Medical Informatics:An IntroductionMichael Hogarth, M.D.Associate ProfessorDept. of Pathology and Laboratory MedicineDept. of Internal Medicine UC Davis School of Medicinehttp://[email protected]://survey.athenacarenetwork.org/presentations/intro_medicalinformatics.pdfOverviewOverview• What is medical informatics? • A brief history• Current state of the discipline• Areas of sub-specialization• What is medical informatics? • A brief history• Current state of the discipline• Areas of sub-specializationMedical InformaticsMedical Informatics " ...the rapidly developing scientific field that deals with the storage, retrieval, and optimal use of biomedical information, data, and knowledge for problem solving and decision making."Shortliffe et al. Medical Informatics: Computer Applications in Healthcare. Addison Wesley, 1990.Applied informaticsApplied informaticsKnowledge transfer in MedicineThe Gross Clinicby Thomas Eakins,1875Medical Informatics: 1890John Shaw Billings:US Army Surgeon general.Founding director of the NLM.Established Index Medicus in 1890Responsible for the US Census 1890National Library of MedicineNLM library hall (circa 1887)Medical Informatics as a Discipline Oznovy Informatiki (Foundations of Informatics), 1968 (Russia) French article (1970):“Study of an informatic system aplied to the Public Health Services”Hatton, et al IFIP Medical Informatics Monograph Series (1974) MEDINFO 74: First Conference on Medical InformaticsWhy Informatics? Introducing an in-depth understanding of healthcare information needs during system design Development of improved methods of information navigation Index Medicus (Billings, 1890) Roget’s Thesaurus (Roget, 1911) MEDLARS (Rogers, 1965) Unified Medical Language System (1986-present) Development of clinical decision support mechanisms and evaluatingtheir effectivenessEvaluation of information systems using scientific methodsKey PointInformatics:1960-1970 MUMPS: Massachusetts General Hospital Utility Multi-Programming System, 1966 Mycin (1970): Ph.D. thesis by Ted Shortliffe,MDevaluating a software program which ‘suggested’antibiotic choices based on clinical information. COSTAR(1970-80): Electronic medical record system developed in MUMPS GEMISCH(Generalized Medical Information System for Community Health): Hammond,Stead,1969Informatics: 1970-1980 MEDLINE (1966-today) 8 million citations MeSH terms (45,000) novel indexing and searching mechanismsInformatics today MEDLINE: 8 million biomedical literature abstracts available from anywhere in the world with an internet connection QMR and Iliad: Decision support systems UMLS: Unified Medical Language System. The HELP program (LDS Hospital, Utah)Why study knowledge and information transfer? Study of 1158 MEDLINE searches producing 476 “changes” in physician action or perception: diagnostic test ordering 34(7%) recognition of a medical problem or condition 104(22%) adjustment of development of a treatment plan 215(45%) treatment plan changes 67(14%) Other (12%)Lindberg, et al. Use of MEDLINE by physicians for clinical problem solving, JAMA 1993Medical Information Needs Pittsburgh study on information needs Setting: academic medical center Results: 337 “clinical information” requests observed in a 17 hour period on one Internal Medicine care team 23% of questions could be answered by using medical literature: journal, textbook, MEDLINE 52% were facts that should have been in the medical record Conclusion: 75% of ‘medical information needs’ require accessing the medical record or medical referencesKnowledge Diffusion in Medicine Stross and Harlan (1979): photocoagulation in diabetic retinopathy more than 2 years after initial publication of its benefits, less than 50% of primary care physicians were aware of its benefits. Despite published guidelines, recommended screening examinations on diabetic patients are not perfomed due to physician lack of awareness of the recommendationHersch,W. Information Retrieval: A Health Care Perspective. Springer-Verlag, 1996Clinical Data Integrity Stanford study on information integrity: 168 consecutive clinic visits, computer lab results and charts available for all visits. In 81% of the cases some of the information desired by the physician in the decision making process was not available. “foraging” for information consumed 38% of a physician’s time during a patient visit. The Workgroup for Electronic Data Interchange: 50% of paper-based medical records are either missing or contain incomplete data (1996)Current status of Clinical Information 11% of laboratory tests must be reordered due to lost results (Institute of Medicine, 1996) 30% of treatment orders are not documented at all (IOM, 1996) Physicians spend 35% of their time doing paperwork (US Dept. of Commerce, 1996) Between 20 and 30% of national healthcare expenditures are associated with informational paperwork (IOM, 1996)Areas of specialization Clinical Information standards development Organizational aspects of informatics Managing enterprise systems, implementations, etc.. Technology diffusion Knowledge representation Knowledge structures (AI) Terminologies and ontologies Information retrieval Decision Making Patients Healthcare professionals Decision Support Bayesian Fuzzy Logic Neural networks Medical ImagingMedical Informatics Resources:Textbooks A History of Medical Informatics in the United States: 1950-1990 (Collen, AMIA Press 1996) Information Retrieval: A Health Care Perspective(Hersch, Springer-Verlag, 1996) Medical Informatics : Computer Applications in Health Care (Shortliffe, Addison Wesley, 2000)Medical Informatics Resources: Organizations American Medical Informatics Association (http://www.amia.org) Other organizations around the world:International Medical Informatics Association (IMIA)American Medical Informatics Association (AMIA)Australian Health Informatics Association (SA)Belgium Medical Informatics Association (MIM)Brazilian Health Informatics Society (SBIS)British Medical Informatics Society (BMIS)French Medical Informatics Association (AIM) (French)German Medical Informatics Association (GMDS)(German)Japanese Association for Medical Informatics (JAMI)Association for Informatics in