Medical informatics
Lecture 1
electronic patient records
The big picture
Standards based
formalisation of
clinical data and
research results
Understandin
Understandin
g Develop
g Develop
diseases and and test
diseases and and test
their treatments
their treatments Patient-specific
treatment Decision-making to
treatment optimise and
personalise treatment
Clinical
engagement, post-
marketing
surveillance, data
mining
Ensure right
Service Ensure right
Service Patients
delivery, Patients
delivery, receive
performance receive
performance right
assessment right
assessment intervention
Manage safe
intervention
workflow, professional
communication,
security
Course objectives
• Provide an overview of the main
development areas in health informatics.
• Understand the role of informatics in
translating medical research into clinical
practice
• Look at Electronic patient records topics
in more depth.
Biomedical informatics (1):
Bio-informatics
• Rapidly developing branch of biology: highly
interdisciplinary, using techniques and concepts
from IT, statistics, mathematics, chemistry,
biochemistry, physics, and linguistics!
• Seeks knowledge from computer analysis of
– biological data (e.g. genomics, proteomics)
– experimental results
– patient statistics
– scientific literature.
• Research in bioinformatics includes development
of methods for storage, retrieval, and analysis of
data, modeling and simulation of
cellular/molecular systems.
Biomedical informatics (2):
Health-informatics
• Also known as medical or clinical informatics
• It is applied to primary and specialist patient
care, nursing, dentistry, pharmacy, public
health etc.
• Deals with the resources, devices, and methods
required to optimize the acquisition, storage,
retrieval, and use of information in delivery of
healthcare services
• A particular focus is on services at the point of
care and emphasis is increasingly being placed
on informatics for patients and carers as well as
professionals.
Topics in health informatics (1):
traditional perspective
• Architectures for electronic medical records
and other health information systems used
for billing, scheduling, and research
• Standards (e.g. DICOM, HL7) … to facilitate
the exchange of information between
healthcare information systems - these
specifically define the means to exchange
data, not the content
• Controlled vocabularies … used to allow a
standard, accurate exchange of data
content between systems and providers
• Software for specialist services and devices
Topics in health informatics
(2):
new drivers
• Quality and safety
– US Institute of Medicine
• “To err is human”
• “Crossing the quality chasm”
• McGlynn data on service delivery
• Fineberg lecture on YouTube
– NHS
• Emergence of clinical decision support
and workflow management systems
Topics in health informatics (3):
Contemporary multidisciplinary
view
• Traditional “engineering” topics
– Hardware and software service architectures
– Specialist technical services
– Digital signal processing
• Human and organisational factors in quality and
safety
– User interface design (Tang lecture on YouTube)
– Organisational memory
– Learning from experience
– Change management
• Formal representation of data and knowledge
– Controlled vocabularies, “ontologies”
– Applying knowledge to data: logic and description logics,
decision theory, guidelines and workflows
The key challenges
(adapted from Coiera p 104)
• How do we apply knowledge to
achieve a particular clinical objective?
• How do we decide how to achieve a
particular clinical objective?
• How do we improve our ability to
deliver clinical services?
Medical research, clinical
practice
Understandin
Understandin
g Develop
g Develop
diseases and and test
diseases and and test
their treatments
their treatments
treatment
treatment
Health
Records
Ensure right
Service Ensure right
Service Patients
delivery, Patients
delivery, receive
performance receive
performance right
assessment right
assessment intervention
intervention
First …
• Capture your
data,
accurately,
completely
• Make the data
readily
accessible
The paper record, pros
• Portable
• Familiar and easy to use
– Exploits everyday skills of visual search,
browsing etc
• Natural: “direct” access to clinical
data
– Handwriting
– Charts, graphs
– Drawings, images…
The paper record: cons
• Can only be used for one task at a time
– If 2 people need notes one must wait
– Can lead to long waits (unavailable up to 30%
of time in some studies)
• Records can get lost
• Consume space
• Large individual records are hard to use
• Fragile and susceptible to damage
• Environmental cost
Electronic health records
• An electronic health record
is a repository of
information about a single
person in a medical setting,
including clinical,
demographic and other
data.
• The repository resides in a
system specifically designed
to support users by
– providing accessibility to
complete and accurate data
– may include services to
provide alerts, reminders,
links to medical knowledge
and other aids to clinical
practice.
The electronic medical
record
Examples
Driving Factor to Adopt an
EMR
• Different charting methods in
different offices
• Growing practice – adding new docs
• Rising transcription costs -
$250k/year in 1998 and going up
• Need to enhance quality of care
• Reduce practice overhead
Goals of Using the EMR
• Provide a single, uniform medical
record.
• Ability to access medical records from
any location.
• Improve documentation and coding.
• Improve research / clinical trials data /
enhance quality.
• Reduce transcription and other rising
costs.
Functions of the EHR (1)
1. Supports structured data collection using a defined
vocabulary.
2. Accessible at any or all times by authorized
individuals.
3. Contains a problem list - patient’s clinical problems
and current status
4. Supports systematic measurement and recording of
data to promote precise and routine assessment of the
outcomes of patient care
5. States the logical basis for all diagnoses or
conclusions as a means of documenting the clinical
rationale for decisions about the management of the
patient’s care.
Functions of the EHR (2)
1. Can be linked with other clinical records of a patient—from
various settings and time periods—to provide a longitudinal
(i.e. lifelong) record of events that may have influenced a
person’s health.
2. Can assist the process of clinical problem solving by providing
clinicians with decision analysis tools, clinical reminders,
prognostic risk assessment and other clinical aids.
3. Can be linked to both local and remote databases of
knowledge, literature and bibliography or administrative
databases and systems so that such information is readily
available to assist practitioners in decision making.
4. Addresses patient data confidentiality.
5. Can help practitioners and health care institutions manage the
quality and costs of care.
Benefits Realized
• Staff to physician ratio decreased below
national ratio average.
• Practice overhead costs will be reduced.
• Patient perception of practice improved.
• Better patient coverage during off hours
since information was more consistent,
complete and accessible.
Benefits continued…
• e-Prescribing improves patient safety
(instructions, warnings and legibility)
• Sharing data efficiently outside the practice.
• improves quality of care at other provider
organizations
• Rewards (financial) for documenting clinical
performance
• Improved quality of life for physicians
Electronic health records:
pros
• Compact
• Concurrent use
• Easily copied/archived
• Portable (handheld and wireless devices)
• Secure
• Supports many other services
– Decision support
– Workflow management
– Performance audits
– Research
Electronic health records:
cons
• High capital investment
– Hardware, software, operational costs
– Transition from paper to computer
• Training requirements
• Continuing security debate
– Stealing one paper record is easy, 20 is harder,
10,000 effectively impossible – the security
risks are very different for electronic data.
• Power outs – the whole system goes
down!
Ad hoc view
User view
Service architecture view
Chronic
care
services
Primary Communication & Point of Search and
Acute
Care Coordination care analysis
services
services services services services
Clinical data Federated Terminologies Clinical Clinical
“Organisational EHR Ontologies guideline trials
Memory” repository repository
Functional view
