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Medical Informatics

Medical Informatics. Human Variation Informatics Issues Ethical Issues. Medical Informatics. storage, retrieval, and optimal use of biomedical information, data, and knowledge for problem solving and decision making . Genetics Variation. Medicine. Issues. Nature of medical information

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Medical Informatics

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  1. Medical Informatics Human Variation Informatics Issues Ethical Issues Chuck Staben

  2. Medical Informatics storage, retrieval, and optimal use of biomedical information, data, and knowledge for problem solving and decision making Genetics Variation Medicine Chuck Staben

  3. Issues • Nature of medical information • Technical challenges • Uses of medical information • medicine • research • Status of development in field • Ethical concerns • Professional Career Trajectories Chuck Staben

  4. Information Types • Textual • chief complaint, symptoms, history of present illness, history, family history, physical exam, insurance information… • Graphical • ECG, ultrasound, X-ray, hand-drawn figures… • longitudinal data (blood pressure graph) • Digital (X-rays, …) Chuck Staben

  5. Text Information-Issues • Non-digital, non-shareable, non-searchable, non-standard • Synonyms • thrombophlebitis=phlebothrombosis, DVT, blood clot in the leg, milk leg, phlegmasia caerulea dolens, dropsy… • Changing • generalized idiopathic lymphandenopathy (1980) => AIDS!!! Chuck Staben

  6. Text Standards • Ideal Terminology • Complete, Formal, Universal, Translatable • Candidate languages • SNOMED, UMLS, ICD, Read Codes, DSM • Digital • Entry, storage, retrieval, usage? Chuck Staben

  7. Images • Sharable • Searchable • Transmittable • Multiple input/output formats Chuck Staben

  8. Physicians DO NOT WANT a data entry clerk paid $200,000/year! Chuck Staben

  9. Integrating Delivery • Asynchronous communication • FAX, VoiceMail • e-mail • office histories • Synchronous communication • voice, phone, paging Chuck Staben

  10. Medical Delivery Issues • Periodic health screening • enhanced reminders • Physician variability • managed care can reduce variability • Data quality, type varies from physician to physician Chuck Staben

  11. Impediments to Electronic Records • Terminology/data types • Data entry methods • Information needs • ear infection vs bone-marrow transplant • Impact on physician-patient • Impact on physician-patient-society • confidentiality, responsibility Chuck Staben

  12. Experience with Electronic Records • Reliability problems • as good as electronic banking! • Free-text fields (clinical notes) • Nomenclature • Interfacing with other systems • Enormous cost of switchover • who pays that cost? Chuck Staben

  13. Medical Uses of Enhanced Records • Improved care day-to-day • UKHMO: what are your current meds? • Monitoring clinical success • all patient records become clinical trials Chuck Staben

  14. Medical Genetics Basic disease work Epidemiology Infectious disease Life history, risk factor... Pharmacogenomics Tissue Banks Pedigrees/Populations DATAMINING Research Uses Chuck Staben

  15. Medical Informatics-Status • Medicare/Medicaid/Managed Care “Coding” • NIH • major initiatives in electronic records • Company initiatives • HMO, Healtheon, … • Pharmacogenomics companies • Iceland, Scandinavian records Chuck Staben

  16. Examples • Genomic labeling • P450 variation and cancer chemotherapy • Pharmaco interest in pharmacogenomics Chuck Staben

  17. P450 and Drugs Cytochrome P450 2D6 - 6 to 10% of Caucasians have genetic variationassociated with poor metabolism of drugs utilizing this pathway. Substrates using this pathway include: antiarrhythmic agents, antihypertensives, ß-blockers, monamine oxidase inhibitors, morphine derivatives, antipsychotics, and tricyclic antidepressants. Chuck Staben

  18. BIG BROTHER Healtheon, Medicaire…. Chuck Staben

  19. Training • “Interested Physicians” • Formal Training • Medical Information Scientist Training Program, Stanford University • National Library of Medicine Chuck Staben

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