Computational Methods and Imaging in MedicineComputational Methods and Imaging in MedicineHEALTH INFORMATICS MODULEHEALTH INFORMATICS MODULE

INTRODUCTIONINTRODUCTIONDr Jeremy Rogers MD MRCGPSenior Clinical Fellow in Health InformaticsNorthwest Institute of Bio-Health Informatics

OutlineOutline

►What Health Informatics is

►Who wants Health Informatics

►A history of Health Informatics

What Health Informatics isWhat Health Informatics is

What is health informatics ?What is health informatics ?

Informatics, Informatics, as applied to healthcare, as applied to healthcare,

of course!of course!

What’s Informatics, then?What’s Informatics, then?

► Jargon term, even in 2005

► Some dictionaries xRefer to ‘Information Science’► = librarianship

‘The creation, recognition, representation, collection, organization, transformation, communication, evaluation and control of information in a system…

The art, science and human dimensions of information technologies.’

Indiana University School of Journalism 2002

What is ‘Healthcare’?What is ‘Healthcare’?

United Kingdom Infrastructure

Hospitals

Doctors

Nurses

Annual Cost (2002)

UK

USA

Western World

Population

GP Consultations per year

A&E Consults per year

Hospital Admissions

New OPD referrals

SUPPLYDEMAND (UK)

59 Million

300 Million (95% of population)

2000

91,000 (1:650)

500,000

$130 billion (£1200 per citizen)

$1.5 trillion (£3000 per citizen)

$3 trillion (£1500 per citizen)

~14% of population

~23% of population

~18% of population

What health informatics is #1What health informatics is #1

The understanding, skills and tools that enable the sharing and use of information to deliver healthcare and promote health.

British Health Informatics Society

What health informatics is #2What health informatics is #2

The knowledge, skills and tools which enable information to be collected, managed, used and shared to support the delivery of healthcare and promote health (qv BMIS)

Lead, promote and manage use of resources to improve health care delivery

Identify, collect, analyse, disseminate and maintain data and information to improve health care delivery

Enable, develop and manage knowledge to improve health care delivery

Plan, implement, sustain and review the provision of ICT to support and improve health care delivery

NHS National Occupational Standards for Health Informatics 2004

What health informatics is #3What health informatics is #3

It is the rational study of the way we think about patients, and the way that treatments are defined, selected and evolved.

It is the study of how clinical knowledge is created, shaped, shared and applied.

Ultimately, it is the study of how we organise ourselves to create and run healthcare organisations.

Enrico Coiera, U New South WalesGuide to Health Informatics 2nd Edition

What health informatics is #4What health informatics is #4

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. It touches on all basic and applied fields in biomedical science and is closely tied to modern information technologies, notably in the areas of computing and communication.The emergence of medical informatics as a new discipline is due in large part to rapid advances in computing and communications technology, to an increasing awareness that the knowledge base of biomedicine is essentially unmanageable by traditional paper-based methods, and to a growing conviction that the process of informed decision making is as important to modern biomedicine as is the collection of facts on which clinical decisions or research plans are made.

Ted Shortliffe, Columbia University

What health informatics is #5What health informatics is #5Survey of 16 MSc courses

15 in the UK, one in the USA

Superset of advertised module contents

INFRASTRUCTUREDatabase resourcesInternet and communicationsMetadata and provenanceStandards

TECHNICAL CHALLENGESDecision SupportTerminologyInformation Governance & SecurityBiosignal ProcessingInformation ModelsElectronic Patient RecordsNatural Language ProcessingTelemedicine

USERS & BENEFITSHealthcare Management

Evidence Based Medicine

Clinical Research

Patient Empowerment

INFORMATICS IN PRACTICEStrategy

Evaluation

Change Management

Human Computer Interaction

InfluencesInfluences

Health Informatics

Specialtiese.g. nursing informatics

RegulationComputer Science

Biomedical Engineering

Medical specialties

Other basic and applied

sciences

Health Informatics:Health Informatics:Broad ThemesBroad ThemesComplexity – systems (Coiera)

Human factors

Standards

Ownership of data

Data entry

Integration

Ethics

Evaluation

Who wants Health Who wants Health Informatics?Informatics?

Who wants health informatics?Who wants health informatics?The Clinicians’ StoryThe Clinicians’ Story

►11% of lab tests repeated►Because result is lost

►30% of treatment orders are undocumented

►70% of acutely ill patients get right treatment►30% get contraindicated treatment

►500% growth in number of new drugs in a decade

One doctor’s clinic….One doctor’s clinic….…one patient’s notes…one patient’s notes

Who wants health informatics?Who wants health informatics?The Clinicians’ StoryThe Clinicians’ Story

►Increasing patient expectation and education►Increasing litigation

►Demand for transparent processes►Clinical governance and audit

►Unmanageable cognitive burden►Approx 100 articles published in 1966 from RCTs;

►Over 10,000 annually by 1995 (Chassin, 1998)

