women s health informatics workshop aofog ranzcog 2009
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Women’s Health Informatics Workshop AOFOG/RANZCOG 2009. Introduction and Outline of Workshop. Who are we?. Dr Dave Parry: Senior Lecturer in Computer Science at AUT. Developed first online teaching course in New Zealand.

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who are we
Who are we?
  • Dr Dave Parry: Senior Lecturer in Computer Science at AUT. Developed first online teaching course in New Zealand.
  • Dr Emma Parry: Consultant O&G at ACH. MD in the area of Induction of Labour & HI.
  • Dr Phurb Dorji: Consultant O&G in Thimphu, Bhutan. Co-developer open source Perinatal Database
programme
Programme
  • What is health informatics ?
  • How is the workshop organised ?
  • What do I have to do ?
what is health informatics
What is Health Informatics ?
  • “Medical Informatics (MI) is the study of information processing as it is used in healthcare. “ MIT
  • Medical informatics is the scientific field that deals with the storage, retrieval, sharing, and optimal use of biomedical information, data, and knowledge for problem solving and decision making.
    • Colombia
health medical nursing
Health/Medical/Nursing ?
  • Healthcare has a strong tradition of attaching importance to names – see HPCA http://www.moh.govt.nz/hpca
  • Health tends to be broader than “medical” and not imply that Doctors do it…
useful information sources
Useful information sources
  • HINZ – www.hinz.org.nz
  • IMIA - http://www.imia.org/
  • Health IT cluster :http://www.healthit.org.nz/
  • NZHIS: http://www.nzhis.govt.nz/
  • HISAC: http://www.hisac.govt.nz/
  • HISA (Australia)- http://www.hisa.org.au/
what does health informatics include
What does Health Informatics include ?
  • Electronic Health data
  • Knowledge Management
  • Decision support
  • Telemedicine and telecare
  • Standards
  • Evidence for benefit/harm
health informatics is important
Health informatics is important..
  • It’s a “Grand Challenge”

http://www.engineeringchallenges.org/cms/8996/8938.aspx

  • $142-$371 billion savings in US ?
  • Academically rich area:
    • Expert systems (MYCIN)
    • Ontologies (UMLS)
    • Messaging (HL7)
programme1
Programme
  • What is health informatics ?
  • How is the workshop organised ?
  • What do I have to do ?
outline
Outline
  • 14:00 Intro and complete MCQ
  • 14:15 Maternity data and perinatal databases
  • 14:30 Coding and Messaging
  • 14:45 Internet
  • 15:00 Security
  • 15:15 Panel Discussion and Questions
programme2
Programme
  • What is health informatics ?
  • How is the workshop organised ?
  • What do I have to do ?
    • MCQs: RANZCOG 5 PR&CRM points
    • Play along with your laptop if you have
      • Login:
      • Password:
    • Go Home and think BIG!
the health record
The Health record
  • Records information about people in terms of:
    • Results of tests and clinical examinations
    • Encounters with health professionals
    • Potential diagnoses
    • Plans for treatment and further testing
definition of an electronic health record
Definition of an electronic health record

Pubmed “Computer-based systems for input, storage, display, retrieval, and printing of information contained in a patient\'s medical record. “

Part of a clinical information system relating to individuals

slide18

Imaging (including PACS)

Laboratory results

Administration Systems

Etc.

Other health care providers

Government and provider statistics

Electronic Health Record

Clinical users

slide19

Laboratory

systems

Electronic Health Record

Imaging

(including PACS)

Administration

Systems

Middleware e.g. Web Portal

Clinical users

advantages of electronic
Advantages of electronic
  • Always available
  • Different views
    • Temporal, problem based
  • Audit and decision support
  • Security
problems
Problems
  • Free text vs. coding
  • Legal status
  • Need a computer
  • “fishing expeditions”
  • Maternity unique:
    • New identifier for fetus
    • Multiple pregnancy
    • Subsequent pregnancy
    • Cross link with partner, other children
slide22

Cottagemed

http://www.sysmex.co.nz/default.asp?pageid=9

five uses of clinical data moh
“Five uses of clinical data” (MOH)

Data collected should be available for:

