Medical Informatics. Учебное пособие

Частное образовательное учреждение

высшего образования

«Санкт-Петербургский медико-социальный институт»

Manual

Vladimir Dolgov

Medical Informatics

This manual provides the systematization of knowledge acquired in lectures and practical classes, as well as the revising for exam. The manual is designed for foreign students studying at doctor training faculty.

Санкт-Петербург

2016

Strictly speaking, although the concept "information technology" is broader than computer technology, they are practically identical as applied to modern medical science.

The main goal of MI is to optimize the information processes in medicine through the use of computer technology, providing high-quality medicare of the population.

Taking into account that MI is one of the applied kinds of information technology, it can be presented as consisting of two sections: general or basic informatics and proper medical informatics.

General informatics covers hardware and software, principles of computer systems design common to all applications of informatics.

Medical informatics studies medical applications of information technologies with both use of standard, universal means of informatics for solution of health problems and special medical information technologies and systems.

1. The concept of medical information

Any human activity is a process of data collection and processing, making decisions based on them and their implementation. With the appearance of modern computer technology information has become one of the most important resources of scientific and technical progress.

The concept of information is one of the basic general scientific concepts. Therefore it is almost impossible to give a precise definition of information through other concepts. There are many definitions of information. For example, the general theory of information defines it in the following way: "Any interaction between objects, in the process of which one acquires a certain substance and the other does not lose it, is called information interaction. This transmitted substance is called Information" (Jankowski, 2000).

The peculiar definition of information was given by Norbert Wiener (1968): "Information is information, not matter or energy".

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Simple and clear to each person definition of information is given in

Ozhegov’s definition dictionary (1999) "Information is: 1) details about the world and processes taking place in it; 2) messages informing about the situation, the status

of anything".

Along with a variety of definitions, there are many classifications of

information, one of which is shown in Table 1.

Table 1 Types of information

In modern literature (science) the term "medical information" includes two definitions. Medical information in the broad sense of the term is any information relating to medicine. In then sense it is information relating directly to a person as a patient, that is, information about his health, characteristics of the organism, past medical history and so on. In recent times, the term "medical information" is increasingly used in the narrow sense. Further, in the text, we will stick to this interpretation of medical information.

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2. Types of Medical Information

All kinds of medical information can be divided into four main groups:

-alphanumeric information;

-visual information:

a)static;

b)dynamic;

-sound information;

-combined types of information.

2.1 Alphanumeric information

Alphanumeric information is the basis of almost all forms of printed and handwritten documents (unless the document is a chart or a diagram). It is a great informative part of medical information.

2.2 Static visual information

This category of medical information includes various images (radiographs, echocardiograms, etc.). Depending on technical means and other features the information acquired can be gray-scale (for example, x-ray images) or color (for example, endoscopic images).

2.3. Dynamic visual information (video)

The examples of such information are patients’ gait, facial expressions or cramps, tendon reflexes, eye pupil reaction to the light, dynamic image generated by the diagnostic equipment.

2.4 Sound information

The sound information includes speech, natural sounds of the human body reinforced by technical way and acoustical signals generated by medical equipment.

The examples of speech information are: doctor’s comments, patient’s speech with neurological or mental disorders, patient’s speech with pathology of the larynx.

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The examples of acoustical signals reinforced by technical way are: tones, noise, rattles and other elements of auscultation, audible via phonendoscope.

The examples of acoustical signals generated by medical equipment are Doppler blood flow signals during echocardiography, metric signals, signals from fetal monitors, etc.

Some types individual cases of sound information may be included in the combined types of medical information (e.g., in conjunction with visual image information).

2.5 Combined types of information

Combined type of information is referred to medical information, representing any combination of alphanumeric, visual-graphic and sound (audio) information.

The most popular combined type of information is a combination of dynamic visual information with sound information. However, in practice other combinations are widely used, for example, static visual information with sound information, static information with alphanumeric and others.

3. The nature of medical data

In medical practice, such terms as "data collection" or "information acquisition" are often used. These terms can be interpreted incorrectly on the assumption that medical information can be found in the real world in the state of availability for its use in diagnostic or therapeutic purposes. Actually some objective parameters such as biological dosage can be interpreted or, in other words, become information only in the context of, for example, motivation for drug administration, the conditions for obtaining blood sample used for measuring method, and so on. Clinical sign clinical or radiological sign is a result of comprehensive decisionmaking process.

