1、10/4/2018,Chuck Staben,1,Medical Informatics,Human Variation Informatics Issues Ethical Issues,10/4/2018,Chuck Staben,2,Medical Informatics,storage, retrieval, and optimal use of biomedical information, data, and knowledge for problem solving and decision making,Genetics Variation,Medicine,10/4/2018
2、,Chuck Staben,3,Issues,Nature of medical information Technical challenges Uses of medical information medicine research Status of development in field Ethical concerns Professional Career Trajectories,10/4/2018,Chuck Staben,4,Information Types,Textual chief complaint, symptoms, history of present il
3、lness, history, family history, physical exam, insurance information Graphical ECG, ultrasound, X-ray, hand-drawn figures longitudinal data (blood pressure graph) Digital (X-rays, ),10/4/2018,Chuck Staben,5,Text Information-Issues,Non-digital, non-shareable, non-searchable, non-standard Synonyms thr
4、ombophlebitis=phlebothrombosis, DVT, blood clot in the leg, milk leg, phlegmasia caerulea dolens, dropsy Changing generalized idiopathic lymphandenopathy (1980) = AIDS!,10/4/2018,Chuck Staben,6,Text Standards,Ideal Terminology Complete, Formal, Universal, Translatable Candidate languages SNOMED, UML
5、S, ICD, Read Codes, DSM Digital Entry, storage, retrieval, usage?,10/4/2018,Chuck Staben,7,Images,Sharable Searchable Transmittable Multiple input/output formats,10/4/2018,Chuck Staben,8,Physicians,DO NOT WANT a data entry clerk paid $200,000/year!,10/4/2018,Chuck Staben,9,Integrating Delivery,Async
6、hronous communication FAX, VoiceMail e-mail office histories Synchronous communication voice, phone, paging,10/4/2018,Chuck Staben,10,Medical Delivery Issues,Periodic health screening enhanced reminders Physician variability managed care can reduce variability Data quality, type varies from physicia
7、n to physician,10/4/2018,Chuck Staben,11,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,10/4/2018,Chuck Staben,12,Exp
8、erience 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?,10/4/2018,Chuck Staben,13,Medical Uses of Enhanced Records,Improved care day-to-day UKHMO:
9、 what are your current meds? Monitoring clinical success all patient records become clinical trials,10/4/2018,Chuck Staben,14,Research Uses,Medical Genetics Basic disease work Epidemiology Infectious disease Life history, risk factor. Pharmacogenomics,Tissue Banks Pedigrees/Populations DATAMINING,10
10、/4/2018,Chuck Staben,15,Medical Informatics-Status,Medicare/Medicaid/Managed Care “Coding” NIH major initiatives in electronic records Company initiatives HMO, Healtheon, Pharmacogenomics companies Iceland, Scandinavian records,10/4/2018,Chuck Staben,16,Examples,Genomic labeling P450 variation and c
11、ancer chemotherapy Pharmaco interest in pharmacogenomics,10/4/2018,Chuck Staben,17,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, antihype
12、rtensives, -blockers, monamine oxidase inhibitors, morphine derivatives, antipsychotics, and tricyclic antidepressants.,10/4/2018,Chuck Staben,18,BIG BROTHER,Healtheon, Medicaire.,10/4/2018,Chuck Staben,19,Training,“Interested Physicians” Formal Training Medical Information Scientist Training Program, Stanford University National Library of Medicine,
