bmi overview done

8/6/2019 Bmi Overview Done

1/39

Topic:Overview

of

BMI

Baldi/Hayes/Smyth:IntroductiontoBiomedicalInformatics:1


2/39

Introductiontotheclass

Motivatingexample:healthrecords

RelationshipofBMItootherdisciplines

Dataacquisition,storage,anduse

Conclusionsanddiscussion


Recommended

reading


3/39

ThisclasswillNOT

eac you o eaprogrammer

teachyoutofixbrokencomputers

tellyouabouteveryimportantbiomedicalcomputingsystemor

ThisclassWILL

introduceyoutoconceptsunderlyingbiomedicalinformatics encourageyou orea a ona re a e ma er a

helpyouconnectbroadconceptsinbiomedicalinformaticstoyour

currentandfuturework

managementofinformation(Shortliffe&Cimino,3rd ed.)



4/39

Modernpaperbasedrecordsgrewoutofthe

Whataresomecurrentchallenges?



5/39

Whatare

all

the

things

that

go

into

a

medical



6/39

Whatareallofthewaysinwhichthemedicalrecordisused?



7/39

Challengestoimplementingelectronicmedicalrecor s:

Impossibletofullyautomaterecordkeepingprocesses

Limitedstandardsforclinicalterminology,billinganddiagnostic

codes,andinteroperabilityamongsystems(bothwithinonemedical

cen eran eyon omany

Dataprivacy,confidentiality,andsecurity(importantlythreedifferent

butrelatedissues)



8/39

medicalcomputerscience

n orma onsc ence

informationtheory

biomedicalcomputingorbiocomputation

medicalinformatics

bioinformatics

biomedical informatics



9/39

HistoryofBiomedicalInformatics 1890:Hollerithusedpunchcarddata

rocessin intheUScensus ledto

epidemiologicalsurveillanceviapunch

cardsMarcin Wichary:1960s IBMpunch card

dannyman: punchcard loom

(likely 19th ctry)

Late1950s:Startedtoseeapplicationsof

digitalcomputersinmedicinein

en ineerin ublications

1960s:ComputerScienceasadiscipline

1970sand1980s:emergenceofthe

jovike: 1978 IBM System/370 Model 145



10/39

1968:A.I.Mikhailov,alongwithotherscoinedtheterm

Informatika durin the develo ment of the field of Information

Science

in

Russia 1976: NauchnyeKummunikatsiiInformatikaInformatics: the

scienti icdisci linethatstudiesthestructureand eneralpropertiesofscientificinformationandthelawsofallprocessesofscientificcommunication.

Late1960s:Universit de artmentsinFrance Holland and

Belgiumestablishedwiththetitleinformatiquemedicale

1974:MedicalInformaticsbecamethetermofartatKings

Colle eHos italinLondon informfromdinformati ue

aticsfromdautomatique.



11/39

FormalDefinitionsandStandardsBodies 1985:AmericanStandardsforTestingMaterials(ASTM,

developsvoluntarystandards)establishedSubcommitteeonMedicalInformatics

developingbodyofknowledgeandsetoftechniquesconcerningthe

organization

and

management

of

information

in

support

of

, .

Forthepurposesofthiscourse,Biomedicalinformaticsisascientificfieldthatdealswithbiomedicalinformation,data,andknowledge theirstorage,retrievalandoptimaluseforproblemsolvinganddecisionmaking.



12/39

BiomedicalInformatics ApplicationDomains BiomedicalInformaticshasmajorapplication

Bioinformatics directedatthelevelofmolecularandcellularprocesses

. . . directedatthelevelofindividuals(includesmedicalinformatics,nursinginformatics,dental,etc.)

PublicHealthinformatics directedatpopulationsandsociety

SocialInformatics socialimpactsofinformationtechnologyinhealthcarefield.

mag ng n orma cs rec e a e eve o ssuesan organs,e.g.,pathologyinformatics,radiologyinformatics



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HowdoyouthinkBiomedicalInformaticsrelatestoot er sc p nes



14/39

Introductiontotheclass

Motivatingexample:healthrecords

Relationship

of

BMI

to

other

disciplines

Dataacquisition,storage,anduse

ec ron c

e ca

ecor s

Conclusionsanddiscussion


Recommendedreading


15/39

Medicalpracticeisallaboutgathering,reviewingandinterpretingdata

a aarecen ra oa me ca care

Dataarecentraltotheprocessofdecisionmaking

Whataremedicaldata?



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Anindividualmedicaldatapoint(datum)isasingleo servationa outapatient

Thepatientinquestion

Theparameterbeingobserved

Thevalueoftheparameterinquestion

T etimeo t eo servation



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Medicaldataareuncertain.

Absence

of

standard

medical

vocabularies

based

on

cleardefinitionsmakesallmedicalobservationsfuzzy.

Commonfindingsmaymaskrareones.

Symptomsanddiagnosescancooccurevenwhennot

related.

Contexthelpsremedythisissuetoadegree.



