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Medical Informatics:. Computers, Decisions, and Communications. Vlad Olchanski, PhD o Moscow Institute of Physics and Technology o Institute of Control Sciences o International Institute for Applied Systems Analysis o World Health Organization o Medical College of Virginia.

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medical informatics

Medical Informatics:

Computers, Decisions, and Communications

Vlad Olchanski, PhD

o Moscow Institute of Physics and Technology

o Institute of Control Sciences

o International Institute for Applied Systems Analysis

o World Health Organization

o Medical College of Virginia


content as



MCV Course for 4th year medical students

Dr. Olchanski Home Page

November 7, 2002

Richmond, VA

medical informatics2
Medical Informatics

Outline of Lecture


Philosophy of Governing Life

Component 2

Decision Support and Theory

Medical Records

Diagnostic Support

Pharmaceutical Prescriptions

Health System Modeling

Data Mining

Component 1

Information Technology




Overview of the subject and a couple of practical advises

medical informatics3
Medical Informatics



content as



phi beta kappa philosophia biou kybernetes philosophy governs life
Phi Beta Kappa- philosophia biou kybernetes Philosophy Governs Life
  • Philosophy
  • Mathematics
  • Natural Philosophy
  • Physics
  • Engineering
  • General Theory of Systems
  • Cybernetics
  • Informatics
general theory of systems
General Theory of Systems

Bertalanffy (Austria-Hungary), Bogdanov (Russia) - 1908

Crash of empires after the Great War

The Second World War: FLAK

Norbert Wiener (MIT):

Cybernetics: Control and Communication in the

Animal and the Machine - 1948

The Second World War: Enigma

Theory of Information, Finite Mathematics, Probabilities

John von Neumann (Princeton)

Alan Turing (Bletchley Park)

Claud Shannon (MIT)

Andrey Kolmogorov (Moscow State)

  • Theory of InformationCommunicationsCodingAlgorithmsProbabilities and Stochastic Processes
  • Theory of ControlOperations ResearchOptimizationManagement Science
  • Systems Analysis
  • Live, bio-systems
  • Engineering, machines, robots
  • Organizational systems
  • Computer Science
  • Systems AnalysisDecision Support, Artificial Intelligence
whence informatics
Whence Informatics?
  • Concept of Cybernetics turned too broad
  • Word Cybernetics tarnished, devalued by Sci-Fi and Pop culture
  • Pragmatic reduction to Computer Sciencein USA
  • CS translated into INFORMATIQUE in France
  • Backward translation of CS as INFORMATICS expanding the scope
handbook of medical informatics
Handbook of Medical Informatics

This excellent book unfortunately

has very little coverage of the

Internet applications.

Otherwise, this is the #1 Resource!

medical informatics definitions
Medical InformaticsDefinitions
  • Medical Information Science is the science of using system-analytic tools . . . to develop procedures (algorithms) for management, process control, decision making and scientific analysis of medical knowledge - Ted Shortliffe
  • Medical Informatics comprises the theoretical and practical aspects of information processing and communication, based on knowledge and experience derived from processes in medicine and health care - Jan van Bemmel
whence informatics11
Whence Informatics?
  • Computer Science and Informatics are practically synonyms: the difference in emphasizing the application aspect
  • Informatics is frequently understood as broadly as Cybernetics --Information Processing including Decision Making and Systems Analysis
informatics what
Informatics - What?
  • Information Technology and TheoryComputers, Communications, Data Processing, Algorithms
  • Decision Theory and ApplicationsBayesian Approach, Expert Systems, Artificial Intelligence, Knowledge-based Systems, Algorithms
a good intro to informatics
A Good INTRO to Informatics

But should we go all the way together?

medical informatics14
Medical Informatics




content as



computers evolution
Computers: Evolution

Von Neuman and the first MAINFRAME at IAS (1948)

Vacuum tubes, punch cards or tape

Batch mode of operation

Low reliability - maintenance team of electronics engineers

Transistors- Bill Shockley, 1956 NP


Interactive mode of operation

Reduced size and enhanced

reliability due to Integrated Circuits


Interactive mode of operation

Higher reliability due to Transistors




Renamed from minicomputers to show due respect


programming mainframe
Programming Mainframe

Booting your computer --

giving it a kick?


It is short from bootstrapping.

