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Lecture notes, lecture Week 1 - Introduction to health

informatics - goes through an overview about what we will be
learning for the semester, 49 slides w/ study topics at the end
Health Informatics (Ohio University)

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Introduction to Health
Informatics (HLTH 3735)
Dr. Xia Jing
Department of Social and Public Health, CHSP, Ohio University
2015-2016 Fall semester
Week 1 (27th Aug, 2015) --- Overview of health informatics

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Overview of Health Informatics

• Overview of the lecture
• What is health informatics?
• Data-information-_________- wisdom
• Why do we need health informatics?
• Historical highlights
• Tr_______ from data to __________ to knowledge
• Clinical data warehouse (CDW)
• What makes health informatics difficult?

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Overview of Health Informatics

• What is health informatics?
• Multiple definitions

Health informatics is the science that underlies the academic investigation and
practical application of computing and communications technology to
healthcare, health education and biomedical research.

(University of Virginia,
http://www.medicine.virginia.edu/clinical/departments/phs/informatics/HealthInfDef-page )

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What is informatics?
• What is informatics?
• https://www.youtube.com/watch?v=xha0EI3r4hY
• The science concerned with gathering, storing, manipulating, retrieving and
classifying recorded information

• What is health informatics?

• https://www.youtube.com/watch?v=5gKspYFAc9Q
• UK NHS (National Health Service)

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Overview of Health Informatics

• Why do we need health informatics?
• Vo_____ of medical knowledge
• Limited consultation _______
• Limited pro________ capability of human brain
• Human beings & computers are good at different things
• Information sharing and coordination requirements
• A gap between what clinicians’ ______ and what current computers and
technologies can provide
• Turn level 1-3 data into level __ data

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Overview of Health Informatics

• Health information technology (HIT or health IT)
• A part of health informatics: APP________ of computers and technology in
healthcare settings
• Main focus of this course
• ≈ health informatics in HLTH3735

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Overview of Health Informatics

• HIT adoption driving forces
• Increase the efficiency of healthcare (↓costs, ↑ productivity)
• Improve the quality of healthcare (patients outcomes)
• Improve patients _______ (↓ medical errors)
• Accelerate access to care and administrative transactions
• Computerized clinical guidelines
• Data  evidence based decisions
• Standardize the care of common and expensive conditions
• Protect privacy & ensure security

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Overview of Health Informatics

• Barriers to HIT adoption
• Time
• Cost
• Productivity
• Behavior
• Change in workflow
• Lack of interoperability
• Require advanced training
• Lack of high quality studies
• Legal
• Privacy
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Overview of Health Informatics

• History
• The field starts from 1950-1960s
• “Medical informatics” from _______ in 1960s
• Highlighted in the US recently
• Different names over the time
• US HIT is about 10-12 years behind other industrialized countries
• 2006 data

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Overview of Health Informatics

• Historical highlights
• MUMPS (Octo Barnett, MGH, 1970s)
• VA, Epic
• MEDLINE: mid-1960s, NLM
• a leap from Index Medicus (1879-2004)
• Artificial Intelligence:
• MY___ (Stanford, 1970s)
• INTER____-1 (U Pittsburg, 1970-1980s)

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Overview of Health Informatics

• Historical highlights
• Internet---1960
• Tim Berners-Lee (WWW)
• MOSAIC--1993
• Electronic Health Record
• Mobile technology
• Human Genome Project (2003)
• Nationwide Health Information Network

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http://srssoft.com/orthopaedic-ehr

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http://teachwithtech.global2.vic.edu.au/2011/11/14/mobile-
technology-mobile-learning/ HLTH3735 2015/16 Fall Xia Jing @ OU
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Overview of Health Informatics

• ARRA (American Recovery and Reinvestment Act, 2009)
• HIT adoption (EHR), training and research
• HITECH is part of ARRA
• Health Information Technology for Economic & Clinical Health
• Devoted to funding of HIT programs
• Goals
• Improve quality, safety, efficiency and reduce health disparities
• En____ patients and families
• Improve care coor________
• Ensure adequate privacy and security of personal health information
• Improve population and public ______

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Overview of Health Informatics

• What is the HITECH, an overview

• https://www.youtube.com/watch?v=OM8tmPy-ApI

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Overview of Health Informatics

• ONC (Office of the National Coordinator for Health Information
Technology)
• ONC is responsible for coordinating all aspects of _________ in the US
• Ado_____
• Standards harmonization
• Intero__________
• Privacy/security
• Certification of EHR
• ONC reports directly to the Secretary of HHS

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Overview of Health Informatics

• Organizations involved with HIT
• IOM
• US federal government
• HHS
• ONC
• AHRQ
• CMS
• CDC
• HRSA
• State government
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Overview of Health Informatics

• Health informatics organizations
• AMIA (American Medical Informatics Association)
• EFMI (European Federation for Medical Informatics)
• IMIA (International Medical Informatics Association)
• HI___ (Healthcare Information and Mana______ System Society)
• AHIMA (American Health Information Management Association)

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Healthcare Data, Information and