  • Supporting clinical intervention
  • Clinical Governance
  • Administration (in all parts of Health)
  • Strategy and policy development
  • Research
the sixth use
The sixth use ?
  • Patient (consumer) self-management and self care.
  • http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1127483
decision support
Decision support
  • Use data from Electronic record, combine with rules
  • Reminders – eg high blood pressure, protocols
  • Decision Analysis – need utility values
web 2 0 medical records
Web 2.0 Medical records
  • Web 2.0 – user generated content- see later.
  • Google http://googleblog.blogspot.com/2008/02/google-health-first-look.html
  • Microsoft – health vault
  • http://healthvault.com/hvindex.htm?rmproc=true
the central paradox
The central paradox
  • Every patient is different…
  • BUT we want to compare them..
medical vocabularies
Medical vocabularies
  • Complex in natural language
  • Can contain ambiguities and circular references
  • Much of medical training devoted to learning them
why standardise
Why standardise ?
  • Synonyms and obsolescent terms
  • (HTLVIII vs HIV)
  • Needed for clinical activity
    • Communication
    • Data analysis
    • Coding !
    • Reminders etc.
early work
Early work
  • Index Medicus (1850) leading onto MeSH and UMLS
  • Read codes
  • LOINC (Standardised pathology reporting)
  • SNOMED CT
systematized nomenclature of medicine clinical terms snomed ct
Systematized Nomenclature of Medicine-Clinical Terms - SNOMED CT
  • >600,000K Concepts
  • SNOMED CT is a clinical vocabulary currently administered by the international health terminology standards development organisation (IHTSDO) http://www.ihtsdo.org/. Member countries are; Australia, Canada, Denmark, Lithuania, The Netherlands, New Zealand, Sweden, United Kingdom and United States.
snomed ct
SNOMED CT
  • Hierarchical
  • Concepts also link concepts
  • Synonyms and different languages
  • Free in member countries..
why use a vocabulary example
Why use a vocabulary ? example…
  • Pre-eclampsia
  • Gestational Proteinuric Hypertension
  • Toxaemia
  • GPH
  • PET
  • PE
  • All the same all map to.. pre-eclampsia 398254007 -code
why use it
Why use it ?
  • In EHR systems, to replace/enhance free text.
  • To support reminders “If patient has allergy to a drug code recorded then alert if drug is being prescribed”
  • Converting free text to coded data….
coding
Coding
  • Disease outcomes, diagnoses, procedures have been coded for many years.
  • Often Coding is used to describe outcomes – so it happens at the end of an episode.
examples of codes
Examples of Codes
  • International Classification of disease (ICD) currently version 10. WHO standard
  • http://www.who.int/classifications/icd/en/
coding activity
Coding activity
  • Often done by coders !

eg http://www.aacca.net

  • Identifies the casemix, and often leads/follows funding
  • May not be particularly simple or easy
  • Errors propagate…
other codes
Other codes
  • Diagnostic related groups (DRGS)
    • Used to determine funding
    • Groups ICD 10 codes
  • Read codes
    • Primary care focussed
    • http://www.wolfbane.com/icd/read3h.htm
    • More like a vocabulary
    • SNOMED to replace
messaging hl 7
Messaging - HL 7
  • Health level 7
  • Initial version going back to 1987 (http://www.hl7.org.za/patient/ch100005.htm)
  • Extensive use around the world, and since 1994 in New Zealand
why messages
Why messages ?
  • No communication electronically at all – life is difficult
  • Shared universal record – so far impossible c.f. connecting for health UK
  • Messaging – send standard, relevant pieces of information between electronic systems.
general model
General model

