Health Informatics

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Health Informatics

• Elmer V. Bernstam, MD, MSE, MS
• Assistant Professor
• School of Health Information Sciences and
  Internal Medicine
• UT - Houston

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Better information Better care
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Definition

• Informatics field of study concerned with
  information
• Health (Biomedical) informatics informatics
  applied to health (biomedicine)

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This is health informatics!

• Bioinformatics1. Biological structure
  informatics2. Computational biology3.
  Expression profiling and microarrays4. Genomic
  ontologies5. Genomics6. Linking the genotype
  and phenotype7. Neuroinformatics8.
  Pharmacogenomics9. Proteomics
• Clinical Informatics10. Barriers to clinical
  system implementation11. Clinical systems in
  ambulatory care12. Clinical systems in high
  intensity care13. Careflow and process
  improvement systems14. Disease management15.
  E-health and clinical communication16.
  Evaluation of health information systems17.
  Health data warehousing18. Health information
  systems19. Integrated health and financial
  systems
• Education and Training20. Computer-assisted
  medical education21. Consumer health
  information22. E-learning or distance
  learning23. Education and training24. Library
  information systems25. Medical informatics
  teaching26. Patient education and self-care27.
  Professional education
• Human Information Processing and Organizational
  Behavior28. Cognitive models and problem
  solving29. Data visualization30. Natural
  language understanding and text generation31.
  Human factors and usability32. Human factors and
  user interfaces33. Human-computer
  interaction34. Models of social and
  organizational behavior35. Natural language
  processing

Imaging and Signal Analysis36. Image processing
and transmission37. Image recognition,
registration, and segmentation methods38.
Imaging and signal standards39. Knowledge
representation and ontologies for imaging40.
Model-based imaging41. Signal processing and
transmission42. Virtual reality and active
vision methods and applications Innovative
Technologies in Health Care43.
Computer-communication infrastructures44.
Internet applications45. Mobile computing and
communication46. Portable patient records47.
Security and data protection48. Software agents
and distributed systems49. Telemedicine50.
Virtual reality51. Wireless applications and
handheld devicesKnowledge Management52.
Automated learning and discovery53. Clinical
guidelines and protocols54. Controlled
terminology, vocabularies, and ontologies55.
Intelligent data analysis and data mining56.
Decision support systems57. Knowledge
management58. Knowledge representation59.
Neural network techniques60. Pattern
recognition/classification Nursing
Informatics61. Nursing informatics62. Nursing
care systems63. Nursing vocabulary and
terminology64. Nursing education/Curriculum in
nursing informatics65. Nursing documentation
Organizational Issues66. Careflow management
systems67. Care delivery systems68. Cooperative
design and development69. Economics of care70.
Ethical and legal issues71. Health services
evaluation performance and quality72.
Organizational impact of information systems73.
Quality assessment and improvement74. System
implementation and management issues75.
Technology assessment Patient Record76.
Cryptography, database security, and
anonymization77. Database access and
delivery78. Database design and construction79.
Data standards and enterprise data sharing80.
Patient record management81. Privacy,
confidentiality, and information protection82.
Standard medical vocabularies83. Standards for
coding84. Standards for data transfer Public
Health Informatics85. Administrative/financial
systems86. Biosurveillance87. Consumer health
informatics88. Emergency and disaster
response89. Genetic epidemiology90. Health
intervention systems91. Health promotion
systems92. Health outcomes assessment93.
Patient self-care and patient-provider interaction
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Theme

• Informatics not just application of computers to
  medicine
• Computers are transforming tools
• There are other tools drawn from
• Clinical and basic (biological) science
• Decision analysis
• Probability and statistics
• Cognitive and social science, pedagogy
• Etc.