“Bootstrap” was the name of

a short length of the punched

tape that was fed to a

computer to initiate loading of

the Operating System.

medical informatics17
Medical Informatics




content as



communication protocols
Communication Protocols
  • Communications include -
  • Noise elimination in the channel
  • Coding (error detection and correction)
  • Encryption (security)
  • Internet
  • Standards - 7 layers of ISO communication protocols from bits, wires to applications
  • Internet protocols FTP, Telnet, Email, NNTP, HTTP==WWW
internet protocols
Internet Protocols
  • FTP (file transfer protocol) serves to exchange data with a remote computer
  • Telnet allows to run programs on a remote computer


Upload - send TO a remote recipient

Download - receive FROM a remote sender

remote computing i
Remote Computing - I

Fred at UBC hasreport software...

Wilma at CUNY has data, needs report!


Remote Computing - II

Fred sends Wilma

the username

and the password

Never by EMAIL !!!

Wilma at CUNY has data, needs report!


Remote Computing - III

Fred at UBC hasreport software...


Wilma uploads her data with FTP


Remote Computing - IV

Fred at UBC hasreport software...


Wilma manipulates her data on Fred’s

computer with Telnet


Remote Computing - V

Fred at UBC hasreport software...


Wilma downloads the report with FTP


Remote Computing - VI

Fred at UBC hasreport software...


Wilma prints the report in her office

and sends her kisses to Fred by email

using email 1
Using Email - 1

Email is very much like Regular Mail:sending mail and receiving are done quite differently!

To send mail, you may drop a letter in any mail drop box in the street.

To send email, you may connect and use any SMTP serverin the world. It is for public convenience.

SMTP server sends email

using email 2
Using Email - 2

You send a letter thru a Mail Drop Box

You may use any one you find in the street

using email 3
Using Email - 3

You send an email thru a SMTP server

access controlled

access controlled

access controlled

access controlled

access controlled

access controlled

open for all

You may use any one you find in the Internet

using email 4
Using Email - 4

Email is very much like Regular Mail:sending mail and receiving are done quite differently!

To receive mail, you must have either your own mailbox

or rent a box at any Post Office.

To receive email, you must have an account with any

POP3 server. It will be your private possession. You may

have as many as you may wish.

POP3 server receives email

using email 5
Using Email - 5

To receive a letter, you must have a homeor a number in a US Post Office

using email 6
Using Email - 6

To receive an email, you must have an accountat a POP or IMAP mail server

you may have as many of these as you like

using email 7
Using Email - 7

POP server delivers all messages to your computer --good when you are on a fast connection

IMAP server delivers only message headers and messages on demand -- good when you are on a dial-upYet you will not have all messages on your computer

Mozilla, Eudora, TheBat! support multiple email accounts

Webmail allows to use email with your browser --good when you are on the go

The poor and street people use Hotmail, Yahoo, etc. --but it is not a true email

using email 8 basic rules of nice conduct
Using Email - 8 Basic Rules of Nice Conduct

1. Never consider email as confidential

2. Email should best be a simple message

3. Do not send messages formatted with HTML --

not all email clients can deal with them,

it confirms a hit for spammers

(impossible not to use in AOL email program )

4. Avoid sending binary attachments

these may come corrupted and can carry


How to avoid binary attachments in Email, see


the most intimate secret
The Most Intimate Secret

Like Wine dichotomy in Russia

- White wine: Moonshine, Vodka, Brandy

- Red wine: all the rest

the most intimate secret36
The Most Intimate Secret

Data dichotomy in Internet

- Text files: Plain English text: A-Z, a-z, 0-9

- Binary files: all the rest

the most intimate secret37
The Most Intimate Secret

Symbols -- Bytes -- Octets

Secret == 53 65 63 72 65 74


1010011 1100101 1100011 1110010 1100101 1110100

Sept “bits” fassent un “octet”! This is the ASCII Standard.

This has been implemented in communication networks

hardware. Yet --

Éç == C9 E7 == 11001001 11100111

Now you see that the French have a reason to call

the “byte” not “septet” but “octet”!

If you strip the 8th bit then corruption occurs:

É -> 49 == I and ç -> 67 == g

the most intimate secret38
The Most Intimate Secret

The Revelation

Only text files may be sent through Internet

Binary files will come corrupted

To send a binary, it must be converted to

a text file (encoded) and on the receiving end

the encoded file must be decoded.

In FTP protocol, the type must be told explicitly

In Email, binary files go as attachments.

There are different encode/decode procedures

which may lead to confusion and errors

security cryptography
Security: Cryptography

Fred reads my message

I send message to Fred

Dear Fred, bla-bla...


Dear Fred, bla-bla...

