Vlad Olchanski, PhD

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Medical Informatics
Computers, Decisions, and Communications

• Vlad Olchanski, PhD
• o Moscow Institute of Physics and Technology
• o Institute of Control Sciences
• o International Institute for Applied Systems
  Analysis
• o World Health Organization
• o Medical College of Virginia

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MCV Course for 4th year medical students Dr.
Olchanski Home Page
November 14, 2001
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Medical Informatics
Outline of Course Philosophy of Governing
Life Informatics
Component 2 Decision Support and Theory Medical
Records Diagnostic Support Pharmaceutical
Prescriptions Health System Modeling Data Mining
Component 1 Information Technology Computers Commu
nications Internet
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Medical Informatics
INTRODUCTION
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Why Learn Medical Informatics?
Cutting Edge Technologies 1930s
1990s
Radio communications
Computers, Internet
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Why Learn Medical Informatics?

• In the 1920-1930s the Radio was very cool.
• In those days, the Radio was not a black box with
  buttons you have in your car.
• To get a good reception, you had to know a little
  bit about electronics and things...

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Why Learn Medical Informatics?

• Computers are cool today.
• If you dont know a little bit about what "coils
  are inside -
• you will get frustrated and will bother other
  people.
• And yet we want computers and IT now!

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Why Learn Medical Informatics?
21st Century the Age of Informatics Major Tool of
Informatics -- INTERNET

• IT is not as simple today as is Radio.
• Internet will turn into a black box with buttons.
• But not today.
• And not tomorrow.

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Why Learn Medical Informatics?

• Therefore, to behave as a conscious Medical
  Professional, a Physician of today has to know
  the basics of Information Technology as well as
  the basics of Physiology and Pharmacology.
• Yet the Information Technology alone cannot help
  you without the intellectual component of
  Medical Informatics the Decision Theory.

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Phi Beta Kappa - philosophia biou kybernetes
Philosophy Governs Life

• Philosophy
• Mathematics
• Natural Philosophy
• Physics
• Engineering
• General Theory of Systems
• Cybernetics
• Informatics

KybernetesGoverns Cybernetics
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General Theory of Systems
Bertalanffy (Austria-Hungary), Bogdanov (Russia)
- 1908 Crash of empires after the
Great War The Second World War
FLAK, Enigma Norbert Wiener (MIT) Cybernetics
Control and Communication in the Animal and the
Machine - 1948 Theory of Information, Finite
Mathematics, Probabilities John von Neumann
(Princeton) Alan Turing (Bletchley Park) Claud
Shannon (MIT) Andrey Kolmogorov (Moscow State)
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First Computers

• This weaponry could not protect England

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Cybernetics

• Theory of InformationCommunicationsCodingAlgori
  thmsProbabilities and Stochastic Processes
• Theory of ControlOperations ResearchOptimization
  Management Science
• Systems Analysis

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Applications

• Live, bio-systems
• Engineering, machines, robots
• Organizational systems
• Computer Science
• Systems AnalysisDecision Support, Artificial
  Intelligence

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Whence Informatics?

• Concept of Cybernetics too broad
• Word Cybernetics tarnished, devalued by Sci-Fi
  and Pop culture
• Pragmatic reduction to Computer Science in USA
• CS translated into INFORMATIQUE in France
• Backward translation of CS as INFORMATICS
  expanding the scope

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Handbook of Medical Informatics

• http//www.mieur.nl/mihandbook
• http//www.mihandbook.stanford.edu/

This excellent book unfortunately has very little
coverage of the Internet applications. Otherwise,
this is the 1 Resource!
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Medical InformaticsDefinitions

• Medical Information Science is the science of
  using system-analytic tools . . . to develop
  procedures (algorithms) for management, process
  control, decision making and scientific analysis
  of medical knowledge - Ted Shortliffe
• Medical Informatics comprises the theoretical and
  practical aspects of information processing and
  communication, based on knowledge and experience
  derived from processes in medicine and health
  care - Jan van Bemmel

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Whence Informatics?

• Computer Science and Informatics are practically
  synonyms the difference in emphasizing the
  application aspect
• Informatics is frequently understood as broadly
  as Cybernetics --Information Processing
  including Decision Making and Systems Analysis

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Names used for Medical Informatics

• medical computer science
• medical information science
• computer application(s) in medicine
• health informatics, and more specialized terms
  such as
• nursing informatics
• dental informatics
• and so on.

