Women’s Health Informatics Workshop AOFOG/RANZCOG 2009

1. Women’s Health Informatics WorkshopAOFOG/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 O&G at ACH. MD in the area of Induction of Labour & HI. • Dr Phurb Dorji: Consultant O&G 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.. • It’s 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 • 14:00 Intro and complete MCQ • 14:15 Maternity data and perinatal databases • 14:30 Coding and Messaging • 14:45 Internet • 15:00 Security • 15:15 Panel Discussion and Questions

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

13. Maternity data and Perinatal Databases Emma Parry emmap@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?pageid=9

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.fcgi?artid=1127483

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/google-health-first-look.html • Microsoft – health vault • http://healthvault.com/hvindex.htm?rmproc=true

28. Coding and Messaging Dave Parry Dave.parry@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

34. Systematized Nomenclature of Medicine-Clinical Terms - SNOMED CT • >600,000K 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/

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 formats…avoids 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.

50. Using the Internet to your Advantage Emma Parry emmap@adhb.govt.nz