Consequently, medical information as it is exists only in interpreted environment and should be constantly updated in order to avoid diagnostic mistakes. Hypotheses arising from the doctors, determine the direction of data collection and

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criteria for the assessment of information “usefulness”. Subjectivity plays a predominant role in medicine. This situation partly explains the inexhaustible nature of medical information. Information can be absent because the patient was not asked a question or because the response of the patient has not been recorded. It is believed (Bentsen, 1976) that 40% of the problems, identified as part of the study, were related to the fact that medical information was not correctly stored.

Consequently, the assessment of medical data quality is very important and should primarily permit to estimate their information value.

A characteristic feature of medical information is its privacy.

4. Information aspects of diagnostics, treatment, prognosis of the body

state

To ensure that human activity was effective, that decisions were adequate to the tasks facing the participants of any activity, they must have all necessary information to implement it. So they must have time to get all necessary data in such a way that they can be used for analysis and decision making. Therefore, the essence of Informatics (information science), its basic task can be summarized in the form of the slogan: "The right data - in the right place - at the right time".

This task also includes obtaining all necessary data and sending them through the channels of communication and presentation in the proper form to use.

As information processes accompany all kinds of human activities, consequently relevant information technology formed a very long time ago. All types of writing, the system of musical notation, book printing, sound and video recording can be considered as general information technology, that is actually all ways to record data. At the same time, special information technologies formed in each area of activity, adequate to the goals of these activities.

One of such particular information technology is maintenance of health records. Being some kind of journal of observation, a very widely used information technology, health record has quite a specific structure, its maintenance also follows many specific rules.

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Examples of information technology that were formed later are the telegraph, telephone and fax, radio, television and, finally, all information technology related to computer technology, the leading part of which plays the Internet and database technology (DB).

Let’s return now to the medical application of modern information technologies. New technical capabilities, namely the development of the Internet and communication tools, gave rise to new problems, which previously was not even spoken about.

1. The possibility of long-distance transmission of images, both static and mobile, allowed to put the problem of organization of distant counseling and when the patient and medical consultant may stay arbitrary points of the globe

(telemedicine).

2.The development of information technologies makes it possible to put another task that can be considered as additional to the problem of obtaining a remote consultation. It is the task of forming a unified health record (or rather a unified life history) of a person.

3.Both of the above mentioned tasks are synthesized in one "super task" - the task of forming unifie information space of medicine, or if you look wider, the unified information space of health service.

The unified information space of health service is a set of technical tools and

regulatory acts designed to address two interrelated and mutually reinforcing

objectives:

-providing technical access to any relevant data for diagnostic and treatment or health care actions anywhere and anytime;

-ensuring adequate regulation of data access for the legitimate rights of all participants of the process.

Electronic health record is the core of the unified information space of an inpatient facility.

A health record a major component of the diagnostic and treatment process, as it is designed to ensure its continuity "in space and time": full maintenance of health

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record makes it easy to get new professionals involved in the treatment of patients who can form the picture of clinical course and patient treatment on the basis of available information from the health record and during the break in the treatment the process does not start again but continues on a basis of previously collected data.

There is a certain technology of clinical recording in any health care facility that reflects the experience and traditions of this facility We can say that there is some formed information environment in any health care facility, the important part of which is the health record.

The traditional health record is a paper document, and the transition to the electronic health record (EHR) can be regarded as "technological intervention" in the existing information process. It is clear that it is impossible to conduct the transition from the paper health record to EHR by a single act of implementation. Human and technical factors plays here their role.

5. Who and why needs electronic health record?

EHR has several different categories of users who apply it for different purposes and make different demand son it.

Health care administration, medical statisticians, economic and planning services. The main issues that the named users address EHR relate to the monitoring and analysis of patients flow. These users rarely perform data entry into EHR. To meet their requirements the system should contain the developed analytical component. There is an opportunity to establish an accurate and operational accounting services rendered to the patient, which is very important for the analysis of healthcare facility economic activities.

Physicians. This category of users provides the most active data entry into EHR. Accordingly, they make the greatest demands on the convenience of the system interface and minimizing data re-entry. Physicians are interested in receiving reports about their personal medical activity, but they can get such a report only by continuous use of EHR. This fact is a strong enough incentive to transition to a new technology of patient recording.

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