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Women

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Dr Dave Parry: Senior Lecturer in Computer Science at AUT. Developed first online teaching course in New ... HINZ www.hinz.org.nz. IMIA - http://www.imia.org ... – PowerPoint PPT presentation

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Title: Women


1
Womens Health Informatics Workshop AOFOG/RANZCOG
2009
  • Introduction and Outline of Workshop

2
Who are we?
  • Dr Dave Parry Senior Lecturer in Computer
    Science at AUT. Developed first online teaching
    course in New Zealand.
  • Dr Emma Parry Consultant OG at ACH. MD in the
    area of Induction of Labour HI.
  • Dr Phurb Dorji Consultant OG in Thimphu,
    Bhutan. Co-developer open source Perinatal
    Database

3
Programme
  • What is health informatics ?
  • How is the workshop organised ?
  • What do I have to do ?

4
What is Health Informatics ?
  • Medical Informatics (MI) is the study of
    information processing as it is used in
    healthcare. MIT
  • Medical informatics is the scientific field that
    deals with the storage, retrieval, sharing, and
    optimal use of biomedical information, data, and
    knowledge for problem solving and decision
    making.
  • Colombia

5
Health/Medical/Nursing ?
  • Healthcare has a strong tradition of attaching
    importance to names see HPCA http//www.moh.govt
    .nz/hpca
  • Health tends to be broader than medical and not
    imply that Doctors do it

6
Useful information sources
  • HINZ www.hinz.org.nz
  • IMIA - http//www.imia.org/
  • Health IT cluster http//www.healthit.org.nz/
  • NZHIS http//www.nzhis.govt.nz/
  • HISAC http//www.hisac.govt.nz/
  • HISA (Australia)- http//www.hisa.org.au/

7
What does Health Informatics include ?
  • Electronic Health data
  • Knowledge Management
  • Decision support
  • Telemedicine and telecare
  • Standards
  • Evidence for benefit/harm

8
Health informatics is important..
  • Its a Grand Challenge
  • http//www.engineeringchallenges.org/cms/8996/8938
    .aspx
  • 142-371 billion savings in US ?
  • Academically rich area
  • Expert systems (MYCIN)
  • Ontologies (UMLS)
  • Messaging (HL7)

9
Programme
  • What is health informatics ?
  • How is the workshop organised ?
  • What do I have to do ?

10
Outline
  • 1400 Intro and complete MCQ
  • 1415 Maternity data and perinatal databases
  • 1430 Coding and Messaging
  • 1445 Internet
  • 1500 Security
  • 1515 Panel Discussion and Questions

11
Programme
  • What is health informatics ?
  • How is the workshop organised ?
  • What do I have to do ?
  • MCQs RANZCOG 5 PRCRM points
  • Play along with your laptop if you have
  • Login
  • Password
  • Go Home and think BIG!

12
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13
Maternity data and Perinatal Databases
  • Emma Parry
  • emmap_at_adhb.govt.nz

14
The Health record
  • Records information about people in terms of
  • Results of tests and clinical examinations
  • Encounters with health professionals
  • Potential diagnoses
  • Plans for treatment and further testing

15
Problems with paper
16
Problems with paper
17
Definition of an electronic health record
  • Pubmed Computer-based systems for input,
    storage, display, retrieval, and printing of
    information contained in a patient's medical
    record.
  • Part of a clinical information system relating to
    individuals

18
Imaging (including PACS)
Laboratory results
Administration Systems
Etc.
Other health care providers
Government and provider statistics
Electronic Health Record
Clinical users
19
Laboratory systems
Electronic Health Record
Imaging (including PACS)
Administration Systems
Middleware e.g. Web Portal
Clinical users
20
Advantages of electronic
  • Always available
  • Different views
  • Temporal, problem based
  • Audit and decision support
  • Security

21
Problems
  • Free text vs. coding
  • Legal status
  • Need a computer
  • fishing expeditions
  • Maternity unique
  • New identifier for fetus
  • Multiple pregnancy
  • Subsequent pregnancy
  • Cross link with partner, other children

22

Cottagemed
http//www.sysmex.co.nz/default.asp?pageid9
23
Five uses of clinical data (MOH)
  • Data collected should be available for
  • Supporting clinical intervention
  • Clinical Governance
  • Administration (in all parts of Health)
  • Strategy and policy development
  • Research

24
The sixth use ?
  • Patient (consumer) self-management and self care.
  • http//www.pubmedcentral.nih.gov/articlerender.fcg
    i?artid1127483

25
Decision support
  • Use data from Electronic record, combine with
    rules
  • Reminders eg high blood pressure, protocols
  • Decision Analysis need utility values

