Medical Informatics Representation and Computation on Medical

Medical Informatics Representation and Computation on Medical and Health Care Information

Medical Informatics Health records in paper Problems: High chances of damage of patient records. Automated processing of records is impossible. Increased use of electronic media, devices. Advantages: Less chances of damage, ease of maintenance. Data insertion and retrieval is simple. Easily interoperable. Migration of healthcare industry to electronic domain.

Targeted at Design and Development of Information System for Medical Science and Technology Health Care Services Business world involving health care

Health Care Informatics Suppliers’ Enterprise Systems Pharmacies Medical suppliers Insurance providers E X T R A N E T S Providers’ Enterprise Systems ERP GDSS DSS CDSS I N T R A N E T S Physician s And Specialist s P R M Patients Internet Src: K.Siau, “Health Care Informatics”, IEEE trans. On Info. Tech. In Biomedicine, 7(1), March, 2003, pp. 1-7

Enterprise Resource Planning Full integration of an organization's information from pay-roll and human resources to accounting and finance. Database integration (Information Sharing) Information logged once and accessed by different modules maintaining the data consistency. Track inventory, order information and delivery requirements Determine equipment usage and maintenance schedule

Decision Support System (DSS) Conventional DSS: financial and scheduling. Clinical DSS (CDSS): diagnosis, pharmacy, emergency and nursing practices. CDSS used to send alerts and reminders to patients about preventive care.

Patient Relationship Management (PRM) Primary focus on determining and meeting patients' needs. Tracking patients’ information from diet and exercise data to past diagnosis information from family history and allergy information. Send E-mails satisfying queries, informing newly published health care studies and reminding about preventive measures.

Medical Informatics and Tele-consultation In early days tele-consultation means Sending all hardcopies of patient records. takes significant amount of time. Send the patient to a remote center. nearly impossible for emergency patient. Using medical informatics teleconsultation means Sending the medical records only. Most of the time, no need to send the patient. Online consultation among doctors. Large scope of knowledge sharing.

Standards HL7: Health Level Seven. It is an international healthcare standard for medical data exchange between computer systems in healthcare. http://www.hl7.org/ LOINC: Logical Observation Identifiers Names and Codes. These identify the test results or clinical observations uniquely. http://www.loinc.org/ ICD-10: International Statistical Classification of Diseases and Related Health Problems. ICD provides codes to classify diseases and a wide variety of signs, symptoms etc. Every health condition can be assigned to a unique category and given a code. http://www.who.int/classifications/icd/en/ ICD-10-PCS: ICD-10 Procedure Coding System. This is a system of medical classification used for procedural codes which is developed as a replacement of ICD-9-CM volume 3 (contains inpatient procedures). DICOM: Digital Imaging and Communications in Medicine.

Message Transmission HL7 Standard Sender Data HL7 Message Creation HL7-enabled system Hospital A MSH \& REGAEVN A05 199901PID 1 191919 NK1 1 MASSIE ENK1 2 MASSIE I HL7 Message HL7 Standard Receiver HL7 Message Parsing HL7-enabled system Hospital B Data

HL7 Message Structure Event Message N Message1 SegN Seg1 Field1 Field1 Comp 1 Terminated by CR Comp N Separated by ' ' Separated by ' '

Message Encoding Sequence of segments separated by ' ' Compulsory and optional segments Segments as sequence of fields separated by ' ' Compulsory and optional fields A field is described by a data type (e.g. AD data-type denoting an Address)

An example of HL7 message for patient admission MSH \ & Clinic Central Reg ADT A01 MSG00005 P 2.3 EVN A01 199601051530 PID 2-687005 Evans Carolyn 19620324 F 903 Diane Circle Phoenixville PA 19460 (610) 555 – 1212 (610) 555 – 1212 S C 156 – 96 – 2542 PV1 E Emergency

Admit/Visit Notification 1. Message Header (i) From: Clinic (ii) To : Central 2. Event (i) Date: 1996-01-05 (ii) Time: 15:30 3. Patient Identification (i) Internal Patient ID Number: 2-687005 (ii) Family Name: Evans (iii) Given Name: Carolyn (iv) Birth Date: 1962-03-24 (v) Sex: F

