Computers in Medicine

Lecturer and Coordinator

Israel Gannot

Tel: 6711, E-mail: gannot@eng.tau.ac.il

Assistant

Shamai Salzberger

shamai@eng.tau.ac.il

WEBsite: http://www.eng.tau.ac.il/~gannot/MI/

What does it mean

computers

in medicine ?

The Computer Meets Medicine and Biology:

Emergence of a Discipline

After taking this course, you should know the answers to these questions:

Why is information management a central issue in biomedical research and clinical practice?

What are integrated information-management environments and how might we expect them to affect the practice of medicine and biomedical research in coming years?

What do we mean by the terms medical computer science, medical computing ,medical informatics, clinical informatics, nursing informatics, bioinformatics, and health informatics?

Why should health professionals and students of the health professions learn about medical-informatics concepts and informatics applications?

How has the development of mini-computers, microprocessors, and the Internet changed the nature of biomedical computing?

How is medical informatics related to clinical practice, biomedical engineering, molecular biology, decision science, information science, and computer science?

How does information in clinical medicine and health differ from information in the basic sciences?

How can changes in computer technology and the way medical care is financed influence the integration of medical computing into clinical practice.

Subjects Index:

•Medical Decision making: Probabilistic medical reasoning.•Patient care systems.•Patient monitoring systems.•Computer aided surgery.•Computer based patient record systems.•Clinical decision support systems.•The internet.•Standards in medical informatics.•Imaging modalities.•Image management systems.•Telemedicine.•Bioinformatics.

Inputs to the medical recordsTraditional paper medical records

Outputs of the medical records

Conventional data collection for clinical trial

Clinical trial design• Definition of data elements•Definition of eligibility•Process descriptions•Stopping criteria•Other details of the trial

Data sheets

Computer database

Analyses

Results

Medical records

Role of EMR in supporting clinical trials

Clinical trial design• Definition of data elements•Definition of eligibility•Process descriptions•Stopping criteria•Other details of the trial

Clinical trial database

Analyses

Results

Medical records systems

Clinical datarepository

Networking the organization

Enterprise network

Patientworkstation

Clinical workstations

Clerical workstation

Researchdatabeses

Administrative systems(e.g. admissions, discharges and transfers)

Libraryresources

Radiology

Billing andfinancial systems

Costaccounting

Microbiology

Pharmacy

Clinical databasesElectronic medical

records

Personnelsystems

Materialmanagement

Educationalprograms

Clinicallaboratory

Datawarehouse

Moving beyond the organization

Patients

Healthyindividuals

Providersin officesor clinics

Informationresources

(Medline..)

Governmentmedical research

agencies

3rd partypayers

The InternetGovernment

health insuranceprograms

Other hospitalsand physicians

Pharmaceuticalsregulators

Communicabledisease agencies

Health ScienceSchools

Vendorsof various types

(e.g. pharmaceuticalscompanies

Healthcare institutes are seeking

Integrated clinical work stations

that will :

assist with clinical matters by:

•reporting results of tests.

•allowing direct entry of orders by clinicians.

•facilitating access to transcribed reports.

•supporting telemedicine applications.

•Supporting decision-support functions.

administrative and financial topics

• tracking of patients within the hospital.

•managing materials and inventory

•.supporting personnel functions.

• managing the payroll.

research

•analyzing the outcomes associated with treatments and procedures.

•performing quality assurance.

• supporting clinical trials.

•implementing various treatment protocols.

scholarly information

•accessing digital libraries.

•supporting bibliographic search.

•providing access to drug-information

databases.

•office automation (providing access to

•spreadsheets, word processors, and the like).

The key notion is that at the heart of the evolving clinical

workstation lies the medical record in a

new incarnation: • electronic,

•accessible.

•Confidential.

• Secure.

•acceptable to clinicians and patients.

•integrated with other types of

non-patient-specific information.

References:

Course textbook:

1. HANDBOOK of MEDICAL INFORMATICS Editors: J.H. van Bemmel, Erasmus University, Rotterdam M.A. Musen, Stanford University Stanford, Springer, 1997.

Additional books:

2. The computer based patient records: An essential Technology for Healthcare, Institute of Medicine National Academy Press, 1997.3. Strategies and Technologies for healthcare information: Theory and practice, Marion J. Ball, Judith V. Douglas and David E. Garrets, editors, Springer, 1999.4. Clinical decision support systems: Theory and practice. Eta S. Berner, Springer, 1998.5. Telemedicine-Practicing in the information age, Stevan F. Viegas, Kim Dunn, Editors, Lippincott-Raven, 1998.

WEBsites:•National Institutes of Healthhttp://www.nih.gov•National Library of Medicine (Medline)-http://igm.nlm.nih.gov/•American Medical Informatics Association-http://www.amia.org/•The international Society for computer aided surgery.http://igs.slu.edu/• The helath level 7 committee: http://www.hl7.org• The European Committee for Standardization Technical Committee for Health Informaticshttp://www.centc251.org/• BioInformatics resources on the WEBhttp://www.niehs.nih.gov/science/bioinfo.htm• Tools for DNA gene and protein sequencing.http://www.ncbi.nlm.nih.gov/Tools/index.html

Journals:

•CRITICAL REVIEWS IN MEDICAL INFORMATICS.

