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Medical Informatics. Human Variation Informatics Issues Ethical Issues. Medical Informatics. storage, retrieval, and optimal use of biomedical information, data, and knowledge for problem solving and decision making . Genetics Variation. Medicine. Issues. Nature of medical information

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Medical informatics

Medical Informatics

Human Variation

Informatics Issues

Ethical Issues

Chuck Staben


Medical informatics1
Medical Informatics

storage, retrieval, and optimal use of biomedical information, data, and knowledge for problem solving and decision making

Genetics

Variation

Medicine

Chuck Staben


Issues
Issues

  • Nature of medical information

  • Technical challenges

  • Uses of medical information

    • medicine

    • research

  • Status of development in field

  • Ethical concerns

  • Professional Career Trajectories

Chuck Staben


Information types
Information Types

  • Textual

    • chief complaint, symptoms, history of present illness, history, family history, physical exam, insurance information…

  • Graphical

    • ECG, ultrasound, X-ray, hand-drawn figures…

    • longitudinal data (blood pressure graph)

  • Digital (X-rays, …)

Chuck Staben


Text information issues
Text Information-Issues

  • Non-digital, non-shareable, non-searchable, non-standard

  • Synonyms

    • thrombophlebitis=phlebothrombosis, DVT, blood clot in the leg, milk leg, phlegmasia caerulea dolens, dropsy…

  • Changing

    • generalized idiopathic lymphandenopathy (1980) => AIDS!!!

Chuck Staben


Text standards
Text Standards

  • Ideal Terminology

    • Complete, Formal, Universal, Translatable

  • Candidate languages

    • SNOMED, UMLS, ICD, Read Codes, DSM

  • Digital

    • Entry, storage, retrieval, usage?

Chuck Staben


Images
Images

  • Sharable

  • Searchable

  • Transmittable

  • Multiple input/output formats

Chuck Staben


Physicians
Physicians

DO NOT WANT

a data entry clerk

paid $200,000/year!

Chuck Staben


Integrating delivery
Integrating Delivery

  • Asynchronous communication

    • FAX, VoiceMail

    • e-mail

    • office histories

  • Synchronous communication

    • voice, phone, paging

Chuck Staben


Medical delivery issues
Medical Delivery Issues

  • Periodic health screening

    • enhanced reminders

  • Physician variability

    • managed care can reduce variability

  • Data quality, type varies from physician to physician

Chuck Staben


Impediments to electronic records
Impediments to Electronic Records

  • Terminology/data types

  • Data entry methods

  • Information needs

    • ear infection vs bone-marrow transplant

  • Impact on physician-patient

  • Impact on physician-patient-society

    • confidentiality, responsibility

Chuck Staben


Experience with electronic records
Experience with Electronic Records

  • Reliability problems

    • as good as electronic banking!

  • Free-text fields (clinical notes)

  • Nomenclature

  • Interfacing with other systems

  • Enormous cost of switchover

    • who pays that cost?

Chuck Staben


Medical uses of enhanced records
Medical Uses of Enhanced Records

  • Improved care day-to-day

    • UKHMO: what are your current meds?

  • Monitoring clinical success

    • all patient records become clinical trials

Chuck Staben


Research uses

Medical Genetics

Basic disease work

Epidemiology

Infectious disease

Life history, risk factor...

Pharmacogenomics

Tissue Banks

Pedigrees/Populations

DATAMINING

Research Uses

Chuck Staben


Medical informatics status
Medical Informatics-Status

  • Medicare/Medicaid/Managed Care “Coding”

  • NIH

    • major initiatives in electronic records

  • Company initiatives

    • HMO, Healtheon, …

  • Pharmacogenomics companies

    • Iceland, Scandinavian records

Chuck Staben


Examples
Examples

  • Genomic labeling

    • P450 variation and cancer chemotherapy

  • Pharmaco interest in pharmacogenomics

Chuck Staben


P450 and drugs
P450 and Drugs

Cytochrome P450 2D6 - 6 to 10% of Caucasians have genetic variationassociated with poor metabolism of drugs utilizing this pathway.

Substrates using this pathway include: antiarrhythmic agents, antihypertensives, ß-blockers, monamine oxidase inhibitors, morphine derivatives, antipsychotics, and tricyclic antidepressants.

Chuck Staben


Big brother
BIG BROTHER

Healtheon, Medicaire….

Chuck Staben


Training
Training

  • “Interested Physicians”

  • Formal Training

    • Medical Information Scientist Training Program, Stanford University

    • National Library of Medicine

Chuck Staben