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Returntoourexample:the

medicalrecord

Legaldocumentbenben:modernclinic

woodenmask:ancestryrecordsfromlate1800s

Growingtendencytostructuredata

recordsstorage

Oftenreviewedintensely


mandiberg:medicalrecordunderreview


19/39

Physicians

Nurses

Laboratory

Officestaffsadmissionpersonnel

Technologicaldevices



20/39

HistoricalRecord

Communication

DiagnosisandMonitoring

Le al Records

Clinicaland/orEpidemiologicalResearch

Perhapscustomtreatments/personalizedmedicine



21/39

Prosand

Cons

of

Pa er

Records

+ Flexibility - Logisticalissues

- Unabletosharewithmultiple

+ Accessibility(paperis

everywhere)

users

- Theincompleteofthe

records

+ Familiarity - Legibility

- Disorganizationofthepaper

records

- Redundancyandinefficiency

- InfluenceonClinicalResearch

-

entered,itshardtoaccessby

paperalone)


-


22/39

GoalsofComputerizedRecords Facilitatepatientcarebyservingasorganized

externalmemoryforpractitioners

Enhancecommunicationsbetweenprovidersandspecialists

Ensurecontinuityofcareduringinpatientstaysand

acrossoutpatientvisits

ega an nanc a purposes

Researchsupport



23/39

Prosand

Cons

of

Electronic

Records

+ Accessibility remotelyand - Initialinvestment

- Continuingcosts(training,

+ Legibility+ Automaticdecisionmaking

maintenanceofconfidentiality,

etc.)

- Subtlefailures(e.g.,transcription

askingformissing

information,alerts,

errorsofhandwrittennotesby

dataentryperson)

- Catastrophicfailures

+ Enhancedscope(haveall

inpatientandoutpatient

- Dataglutdifficulties(physicians

oftenuseagreatdealofdataof

lowdecisionvaluetomake

dataandtestresultsavailableevenifapatientis

outsidelocalarea

smalldecisions. Captureisdifficultandexpensive.)



24/39

Comprehensivenessofinformation

urat ono usean retent ono ata

Ubi uit ofaccess



25/39

Recordin datainthemomentcantakea ersonoutofthat

moment(e.g.,notesinclass,recordsduringpatientvisit)

Comprehensivecaptureofalldataisimpractical need

pr or es

Relyingonselfreportalonecanleadtomissinginformation

resultsautomaticallygatheredfromoriginalsource

Chancetotrackdataprovenanceindetail

Formoreonthisissuefromacomputersciencestandpoint(ratherthanBMI),seeTruong,K.N.andHayes,G.R. Ubiquitous

ComputingforCaptureandAccess,FoundationsandTrendsinHumanComputerInteraction:(2):2,95171.2009.



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Butwhendatacannotbegatheredautomatically

Emphasisonpersonnelinvestmentneeded

Avoidanceoffreetextsinceinterpretationbyinput

Carefulcodin em hasisontrainin

Workonareastoincreaseaccuracyofdatainput(e.g.,

structureddataentry,voicerecognition)



27/39

Medicalcare

is

informational

Physicianencountersareinformationrich

Whataresomeexamplesfromyourexperiences?



28/39

Wheredidtheideaofstoringall Asinotherdomains,complexityandquantityof

n ormat onrequ res g ta ata aseso ut ons toa

degree) 1950s:Splitbetweenclinicalandresearchinformation

repositories

1960s:

advent

of

computer

based

hospital

1969:LawrenceWeedintroducedproblemoriented medical record POMR



29/39

Thesourceorientedinformationofamedicalchart

plusademandorientedfrontend.(Stead,1987)

Lin erg i ea EMRconcepts:

Carefulmeasurementsoverpatientsconditionsshouldbemade,

recordedandmonitored; Lifelongrecordmustbecompleteandmachinereadable;

Linkagesshouldbeincludedtosourcesofmedicalknowledge.



30/39


31/39

WhatisthedifferencebetweenanEMRandan



32/39

Lotsoftypesofdatatostore

otso peop etoma e appy



33/39

WhatdoestheEMRinparticularhavetodo?



34/39

DesirableFeatures Modular

OpenSource(meansdifferentthingstodifferentpeople);

Patientcentric

Usableinresearchcontext(iftheclinicalsettingusingtheEMRdoesresearch)



35/39

Privacy

Interoperability

Standards

Usabilit

Workflow



36/39

DemofromQuestSystem



37/39

Data: sin le uninterru tedobservation oint e. .

one

BP

reading) Information: elementsofdataarrangedtoconvey

meaning

Knowledge: generalizedtruthsformedfrom

ana ys so n orma on

knowledgebase?Whydoesitmatter?



38/39

Whatdoyouthinkisthelongtermrelationshipbetweenhealth

Forthepractitionersintheclass,howhavethingschangedforyouinyourprofessionovertheyears?

c n c ans ev ewe asou mo e ey ono urn o

computationaltoolsforassistance?



39/39

HeathandLuff Documentsandprofessionalpractice:bad

Marc

Berg

The

multiple

bodies

of

the

medical

record Altman Informaticsinthecareofpatients:Tennotablechallenges

forthe21st Century

Collen1995 ahistoryofmedicalinformaticsintheUnitedStates

Weed1969 MedicalRecords,MedicalEvaluation,andPatientCare:TheProblemOrientedRecordasaBasicTool.

Cha ters1 2 and12inbluebook