26
Web 2.0 Medical records
  • Web 2.0 user generated content- see later.
  • Google http//googleblog.blogspot.com/2008/02/goog
    le-health-first-look.html
  • Microsoft health vault
  • http//healthvault.com/hvindex.htm?rmproctrue

27
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28
Coding and Messaging
  • Dave Parry
  • Dave.parry_at_aut.ac.nz

29
The central paradox
  • Every patient is different
  • BUT we want to compare them..

30
Medical vocabularies
  • Complex in natural language
  • Can contain ambiguities and circular references
  • Much of medical training devoted to learning them

31
Why standardise ?
  • Synonyms and obsolescent terms
  • (HTLVIII vs HIV)
  • Needed for clinical activity
  • Communication
  • Data analysis
  • Coding !
  • Reminders etc.

32
Early work
  • Index Medicus (1850) leading onto MeSH and UMLS
  • Read codes
  • LOINC (Standardised pathology reporting)
  • SNOMED CT

33
MeSH
Code Description
C13 Female Genital Diseases and Pregnancy Complications
A16 Embryonic Structures
A01.673 Pelvis
A16.378 Fetus
A16.254 Embryo
A16.759 Placenta
A16.950 Zygote
A16.631 Ovum
C02.800 Sexually Transmitted Diseases
C13.371 Genital Diseases, Female
C13.703 Pregnancy Complications
E04.520 Obstetric Surgical Procedures
F03.600 Mood Disorders
F03.800 Sexual and Gender Disorders
G08.520 Reproduction
M01.438 Multiple Birth Offspring
34
Systematized Nomenclature of Medicine-Clinical
Terms - SNOMED CT
  • gt600,000K Concepts
  • SNOMED CT is a clinical vocabulary currently
    administered by the international health
    terminology standards development organisation
    (IHTSDO) http//www.ihtsdo.org/. Member countries
    are Australia, Canada, Denmark, Lithuania, The
    Netherlands, New Zealand, Sweden, United Kingdom
    and United States.

35
SNOMED CT
  • Hierarchical
  • Concepts also link concepts
  • Synonyms and different languages
  • Free in member countries..

36
Why use a vocabulary ? example
  • Pre-eclampsia
  • Gestational Proteinuric Hypertension
  • Toxaemia
  • GPH
  • PET
  • PE
  • All the same all map to.. pre-eclampsia 398254007
    -code

37
Web http//www.clinical-info.co.uk
38
Why use it ?
  • In EHR systems, to replace/enhance free text.
  • To support reminders If patient has allergy to a
    drug code recorded then alert if drug is being
    prescribed
  • Converting free text to coded data.

39
Coding
  • Disease outcomes, diagnoses, procedures have been
    coded for many years.
  • Often Coding is used to describe outcomes so it
    happens at the end of an episode.

40
Examples of Codes
  • International Classification of disease (ICD)
    currently version 10. WHO standard
  • http//www.who.int/classifications/icd/en/

ICD10 Code Description
O104.11 Pre-existing secondary hypertension complicating pregnancy, first trimester
O104.12 Pre-existing secondary hypertension complicating pregnancy, second trimester
O104.13 Pre-existing secondary hypertension complicating pregnancy, third trimester
O104.19 Pre-existing secondary hypertension complicating pregnancy, unspecified trimester
41
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42
Coding activity
  • Often done by coders !
  • eg http//www.aacca.net
  • Identifies the casemix, and often leads/follows
    funding
  • May not be particularly simple or easy
  • Errors propagate

43
Other codes
  • Diagnostic related groups (DRGS)
  • Used to determine funding
  • Groups ICD 10 codes
  • Read codes
  • Primary care focussed
  • http//www.wolfbane.com/icd/read3h.htm
  • More like a vocabulary
  • SNOMED to replace

44
Messaging - HL 7
  • Health level 7
  • Initial version going back to 1987
    (http//www.hl7.org.za/patient/ch100005.htm)
  • Extensive use around the world, and since 1994 in
    New Zealand

45
Why messages ?
  • No communication electronically at all life is
    difficult
  • Shared universal record so far impossible c.f.
    connecting for health UK
  • Messaging send standard, relevant pieces of
    information between electronic systems.

46
Standard formatsavoids n(n-1) problem
GP
Pharmacy
Labs
Hospital
47
General model
Extract SNOMED terms
EHR
Unstructured text
Map to ICD 10
Send/receive messages
48
Take home
  • Look for standards.. SNOMED, HL7, DICOM (Images),
    ICD-10
  • Single definitive storage if possible, but
    communicate
  • Fully automatic coding is difficult, Fully human
    coding is sometimes inaccurate
  • Support the human coders and its probably not
    you.