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Distance

• Overcoming physical separation
• Doctor/patient
• Teacher/learner
• Researcher/data

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Social issues

• Dealing with people
• Change management
• Culture, roles, workflow
• Law, ethics, economics

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Research themes in informatics

• Vocabularies, standards
• (Automatic) similarity determination
• Data presentation
• Decision making
• Evaluation

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Vocabularies and standards

• Naming concepts and relating them to each other
• Standards agreed-upon conventions
• Allow communication
• Ex Start numbering with 0 vs. 1

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Data presentation

• Dealing with information overload
• Knowledge-based information display
• Knowledge about the task, environment, decision
  to be made

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Decision making

• What makes a good decision?
• How do you help people make better decisions?
• Error prevention

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Evaluation

• Does it work?
• Do people use it? Like it?
• Does it improve outcomes?
• Limitations of technology
• Pen and paper are hard to beat

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Bioinformatics challenges

• Lots of data ? what does it mean?
• Collecting data ? using data ? predicting data
• Genome annotation (functional genomics)
• What does this piece of DNA do?
• Protein structure is related to function (protein
  folding)
• Can we predict structure from sequence and basic
  physics?

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Bioinformatics future

• Build models of
• Molecules
• Cells
• Tissues
• Organisms
• Systems
• Try a drug on a model, rather than a patient
• Opportunity is in combination of bio- and
  clinical informatics

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Pharmacogenomics

• Different people respond to drugs differently
• Many drugs
• Many genetic differences between people
• In addition, genetics influence
• Risk factors ? are you going to get the disease?
  (e.g. smoking ? emphysema, heart disease)
• Operative risk
• How to collect and use these data?
• Memory is not enough, nseed tools

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Clinical informaticsInformation in health care
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Not there yet EMR

• Electronic medical records
• Holy Grail of medical informatics
• MI projects Given an EMR,
• Prevent errors, etc.
• But
• Not widely accepted in this country
• Depends on what you consider an EMR
• MD order entry? (4 of hospitals)
• Difficult to get right few successful
  implementations

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Social barriers to EMR

• Who benefits?
• Mismatch between costs and benefits
• Physicians
• Weak case for time savings
• Often inconvenient poor workflow integration
• Payers
• Likely benefit ? case becoming stronger
• Patients
• Strong case for benefit
• What if I buy your EMR and your company goes out
  of business?
• No single dominant player

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Social barriers to EMR

• Technology is dominated by two types of people
  those who understand what they do not manage, and
  those who manage what they do not understand. -
  Anonymous
• Computers make it easier to do a lot of things,
  but most of the things they make it easier to do
  don't need to be done. - Andy Rooney
• The case for biomedical informatics training
  need people who understand both
• What needs to get done biomedicine
• How to get it done technology

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Not there yet decision support

• What do physicians do?
• Gather information
• MAKE DECISIONS
• Execute
• Decision support (technological) support for
  decision-making
• Only effective way to influence decisions
• Clinical practice guidelines
• Realization practice variation that cannot be
  justified by science
• Little effect of published guidelines
• Integration into workflow required CPOE

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Problem

• Components of a decision
• Knowledge about the world difficult to encode
• Medical literature
• Experience
• Patient information requires EMR
• Age, sex, laboratory data, etc.

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Trends Affecting Informatics

• Improvement in computer technology
• Faster
• Smaller
• More portable better displays and batteries
• Improvement in communication technology
• High-throughput biological techniques
• Human genome project

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Trends Affecting Informatics

• (Threat of) Terrorism
• Health care
• Aging of the population
• Increasing growth of knowledge
• Increasing financial pressures
• Increasing patient expectation and empowerment
• Increasing awareness and decreasing tolerance of
  medical errors
• Erosion of respect for physicians
• Decreasing physician autonomy

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Medico-legal pressures
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Opportunities in informatics

• Information overload
• Providing better care biological advances in
  clinical practice
• Overcoming distance
• Bio Terrorism detection and coordinating
  response
• Telemedicine frequent checks on the chronically
  ill
• Social issues
• Facilitate change to better ways

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• Thank you!
• Elmer.V.Bernstam_at_uth.tmc.edu