Werner CEUSTERS, MD Center of Excellence in Bioinformatics and Life Sciences, and

1. MHI 501 – Introduction to Health InformaticsCourse Introduction(adapted from Gary Byrd)SUNY at Buffalo - September 2, 2010 Werner CEUSTERS, MD Center of Excellence in Bioinformatics and Life Sciences, and Department of Psychiatry, University at Buffalo, NY, USA http://www.org.buffalo.edu/RTU

2. Today’s agenda • Introduction of people • Brief overview of the syllabus • Video: Reinventing healthcare • Lecture: Introduction to Medical Health Informatics

3. Introduction

4. MHI 501 core faculty Peter Winkelstein, MD Chief, Division of General Pediatrics David Ellis, MDDirector, Division of Telehealth and Healthcare Informatics Gary D. Byrd, Ph.DDirector, Health Sciences Library Werner Ceusters, MDDirector, Ontology Research Group

5. 1959 - 2010 My short history ? 1977 2006 Short personal history 2004 1989 1992 2002 1995 1998 1993

6. Relevant UB Faculty and guest lecturers • Dr. Barry Smith, Philosophy Dept. • Medical Ontologies • Dr. David Ellis, Emergency Medicine Dept. • Telemedicine Applications • Dr. Raj Sharman, School of Management • Medical Data Security • Dr. Gene Morse, School of Pharmacy • Pharmacotherapy Information Network • Dr. Isaac Ehrlich, Economics Dept. • Economic Value of Health Information • Dr. Alan Hutson, Biostatistics Dept. • Analysis of Clinical Trials Information • Dr. John Eisner, School of Dental Medicine • Dental Informatics and Curriculum Management • Dr. William Rapaport, Computer Sciences Dept. • Medical Natural-Language Processing • New positions being recruited

7. MHI 501 Syllabus

8. Use MyUB and UBlearns

9. Reinventing healthcare

10. Overview of the field

11. ‘Medical’ – ‘Health’ – ‘Informatics’ • Why these words? • Scope of the field • History of the field • Definitions • Major challenges • National and local expertise & resources

12. Names for Components of the Field • Bioinformatics • Biomedical Informatics • Medical Informatics • Health Informatics, Public Health Informatics • Healthcare Informatics • Nursing Informatics, Dental Informatics, etc. • Medical Computer Science • Computers in Medicine • Biomedical Computing • Medical Information Science • …

13. Characteristics of Field • Heterogeneous • Healthcare professionals • Technicians • Researchers • No precisely defined set of skills & competencies • Vs. other professions (accounting, surgery, etc.) • Few, if any, jobs require formal training • Though many health IT leaders would benefit

14. Is Medical/Health Informatics a Profession? • Professions are characterized by: • Professional societies • Accredited curriculum • Norms of conduct specified in code of ethics • Specialized skills and continuing education • Certification or licensing • By these standards, MHI is not yet a fully a profession in the US, but it is getting close

15. The American Medical Informatics Association (AMIA) http://www.amia.org/index.html The European Federation for Medical Informatics (EFMI) http://www.efmi.org/ The International Medical Informatics Association (IMIA) http://www.imia.org/ Associations

16. American Medical Informatics Association • AMIA is dedicated to promoting the effective organization, analysis, management, and use of information in health care in support of patient care, public health, teaching, research, administration, and related policy. AMIA’s 4,000 members advance the use of health information and communications technology in clinical care and clinical research, personal health management, public health/population, and translational science with the ultimate objective of improving health.

17. American Health Information Management Association http://www.ahima.org/ Name changes: 1928 : Association of Record Librarians of North America 1938 : American Association of Medical Record Librarians 1970 : American Medical Record Association 1991 : American Health Information Management Association ‘Its current name captures the expanded scope of clinical data beyond the single hospital medical record to health information comprising the entire continuum of care’ Associations (cont.)

18. JAMIA: Journal of the American Medical Informatics Association Methods of Information in Medicine (IMIA) Core Journals