►‘The scarcely tolerable burden of information that is imposed taxes the memory but not the intellect’ (GMC 1993)

Who wants health informatics?Who wants health informatics?The Accountants’ StoryThe Accountants’ Story

►Spiralling health care costs►Developed world in 2002:

USD $3 Trillion on 1.2 billion people►11% of GDP►e.g. $5.5M in 37 Days on one patient (Duke University)

►Per capita health cost inflation: 8% per year►Population expansion ►Demographic shift►New advances

►No visible means of control

Who wants health informatics?Who wants health informatics?The Accountants’ StoryThe Accountants’ Story

www.irdes.fr/ecosante/OCDE/411010.html

A Convergence of NeedA Convergence of Need

Post genomic research Need for more Need for more

and better and better clinical clinical

informationinformation

Clinical trials recruitment

Clinical Practice, Audit &

Governance

Management& Policy

Evidence based

health care

Who wants health informatics?Who wants health informatics? StakeholdersStakeholders

►Health professionals►Doctors (Primary / secondary care)

►Nurses

►Allied professions

►Administrators / Government

►Researchers

►Pharmaceutical Companies

►IT professionals

►Patients ?????????

Health Informatics:Health Informatics:A HistoryA History

ComputersComputers

1950 Prototypes

1960 Transistors

1970 Integrated circuits

1980 Microcomputer; Windows.

1990 Internet; Web

2000 Google

1965: Moore’s Law1965: Moore’s Law“The density of transistors on a chip will double every 2 years”

Gordon E. Moore, INTEL co-founder

Health informaticsHealth informaticsA History: The 50s & 60sA History: The 50s & 60s

1959 Ledley “Reasoning foundations of medical diagnosis”

1960’s onward – Barnett “Mumps”First version had 4k core and 1k for each of 4 users. Everything stored on tape (1 per patient).‘Great day’ when got first hard disk, storing 30k

1961 Methods Inf Medicine Vol 11964 NLM adopts Medlars / Index Medicus1969 Weed “Problem-oriented medical record”1969 World’s first EPR

Nursing system, Kings College London

Systems predominantly for payroll, or pathologyHigh volumeRepetitiousRule-based processing (of numerical data)

Health informaticsHealth informaticsA History: The 70sA History: The 70s

1970 World’s first real-time GP system(Whipton, Essex)

1971 1972 de Dombal “Computer-aided diagnosis of abdominal pain”. Anderson King’s College Hospital record system.

1974 First Medinfo conference, Stockholm.1976 EMI scanner1979 Founding of IMIA

International Medical Informatics AssociationSystems still mainly finance or pathologyData Processing becomes ‘computer systems’Early steps to manage and control IT in healthcareFirst hints at potential for better information to upset apple cart:Protti told by CEO not to collect prescribing data at physician level

1970: 1970: A moment in history…A moment in history…

1970 Delivery of fastranII main backing store for 418/III at The London Hospital: Capacity 132 Mb.

Health informaticsHealth informaticsA History: 80s and 90sA History: 80s and 90s

1981 BCS PHCSG Founded

1982 Micros for GPs scheme

1983 READ codes1983 BJHC Launched1984 Korner report, UK1986 HIMMS1986 BMIS Founded

1990 AMIA Founded1990 Wessex IT Scandal (£63M)

1990 HL7 v 2.11991 First steps to HL7 v 3.01991 GP system RFA11992 London Ambulance

Despatch System Disaster1993 Cochrane collaboration1994 UMLS1994 JAMIA1999 Information for Health

1990s1980s

First integrated Hospital Information SystemsShift to clinical systemsGoal now to improve quality of care

Health informaticsHealth informaticsRecent HistoryRecent History

►2000► Electronic Record Development and Implementation Programme

►2002-2003► Wanless Report

► SNOMED CT

► National Programme for NHS IT (CfH)

► Integrated Care Record Service

► UK Council for Health Informatics Professionals (UKCHIP)

►2005► NHS Faculty of Health Informatics

Health InformaticsHealth InformaticsBest Practice in 2005Best Practice in 2005

► Denmark► 85% of health sector integrated within single system

► 2 million messages a month

► Central database of all prescriptions and all lab tests

► New Zealand► 75% of health sector integrated

► 3 million messages a month

► Veterans Administration► $21 billion, covering 25 million servicemen & families

► Highest score in every category of quality assessment in 2003

► Care based on VISTA, enabling Continuous Quality Control

► Cost per patient static over last decade (all other US providers 50%)

Health InformaticsHealth InformaticsInto the futureInto the future

► New Focus► Clinical Data Repositories

► Surrounded by rule-based alerts and DSS

► New Technologies► Designer Drugs and Bioinformatics

► Wearable Computing and RFID

► Wireless Connectivity and New portable formats

► New Users► Patient Empowerment and Intelligent Agents

► New Drivers► Patient Safety

► Regulation and Accountability of Solutions

RecapRecap

►Medicine is broken

►Medicine is expensive

►IT hasn’t helped yet despite 40 years►But we live in hope