.Design to store, manipulate and distribute patient radiological data and injuries

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HIS – case study

Two kinds of HIS in real life : 1. Professional HIS

Hospitals all over the world Nowadays every bigger hospital has some kind of

HIS

2. Open source HIS Care2x

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Hospital Na Homolce

Laboratory :Clinical biochem., hematology a

imunology (OKBHI)

Hospital has Laboratory Informatinonal System (LIS) All measured data are transmitted in to LIS and then properly managed

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Care2xCare2x HIS is an open source development (OSD) "GNU General Public License"Its source code is freely-distributed and available to the general public.Care2x integrates data, functions and workflows in a healthcare environment. It is currently composed of four major components. Each of these components can also function individually.

HIS - Hospital/Healthservice Information System Care2x HIS solves the problems of multiple noncompatible programs. Integration of almost any type of services, systems, departments, clinic, processes, data, communication, etc.

that exist in a hospital. non-medical services or functions as well( like security, maintenance, etc.) standard SQL database format for storing and retrieving data. The use of a single data format solves the

problem of data redundancy. can support multiple database configuration to enhance data security and integrity. no need for a special user interface software – simple web browser

PM - Practice (GP) management It is designed to work in single department medical practices or clinics.

CDS - Central Data Server central database server for the entire integrated healthcare environment.

HXP - Health Xchange Protocol standard data exchange protocol being used by Care2x to communicate transparently with other healthcare

applications regardless of their platforms.

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MEDICAL INFORMATION MEDICAL INFORMATION SOURCES ON THE INTERNETSOURCES ON THE INTERNET

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Medicine & Internet

Most common use of computers in medicine : communication by Email searching for medical information

Other reasons : eCommerce - sale & purchase of drugs,

equipment, instruments books medical software

eJournalsMEDLINE

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Medical Libraries

Design to assist finding health and science informations, which will improve or evaluate health careInstituitions – hospitals, medical schools, privat industry, health associationEvery medical library should have access to MEDLINE World largest medical library – National Library of medicine (US)

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National library of medicine

(NLM)• Operated by federal government

• More then 7 000 000 books, journals, technical support, manuscript,, microfilms, photographs, images

• World’s rarest and oldest works

• established 1836 (now Bethseda, Maryland)

• Runs National Center of Biotechnological Informatics

•The NLM Catalog -1.2 million journals, books, audiovisuals, computer software, electronic resources, and other materials ( the NCBI Entrez retrieval system).

•Updated every weekday,

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National Center of Biotechnological

Informatics (NCBI)

Most visible part of NLMHouses biological databasesFreely accessible over internet through Entrez engine and PubMedPubMed - MEDLINE

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MEDLINE

Medical Literature analysis and retrieval online systemdatabase of life science and biomedical informationscovers the fields of medicine, nursing, dentistry, veterinary medicine, and the health care system. freely available on the Internet through PubMed, searchable with the Entrez engine. 14 000 000 records from 4800 publications (medical journals) from 1950’s till nowDaily addedGlobal coverage (mostly English sources)Medical Subject Headings for information retrievalEngines design to search Medline uses Boolean Expressions (combining MeSH terms, article words and date of publications)

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Examples of MeSH

HEADINGS : STRUCTURE :

Structure information

retrieval through PubMed

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MEDLINE II.

Many tutorialsImportant source for biomedical scientists and journal clubs.Many other sources build on MedLine.MedLine influences researchers in their choice of journals in which to publish.MedLinePlus – Health informations for patients and health consumers.

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MedlinePlus

for patients and health care consumersextensive information from the National Institutes of Health and other trusted sources on over 650 diseases and conditionsinteractive health tutorialslists of hospitals and physiciansa medical encyclopedia (adam.com Health Illustrated Encyclopedia)a medical dictionary (Merriam-Webster)health information in Spanishextensive information on prescription and nonprescription drugshealth information from the medialinks to thousands of clinical trialslinks to pre-formulated searches of the MEDLINE/PubMed database for recent research articles on selected health topics

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OMIN

Online Mendelian Inheritance in ManDatabase that catalogues all the known diseases with a genetic component (genetic disorders)Main focus inherite, heritable, genetic disordersPart of NLMBased on book : Mendelain Inheritance in Man (John Hopkins University) author : Dr. Victor A. McKusick

Each OMIM entry is given a unique six-digit number whose first digit indicates the mode of inheritance of the gene involved:

1----- (100000- ) Autosomal loci or phenotypes (entries created before May 15, 1994) 2----- (200000- ) Autosomal loci or phenotypes (entries created before May 15, 1994) 3----- (300000- ) X-linked loci or phenotypes 4----- (400000- ) Y-linked loci or phenotypes 5----- (500000- ) Mitochondrial loci or phenotypes 6----- (600000- ) Autosomal loci or phenotypes (entries created after May 15, 1994)

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INTERNET BASED INTERNET BASED APPLICATIONS APPLICATIONS OF MEDICINEOF MEDICINE

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Consumer Health Informatics

(CHI)“Provide patients and health consumers with the

tools, skills and support they need to better manage their health decisions “

CHI tools : Web sites providing self-care information, Internet-based disease management tools telemedicine personal health records (PHRs) online support groups

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Electronic Medical Records

An electronic medical record (EMR) is a computer-based patient medical record. An EMR facilitates :

access of patient data by clinical staff at any given location accurate and complete claims processing by insurance companies building automated checks for drug and allergy interactions clinical notes prescriptions scheduling sending and viewing labs

The goal of NHS (National Health Service,UK) is to have 60,000,000 patients with a centralized electronic medical record by 2010.

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TELEMEDICINE

The term Telemedicine is “the delivery of medicine at a distance”. The term is composed of the Greek word τελε (tele) meaning 'far', and medicine. “

Samples from history African villagers – smoke signals in case of disease 1900’s – two way radios to communicate with Royal Flying Doctor Service of

Australia

Two basic forms : Live telemedicine

Telephone call, vidoconference Both sides, high-bandwidth, low latency Remote tactile support

Store-and-Forward telemedicine acquiring data, images and/or video and transmitting this material to a doctor or medical

specialist at a convenient time for assessment offline Not both parties at the same time Low bandwidth, high latency

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TELEMEDICINE II.A proper Telemedicine interaction would involve store and forward followed by a live interactionTime tables :

“JJ Hospital shall be talking to BB Clinic at 11.00 Hrs to discuss patient ABC” Telemedicine Consultant Sessions (TCS)

patient – doctor local doctor - specialist

Special links at mobile phones in case of emergencyUse : extremely isolated cases, very high demand of specialistradiology, ophtalmology, otolaryngology, dermatology, etc.

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e-Healthhealth care practice which is supported by electronic processes and communication.

Electronic Medical Records: enable easy communication of patient data between different healthcare professionals (GPs, specialists, care team, pharmacy) Telemedicine: includes all types of physical and psychological measurements that do not require a patient to travel to a specialist. When this service works, patients need to travel less to a specialist or conversely the specialist has a larger catchment area. Evidence Based Medicine: entails a system that provides information on appropriate treatment under certain patient conditions. A healthcare professional can look up whether his/her diagnosis is in line with scientific research. The advantage is that the data can be

kept up-to-date. Citizen-oriented Information Provision: both healthy individuals and patients want to be informed on medical topics. Specialist-oriented Information Provision: e.g. in an overview of latest medical journals, best practice guidelines or epidemiological tracking. Virtual healthcare teams: consist of healthcare professionals who collaborate and share information on patients through digital equipment

TeleHealthUmbrella term to describe all possible variations of healthcare services using telecommunications

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Future of TelemedicineTELESURGERY “Ability for a doctor to perform surgery on a patient even

though they are not physically in the same location.” It is a form of telepresence.

TELEPRESENCE a human/machine system in which the human uses of (head-

mounted) displays and body-operated remote actuators and sensors to control distant machinery.

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Statistics

69% patients discussed information found on the internet with their health care professionals

80% doctors found this fact to be helpful (improving knowledges, shorten general practice)20% thought the opposite – risk of self-treatment

78% doctors recommended medical websites72% doctors recommended support groups

1 million health webs1000 new added every monthHealth – the second most searchable word on the internet

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Obstacles with internet

Lack of time

51%

Poor quality of

informations

26%

Insufficient IT

training

23%

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CyberMedicine(future)

Global exchange of open, non-clinical information by patients and doctor

Preventive medicine/ Public Health (Telemedicine/ diagnostic/curative)

Advances in communication technology - Increasing bandwidth, faster

speed of access  images,voice, data

Free Internet

Online hospitals

Telemedicine/Telesurgery

Global teaching

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Reference

Internet : www.wikipedia.org www.care2x.com www.nlm.nih.gov www.health-infosys-dir.com www.google.com

Knihy : Informatika v klinické praxi : Josef Berger