19. Core Journals (cont.) • International Journal of Medical Informatics (Elsevier)

20. Journal of Biomedical Informatics Recent | Top 10 Cited | Most Downloaded Mon Aug 30 19:26:25 BST 2010 • Using an ECG reference ontology for semantic interoperability of ECG data25 August 2010, Bernardo Gonçalves, Giancarlo Guizzardi, José G. Pereira Filho • vSPARQL: A View Definition Language for the Semantic Web25 August 2010, Marianne Shaw, Landon T. Detwiler, Natalya Noy, James Brinkley, Dan Suciu • Using text to build semantic networks for pharmacogenomics17 August 2010 Adrien Coulet, Nigam Shah, Yael Garten, Mark Musen, Russ B. Altman • A Quality Improvement Model for Healthcare Terminologies17 August 2010 Tae Youn Kim, Amy Coenen, Nicholas Hardiker • Detecting Hedge Cues and their Scope in Biomedical Literature with Conditional Random Fields13 August 2010 Shashank Agarwal, Hong Yu • The Equity in Prescription Medicines Use Study: Using Community Pharmacy Databases to Study Medicines Utilisation13 August 2010 Simon Horsburgh, Pauline Norris, Gordon Becket, Peter Crampton, Bruce Arroll, • Measuring clinical pathway adherence7 August 2010 Joris van de Klundert, Pascal Gorissen, Stef Zeemering.

21. Journal of Biomedical Informatics Recent | Top 10 Cited | Most Downloaded Mon Aug 30 19:26:25 BST 2010 • 123 2005 The use of receiver operating characteristic curves in biomedical informatics • 94 2006 Missing data and the design of phylogenetic analyses • 40 2007 NCI Thesaurus: A semantic model integrating cancer-related clinical and molecular information • 36 2006 Methods in biomedical ontology • 36 2005 Primary care physician time utilization before and after implementation of an electronic health record: A time-motion study • 36 2005 Algorithms for rapid outbreak detection: A research synthesis • 34 2008 Bio2RDF: Towards a mashup to build bioinformatics knowledge systems • 34 2005 Modeling a description logic vocabulary for cancer research • 32 2007 Data integration and genomic medicine • 31 2005 Artifacts and collaborative work in healthcare: Methodological, theoretical, and technological implications of the tangible. Can you explain the dates?

22. Journal of Biomedical Informatics Recent | Top 10 Cited | Most Downloaded Mon Aug 30 19:26:25 BST 2010 • April 2010 Cloud computing: A new business paradigm for biomedical information sharing • February 2010 The Technology Acceptance Model: Its past and its future in health care • April 2009 Research electronic data capture (REDCap)-A metadata-driven methodology and workflow process for providing translational research informatics support • April 2010 Information system design for a hospital emergency department: A usability analysis of software prototypes • August 2007 Understanding the information needs of public health practitioners: A literature review to inform design of an interactive digital knowledge management system • April 2009 Creating and sharing clinical decision support content with Web 2.0: Issues and examples • February 2004 Cognitive and usability engineering methods for the evaluation of clinical information systems • February 2010 What is biomedical informatics? • August 2007 Redesigning electronic health record systems to support public health. Can you explain the dates?

23. Core Texts • Edward H. Shortliffe & James J. Cimino., eds. Biomedical Informatics: Computer Applications in Health Care and Biomedicine, 3rd ed., Springer, 2006 • Review of "Biomedical Informatics; Computer Applications in Health Care and Biomedicine" Gari D Clifford BioMedical Engineering OnLine 2006, 5:61

24. Springer Health Informatics Series http://www.springeronline.com/sgw/cda/frontpage/0,10735,4-10062-0-0-0,00.html Core Texts (Cont.)

25. Accreditation for Education Programs • AHIMA and AMIA partnership • Report: Building the Work Force for Health Information Transformation (http://www.ahima.org/emerging_issues/Workforce_web.pdf) • CAHIIM (Commission on Accreditation for Health Informatics and Information Management Education) http://www.cahiim.org/

26. Code of Ethics • AMIA “Code of Professional Ethical Conduct” • Principles and Guidelines of Ethical Conduct regarding: • Patients, families, significant others and representatives • Colleagues • Institutions, employers and clients • Society and research • General ethical guidelines

27. “Informatics” origins • European (Russian/French) • Informatique Médicale (“medical computing” or “data processing”) • Late 1970’s to USA

28. Nature of Medical Information • Data: un-interpreted observation points • blood pressure readings • Information: data organized to convey meaning • graph showing gradually increasing blood pressure over past year • Knowledge: generalized “truths” from the analysis of information • individuals with high blood pressure are at increased risk for heart disease • … Wisdom: when to apply the right knowledge

29. Advances in Computing & Telecommunications Factors in Emergence of Field Your brain sucked dry, please insert next programmer.

30. Factors in Emergence of Field (cont.) • Knowledge about medicine unmanageable on paper

31. Recognition of the importance of the process of informed decision making (vs. collections of records or facts) Factors in Emergence of Field (cont.)

