Transcript Health Informatics Elmer V. Bernstam, MD, MSE, MS Assistant Professor

Health Informatics
Elmer V. Bernstam, MD, MSE, MS
Assistant Professor
School of Health Information Sciences and Internal Medicine
UT - Houston
Better information
Better care
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Definition
Informatics: field of study
concerned with information
Health (Biomedical) informatics:
informatics applied to health
(biomedicine)
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This is health informatics!
Bioinformatics
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Biological structure informatics
Computational biology
Expression profiling and microarrays
Genomic ontologies
Genomics
Linking the genotype and phenotype
Neuroinformatics
Pharmacogenomics
Proteomics
Clinical Informatics
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Barriers to clinical system implementation
Clinical systems in ambulatory care
Clinical systems in high intensity care
Careflow and process improvement systems
Disease management
E-health and clinical communication
Evaluation of health information systems
Health data warehousing
Health information systems
Integrated health and financial systems
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Computer-assisted medical education
Consumer health information
E-learning or distance learning
Education and training
Library information systems
Medical informatics teaching
Patient education and self-care
Professional education
Imaging and Signal
Analysis
36. Image processing and transmission
37. Image recognition, registration, and segmentation
methods
38. Imaging and signal standards
39. Knowledge representation and ontologies for
imaging
40. Model-based imaging
41. Signal processing and transmission
42. Virtual reality and active vision methods and
applications
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Cognitive models and problem solving
Data visualization
Natural language understanding and text generation
Human factors and usability
Human factors and user interfaces
Human-computer interaction
Models of social and organizational behavior
Natural language processing
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Careflow management systems
Care delivery systems
Cooperative design and development
Economics of care
Ethical and legal issues
Health services evaluation: performance and quality
Organizational impact of information systems
Quality assessment and improvement
System implementation and management issues
Technology assessment
Patient Record
Innovative
Technologies in
Health Care
Education and Training
Human Information
Processing and
Organizational
Behavior
Organizational Issues
43. Computer-communication infrastructures
44. Internet applications
45. Mobile computing and communication
46. Portable patient records
47. Security and data protection
48. Software agents and distributed systems
49. Telemedicine
50. Virtual reality
51. Wireless applications and handheld devices
Knowledge Management
52. Automated learning and discovery
53. Clinical guidelines and protocols
54. Controlled terminology, vocabularies, and ontologies
55. Intelligent data analysis and data mining
56. Decision support systems
57. Knowledge management
58. Knowledge representation
59. Neural network techniques
60. Pattern recognition/classification
76. Cryptography, database security, and
anonymization
77. Database access and delivery
78. Database design and construction
79. Data standards and enterprise data sharing
80. Patient record management
81. Privacy, confidentiality, and information protection
82. Standard medical vocabularies
83. Standards for coding
84. Standards for data transfer
Public Health
Informatics
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Administrative/financial systems
Biosurveillance
Consumer health informatics
Emergency and disaster response
Genetic epidemiology
Health intervention systems
Health promotion systems
Health outcomes assessment
Patient self-care and patient-provider interaction
Nursing Informatics
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Nursing
Nursing
Nursing
Nursing
Nursing
informatics
care systems
vocabulary and terminology
education/Curriculum in nursing informatics
documentation
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Theme
• Informatics: not just application of
computers to medicine
• Computers are [transforming] tools
• There are other tools drawn from:
– Clinical and basic (biological) science
– Decision analysis
– Probability and statistics
– Cognitive and social science, pedagogy
– Etc.
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Distance
• Overcoming physical separation
• Doctor/patient
• Teacher/learner
• Researcher/data
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Social issues
• Dealing with people
• Change management
• Culture, roles, workflow
• Law, ethics, economics
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Research themes in informatics
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Vocabularies, standards
(Automatic) similarity determination
Data presentation
Decision making
Evaluation
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Vocabularies and standards
• Naming concepts and relating them to
each other
• Standards: agreed-upon conventions
– Allow communication
– Ex: Start numbering with 0 vs. 1
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Data presentation
• Dealing with information overload
• Knowledge-based information display
– Knowledge about the task, environment,
decision to be made
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Decision making
• What makes a good decision?
• How do you help people make better
decisions?
• Error prevention
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Evaluation
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Does it work?
Do people use it? Like it?
Does it improve outcomes?
Limitations of technology
– Pen and paper are hard to beat
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Bioinformatics challenges
• Lots of data  what does it mean?
• Collecting data  using data  predicting
data
• Genome annotation (functional genomics)
– What does this piece of DNA do?
• Protein structure is related to function
(protein folding)
– Can we predict structure from sequence and
basic physics?
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Bioinformatics future
• Build models of
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Molecules
Cells
Tissues
Organisms
Systems
• Try a drug on a model, rather than a patient
• Opportunity is in combination of bio- and
clinical informatics
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Pharmacogenomics
• Different people respond to drugs differently
– Many drugs
– Many genetic differences between people
• In addition, genetics influence
– Risk factors  are you going to get the
disease? (e.g. smoking  emphysema, heart
disease)
– Operative risk
• How to collect and use these data?
• Memory is not enough, nseed tools
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Clinical informatics
Information in health care
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Not there yet: EMR
• Electronic medical records
• “Holy Grail” of medical informatics
– MI projects: Given an EMR, […]
– Prevent errors, etc.
• But…
– Not widely accepted in this country
• Depends on what you consider an EMR
• MD order entry? (4% of hospitals)
– Difficult to get right: few successful
implementations
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Social barriers to EMR
• Who benefits?
– Mismatch between costs and benefits
– Physicians
• Weak case for time savings
• Often inconvenient – poor workflow integration
– Payers
• Likely benefit  case becoming stronger
– Patients
• Strong case for benefit
• What if I buy your EMR and your company
goes out of business?
– No single dominant player
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Social barriers to EMR
• Technology is dominated by two types of people:
those who understand what they do not manage,
and those who manage what they do not
understand.
- Anonymous
• Computers make it easier to do a lot of things, but
most of the things they make it easier to do don't
need to be done.
- Andy Rooney
• The case for biomedical informatics training: need
people who understand both
– What needs to get done: biomedicine
– How to get it done: technology
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Not there yet: decision support
• What do physicians do?
– Gather information
– MAKE DECISIONS
– Execute
• Decision support: (technological) support
for decision-making
– Only effective way to influence decisions
– Clinical practice guidelines
• Realization: practice variation that cannot be justified
by science
• Little effect of published guidelines
• Integration into workflow required: CPOE
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Problem
• Components of a decision
– Knowledge about the world: difficult to
encode
• Medical literature
• Experience
– Patient information: requires EMR
• Age, sex, laboratory data, etc.
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Trends Affecting Informatics
• Improvement in computer technology
– Faster
– Smaller
– More portable: better displays and
batteries
• Improvement in communication
technology
• High-throughput biological techniques
– Human genome project
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Trends Affecting Informatics
• (Threat of) Terrorism
• Health care
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Aging of the population
Increasing growth of knowledge
Increasing financial pressures
Increasing patient expectation and
empowerment
• Increasing awareness and decreasing tolerance of
medical errors
• Erosion of respect for physicians
• Decreasing physician autonomy
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Medico-legal pressures
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Opportunities in informatics
• Information overload
– Providing better care: biological advances in
clinical practice
• Overcoming distance
– [Bio] Terrorism: detection and coordinating
response
– Telemedicine: frequent checks on the
chronically ill
• Social issues
– Facilitate change to better ways
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Thank you!
[email protected]
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