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Medical Informatics. Representation and Computation on Medical and Health Care Information. Medical Informatics. Health records in paper Problems: High chances of damage of patient records. Automated processing of records is impossible. Increased use of electronic media, devices.

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medical informatics
Medical Informatics

Representation and Computation on Medical and Health Care Information

slide2

Medical Informatics

  • Health records in paper
  • Problems:
      • High chances of damage of patient records.
      • Automated processing of records is impossible.
  • Increased use of electronic media, devices.
  • Advantages:
      • Less chances of damage, ease of maintenance.
      • Data insertion and retrieval is simple.
      • Easily interoperable.
  • Migration of healthcare industry to electronic domain.
targeted at design and development of information system for
Targeted at Design and Development of Information System for
  • Medical Science and Technology
  • Health Care Services
  • Business world involving health care
health care informatics

E

X

T

R

A

N

E

T

S

I

N

T

R

A

N

E

T

S

Providers’

Enterprise

Systems

  • ERP
  • GDSS
  • DSS
  • CDSS

Suppliers’

Enterprise Systems

  • Pharmacies
  • Medical suppliers
  • Insurance providers

P

R

M

Physicians

And

Specialists

Patients

Internet

Health Care Informatics

Src: K.Siau, “Health Care Informatics”, IEEE trans. On Info. Tech. In Biomedicine, 7(1), March, 2003, pp. 1-7

enterprise resource planning
Enterprise Resource Planning
  • Full integration of an organization\'s information from pay-roll and human resources to accounting and finance.
  • Database integration (Information Sharing)
  • Information logged once and accessed by different modules maintaining the data consistency.
  • Track inventory, order information and delivery requirements
  • Determine equipment usage and maintenance schedule
decision support system dss
Decision Support System (DSS)
  • Conventional DSS: financial and scheduling.
  • Clinical DSS (CDSS): diagnosis, pharmacy, emergency and nursing practices.
  • CDSS used to send alerts and reminders to patients about preventive care.
patient relationship management prm
Patient Relationship Management (PRM)
  • Primary focus on determining and meeting patients\' needs.
  • Tracking patients’ information from diet and exercise data to past diagnosis information from family history and allergy information.
  • Send E-mails satisfying queries, informing newly published health care studies and reminding about preventive measures.
slide8

Medical Informatics and Tele-consultation

  • In early days tele-consultation means
    • Sending all hardcopies of patient records.
      • takes significant amount of time.
    • Send the patient to a remote center.
      • nearly impossible for emergency patient.
  • Using medical informatics tele-consultation means
    • Sending the medical records only.
    • Most of the time, no need to send the patient.
    • Online consultation among doctors.
    • Large scope of knowledge sharing.
slide9

Standards

HL7:Health Level Seven. It is an international healthcare standard for medical data exchange between computer systems in healthcare. http://www.hl7.org/

LOINC:Logical Observation Identifiers Names and Codes. These identify the test results or clinical observations uniquely. http://www.loinc.org/

ICD-10:International Statistical Classification of Diseases and Related Health Problems. ICD provides codes to classify diseases and a wide variety of signs, symptoms etc. Every health condition can be assigned to a unique category and given a code.http://www.who.int/classifications/icd/en/

ICD-10-PCS:ICD-10 Procedure Coding System. This is a system of medical classification used for procedural codes which is developed as a replacement of ICD-9-CM volume 3 (contains inpatient procedures).

DICOM:Digital Imaging and Communications in Medicine. This is a standard for handling, storing, printing, and transmitting information on medical imaging. http://medical.nema.org/

message transmission

MSH|^~\&|REGAEVN|A05|199901PID|1||191919^NK1|1|MASSIE^ENK1|2|MASSIE^I…MSH|^~\&|REGAEVN|A05|199901PID|1||191919^NK1|1|MASSIE^ENK1|2|MASSIE^I…

HL7

Standard

HL7

Standard

HL7

Message

Parsing

Sender

Receiver

HL7

Message

Creation

HL7

Message

Data

Data

HL7-enabled system

Hospital A

HL7-enabled system

Hospital B

Message Transmission
hl7 message structure
HL7 Message Structure

Event

MessageN

Message1

SegN

Terminated by <CR>

Seg1

Separated by \'|\'

