M EDICAL INFORMATICS IN THE AGE OF INTERNET

1. MEDICAL INFORMATICSIN THE AGE OF INTERNET Jan Pojer

2. Major points • Hospital information systems • Medical information sources on the internet • Internet based applications of medicine X33BMI

3. Hospital information systems Definition • A 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)*. X33BMI * LIS,RIS will be talked about later.

4. HIS FUNCTIONS X33BMI

5. 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 X33BMI

6. Laboratory Informational System(LIS) • Software storing informations generated by labs • Must interface with other informationals system (HIS) • Functions : Order Entry, Patient Check In,Specimen Receipt, Results Entry, Reporting ,Patient Demographics, Physician Demographics • Types : 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 X33BMI

7. HIS – case study Two kinds of HIS in real life : • Professional HIS • Hospitals all over the world • Nowadays every bigger hospital has some kind of HIS • Open source HIS • Care2x X33BMI

8. 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 X33BMI

9. Care2x • Care2x 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. X33BMI

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14. MEDICAL INFORMATION SOURCES ON THE INTERNET X33BMI

15. 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 • eJournals • MEDLINE X33BMI

16. Medical Libraries • Design to assist finding health and science informations, which will improve or evaluate health care • Instituitions – hospitals, medical schools, privat industry, health association • Every medical library should have access to MEDLINE • World largest medical library – National Library of medicine (US) X33BMI

17. 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, X33BMI

18. National Center of Biotechnological Informatics(NCBI) • Most visible part of NLM • Houses biological databases • Freely accessible over internet through Entrez engine and PubMed • PubMed - MEDLINE X33BMI

19. MEDLINE • Medical Literature analysis and retrieval online system • database of life science and biomedical informations • covers 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 now • Daily added • Global coverage (mostly English sources) • Medical Subject Headings for information retrieval • Engines design to search Medline uses Boolean Expressions (combining MeSH terms, article words and date of publications) X33BMI

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21. Examples of MeSH Structure information retrieval through PubMed HEADINGS : STRUCTURE : X33BMI

22. MEDLINE II. • Many tutorials • Important 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. X33BMI

23. MedlinePlus • for patients and health care consumers • extensive information from the National Institutes of Health and other trusted sources on over 650 diseases and conditions • interactive health tutorials • lists of hospitals and physicians • a medical encyclopedia (adam.com Health Illustrated Encyclopedia) • a medical dictionary (Merriam-Webster) • health information in Spanish • extensive information on prescription and nonprescription drugs • health information from the media • links to thousands of clinical trials • links to pre-formulated searches of the MEDLINE/PubMed database for recent research articles on selected health topics X33BMI

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26. OMIN • Online Mendelian Inheritance in Man • Database that catalogues all the known diseases with a genetic component (genetic disorders) • Main focus inherite, heritable, genetic disorders • Part of NLM • Based 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) X33BMI

27. INTERNET BASED APPLICATIONS OF MEDICINE X33BMI

28. 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 X33BMI

29. 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. X33BMI

30. 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 X33BMI

31. TELEMEDICINE II. • A proper Telemedicine interaction would involve store and forward followed by a live interaction • Time 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 emergency • Use : extremely isolated cases, very high demand of specialist • radiology, ophtalmology, otolaryngology, dermatology, etc. X33BMI

32. e-Health • health 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 TeleHealth • Umbrella term to describe all possible variations of healthcare services using telecommunications X33BMI

33. Future of Telemedicine • TELESURGERY • “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. X33BMI

34. 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 websites • 72% doctors recommended support groups • 1 million health webs • 1000 new added every month • Health – the second most searchable word on the internet X33BMI

35. Obstacles with internet X33BMI

36. 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 X33BMI

37. 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 X33BMI