Admit/Visit Notification 3.(Contd.) Patient Identification (contd.) (vi) Street Address: 903 Diane Circle (vii) City: Phoenixville (viii) State of Province: PA (ix) Zip or Postal Code: 19460 (x) Phone (Home): (610) 555 – 1212 (xi) Phone (Office): (610) 555-1212 (xii) Marital Status: S (xiii) Religion: C (xiv) Social Security Number: 156-96-2542 4. Patient Visit (i) Patient Class: E (ii) Point of Care: Emergency (iii) Attending Doctor's ID: 0148 (iv) Family Name: Addison (v) Given Name: James (vi) Hospital Service: SUR

File as Reference Pointer (RP) of OBX MSH \& TELEMEDICINE TELEMEDICINE 200808141246 ORU R01 SUR P 2.4 EVN R01 200808141246 PID SUR05032008000 Mandal Pulin Bihari 198003050000 M Block - D VSRC, IIT Kharagpur Kharagpur West Bengal 721302 India 91 754123 Hindu NK1 1 Sumita Mandal Mother Parikpur, Hansda West Midnapore OBR 4 ZIITKGP9903 Patient Images HL7IITKGP 200808141246 OBX RP ZIITKGP9903-1 Sample blood slide HL7IITKGP SUR0503200800005032008BLD00.JPG TELEMEDIK 2005 IM X 20080209 20080305 OBX RP ZIITKGP9903-2 Routine Blood tests and Grouping {Blood R/E} HL7IITKGP SUR0503200800005032008i0000.JPG TELEMEDIK 2005 IM X 20080305 20080305 Multimedia file is not contained within HL7 message. Reference path to the file is kept in the message. Multimedia file has to be sent with HL7 message.

File as Encoded Data (ED) of OBX MSH \& TELEMEDICINE TELEMEDICINE 200705091251 ORU R01 SUR P 2.4 EVN R01 200705091251 PID SUR17012007000 Kijhari Punam 196801170000 F aaaa bbbb eeee West Bengal 897454 India 91 7855596 Hindu NK1 1 kkkk hhhh gdagsv fg jfsgfgjadsg gdsa g fagsg OBR 6 ZIITKGP9903 Patient Images HL7IITKGP 200705091251 TXA 1 IM multipart 200705091251 20040404 ZIITKGP9903-1 ZIITKGP9903 AU OBX ED ZIITKGP9903-1 blood slide HL7IITKGP multipart related A MIME-Version: 1.0 Content-Type: multipart/related; boundary "HL7-CDA-border-CDA-HL7" EXT: JPG TYPE: BLD ENTRYDATE: 20070117 SIZE: 16601 --HL7-CDA-border-CDA-HL7 Content-Location:SUR1701200700017012007BLD00.JPG Content-Transfer-Encoding:BASE64 Content-Type:image/pjpeg /9j/4AAQSkZJRgABAgEASABIAAD/7RBKUGhvdG9zaG9wIDMuMAA4QklNA 0AAAAAABAASAAAAAEA DAwRDAwMDAwMDAwMDAwMDAwMDAwMDAwMDAwMDAwMDAENCwsNDg0QDg4QFA4ODhQUDg4ODhQRDAwM CgAyADAAMAAgADMANgAzAAoA --HL7-CDA-border-CDA-HL7-- X 200705091251

Reference Information Model (RIM) Root of all information models. Provides a static view of the information. A HL7-wide common reference model that integrates all Technical Committees’ domain views. Committees and SIGs generally work with a small subset of the RIM - called Domain Information Model or DIM.

Reference Information Model (RIM) contd. Foundation Classes Acts an intentional action in the business domain of HL7. Ex: patient observation Participations exists only in the scope of one act. Ex: surgeon Roles a socially expected behavior pattern usually determined by an individual's status in a particular society. Ex: doctor Entities physical thing or organization and grouping of physical things. Ex: a person Act Relationship To relate 2 acts. Role Link To relate 2 entity roles.

LOINC Logical Observation Identifiers Names and Codes. Names & codes uniquely identify observations. Laboratory Observations Clinical Observations Administrative Observations Compatible with HL7 and SNOMED Represent observation in HL7 message.

LOINC The fully specified name of a test result or clinical observation has five or six main parts Analyte / component : kind of property of observation or measurement : time aspect : system (sample) : scale : method QRS AXIS representation in LOINC: QRS AXIS : ANGLE : PT : HEART : QN : EKG 2951-2

LOINC in HL7 Message generator generates a message with observation results using LOINC. System supports LOINC, parse HL7 message, retrieve observation result. OBX-3: Observation Identifier OBX TX 2093-3 Total cholesterol LN 0 78 mg/dl F 20050223 Code Text Coding System

DICOM Digital Imaging and Communications in Medicine Standard for handling, storing, printing, and transmitting information on medical imaging. Specifies the following protocols for devices claiming conformance to DICOM syntax and semantics of data to be exchanged. format for storing media in DICOM compatible devices etc.

