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1. http://creativecommons.org/licenses/by-sa/2.0/

2. Medical Bioinformatics Prof:Rui Alves ralves@cmb.udl.es 973702406 Dept Ciencies Mediques Basiques, 1st Floor, Room 1.08 Website of the Course:http://web.udl.es/usuaris/pg193845/Courses/Bioinformatics_2007/ Course: http://10.100.14.36/Student_Server/

3. What is Medical Informatics? • What is Medical Bioinformatics? • Medical informatics has to do with all aspects of understanding and promoting the effective organization, analysis, management, and use of information in health care. MI emphasizes technology as an integral tool to help organize, analyze, manage, and use information.

4. What is Medical Informatics? • What REALLY is Medical Bioinformatics? • The science of managing information for health care, research, education, and administration by applying, integrating, and evaluating information technology along with its associated policies, procedures, and organizational cultures.

5. Three Legs of MI Technology Culture Policy and Procedures • Technology • Policy • Culture

6. MI assisting in Medicine • Different tools and approaches of MI can help in the decision making process. • Regulations/Privacy/Security • Database/Literature Searching -- EMB • Public Health Informatics • Outcomes Research • Standards Development • Decision Support • Electronic Medical Record’s Development • Telemedicine • Simulation

7. Tools for literature search/public health applications

8. Tools for literature search/public health applications

9. Problems • Changing the culture of medical doctors • These tools will become more useful as more people use them and input data • Medical doctors are notorious for not adapting to new tools that do not have an instant and direct effect on their practice and for not sharing information freely

10. MI assisting in Medicine • Different tools and approaches of MI can help in the decision making process. • Regulations/Privacy/Security • Database/Literature Searching -- EMB • Public Health Informatics • Outcomes Research • Standards Development • Decision Support • Electronic Medical Record’s Development • Telemedicine • Simulation

11. Decision Making in Medicine • Decision Making obeys a hierarchy of evidence levels. • Anecdotal Accounts • Expert Opinion • Consensus Opinion • Retrospective Analysis • Prospective Analysis (Open study) • Single Blind • Double Blind Placebo Controlled

12. MI assisting in Decision Making • Working in a clinic is very similar to monitoring a continuous process. • Let physicians do what they do best: • Pattern recognition • Examine & Interact with patients • Collect and filter data • Apply the art of medicine • Let computers do what they do best: • Provide the physician with the right amount of information they need WHERE and WHEN they need it • Keep track of ALL the details ALL of the time

13. The Fundamental Principle of Decision Theory THE BAYES THOREM [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 Function: 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)

14. Medical Decision Support to mention a few Clinical Systems Financial Medical Records Comprehensive Diagnostic Systems QMR, Iliad, DXPlain, etc. Pharmaceutical Prescriptions Health System Modeling Research Data Mining

15. Medical Decision SupportClinical Systems Computerized Medical Record systems : TMR - CMR from Duke Medical Center Pharmaceutical System for Multiple Drug Therapy in ICU, Pharm-X Comprehensive system for VCU HealthSystem .

16. Medical Decision SupportDiagnostic Systems knowledge base decision mechanism diagnoses observations explanations feedback to adjust observations Knowledge Engineering, Expert Systems, AI are discussed in class

17. Medical Decision SupportHealth Systems Modeling - 1 All over the world, with an aging population, there is a problem of how many physicians schools need to form. People have used different types of modeling to predict the evolution of the health care system needs Neural Nets

18. Medical Decision SupportHealth Systems Modeling - 2 With the increase of population population, there is a problem of how many physicians schools need to form. People have used stochastic modeling to predict the number of MDs needed to keep the health care system working properly. Master Equation

19. Medical Decision SupportHealth Systems Modeling - 3

20. Medical Decision SupportIntensive Care Unit At the ICU of Arnau Vilanova the team has developed a decision tree method to assist them in making decisions regarding diagnostic and treatment

21. Handbook of Medical Informatics • http://www.mieur.nl/mihandbook • http://www.mihandbook.stanford.edu/

22. Handbook of Medical Informatics Unfortunately lacks the details on the Internet

23. Next: Ester Vilaprinyo • Different tools and approaches or MI can help in the decision making process. • Regulations/Privacy/Security • Database/Literature Searching -- EMB • Public Health Informatics • Outcomes Research • Standards Development • Decision Support • Electronic Medical Record’s Development • Telemedicine • Simulation