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Informatics - What?

• Information Technology and TheoryComputers,
  Communications, Data Processing, Algorithms
• Decision Theory and ApplicationsBayesian
  Approach, Expert Systems, Artificial
  Intelligence, Knowledge-based Systems, Algorithms
  

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A Good INTRO to Informatics
But should we go all the way together?
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Medical Informatics
INFORMATION TECHNOLOGY COMPUTERS
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Computers Evolution
Von Neuman and the first MAINFRAME at IAS (1948)
Vacuum tubes, punch cards or tape Batch mode of
operation Low reliability - maintenance team of
electronics engineers
Transistors - Bill Shockley, 1956 NP
MICROCOMPUTERS Interactive mode of
operation Reduced size and enhanced reliability
due to Integrated Circuits
MINICOMPUTERS Interactive mode of
operation Higher reliability due to Transistors
SUPERMINIS WORKSTATIONS
PERSONAL COMPUTERS Renamed from minicomputers to
show due respect
SUPERCOMPUTERS
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Computers Operating Systems
Mainframe OS -- oriented to batch
processing Minicomputers -- more interactive,
usually designed by hardware manufacturer, like
RSX, VMS for late DEC machines Unix - an
attempt to standardize Personal computers --
CP/M, MS DOS, IBM OS/2, Mac OS, Windows,
Unix Internet developed mainly on Unix
machines
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Computers Operating Systems
Windows should not be used for critical
applications
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Programming Mainframe
A punch card and the editing tool
H
Page 104 of a program listing
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Programming Mainframe
Booting your computer -- giving it a kick?
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Programming Mainframe
Booting your computer -- giving it a kick?
No! It is short from bootstrapping. Bootstrap
was the name of a short length of the
punched tape that was fed to a computer to
initiate loading of the Operating System.
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Computer Architecture
CPU, RAM, Bus, etc. are discussed in class
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Computers Objects
Files Windows Commander
http//www.ghisler.com
Name long name, DOS name avoid spaces in
names! Type extension, internal header, MIME
type Size actual / on disk Time creation /
modification / access Attrib hidden /
system Owner sysadmin/owner / group /
world/other
Directories (folders)
c\ root ..\ parent
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Computers Startup Files
config.sys autoexec.bat system.ini win.ini in
Unix .cshrc
Registry System.dat User.dat SAM
Text editors Notepad.exe UltraEdit.exe
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Computers Commands
dir cd delete copy mkdir rmdir attrib xcopy diskco
py format tree
date, time path set sort more /p - by
page help /? -? /h -h
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Computer Architecture
Data storage on disks File Allocation
Table Security issues are discussed in
class after Information Coding presentation
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Some Utilities

• Calculator (scientific mode)
• Character Map (Symbols to Computer Code)
• Notepad (Text editor)

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Medical Informatics
INFORMATION TECHNOLOGY COMMUNICATIONS
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Communication Protocol Layers
ISO Open System Interface
Internet
the application level is what we use Email,
FTP, Telnet, HTTP, etc.
the physical layer is a stream of bits
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Internet Protocols

• FTP (file transfer protocol) serves to exchange
  data with a remote computer
• Telnet allows to run programs on a remote
  computer