Field1

Field1

CompN

Comp1

Separated by \'^\'

message encoding
Message Encoding
  • Sequence of segments separated by \'|\'
  • Compulsory and optional segments
  • Segments as sequence of fields separated by \'^\'
  • Compulsory and optional fields
  • A field is described by a data type (e.g. AD data-type denoting an Address)
slide13

An example of HL7 message for patient admission

MSH | ^~ \ & | Clinic || Central|Reg ||| ADT^A01 |MSG00005 | P | 2.3

EVN | A01 | 199601051530

PID ||| 2-687005 || Evans^Carolyn || 19620324 | F ||| 903 Diane Circle^^Phoenixville^PA^19460

|| (610) 555 – 1212 | (610) 555 – 1212 || S | C ||156 – 96 – 2542

PV1|| E | Emergency |||| 0148^Addison^James ||| SUR

slide14

Admit/Visit Notification

1. Message Header

(i) From: Clinic

(ii) To : Central

2. Event

(i) Date: 1996-01-05

(ii) Time: 15:30

3. Patient Identification

(i) Internal Patient ID Number: 2-687005

(ii) Family Name: Evans

(iii) Given Name: Carolyn

(iv) Birth Date: 1962-03-24

(v) Sex: F

slide15

Admit/Visit Notification (Contd.)

3. Patient Identification (contd.)

(vi) Street Address: 903 Diane Circle

(vii) City: Phoenixville

(viii) State of Province: PA

(ix) Zip or Postal Code: 19460

(x) Phone (Home): (610) 555 – 1212

(xi) Phone (Office): (610) 555-1212

(xii) Marital Status: S (xiii) Religion: C

(xiv) Social Security Number: 156-96-2542

4. Patient Visit

(i) Patient Class: E

(ii) Point of Care: Emergency

(iii) Attending Doctor\'s ID: 0148

(iv) Family Name: Addison (v) Given Name: James

(vi) Hospital Service: SUR

file as reference pointer rp of obx
File as Reference Pointer (RP) of OBX

MSH|^~\&|TELEMEDICINE||TELEMEDICINE||200808141246||ORU^R01|SUR|P|2.4|

EVN|R01|200808141246|

PID|||SUR05032008000||Mandal^Pulin^Bihari||198003050000|M|||Block - D^VSRC, IIT Kharagpur^Kharagpur^West Bengal^721302^India|91|754123||||Hindu|

NK1|1|Sumita Mandal|Mother|Parikpur, Hansda West Midnapore|

OBR|4|||ZIITKGP9903^Patient Images^HL7IITKGP|||200808141246|

OBX||RP|ZIITKGP9903-1^Sample blood slide^HL7IITKGP||SUR0503200800005032008BLD00.JPG^TELEMEDIK 2005^IM||||||X|||20080209||||||20080305|

OBX||RP|ZIITKGP9903-2^Routine Blood tests and Grouping {Blood R/E}^HL7IITKGP||SUR0503200800005032008i0000.JPG^TELEMEDIK 2005^IM||||||X|||20080305||||||20080305|

  • Multimedia file is not contained within HL7 message.
  • Reference path to the file is kept in the message.
  • Multimedia file has to be sent with HL7 message.
file as encoded data ed of obx
File as Encoded Data (ED) of OBX

MSH|^~\&|TELEMEDICINE||TELEMEDICINE||200705091251||ORU^R01|SUR|P|2.4|

EVN|R01|200705091251|

PID|||SUR17012007000||Kijhari^Punam^||196801170000|F|||aaaa^bbbb^eeee^West Bengal^897454^India|91|7855596||||Hindu|

NK1|1|kkkk|hhhh|gdagsv fg jfsgfgjadsg gdsa g fagsg|

OBR|6|||ZIITKGP9903^Patient Images^HL7IITKGP|||200705091251|

TXA|1|IM|multipart|200705091251||20040404||||||ZIITKGP9903-1|ZIITKGP9903||||AU|

OBX||ED|ZIITKGP9903-1^blood slide^HL7IITKGP||^multipart^related^A^MIME-Version: 1.0