Extract SNOMED terms

EHR

Unstructured text

Map to ICD 10

Send/receive messages

take home
Take home
  • Look for standards.. SNOMED, HL7, DICOM (Images), ICD-10
  • Single definitive storage if possible, but communicate
  • Fully automatic coding is difficult, Fully human coding is sometimes inaccurate
  • Support the human coders – and its probably not you.
history
History
  • Internet started in 1960s – to protect networks in the case of nuclear warfare.
  • World Wide Web – suggested in paper published in 1988.
  • Browsers early 1990’s
  • 19.2 Billion webpages in 2005
  • Most users now access WWW via mobile devices.
terminology
Terminology
  • The Internet
  • Operating Systems
  • Browser
  • Web pages
  • Web site
  • Web Server
  • Internet Provider
  • Dial up/ Broadband/ Wireless
  • Network card
uses for the clinician
Uses for the Clinician
  • How to manage purple tongue disease…
    • Pubmed
    • Expert pages eg Thefetus.net
    • Government and Institutional sites
    • Individuals
google
Google
  • Google Search
    • Generic
    • Images
    • Scholar http://scholar.google.co.nz/
web 2 0
Web 2.0
  • User-generated content
  • www.Facebook.com , www.Linkedin.com
  • www.youtube.com
  • http://www.youtube.com/watch?v=BOttNyd9qgI
  • Discussion and support groups eg
  • http://www.nzord.org.nz/ (Rare diseases)
wikipedia www wikipedia org
Wikipedia- www.wikipedia.org
  • An online encyclopedia
  • Produced and edited by volunteers
  • Some topics more popular than others
    • Movie Stars http://en.wikipedia.org/wiki/Kate_Winslet
    • MFM
    • http://en.wikipedia.org/wiki/Maternal_Fetal_Medicine
  • No Formal review ?Quality
  • Available in different languages: different authors
start a blog i did
Start a Blog- I did!
  • What is a blog? (your teens will know!)
  • Why a blog?
    • Easy
    • Cheap/free
    • Can link to other html addresses
  • http://mfmnewzealand.blogspot.com/
why do you need it
Why do you need it ?
  • Electronic Data is critical to successful care.
  • Patient privacy must be assured.
  • Confidential information – including commercial information must be protected.
electronic systems are
Electronic systems are:
  • Easy to search
  • Allow simultaneous access by many people
  • Allow compact data storage
  • Vulnerable to some sorts of attacks
  • Liable to have mishaps
easy to search
Easy to search ?
  • Audit trails can detect who has viewed data
  • “Please explain” letters and clear policies
  • Think about sensitive groups:
    • Celebrities
    • Staff
    • Relatives
mining data
Mining data
  • Combine data that can identify “anonymous” people.
  • Appointments
  • Car parking
  • Web access logs
  • Lab results – who ordered the test, which clinic, who gets the bill ?
risk of loss or destruction
Risk of loss or destruction

Large numbers of Electronic records can be lost, stolen, altered or deleted much more easily than the equivalent paper files. They are especially vulnerable when on removable media such as CD’s or memory sticks.

vulnerable
Vulnerable
  • C:\> Del *.* - Don’t try this at home
  • Power
  • Software “upgrades”
  • Maintenance – especially database
  • A series of links,
    • Physical environment
    • Hardware
    • Operating System
    • Software
    • Operators
computer hygiene
Computer Hygiene
  • Where has that memory stick been ?
  • Antivirus, firewall, anti-malware.
  • Public computers are often high risk
  • Infection control – if you can’t trust the contact, and the contacts contact don’t share.
malicious attacks
Malicious attacks
  • Emails
    • Malware attachments
    • Phishing
    • Nigerian scam, hoaxes etc.
  • Key loggers, data downloader\'s on memory sticks.
  • Packet sniffing and interception
interception
Interception ?
  • Most data on the internet is not encrypted
  • If it’s a normal email – its like a postcard…
  • Websites can use secure
  • communications
  • Proves it is the site you think it is
  • Encrypts data transmission
  • Use recent browser versions
  • Apply upgrades
to protect
To protect…
  • Good set of rules from the RACGP-
  • http://www.gpcg.org.au/index.php?option=com_content&task=view&id=128&Itemid=38
  • Soon – guidelines for New Zealand @ www.hiso.govt.nz
  • Ensure you install operating system security updates, as well as for particular software.
  • If you are really interested - http://www.cert.org/
operating system
Operating system ?
  • The program that lets all the others run
  • Popular ones include Windows (Many varieties), Linux, MacOS.
  • If the operating system is unreliable then the software will be.
  • Modern operating systems can encrypt data so that it cannot be read by others.
simple rules for backup
Simple rules for backup
  • Backup regularly
    • How much data can you afford to loose ?
  • Check that it works
  • Make it someone’s job
  • Don’t hope – plan.
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