Terms Upload - send TO a remote
recipient Download - receive FROM a remote sender
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Remote Computing - I
Fred at UBC hasreport software...
Wilma at CUNY has data, needs report!
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Remote Computing - II
Fred sends Wilma the username and the password
Never by EMAIL !!!
Wilma at CUNY has data, needs report!
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Remote Computing - III
Fred at UBC hasreport software...
FTP
Wilma uploads her data with FTP
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Remote Computing - IV
Fred at UBC hasreport software...
Telnet
Wilma manipulates her data on Freds computer
with Telnet
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Remote Computing - V
Fred at UBC hasreport software...
FTP
Wilma downloads the report with FTP
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Remote Computing - VI
Fred at UBC hasreport software...
Email
Wilma prints the report in her office and sends
her kisses to Fred by email
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Remote Computing -Security
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Using Email - 1
Email is very much like Regular Mailsending
mail and receiving are done quite differently!
To send mail, you may to drop it in any mail drop
box in the street. To send email, you may
connect and use any SMTP serverin the world. It
is for public convenience.
SMTP server sends email
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Using Email - 2
You send a letter thru a Mail Drop Box
You may use any one you find in the street
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Using Email - 3
You send an email thru a SMTP server
access controlled
access controlled
access controlled
access controlled
access controlled
access controlled
open for all
You may use any one you find in the Internet
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Using Email - 4
Email is very much like Regular Mailsending
mail and receiving are done quite differently!
To receive mail, you must have either your own
mailbox or rent a box at any Post Office. To
receive email, you must have an account with any
POP3 server. It will be your private possession.
You may have as many as you may wish.
POP3 server receives email
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Using Email - 5
To receive a letter, you must have a homeor a
number in a US Post Office
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Using Email - 6
To receive an email, you must have an accountat
a POP or IMAP mail server
you may have as many of these as you like
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Using Email - 7
POP server delivers all messages to your computer
-- good when you are on a fast connection IMAP
server delivers only message headers and
messages on demand -- good when you are on a
dial-up Yet you will not have all messages on
your computer Tbird, Eudora, TheBat! support
multiple email accounts Webmail allows to use
email with your browser -- good when you are on
the go Hotmail, Yahoo, etc. may be used for
simple purposes -- but it is not a true email
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Using Email - 8
You read and send email with Email Client There
are so many different Email Client programs
-- make your own choice BUT some of Email
Clients and some of Email USERS go outside
of Internet Standards - incompatibility of
messages - errors in transmission and reception
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Using Email - 9
SMTP
POP3
An operative set of POP3 boxes
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Using Email - 10 Basic Rules of Nice Conduct
1. Never consider email as confidential 2. Email
should best be a simple message 3. Do not send
messages formatted with HTML -- not all email
clients can deal with them, confirms a hit
for spammers (impossible in AOL email
program ) 4. Avoid sending binary
attachments these may come corrupted and can
carry viruses How to avoid binary attachments
in Email, see http//www.intmed.vcu.edu/inm/advic
e.html
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The Most Intimate Secret
Like Wine dichotomy in Russia
- White wine Moonshine, Vodka, Brandy - Red
wine all the rest
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The Most Intimate Secret
Data dichotomy in Internet
- Text files Plain English text A-Z, a-z,
0-9 - Binary files all the rest
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The Most Intimate Secret
Symbols -- Bytes -- Octets
Secret 53 65 63 72 65 74
Bits
1010011 1100101 1100011 1110010 1100101 1110100
Sept bits fassent un octet! This is the ASCII
Standard. Yet --
Éç C9 E7 11001001 11100111
Now you see that the French have a reason to
call the byte not septet but octet! If you
strip the 8th bit then corruption occurs
É -gt 49 I and ç -gt 67 g
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The Most Intimate Secret

• The 7-bit data trasmission was set into the
  infrastructure

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The Most Intimate Secret
The Revelation
Only text files may be sent through
Internet Binary files will come corrupted
To send a binary, it must be converted to a text
file (encoded) and on the receiving end the
encoded file must be decoded. In FTP protocol,
the type must be told explicitly In Email, binary
files go as attachments. There are different
encode/decode procedures which may lead to
confusion and errors
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Security Cryptography

• Sherlock Holmes The Dancing men

ELSIE . .RE . ARE .TO M.EET .THY .GO .
elsie PrePare To Meet Thy GoD
come here at once
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Security Cryptography
Edgar Allan Poe Gold-bug

• 53!305))64826)4.)4)80648!860))8588
  !83(88)5! 46(8896?8)(485)5!2(49562
  (5-

4)88 4069285))6!8)41(94808188148!854
)485!52880681(948(884(?3 448)4161188?