Knowledge
• Data
• Ob__________ reflecting differences in the world—95
• Information
• Meaningful data or f_____ from which conclusions can be drawn
• 95 mmHg (systolic, sit, calm)
• Knowledge
• Justifiably believed _____ information
• 95 mmHg (systolic, sit, calm, age)
• 95 mmHg (diastolic, sit calm, age)

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Overview of Health Informatics

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Overview of Health Informatics

• Different levels of data
• Level 4: com________ e-data
• Level 3: structured, viewable e-data
• Level 2: un__________, viewable e-data
• Level 1: non-e data

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Healthcare Data, Information and

Knowledge
• Computer
• 0
• 1
• Bit (0 or ___)
• Byte (_______ bits)---hard disk, RAM capacities
• 28 = 256; 216 =65536; 232 = 4294967296; 264 =1.8446744e+19
• Data types
• Integers
• Floating point numbers
• Characters (100 0001, 110 0001, 011 0000, 011 0001, 0100100)
• Strings
• Data  _______

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Healthcare Data, Information and

Knowledge
• Healthcare center: gathering data and interpreting their meaning
• Healthcare professionals: record observations, actions and the
rationales for those actions
• Medical data types:
• Narrative, _______ data
• N_______ measurements
• Re______ signal
• Drawings (position, size…)
• Photographs

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Healthcare Data, Information and

Knowledge
• Computer
• File for____
• ______ files: JPG, GIF, PNG
• Text files
• ______ files: WAV, MP3
• Video files: MPG
• Sharing
• Data types and file formats  storing and displaying on a computer
• X meaning, subjects
• Basic mechanism behind the PC scene

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Healthcare Data, Information and

Knowledge
• Data, information, knowledge
• http://www.youtube.com/watch?v=mUgEgkV16Bw

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Healthcare Data, Information and

Knowledge
• Data: the center for IT and computer sciences
• Solutions, technologies and methodologies are ______ subjects
• _______  secondary for IT professionals and computer scientists

• Information and knowledge: the center of ___________

• Overlap and differences between informatics and computer sciences
• Limitation of the figure 2.4 in the text book
• Much bigger overlaps between the two fields
• Most of informatics applications have deep roots in computer sciences ontologies

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Healthcare Data, Information and

Knowledge
• Summarize of clinical recording:
• What was the na____ of the disease or symptom?
• What was the tr_______ decision?
• What was the out____ of that treatment?
• Reality about records: incomplete, selective, inaccurate
• Data cannot effectively serve the delivery of health care unless they
are re_______
• Nursing notes, vital signs sheets, physicians’ progress notes, discharge
summary

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Healthcare Data, Information and

Knowledge
• Conceptual model
• Reflection of physical world
• Only the parts of the physical world that are relevant to the computation
• Define what is irrelevant (out of conceptual model irrelevant)
• Computational model
• Conceptual model is used to designed and implement a computational model
• Computers manipulate computational model
• Representation
• Represented world
• Representing world
• Mapping

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Healthcare Data, Information and

Knowledge

Real world:
human, sun,
Representation Conceptual Design, implement Computational
pets, earth,
flowers, age, model: model:
gender, social name = John
human and
network, Smith
attributes
professional Age = 48
profile…

Represented world Representing world

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Healthcare Data, Information and

Knowledge
Match Match

Real Conceptual Computational Useful

Computer
world model model answers

Mismatch Match

Real Conceptual Computational Useful

Computer
world model model answers
Mismatch Mismatch

Real Conceptual Computational Useful

Computer
world model model answers
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Healthcare Data, Information and

Knowledge
• From data to information
• Documentation, documentation, documentation
• ICD9: 250
• Consistent
• Well documented
• Such as 1 for exclude the conditions
• 95 mmHg (systolic, sit, calm, age)

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Healthcare Data, Information and

Knowledge
• From information to knowledge
• A core goal of science, not only in informatics
• Clinical world:
• Most available knowledge is best described as justified, not proven facts (or there are
conditions)
• Important distinction from traditional hard sciences, such as physics and mathematics
• Clinical data warehouse (CDW)---basis –helps transform language to
knowledge
• Natural language processing (NLP)
• Concept extraction
• Preserved meaning—computerized information
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Healthcare Data, Information and

Knowledge
• Concept extraction
• Identifying concepts within unstructured data (discharge summaries,
pathology reports)
• Controlled vocabularies (ICD-9-CM, SNOMED-CT, LOINC … …)
• Multiple terms  same concept
• High blood pressure
• Hypertension (997.91 )
• Kidney disease
• Renal disorders
• Same abbreviation  multiple meanings
• MS: multiple sclerosis, master of science, Microsoft…
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Healthcare Data, Information and

Knowledge
• CDW
• A clinical data warehouse is a shared database that collects, integrates and
stores clinical data from a variety of sources including electronic health records,
radiology and other information systems. – comes from many different systems
• EHR is designed to support real-time updating and retrieval of
individual data
• Multiple sources  staging database  CDW (meta data)
• Metadata: data that describe other data. Metadata summarize basic
information about data, e.g., author name, date created and date
modified and file size are basic document metadata
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Healthcare Data, Information and