•HEALTH COMMUNICATIONS AND INFORMATICS

•HEALTHCARE INFORMATICS

•INTERNATIONAL JOURNAL OF MEDICAL INFORMATICS

•JOURNAL OF THE AMERICAN MEDICAL INFORMATICS

ASSOCIATION

•MEDICAL INFORMATICS

•MEDICAL INFORMATICS AND THE INTERNET IN

MEDICINE

•STUDIES IN HEALTH TECHNOLOGY AND INFORMATICS

•BIOINFORMATICS

•COMPUTERS AND BIOMEDICAL RESEARCH

•COMPUTERS IN BIOLOGY AND MEDICINE

•COMPUTERS IN HEALTHCARE

•COMPUTERS IN HOSPITALS

•COMPUTERS IN NURSING

Journals:

• http://www.interscience.wiley.com:83/cas/

Bioinformatics:

DNA, protein gene sequencing.

Bioinformatics is the study of how information is

represented and transmitted in biological systems,

starting at the molecular level. Whereas clinical

informatics deals with the management of information

related to the delivery of health care, bioinformatics

focuses on the management of information related

to the underlying basic biological sciences.

NIH group maintains a database of macromolecular 3D structures, as well as tools for their visualization and comparative analysis. MMDB, the Molecular Modeling Database, contains experimentally determined biopolymer structures obtained from the Protein Data Bank.

National library of medicine. Medline

Standards in Medical Informatics

• Medical Information Bus - IEEE 1073

• HL-7 Health Level 7

• DICOM - Digital Imaging and Communications inMedicine.

HL7 Mission Statement

• To provide standards for the exchange, management and integration of data that supports clinical patient care and the management, delivery and evaluation of healthcare services.

A domain-specific, common protocol for the exchange of health care information.

ISO-OSI Communication Architecture ModelISO-OSI Communication Architecture Model

1 Physical1 Physical

2 Data Link2 Data Link

3 Network3 Network

4 Transport4 Transport

CommunicationCommunication

5 Session5 Session

6 Presentation6 Presentation7 Application7 Application

FunctionFunctionFunctionFunction

What does “HL7” stand for?

DICOM Application Domain

MAGN

ETOM

Information Management System

Storage, Query/Retrieve, Storage, Query/Retrieve, Study ComponentStudy Component

Query/Retrieve, Query/Retrieve, Patient & Study ManagementPatient & Study Management

Query/RetrieveQuery/RetrieveResults ManagementResults Management

Print ManagementPrint Management

Media ExchangeMedia Exchange

LiteBox

Medical Information Bus IEEE 1073, Standard for Medical Device

Communications.

This standard for medical device communication

defines a family of standards for providing interconnection

and interoperability of medical devices and computerized

healthcare information systems. Medical devices include a

broad range of clinical monitoring, diagnostic and

therapeutic equipment.

Computerized healthcare information systems similarly

include broad range of clinical data management systems,

patient care systems and hospital information systems.

Applications of Medical Informatics

by NASA

to provide:

•Telemonitoring– people– environment – systems

•Tele-education•Telecare•Telescience

Virtual Reality

• Biocomputation

– improved skills

– pre-surgery planning

– new techniques testing

– immersive robotic surgery

1995ARC telemed demo with Trident & Mt. Sinai Medical CenterSpacebridge to Russia

1997NASA Commercial Space Center theMedical Informatics and TechnologyApplications Consortium (MITAC)

1998Andes/Ecuador surgery consultEverest Extreme Expedition I

1999Virtual Hospital demonstration with ARCEverest Extreme Expedition II

ScheduleDate Lecturer Topic

1 24/2 Dr. Israel Gannot Introduction

2 2/3 Dr. Israel Gannot Patient care and monitoringsystems

3 9/3 Dr. Ido Shoenberg Paperless ICU

12/3 Dr. Ilan Zelingher

4 16/3 Seminar (12/3) instead

5 23/3 Dr. Leo Joscowicz Computer aided surgery

6 30/3 Mr. Shamai Salzberger DICOM

7 6/4 Dr. Allon Zucker Primary & secondary carecomputerization in Israel.

8 13/4 Dr. Israel Gannot/Mr. ShamaiSalzberger

Internet exercise

9 4/5 Dr. Israel Gannot Imaging modalities

10 11/5 Dr. Hayit Greenspan Image management -PACS

11 18/5 Conference Computer aided surgeryMeeting, Technion

12 25/5 Dr. Yuval Shahar Interpretation andvisualization of time orientedmedical data.

13 1/6 Mr. Shamai Salzberger Medical information bus(IEEE 1073) and HL-7standard

14 12/6 Dr. Israel Gannot/Mr. ShamaiSalzberger

Final Examination