8 there are 33. " 26. 4 "
19. ) " 16. " 13. 5 "
12. 6 " 11. ! 1 " 8. 0 "
6. 9 2 " 5. 3 " 4. ? "
3. " 2. - . " 1.
5 represents a ! " d 8 " e 3
" g 4 " h 6 " i
" n " o ( " r
" t
In English, the letter which most frequently
occurs is e. Afterwards, the succession runs
thus a o i d h n r s t u y c f g l m w b k p q
x z
A good glass in the bishop's hostel in the
devil's seat twenty-one degrees and thirteen
minutes northeast and by north main branch
seventh limb east side shoot from the left eye
of the death's-head a bee line from the tree
through the shot fifty feet out.
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Security Criptography

• Enigma, German Coding Machine

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Security Cryptography
Encryption with a keyword this is plaintext ,
the key is key (add codes) keykeykeykeykeyke
Encrypted text dxkfpsnputmsodjss Decryption
with a keyword -- the key must be sent to the
recipient this is the weakest
point Encrypted text dxkfpsnputmsodjss , the
key is key - (subtract codes) keykeykeykeykeyke
Decrypted text this is plaintext
Plain book, a simple but efficient tool
One-time pad
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Security Cryptography
My secret private key
PGP Pretty Good Protection
Freds public key
My public key stored on my website and in public
depositories
My key ring of public keys of my correspondents
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Security Cryptography
Fred reads my message
I send message to Fred
Dear Fred, bla-bla...
Dear Fred, bla-bla...
hk_at_s2kdMs0fHquja...
Freds public key
Freds private key
I read Freds answer
Fred answers my message
My public key
My private key
Dear Vlad, bla-bla...
Dear Vlad, bla-bla...
Msios\iqN7dkoZnu...
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Security Cryptography
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Communications. Security
80 trash, 5 pearls
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Internet Protocols
Usenet, News, Forums -- NNTP Protocol
A small ISP carries 45,000 groups.
Different ISPs give different groups, have
different scopes
Medical and Health Related Groups
listed www.mipt.vcu.edu/ng.html
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Internet Protocols
World Wide Web HTTP protocol User client --
browser Netscape, Internet Explorer, Opera,
Firefox WWW is only a small part of Internet
!!!
AOL and MSN are not Internet at all !!!
Internet
AOL
MSN
gateway
gateway
archive.salon.com/tech/feature/2001/06/26/locking_
up_the_web/index3.html Internet Services
Providers give you full Internet
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Internet Connectivity
Internet Addresses DSN views.vcu.edu Host
file Domain Name Server IP 128.172.65.8
Telephones Name Vlad Olchanski Personal
notebook Phone Directory Number 804.828.5384
look up
look up
dial
connect
PING and TRACERT accessible through START/RUN
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Internet Connectivity
A decent ISP must give a client o SMTP address
to send email o POP3 address to access the
mailbox o NNTP address to get Newsgroups Addition
ally o Space to host website at ISPs IP
address o FTP access to update website Optionally
o Static IP address for hosting own website
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Information TechnologyViruses
Viruses, Trojans, Worms, Bots, Denial of
Service Virus Shields, Firewalls are discussed
in class. Read also Steve Gibsons saga about a
virus attack http//grc.com/dos/intro.
htm
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Information Technology Secure Use of Internet

• Now let us see a presentation on how to practice
  Internet connectivity safely.

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Information TechnologyBasics of Security - 1

• make sure workstation is physically safe and
  secure
• never send passwords by email
• never paste passwords beside the workstation
• install and regularly (weekly) update virus
  protection
• avoid sending attachments
• never open unsolicited attachments, always check
  and double-check the attachments file
  extension

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Information TechnologyBasics of Security -2

• never open unexpected file with extensions EXE
  COM DOC DLL PIF LNK VBS (Windows does not show
  LNK and PIF extensions)
• Never click on a link hover the link with mouse
  and look at the status bar where the link leads
  when clicked
• firewall may protect both yourself and the
  world but may also cheat you)