32. Factors in Emergence of Field (cont.) • Leadership of the National Library of Medicine

33. Some Historical Milestones • 1920’s Epidemiologic Surveys (Hollerith punched-card systems) • 1950’s Physician Decision-Making analysis • 1960’s Hospital Information Systems (HIS) • 1970’s Integrated Time-Shared HIS vs. Distributed Minicomputer HIS Applications • 1980’s Individual and Department Systems on Microcomputers • 1990’s Networked Applications and the Web • 2000’s Ubiquitous computing & telecommunications, portable/handheld devices

34. Definitions

35. Three main purposes of definitions • to specify the conditions that must be satisfied for a term to be an acceptable designator for a given entity in some given community; e.g.: ‘chronic pain’: pain which lasts longer than 3 months • to specify what is characteristic of particulars that instantiate a certain type; e.g.: disorder =def. a combination of bodily components of or in an organism that is clinically abnormal; • to demarcate groups by specifying characteristics that their members must exhibit: e.g.: depressions in patients that participated in clinical trial X.

36. Definitions - 1984 • comprises the theoretical and practical aspects of information processing and communication, based on knowledge and experience derived from processes in medicine and health care. van Bemmel JH. The structure of medical informatics. Med Inform 1984;9:175–80.

37. Definitions - 1990 • The field that concerns itself with the cognitive, information processing, and communication tasks of medical practice, education, and research, including the information science and the technology to support these tasks. Greenes RA, Shortliffe EH. Medical informatics. An emerging academic discipline and institutional priority. JAMA 1990;263 (8):1114–20.

38. Definitions - 1999 • we develop and assess methods and systems for the acquisition, processing, and interpretation of patient data with the help of knowledge that is obtained in scientific research. Musen MA, van Bemmel JH. Handbook of medical informatics. March 25, 1999. Available from: http://www.mieur.nl/mihandbook/ r_3_3/handbook/homepage_self.htm

39. Definitions - 2006 • The scientific field that deals with biomedical information, data and knowledge – their storage, retrieval and optimal use for problem solving and decision making. Shortliffe EH, Blois MS. The computer meets medicine and biology: the emergence of a discipline. In: Shortliffe EH, editor. Biomedical informatics: computer applications in health care and biomedicine. New York, NY: Springer Science + Business Media, LLC; 2006. p. 3–45.

40. A 2010 attempt: What is biomedical informatics? • We define informatics as the science of information, where information is data plus meaning. • Biomedical informatics is the science of information as applied to or studied in the context of biomedicine. • Defining the object of study of informatics as data plus meaning clearly distinguishes the field from related fields, such as computer science, statistics and biomedicine, which have different objects of study. What is biomedical informatics? Elmer V. Bernstam, Jack W. Smith, Todd R. Johnson. Journal of Biomedical Informatics 43 (2010) 104–110.

41. Informatics in General

42. Informatics in General Information Technology Management Library & Information Sciences } } } Computer Science

43. Focus Level: Populations Patients & Healthcare Providers Tissues & Organs Molecules & Cells Informatics Subfield: Public Health Informatics Clinical Informatics Imaging Informatics Bioinformatics Topology/Typology of Field One model from Kukafka/Hersh:

44. Biomedicine Epidemiology Information Sciences Communications Computer Science Decision Sciences Cognitive Science Health information management Linguistics Mathematics, Biostatistics Industrial & Systems Engineering Management Sciences Health Economics Medical Ethics Health IT Librarianship Areas of Knowledge – Interdisciplinary (applied focus)

45. Informatics Data Information Subject Domain Context of use semantics meaning content Computer Science Algorithms Correctness Efficiency Domain secondary syntax form Informatics vs. Computer Science Keywords

46. Informatics All kinds of medical/health information Graduate training Roles for clinicians & researchers Health Info Mgmt Medical records Coding Undergraduate training Career professionals Health Informatics vs.Health Information Management

47. Fundamental Theorem of Field • Creating an environment of “supported practice” • Charles Friedman, (University of Pittsburgh, the National Library of Medicine, Office of the National Coordinator for Health Information Technology)

48. Friedman’s Theorem (cont.) NOT: Corollaries— • More about people than technologies • Resource must offer something people are missing • Depends on the unpredictable interactions between people and resources

49. Part of the HIT Community HIT = Healthcare Information Technology • IT professionals (Computer Science and MIS degrees) • HIM professionals (Medical Records Departments) • Health Sciences Librarians • Clinicians & Other Healthcare professionals (with or without formal informatics training)

50. Scope of Activities • Basic Research (Academic) • Model building; theory development; exploratory experiments • Applied Research (Academic and corporate) • Formal experiments, evaluation of system effectiveness • Engineering (Corporate, academic, clinical) • Tool design & building for specific needs