Medical Informatics:An Introduction

Michael Hogarth, M.D.Associate Professor

Dept. of Pathology and Laboratory MedicineDept. of Internal Medicine

UC Davis School of Medicinehttp://linneaus.ucdavis.edumahogarth@ucdavis.edu

OverviewOverview

• 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-specialization

Medical 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 informatics

Knowledge transfer in Medicine

The Gross Clinicby Thomas Eakins,1875

Medical Informatics: 1890

John Shaw Billings:

US Army Surgeon general.

Founding director of the NLM.

Established Index Medicus in 1890

Responsible for the US Census 1890

National Library of Medicine

NLM 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 Informatics

Why Informatics?

Introducing an in-depth understanding of healthcare information needs during system designDevelopment 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 evaluating their effectiveness

Evaluation of information systems using scientific methods

Key Point

Informatics:1960-1970

MUMPS: Massachusetts General Hospital Utility Multi-Programming System, 1966Mycin (1970): Ph.D. thesis by Ted Shortliffe,MD

evaluating a software program which ‘suggested’antibiotic choices based on clinical information.COSTAR(1970-80): Electronic medical record system developed in MUMPSGEMISCH(Generalized Medical Information System for Community Health): Hammond,Stead,1969

Informatics: 1970-1980

MEDLINE (1966-today)

8 million citationsMeSH terms (45,000)novel indexing and searching mechanisms

Informatics today

MEDLINE: 8 million biomedical literature abstracts available from anywhere in the world with an internet connectionQMR and Iliad: Decision support systemsUMLS: 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 1993

Medical Information Needs

Pittsburgh study on information needsSetting: academic medical centerResults:

337 “clinical information” requests observed in a 17 hour period on one Internal Medicine care team23% of questions could be answered by using medical literature: journal, textbook, MEDLINE52% were facts that should have been in the medical record

Conclusion: 75% of ‘medical information needs’ require accessing the medical record or medical references

Knowledge 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 recommendation

Hersch,W. Information Retrieval: A Health Care Perspective. Springer-Verlag, 1996

Clinical 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 developmentOrganizational aspects of informatics

Managing enterprise systems, implementations, etc..Technology diffusion

Knowledge representationKnowledge structures (AI)Terminologies and ontologies

Information retrievalDecision Making

PatientsHealthcare professionals

Decision SupportBayesianFuzzy LogicNeural networks

Medical Imaging

Medical 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 Medicine, Singapore (AIMS)The Society for the Internet in MedicineThai Medical Informatics Society (TMI)

Medical Informatics Resources: Journals

JAMIAMethods of Information in MedicineComputers and Biomedical ResearchMedical Decision MakingSCAMC ProceedingsMEDINFO Proceedings