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Computers in Medicine Lecturer and Coordinator Israel Gannot Tel: 6711, E-mail: [email protected] tau. ac. il Assistant Shamai Salzberger [email protected] 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 informationmanagement 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 minicomputers, 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 records Traditional paper medical records
Outputs of the medical records
Conventional data collection for clinical trial Medical records Data sheets Clinical trial design • Definition of data elements • Definition of eligibility • Process descriptions • Stopping criteria • Other details of the trial Computer database Analyses Results
Role of EMR in supporting clinical trials Medical records systems Clinical data repository Clinical trial design • Definition of data elements • Definition of eligibility • Process descriptions • Stopping criteria • Other details of the trial Clinical trial database Analyses Results
Networking the organization Personnel systems Clinical databases Electronic medical records Enterprise network Pharmacy Patient workstation Billing and financial systems Clerical workstation Cost accounting Clinical workstations Research databeses Microbiology Library resources Material management Radiology Data warehouse Administrative systems )e. g. admissions, discharges and transfers( Clinical laboratory Educational programs
Moving beyond the organization The Internet 3 rd party payers Government health insurance programs Other hospitals and physicians Patients Pharmaceuticals regulators Healthy individuals Communicable disease agencies Providers in offices or clinics Information resources )Medline(. . Government medical research agencies Vendors of various types )e. g. pharmaceuticals companies Health Science Schools
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 Health http: //www. nih. gov • National Library of Medicine (Medline-( http: //igm. nlm. nih. gov/ • American Medical Informatics Associationhttp: //www. amia. org/ • The international Society for computer aided surgery. http: //igs. slu. edu/ • The helath level 7 committee: http: //www. hl 7. org • The European Committee for Standardization Technical Committee for Health Informatics http: //www. centc 251. org/ • Bio. Informatics resources on the WEB http: //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 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: 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. DNA, protein gene sequencing.
NIH group maintains a database of macromolecular 3 D 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 in Medicine.
HL 7 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.
What does “HL 7” stand for? A domain-specific, common protocol for the exchange of health care information. 7 Application Function 6 Presentation 5 Session 4 Transport 3 Network Communication 2 Data Link 1 Physical ISO-OSI Communication Architecture Model
DICOM Application Domain Lite. Box Storage, Query/Retrieve , Study Component MAGN ETOM Print Management Query/Retrieve Results Management Media Exchange Query/Retrieve , Patient & Study Management Information Management System
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
1995 ARC telemed demo with Trident & Mt. Sinai Medical Center Spacebridge to Russia 1997 NASA Commercial Space Center the Medical Informatics and Technology Applications Consortium (MITAC( 1998 Andes/Ecuador surgery consult Everest Extreme Expedition I 1999 Virtual Hospital demonstration with ARC Everest Extreme Expedition II