Knowledge

EHR 1

CDW
ETL database
EHR 2 Staging

Metadata

EHR 3
CDW overview (ETL: extract, transform and load)

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Healthcare Data, Information and

Knowledge
• Usage of CDW — analysis of data
• Simple analysis
• Summary statistics (counts, means, medians and standard deviations)
• Sophisticated analysis
• Associations (co-occur)
• Similarity determinations
• Trend analysis
• Data mining & knowledge discovery
• Monitor quality in organization level
• Complement traditional clinical trials (what actually happened in practice?)
• Track pathogens within hospitals
• Faster surveillance (aggregated data at organizational level) for public health professionals

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Healthcare Data, Information and

Knowledge
• Popular CDW platform: i2b2 (Integrating Biology and the Bed____)
• https://www.i2b2.org/
• Harvard Medical School/Partners HealthCare System
• Open source
• BTRIS
• NIH Biomedical Tr__________ Research Information System
• http://btris.nih.gov
• Unique setting
• Clinical re______ data from multiple institutes
• Long history
• Complete records

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Healthcare Data, Information and

Knowledge
• Interoperability
• The source system
• The receiving system
• Shared common way of transforming data into information
• Associated information needs to be maintained and communicated clearly
and correctly: dates and contexts, billing codes and actual diagnosis

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Healthcare Data, Information and

Knowledge
• What makes health informatics difficult?
Banking data Health data
Concepts & descriptions Precise General, subjective
Account 123 balance = $10.00 Sick patient
Actions Usually (not always) reversible Often not easily reversible
Transfer money A -> B Give a medication, perform a procedure
Context Precise, constant Vague, variable
US $ Normal lab values differ by labs
User autonomy Well-defined and constrained Variable and dependent on circumstances
What I can do with my checking account= what you Clinical privileges depend on training, change over time,
can do with yours depend on circumstances
Users Clerical staff Varied, including highly trained professionals
Time sensitivity Few true emergencies (seconds) Many time sensitive tasks, highly variable time
sensitivity depending on contexts
Workflow Well-defined Highly variable, implicit

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Healthcare Data, Information and

Knowledge
• What makes health informatics difficult?
• Poorly defined concepts
• Not always direct connection between data & information
• Not always form-based problem
• Not usually defined with necessary and sufficient conditions
• Imprecise boundary in health fields  incomplete conceptual model and
computational model
• Complexity
• RIM (HL7 reference information model)
• Imperfect of information

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Healthcare Data, Information and

Knowledge
• Imperfect of health information
• Incomplete (past history)
• Uncertain
• Imprecise
• Vague (tall, mature, smart..)
• Inconsistent (1/2/2002, 2/1/2002)
• Human can deal with the imperfections (clinical differences)
• Computer
• Must be explicitly programmed
• Too hard to anticipate all exceptions and possible variances beforehand
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Healthcare Data, Information and

Knowledge
• Prospective of HIT
• Improve quality, prevent medical errors, reduce costs, increase administrative
efficiencies, decrease paperwork, expand access to affordable care
• Democrats and Republicans agree on HIT adoption

• HIT adoption does not guarantee these benefits

• Effects of HIT
• ARRA (2009)
• Australia, Belgium, Canada, Denmark, UK – done well in HIT
• HIT can worse quality, increase errors, decrease efficiency
• Negative results are not across institutions

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Healthcare Data, Information and

Knowledge
• Related factors for HIT adoption results:
• System
• How the system is implemented? – closely related to the success of the
system
• In what contexts?
• Workforce
• E-iatrogenesis: the unintended deleterious consequences of HIT

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Healthcare Data, Information and

Knowledge
• Why HIT fails sometimes?
• The problem:
• HIT is HDT (Health Data Technology)
• Current technologies store, manipulate and transmits data not information(large gap in
healthcare)
• Social and administrative reality
• Financial data and administrative data are electronica data
• Computers, emails, web, PDA are common in healthcare settings
• Mismatch between costs and benefits
• Cultural resistance to change
• Lack of an appropriately trained workforce to implement HIT
• Rational skepticism regarding the benefit of current HIT

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Overview of Health Informatics-

study guide
• Definitions and examples about “Data”, “Information”, and “Knowledge”.
• Definition of “health informatics”.
• Four levels of data
• Why do we need health informatics?
• Goals of HIT
• Barriers to HIT adoption

• Full names and main functionality for:

• MUMP
• MYCIN
• INTERNIST
• IOM
• ONC
• CMS
• HITECH
• AMIA
• HIMMS

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Healthcare Data, Information and

Knowledge-study guide
• Bit and Byte
• Medical data types & examples
• File format
• How to transform data to information?
• How to transform information to knowledge?
• Interoperability
• Important components in CDW
• How to use CDW?
• Compare and contrast CDW and EHR in terms of their main functionalities, data sources and update.
• Examples of CDW
• What makes health informatics difficult?
• E-iatrogenesis

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