Content-Type: multipart/related; boundary="HL7-CDA-border-CDA-HL7"

EXT:=JPG

TYPE:=BLD

ENTRYDATE:=20070117

SIZE:=16601

--HL7-CDA-border-CDA-HL7

Content-Location:SUR1701200700017012007BLD00.JPG

Content-Transfer-Encoding:BASE64

Content-Type:image/pjpeg

/9j/4AAQSkZJRgABAgEASABIAAD/7RBKUGhvdG9zaG9wIDMuMAA4QklNA+0AAAAAABAASAAAAAEA

DAwRDAwMDAwMDAwMDAwMDAwMDAwMDAwMDAwMDAwMDAENCwsNDg0QDg4QFA4ODhQUDg4ODhQRDAwM

CgAyADAAMAAgADMANgAzAAoA

--HL7-CDA-border-CDA-HL7--||||||X|||200705091251|

reference information model rim
Reference Information Model (RIM)
  • Root of all information models.
  • Provides a static view of the information.
  • A HL7-wide common reference model that integrates all Technical Committees’ domain views.
  • Committees and SIGs generally work with a small subset of the RIM - called Domain Information Model or DIM.
reference information model rim contd
Reference Information Model (RIM) contd..
  • Foundation Classes
    • Acts  an intentional action in the business domain of HL7. Ex: patient observation
    • Participations  exists only in the scope of one act. Ex: surgeon
    • Roles  a socially expected behavior pattern usually determined by an individual\'s status in a particular society. Ex: doctor
    • Entities  physical thing or organization and grouping of physical things. Ex: a person
    • Act Relationship  To relate 2 acts.
    • Role Link  To relate 2 entity roles.
loinc
LOINC
  • Logical Observation Identifiers Names and Codes.
  • Names & codes uniquely identify observations.
    • Laboratory Observations
    • Clinical Observations
    • Administrative Observations
  • Compatible with HL7 and SNOMED
    • Represent observation in HL7 message.
loinc21
LOINC
  • The fully specified name of a test result or clinical observation has five or six main parts
    • <Analyte / component>:
    • <kind of property of observation or measurement>:
    • <time aspect>:
    • <system (sample)>:
    • <scale>:
    • <method>

QRS AXIS representation in LOINC:

QRS AXIS : ANGLE : PT : HEART : QN : EKG  2951-2

loinc in hl7
LOINC in HL7
  • Message generator generates a message with observation results using LOINC.
  • System supports LOINC, parse HL7 message, retrieve observation result.

OBX-3: Observation Identifier

OBX||TX|2093-3^Total cholesterol^LN|0|78|^mg/dl|||||F|||20050223|

Text

Coding System

Code

dicom
DICOM
  • Digital Imaging and Communications in Medicine
  • Standard for handling, storing, printing, and transmitting information on medical imaging.
  • Specifies the following-
    • protocols for devices claiming conformance to DICOM
    • syntax and semantics of data to be exchanged.
    • format for storing media in DICOM compatible devices etc.
slide24

DICOM Composite Image

IOD Information Model

Patient

1

is subject of

1,n

Study

1

Frame of Reference

contains

Equipment

1

1

1,n

Spatiallyor

Temporally

defines

1,n

0,n

series

creates

1

contains

0,n

0,n

0,n

0,n

0,1

0,n

Curve

Overlay

Image

(Pixels)

VOILUT

Modality

LUT

Waveform

slide25

Patient

1

is subject of

1,n

Study

1

Frame of Reference

contains

Equipment

1

1

1,n

1,n

0,n

temporally

defines

series

creates

1

contains

1,n

Waveform

DICOM Waveform IOD Information Model

slide26

DICOM Waveform Information Model

Patient

Waveform

Attribute

1

Waveform

is subjec of

Time of Acquisition

Acquisition Context

Annotation

1

1,n

contains

Study

1,n

Multiplex Group

Attributes

1

Multiplex

Group

contains

Number of Channels

Sampling Frequency

Timing

1

1,n

Series

contains

1

Channel Definition

Attributes

1,n

Channel

Contains

Channel Source

Metric

Anatomic Location(s)