49
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50
Using the Internet to your Advantage
  • Emma Parry
  • emmap_at_adhb.govt.nz

51
History
  • Internet started in 1960s to protect networks
    in the case of nuclear warfare.
  • World Wide Web suggested in paper published in
    1988.
  • Browsers early 1990s
  • 19.2 Billion webpages in 2005
  • Most users now access WWW via mobile devices.

52
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53
Terminology
  • The Internet
  • Operating Systems
  • Browser
  • Web pages
  • Web site
  • Web Server
  • Internet Provider
  • Dial up/ Broadband/ Wireless
  • Network card

54
Uses for the Clinician
  • How to manage purple tongue disease
  • Pubmed
  • Expert pages eg Thefetus.net
  • Government and Institutional sites
  • Individuals

55
Google
  • Google Search
  • Generic
  • Images
  • Scholar http//scholar.google.co.nz/

56
Web 2.0
  • User-generated content
  • www.Facebook.com , www.Linkedin.com
  • www.youtube.com
  • http//www.youtube.com/watch?vBOttNyd9qgI
  • Discussion and support groups eg
  • http//www.nzord.org.nz/ (Rare diseases)

57
Wikipedia- www.wikipedia.org
  • An online encyclopedia
  • Produced and edited by volunteers
  • Some topics more popular than others
  • Movie Stars http//en.wikipedia.org/wiki/Kate_Wins
    let
  • MFM
  • http//en.wikipedia.org/wiki/Maternal_Fetal_Medici
    ne
  • No Formal review ?Quality
  • Available in different languages different
    authors

58
Start a Blog- I did!
  • What is a blog? (your teens will know!)
  • Why a blog?
  • Easy
  • Cheap/free
  • Can link to other html addresses
  • http//mfmnewzealand.blogspot.com/

59
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60
Information security
61
Why do you need it ?
  • Electronic Data is critical to successful care.
  • Patient privacy must be assured.
  • Confidential information including commercial
    information must be protected.

62
Why are computers different ?
63
Electronic systems are
  • Easy to search
  • Allow simultaneous access by many people
  • Allow compact data storage
  • Vulnerable to some sorts of attacks
  • Liable to have mishaps

64
Easy to search ?
  • Audit trails can detect who has viewed data
  • Please explain letters and clear policies
  • Think about sensitive groups
  • Celebrities
  • Staff
  • Relatives

65
Mining data
  • Combine data that can identify anonymous
    people.
  • Appointments
  • Car parking
  • Web access logs
  • Lab results who ordered the test, which clinic,
    who gets the bill ?

66
Role Based Access
My Patient Any Patient Emergency Patient/ Locum
Clinician Full Access No Access Full Access (but explain)
Administrator Demographic only Demographic only Demographic only
Sysadmin No Access Supervised Access for maintenance (but explain) Change roles
67
Compact Data storage ?
68
Risk of loss or destruction
Large numbers of Electronic records can be lost,
stolen, altered or deleted much more easily
than the equivalent paper files. They are
especially vulnerable when on removable media
such as CDs or memory sticks.
69
Vulnerable
  • C\gt Del . - Dont try this at home
  • Power
  • Software upgrades
  • Maintenance especially database
  • A series of links,
  • Physical environment
  • Hardware
  • Operating System
  • Software
  • Operators

70
Some access control, poor environmental control
71
Computer Hygiene
  • Where has that memory stick been ?
  • Antivirus, firewall, anti-malware.
  • Public computers are often high risk
  • Infection control if you cant trust the
    contact, and the contacts contact dont share.

72
Malicious attacks
  • Emails
  • Malware attachments
  • Phishing
  • Nigerian scam, hoaxes etc.
  • Key loggers, data downloader's on memory sticks.
  • Packet sniffing and interception

73
Interception ?
  • Most data on the internet is not encrypted
  • If its a normal email its like a postcard
  • Websites can use secure
  • communications
  • Proves it is the site you think it is
  • Encrypts data transmission
  • Use recent browser versions
  • Apply upgrades

74
To protect
  • Good set of rules from the RACGP-
  • http//www.gpcg.org.au/index.php?optioncom_conten
    ttaskviewid128Itemid38
  • Soon guidelines for New Zealand _at_
    www.hiso.govt.nz
  • Ensure you install operating system security
    updates, as well as for particular software.
  • If you are really interested - http//www.cert.org
    /

75
Operating system ?
  • The program that lets all the others run
  • Popular ones include Windows (Many varieties),
    Linux, MacOS.
  • If the operating system is unreliable then the
    software will be.
  • Modern operating systems can encrypt data so that
    it cannot be read by others.

76
Backups
77
Simple rules for backup
  • Backup regularly
  • How much data can you afford to loose ?
  • Check that it works
  • Make it someones job
  • Dont hope plan.
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