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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 l.jpg
Medical Informatics

Representation and Computation on Medical and Health Care Information


Slide2 l.jpg

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 l.jpg
    Targeted at Design and Development of Information System for

    • Medical Science and Technology

    • Health Care Services

    • Business world involving health care


    Health care informatics l.jpg

    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 l.jpg
    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 l.jpg
    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 l.jpg
    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 l.jpg

    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 l.jpg

    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 l.jpg

    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 l.jpg
    HL7 Message StructureMSH|^~\&|REGAEVN|A05|199901PID|1||191919^NK1|1|MASSIE^ENK1|2|MASSIE^I…

    Event

    MessageN

    Message1

    SegN

    Terminated by <CR>

    Seg1

    Separated by '|'

    Field1

    Field1

    CompN

    Comp1

    Separated by '^'


    Message encoding l.jpg
    Message EncodingMSH|^~\&|REGAEVN|A05|199901PID|1||191919^NK1|1|MASSIE^ENK1|2|MASSIE^I…

    • 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 l.jpg

    An example of HL7 message for patient admissionMSH|^~\&|REGAEVN|A05|199901PID|1||191919^NK1|1|MASSIE^ENK1|2|MASSIE^I…

    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 l.jpg

    Admit/Visit NotificationMSH|^~\&|REGAEVN|A05|199901PID|1||191919^NK1|1|MASSIE^ENK1|2|MASSIE^I…

    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 l.jpg

    Admit/Visit Notification (Contd.)MSH|^~\&|REGAEVN|A05|199901PID|1||191919^NK1|1|MASSIE^ENK1|2|MASSIE^I…

    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 l.jpg
    File as Reference Pointer (RP) of OBXMSH|^~\&|REGAEVN|A05|199901PID|1||191919^NK1|1|MASSIE^ENK1|2|MASSIE^I…

    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 l.jpg
    File as Encoded Data (ED) of OBXMSH|^~\&|REGAEVN|A05|199901PID|1||191919^NK1|1|MASSIE^ENK1|2|MASSIE^I…

    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 l.jpg
    Reference Information Model (RIM)MSH|^~\&|REGAEVN|A05|199901PID|1||191919^NK1|1|MASSIE^ENK1|2|MASSIE^I…

    • 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 l.jpg
    Reference Information Model (RIM) contd..MSH|^~\&|REGAEVN|A05|199901PID|1||191919^NK1|1|MASSIE^ENK1|2|MASSIE^I…

    • 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 l.jpg
    LOINCMSH|^~\&|REGAEVN|A05|199901PID|1||191919^NK1|1|MASSIE^ENK1|2|MASSIE^I…

    • 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 l.jpg
    LOINCMSH|^~\&|REGAEVN|A05|199901PID|1||191919^NK1|1|MASSIE^ENK1|2|MASSIE^I…

    • 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 l.jpg
    LOINC in HL7MSH|^~\&|REGAEVN|A05|199901PID|1||191919^NK1|1|MASSIE^ENK1|2|MASSIE^I…

    • 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 l.jpg
    DICOMMSH|^~\&|REGAEVN|A05|199901PID|1||191919^NK1|1|MASSIE^ENK1|2|MASSIE^I…

    • 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 l.jpg

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

    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 l.jpg

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

    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 l.jpg

    DICOM Waveform Information ModelMSH|^~\&|REGAEVN|A05|199901PID|1||191919^NK1|1|MASSIE^ENK1|2|MASSIE^I…

    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 l.jpg

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

    Preamble (128 bytes)

    DICM (4 bytes)

    DE1

    DEn


    Slide28 l.jpg

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

    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 l.jpg

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

    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 l.jpg

    Tag Description Hex Encoding (Group, Element)MSH|^~\&|REGAEVN|A05|199901PID|1||191919^NK1|1|MASSIE^ENK1|2|MASSIE^I…

    (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 l.jpg
    PACSMSH|^~\&|REGAEVN|A05|199901PID|1||191919^NK1|1|MASSIE^ENK1|2|MASSIE^I…

    • 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.


    Pacs ref http www advantech com cn l.jpg
    PACSMSH|^~\&|REGAEVN|A05|199901PID|1||191919^NK1|1|MASSIE^ENK1|2|MASSIE^I…(Ref: http://www.advantech.com.cn/)


    Icd 10 l.jpg
    ICD-10MSH|^~\&|REGAEVN|A05|199901PID|1||191919^NK1|1|MASSIE^ENK1|2|MASSIE^I…

    • 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 l.jpg
    ICD-10MSH|^~\&|REGAEVN|A05|199901PID|1||191919^NK1|1|MASSIE^ENK1|2|MASSIE^I…

    • 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 l.jpg
    ICD-10 in HL7MSH|^~\&|REGAEVN|A05|199901PID|1||191919^NK1|1|MASSIE^ENK1|2|MASSIE^I…

    • 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 l.jpg

    ICD-10-PCS (MSH|^~\&|REGAEVN|A05|199901PID|1||191919^NK1|1|MASSIE^ENK1|2|MASSIE^I…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 l.jpg
    SNOMEDMSH|^~\&|REGAEVN|A05|199901PID|1||191919^NK1|1|MASSIE^ENK1|2|MASSIE^I…

    • 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 l.jpg
    Standardization: Complexity in Medical WorldMSH|^~\&|REGAEVN|A05|199901PID|1||191919^NK1|1|MASSIE^ENK1|2|MASSIE^I…

    • 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.


    Slide39 l.jpg

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


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