DICOM Composite Image IOD Information Model Patient 1 is subject of 1,n Study 1 contain s Equipment 1 creates Frame of Reference 1,n 1,n series 0,n 1 1 Spatially or Temporall y defines contain s 0,n Image (Pixels) 0,n Curve 0,n VOIL UT 0,1 Modality LUT 0,n Overlay 0,n Waveform

DICOM Waveform IOD Information Model Patient 1 is subject of 1,n Study 1 1 creates Frame of Reference contains Equipment 1 1,n 1,n 0,n series 1 contains 1,n Waveform temporally defines

DICOM Waveform Information Model Patient 1 is subjec of 1,n Study Waveform 1 contain s 1,n 1 contain s 1,n Series 1 Contai ns Multiplex Group 1 Waveform Attribute Time of Acquisition Acquisition Context Annotation Multiplex Group Attributes Number of Channels Sampling Frequency Timing contain s 1,n Channel 1,n 1 Waveform contain s 1,n Sample Channel Definition Attributes Channel Source Metric Anatomic Location(s) Function Technique Channel Sensitivity Baseline Skew Filter Characteristics

DICOM File Structure Preamble (128 bytes) DICM (4 bytes) DE1 DEn

Dicom Information Structure DICOM Data format Data Element Tag 4 bytes Tag Data Element VR DE VL Data Element VF Explicit VR VF Implicit VR 2 bytes 2 bytes VL 4 bytes

An Example of Data Element Patient Informatio n Patien t Name 0010 0010 0010 0010 VR PN VL VF 000C Sridhar Raja 0000 000C Sridhar Raja Explicit VR Implicit VR

me vital tags for rendering images in DICOM Standa Tag Description Transfer Syntax Tag Samples per pixel Numbers of Frames Number of Rows Number of Columns Number of Bits Allocated Number of Bits Stored Pixel Data Hex Encoding (Group, Element) (0x0002, 0x0010) (0x0028, 0x0002) (0x0028, 0x0008) (0x0028, 0x0010) (0x0028, 0x0011) (0x0028, 0x0100) (0x0028, 0x0101) (0x7FE0, 0x0010)

PACS Picture Archiving and Communication Systems. Goals of PACS are to improve operational efficiency while maintaining or improving diagnostic ability Computers or networks dedicated to the storage, retrieval, distribution and presentation of images. PACS network consists of a central server that stores a database containing the images. Web based PACS system is becoming more and more common. Based on DICOM standard, also accepts other media formats.

PACS (Ref: http://www.advantech.com.cn/)

ICD-10 International Statistical Classification of Diseases and Related Health Problems. Provides codes to classify Diseases Signs, symptoms Abnormal finding Complaints External cause for injury and disease etc.

ICD-10 Every health condition can be assigned to a unique category and a given code. Can be used for Morbidity, mortality statistics Clinical decision support system. The limitations of ICD-9-CM Lack of specificity and details. Can’t support transition of IHDE etc.

ICD-10 in HL7 Segment for diagnosis: DG1 2nd field of DG1: diagnosis coding method (deprecated). 4th field of DG1: diagnosis description (deprecated). 3rd field of DG1: diagnosis code ICD-10 is used to construct 3rd field Identifier Code DG1-3: Diagnosis Code DG1 H11.2 Conjunctival scars ICD10 F 20050223 Diagnosis description. Coding System

ICD-10-PCS (ICD-10 Procedure Coding System.) Medical classification used for procedural codes. Codes are comprised of seven components. Each component is called a “character”. All codes are seven characters long Individual units for each character are represented by a letter or number. Each unit is called a “value” 34 possible values for each character

SNOMED Systematized Nomenclature of Medicine. Collection of medical terminology covering most areas of clinical information. Diseases Findings Procedures Microorganisms Pharmaceuticals etc.

Standardization: Complexity in Medical World Vast and dynamic knowledgebase. Close interaction of different complex systems. Patient Management, Diagnosis and Investigations, Treatment and Procedures, Drug and pharmacology, Disease classification etc. Process Standardization. Regional and demographic variations. Adjustment with real-life constraints. Infrastructure, Human resource, Material resource.