Health Informatics

Elmer V. Bernstam, MD, MSE, MSAssistant Professor

School of Health Information Sciences and Internal MedicineUT - Houston

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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

1. Biological structure informatics2. Computational biology3. Expression profiling and microarrays4. Genomic ontologies5. Genomics6. Linking the genotype and phenotype7. Neuroinformatics8. Pharmacogenomics9. Proteomics

Clinical Informatics10. Barriers to clinical system implementation11. Clinical systems in ambulatory care12. Clinical systems in high intensity care13. Careflow and process improvement systems14. Disease management15. E-health and clinical communication16. Evaluation of health information systems17. Health data warehousing18. Health information systems19. Integrated health and financial systems

Education and Training20. Computer-assisted medical education21. Consumer health information22. E-learning or distance learning23. Education and training24. Library information systems25. Medical informatics teaching26. Patient education and self-care27. Professional education

Human Information Processing and Organizational

Behavior28. Cognitive models and problem solving29. Data visualization30. Natural language understanding and text generation31. Human factors and usability32. Human factors and user interfaces33. Human-computer interaction34. Models of social and organizational behavior35. Natural language processing

Imaging and Signal Analysis36. Image processing and transmission37. Image recognition, registration, and segmentation methods38. Imaging and signal standards39. Knowledge representation and ontologies for imaging40. Model-based imaging41. Signal processing and transmission42. Virtual reality and active vision methods and applications

Innovative Technologies in Health Care43. Computer-communication infrastructures44. Internet applications45. Mobile computing and communication46. Portable patient records47. Security and data protection48. Software agents and distributed systems49. Telemedicine50. Virtual reality51. Wireless applications and handheld devicesKnowledge Management52. Automated learning and discovery53. Clinical guidelines and protocols54. Controlled terminology, vocabularies, and ontologies55. Intelligent data analysis and data mining56. Decision support systems57. Knowledge management58. Knowledge representation59. Neural network techniques60. Pattern recognition/classification

Nursing Informatics61. Nursing informatics62. Nursing care systems63. Nursing vocabulary and terminology64. Nursing education/Curriculum in nursing informatics65. Nursing documentation

Organizational Issues66. Careflow management systems67. Care delivery systems68. Cooperative design and development69. Economics of care70. Ethical and legal issues71. Health services evaluation: performance and quality72. Organizational impact of information systems73. Quality assessment and improvement74. System implementation and management issues75. Technology assessment

Patient Record76. Cryptography, database security, and anonymization77. Database access and delivery78. Database design and construction79. Data standards and enterprise data sharing80. Patient record management81. Privacy, confidentiality, and information protection82. Standard medical vocabularies83. Standards for coding84. Standards for data transfer

Public Health Informatics85. Administrative/financial systems86. Biosurveillance87. Consumer health informatics88. Emergency and disaster response89. Genetic epidemiology90. Health intervention systems91. Health promotion systems92. Health outcomes assessment93. Patient self-care and patient-provider interaction

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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

• 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

• 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– 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 informaticsInformation 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

– 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!Elmer.V.Bernstam@uth.tmc.edu