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Information Theory
Sender and Receiver Noise and Distortion Codes
Detecting Errors Codes Correcting
Errors Checksums Data Packets are discussed in
class
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Information Theory
Data Compression zip, arj, rar, tar, gz, binhex,
7u, etc. Image Compression Image Formats bmp,
tiff, gif, jpg, png, etc. are discussed in
class. Image compression immediately leads to
WEB DESIGN
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Web Design
What is a good website?
-- presentable for all users WIN, Mac, Unix,
etc. -- acceptable for all browsers Opera,
Netscape, Firefox, MSIE, Safari, etc. -- loads
fast byte size lt 50 kB -- does not use Cutting
Edge technologies Learn the culture of Web
Design at webpagesthatsuck.com review the Daily
Sucker site daily!
A web design project is done by
students. Collection here
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Medical Informatics
DECISION SUPPORT AND THEORY
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The Fundamental Principle of Decision Theory
THE BAYES THOREM New Knowledge
Experimentation x Old Knowledge
Application Making Diagnosis Old Knowledge -
we know disease D prevalence, p(D) New
Knowledge - we need to know if the patient
has disease D if he has symptom S,
p(DS) Experimentation - Bayes Theorem builds
the Likelihood Function L(DS) p(SD) /
p(SD) p(D) p(SD) p(D) Now this
Likelihood Function modifies the Old
Knowledge p(DS) L(DS) p(D)
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Medical Decision Support
to mention a few
Clinical Systems Financial Medical
Records Comprehensive
Diagnostic Systems QMR, Iliad, DXPlain, etc.
Pharmaceutical Prescriptions
Health System Modeling
Research Data Mining
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Medical Decision SupportClinical Systems
Computerized Medical Record systems are
discussed in class TMR -- CMR from Duke Medical
Center MedicaLogica Pharmaceutical System for
Multiple Drug Therapy in ICU, Pharm-X is
discussed in class Comprehensive system for VCU
HealthSystem is discussed in class.
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Medical Decision SupportDiagnostic Systems
knowledge base decision mechanism
diagnoses
observations
explanations
feedback to adjust observations
Knowledge Engineering, Expert Systems, AI are
discussed in class
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Medical Decision SupportHealth Systems Modeling
- 1
Primary Care Physician Supply - 1
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Medical Decision SupportHealth Systems Modeling
- 2
Primary Care Physician Supply - 2
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Medical Decision SupportHealth Systems Modeling
- 3
Primary Care Physician Supply - 3
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Medical Decision SupportMeasurement and
Statistics
Use only reasonable precision, round up numbers
to convey your purpose
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Medical Informatics
RECOMMENDED RESOURCE FOR ADVANCED STUDIES
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88
Handbook of Medical Informatics

• http//www.mieur.nl/mihandbook
• http//www.mihandbook.stanford.edu/

MCV Course for 4th year medical students
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Handbook of Medical Informatics
I. Data and Information       1 Introduction and
Overview       2 Information and Communication
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Handbook of Medical Informatics
II. Data in Computers       3 Data
Processing      4 Database Management      5
Telecommunication, Networking and
Integration
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Handbook of Medical Informatics
III. Data from Patients       6 Coding and
Classification       7 The Patient
Record       8 Biosignal Analysis       9
Medical Imaging     10 Image Processing and
Analysis
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Handbook of Medical Informatics
IV. Patient-Centered Information
Systems       11 Primary Care       12 Clinical
Departmental Systems       13 Clinical Support
Systems       14 Nursing Information Systems
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Handbook of Medical Informatics
V. Medical Knowledge and Decision
Support       15 Methods for Decision
Support       16 Clinical Decision-Support
Systems       17 Strategies for Medical
Knowledge Acquisition       18 Predictive Tools
for Clinical Decision Support
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Handbook of Medical Informatics
VI. Institutional Information Systems       19
Modeling of Health Care for Information
Systems Development       20 Hospital
Information Systems Clinical Use       21
Hospital Information Systems Technical
Choices       22 Health Information Resources
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Handbook of Medical Informatics
VII. Methodology for Information
Processing       23 Logical Operations      24
Biostatistical Methods      25 Biosignal
Processing Methods      26 Advances in Image
Processing      27 Pattern Recognition      28
Modeling for Decision Support      29
Structuring the Computer-based Patient
Record      30 Evaluation of Clinical
Information Systems
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Handbook of Medical Informatics
VIII. Methodology for Information
Systems       31 Human-Computer Interaction in
Health Care       32 Costs and Benefits of
Information Systems       33 Security in Medical
Information Systems       34 Standards in
Health-care Informatics and Telematics in
Europe       35 Project Management
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Handbook of Medical Informatics
IX. Medical Informatics as a Profession       36
Education and Training in Medical
Informatics       37 International Developments
in Medical Informatics
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Handbook of Medical Informatics
Unfortunately lacks the details on the Internet
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Education vs Vocational Training
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Medical Informatics
THE END OF PRESENTATION
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MCV Course for 4th year medical students