Fred’s public


Fred’s private key

Fred answers my message

I read Fred’s answer

My public key

My private key

Dear Vlad, bla-bla...


Dear Vlad, bla-bla...

communications security
Communications. Security

80% trash, 5% pearls

internet protocols41
Internet Protocols

Usenet, News, Forums -- NNTP Protocol

A small ISP carries

~45,000 groups.

Different ISPs

give different groups,

have different scopes

Medical and Health

Related Groups listed:

internet protocols42
Internet Protocols

World Wide Web == HTTP protocol

User client -- browser

Opera, Mozilla, Netscape, Internet Explorer

WWW is only a small part of Internet !!!

AOL and MSN are not Internet at all !!!






Internet Services Providers give you full Internet

internet protocols43
Internet Protocols

Web Browsers

web standards are important for compatibility longevity of websites, and future development

Opera and Mozilla are W3C compliantInternet Explorer violates the standards (version 6 may comply)has many security holes

Netscape 4 is incapable to view modern websitesNetscape 7 is a commercialized version of Mozilla 1.0

Replace Netscape 4 with Opera or Mozilla!


internet connectivity
Internet Connectivity

A decent ISP must give a client:

o SMTP address to send email

o POP3 address to access the mailbox

o NNTP address to get Newsgroups


o Space to host website at ISP’s IP address

o FTP access to update website


o Fixed IP address for hosting own website

web design
Web Design

What is a good website?

-- presentable for all users: WIN, Mac, Unix, etc.

-- acceptable for all browsers: Opera, Netscape,

MSIE, etc.

-- loads fast: byte size < 50 kB

-- does not use Cutting Edge technologies

Learn the culture of Web Design at

review the Daily Sucker site daily!

information technology basics of security
Information TechnologyBasics of Security
  • make sure workstation is physically safe and secure
  • never send passwords by email
  • never paste passwords beside the workstation
  • install and regularly (weekly) update virus protection
  • avoid sending attachments
  • never open unsolicited attachments, always check and double-check the attachment’s file extension
  • never open unexpected file with extensions EXE COM DOC DLL PIF LNK VBS (Windows does not show LNK and PIF extensions, you will be taken for a ride by MS )
  • firewall may protect both yourself and the world but may also cheat you)
medical informatics47
Medical Informatics



content as



the fundamental principle of decision theory
The Fundamental Principle of Decision Theory


[New Knowledge] = [Experimentation] x [Old Knowledge]

Application: Making Diagnosis

[Old Knowledge] - we know disease D prevalence, p(D)

[New Knowledge] - we need to know if the patient has

disease D if he has symptom S, p(D|S)

[Experimentation] - Bayes Theorem builds the Likelihood


L(D|S) = p(S|D) / {p(S|D) p(D) + p(S|’D) p(‘D)}

Now this Likelihood Function modifies the Old Knowledge:

p(D|S) = L(D|S) p(D)

medical decision support
Medical Decision Support

to mention a few

Clinical Systems


Medical Records


Diagnostic Systems

QMR, Iliad, DXPlain, etc.

Pharmaceutical Prescriptions

Health System Modeling


Data Mining

medical decision support clinical systems
Medical Decision SupportClinical Systems

Computerized Medical Record systems

are discussed in class:

TMR -- CMR from Duke Medical Center


Pharmaceutical System for Multiple Drug

Therapy in ICU, Pharm-X is discussed in class

Comprehensive system for VCU HealthSystem

(by CERNER) is discussed in class.

medical decision support diagnostic systems
Medical Decision SupportDiagnostic Systems

knowledge base

decision mechanism




feedback to adjust observations

Knowledge Engineering, Expert Systems, AI

are discussed in class

medical decision support health systems modeling 1
Medical Decision SupportHealth Systems Modeling - 1

Primary Care Physician Supply Crisis

medical decision support health systems modeling 2
Medical Decision SupportHealth Systems Modeling - 2

Delays in getting the policy change bring fruits

medical decision support health systems modeling 254
Medical Decision SupportHealth Systems Modeling - 2

The simulation model will give a foresight

medical decision support measurement and statistics
Medical Decision SupportMeasurement and Statistics

Computer arithmetic is more precise

than any measurement

Use only reasonable precision,

round up numbers to convey your purpose

medical informatics56
Medical Informatics




content as



handbook of medical informatics57
Handbook of Medical Informatics

MCV Course for

4th year medical students

medical informatics59
Medical Informatics




content as



MCV Course for 4th year medical students