Function

Technique

Channel Sensitivity

Baseline

Skew

Filter Characteristics

1

1,n

Waveform

contains

1,n

Sample

slide27

DICOM File Structure

Preamble (128 bytes)

DICM (4 bytes)

DE1

DEn

slide28

Data Element

Data Element

D E

……………

Data Element

Tag

VR

VL

VF

Tag

VL

VF

Dicom Information Structure

DICOM Data format

Explicit VR

< 4 bytes >

< 2 bytes >

< 2 bytes >

Implicit VR

< 4 bytes >

slide29

Patient Information

Patient Name

VL

VF

VR

0010 0010

PN

000C

Sridhar Raja

0010 0010

0000 000C

Sridhar Raja

An Example of Data Element

Explicit VR

Implicit VR

slide30

Tag Description Hex Encoding (Group, Element)

(0x0002, 0x0010)

(0x0028, 0x0002)

(0x0028, 0x0008)

(0x0028, 0x0010)

(0x0028, 0x0011)

(0x0028, 0x0100)

(0x0028, 0x0101)

(0x7FE0, 0x0010)

Transfer Syntax Tag

Samples per pixel

Numbers of Frames

Number of Rows

Number of Columns

Number of Bits Allocated

Number of Bits Stored

Pixel Data

Some vital tags for rendering images in DICOM Standard

slide31
PACS
  • Picture Archiving and Communication Systems.
  • Goals of PACS are to improve operational efficiency while maintaining or improving diagnostic ability
  • Computers or networks dedicated to the storage, retrieval, distribution and presentation of images.
  • PACS network consists of a central server that stores a database containing the images. Web based PACS system is becoming more and more common.
  • Based on DICOM standard, also accepts other media formats.
icd 10
ICD-10
  • International Statistical Classification of Diseases and Related Health Problems.
  • Provides codes to classify
    • Diseases
    • Signs, symptoms
    • Abnormal finding
    • Complaints
    • External cause for injury and disease etc.
icd 1034
ICD-10
  • Every health condition can be assigned to a unique category and a given code.
  • Can be used for
    • Morbidity, mortality statistics
    • Clinical decision support system.
  • The limitations of ICD-9-CM
    • Lack of specificity and details.
    • Can’t support transition of IHDE etc.
icd 10 in hl7
ICD-10 in HL7
  • Segment for diagnosis: DG1
    • 2nd field of DG1: diagnosis coding method (deprecated).
    • 4th field of DG1: diagnosis description (deprecated).
    • 3rd field of DG1: diagnosis code
  • ICD-10 is used to construct 3rd field

Identifier Code

DG1-3: Diagnosis Code

DG1|||H11.2^Conjunctival scars^ICD10|||F|||||||||||||20050223|

Diagnosis description.

Coding System

slide36

ICD-10-PCS (ICD-10 Procedure Coding System.)

  • Medical classification used for procedural codes.
  • Codes are comprised of seven components. Each component is called a “character”.
  • All codes are seven characters long
  • Individual units for each character are represented by a letter or number.
  • Each unit is called a “value”
  • 34 possible values for each character
  • Digits 0- 9
  • Letters A-H, J-N, P-Z
snomed
SNOMED
  • Systematized Nomenclature of Medicine.
  • Collection of medical terminology covering most areas of clinical information.
    • Diseases
    • Findings
    • Procedures
    • Microorganisms
    • Pharmaceuticals etc.
standardization complexity in medical world
Standardization: Complexity in Medical World
  • Vast and dynamic knowledgebase.
  • Close interaction of different complex systems.

Patient Management, Diagnosis and Investigations, Treatment and Procedures, Drug and pharmacology, Disease classification etc.

  • Process Standardization.
  • Regional and demographic variations.
  • Adjustment with real-life constraints.

Infrastructure, Human resource, Material resource.

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